pregnancy podcast

Kristin talks with Neri Life Choma, Author and Founder of Birth Coach Method.  They discuss the difference between a Childbirth Educator, Birth Doula, and a Birth Coach.  They also talk about transforming birthing person’s expectations from the “perfect natural birth” to a “positive birth experience.” You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

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Kristin:  Hello, hello.  This is Kristin, co-owner of Gold Coast Doulas, and co-host of Ask the Doulas.  And I am so excited to be joined today by Neri Life Choma.  She is the author of The Art of Coaching for Childbirth and the creator of The Birth Coach Method.  Welcome, Neri!

Neri:  Thank you, thank you!  It’s a pleasure to be here with you.  I am so looking forward to our discussion here.

Kristin:  Yes!  I’d love for you to fill our listeners in a bit about your unique background as a doula and a certified childbirth educator, as well as a life coach to creating this new movement in the birth world.

Neri:  Yeah.  So, I am a seasoned doula and childbirth educator.  I’ve been doing this for 24 years.  My funny accent is Israeli.

Kristin:  It’s a beautiful accent.

Neri:  I actually established the birth support field in Israel.  There were no doulas when I began doing my work, and I am very happy to say that currently there are seven programs certifying doulas in Israel.

Kristin:  That’s amazing.

Neri:  It is amazing.  I have established a birth resource center in Israel and a doula support program in a major hospital in Tel Aviv.  And I’m a childbirth educator, as well.  I moved to the states in 2002.  January 2002, so it’s going to be 20 years soon.

Kristin:  That’s a while, yeah.

Neri:  Yeah.  And I’ve been blessed, Kristin, really blessed to be able to be a pioneer in Israel and then to come here and really smoothly starting to work here.  I think that we were here only about a few months when I was approached by the first expectant mom who asked me to be her doula.

Kristin:  Wow, that’s quick.

Neri:  Yes.  And it took about a year and a half until – of volunteering, actually.  So I started volunteering at a birth resource center located in Palo Alto.  A year and a half into our life here, I was actually offered to direct the center.  It’s called Blossom Birth, and it’s in Palo Alto.  I’ve been blessed to have two wonderful years directing the center.  And the funny – I don’t know if it’s funny.  The thing is, I was really experiencing myself as a very successful birth support practitioner, until I wasn’t.  Until I wasn’t experiencing myself as a successful and impactful one, and yes, it does relate to a birth trauma of supporting a wonderful individual, a beautiful woman, who knew exactly what she wanted and was so well prepared and so well informed for the birth.  And arriving for the hospital with everything changing in front of my eyes and the doctor being very abusive, and the nurses trying to create a ring, you know, a protective ring around my client and supporting me, really, and her.  But the whole experience was so traumatic because I couldn’t speak out my truth, and I couldn’t advocate in a way that I should have, just because I am the doula in the room.

Kristin:  Right.  We have a role, right.

Neri:  We have a role, and there are some limitations.  And the whole experience was traumatic, not only for my client, but to me, actually.  And at that time, I was doula already for about 15 or 16 years, Kristin.

Kristin:  That’s a long time.  Doulas burn out in three years, you know, is the average.

Neri:  Exactly.  And that was such a devastating experience that I actually spent the next two weeks in bed with pneumonia.  I was sure that it had to do with not being able to speak.  I felt the whole time that I was suffocating, that I’m losing my breath, that I need to practice my breathing, as if I was the birth-giver.  And I actually wanted to quit.  Can I admit that loudly?

Kristin:  Yes, of course!

Neri:  I wanted to quit.  I felt, that’s it.  I’m done.  I’m not going back to L&D.  So the question was, what’s next for me?  I enrolled in a year-long program to become a transformational life coach, thinking, well, I have the coaching part in me.  I’m really dedicated and committed to women empowerment.  But I don’t have to go back to L&D.  I can actually coach them and empower them in a variety of life areas: career-wise, relationship-wise, lifestyle.  So going over this yearlong program was revolutionary for me.  I kept thinking, oh, my God.  If only I had practice like this when I was a doula.  And, you know, sometimes when we have a wakeup call for things that we did, and we think, oh, my God; I was doing it all wrong – it comes with a profound sense of guilt, and I was lucky to have my teacher, Dr. Rosie, saying, well, how is it going to serve you, you know?  Everyone is trying to do their best with the resources available for them, and you know this because you’re a compassionate person.  Why don’t you stop beating yourself for this?  Why won’t you write your final paper for our yearlong program about, how would you do things different now with all the strategies that you have?  And so I did.  I actually sat down, and I started implementing all those amazing strategies of transformational coaching into my practice, my own doula practice first, of course.  You don’t start talking to other people before you know it’s actually working.

Kristin:  Right.  You need to test it, of course.

Neri:  Yes.  The first place was testing it.  And oh, my God, Kristin.  It was really such a revealing and freeing process, seeing my clients really claiming their own experience, getting to be accountable for their own experience, having the correct mindset that actually serves them in order to manifest their desired visions.  Also having a vision, you know, instead of a birth plan that looks like birth – like a shopping list, you know, I want this, this, this, this, this.  And so what if one thing doesn’t happen, you know?  Like, what if you went shopping and you came back home, and three of the things that were on your list are not there?  Is it a failure?  Can we say that the whole shopping experience was a failure, or can we go, oh, but you know what happened when I was shopping today, I actually met a friend that I didn’t see for 10 years, and we got to reconnect, and I heard about her daughter and about her life.  And on the way home, I saw an amazing rainbow.  That’s an amazing experience, even though I didn’t bring home three items on my list, right?

Kristin:  Exactly.  Yes.

Neri:  And so I started shifting the way that I think about birth, not as a project, not as an event, but as a process toward creating a vision, working with strategies for clarity, for alignment, helping my clients to align their belief system, their concept around birth, and other topics relating to pregnancy and birth and aligning their belief system first and perception with what they say they want, checking that there is a good alignment and connection and then looking at the steps that they’re taking, the actions toward achieving those goals or this vision, checking that there is a full alignment there.  Oh, my God.  It is such a different process.  And it is so valuable, and the outcomes are amazing.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Neri:  So I published it in a book.  And then the next step after publishing The Art of Coaching for Childbirth was, hmm, there can’t be only one that is doing things this way.  I want all my doula sisters to be able to do the same thing.  And so we need a course, right?  So another two years of just building the course.  And it is so fulfilling.  It’s an amazing process for me, a really growing process, a professional growing process for myself and for my students.  You’re one of them, so you know.

Kristin:  Yes!  And in a way, it was wonderful that you had this online format during the pandemic.  I don’t know that I would have had the time to invest seven weeks otherwise.

Neri:  Right.  Can I share a secret?

Kristin:  Sure.

Neri:  It’s becoming a four-month program.

Kristin:  Wow!  That’s neat.  I felt like we needed more time, especially with role plays, so…

Neri:  Exactly.  We got so much feedback from you, from others, we need more time.  We need more time.

Kristin:  Yes.

Neri:  And I have to admit that since I launched the course, I kept developing more and more strategies and more coaching exercises.  So we need time to implement and to practice, right?

Kristin:  Oh, I love that.

Neri:  So we’re going to have a lesson and then an implementation day after.  So the next week is going to be implementation.  So it’s double in length, in time.  I’m so excited about this.

Kristin:  Yes.  It is a wonderful program, and I learned so much through the certification process.  I’m glad that the new students have time to really connect with each other and grow the process of actually coaching and shifting the mindset for those that are already doulas or other health and wellness professionals.

Neri:  And let me just say, you know, I’m really honored because I find that those who really search and look for me and find me – you know, I don’t have a huge budget like Lamaze or DONA.  I’m a boutique business.  And those who find me, I see them, and they are aware and awake.  The doulas that enroll in my courses, they’re the ones who are actually aware and awake and understand that there is a missing link in their practice and that they are not as impactful and successful as they were hoping to be in leading their clients to healthy, empowering experiences.  And they start looking for this missing link, you know?

Kristin:  Yeah, and I know that when I was a doula in the early years, I felt very responsible for outcomes and almost felt like I failed my client if they didn’t achieve the things on the birth plan checklist.  And I later learned through other certifications that I went through that I wasn’t responsible for the outcomes, so some of that weight lifted, and I did really allow my clients to take some ownership and lead versus feeling like I needed to direct as a doula.  But there were still so many missing links that you talked about, and I didn’t have the coaching education that you do.  So this was brilliant for me and allowed me to get out of the typical process that we as doulas have with every client of when to call us in prenatal and the basics, reviewing the birth preferences and the type of support that they like.  But this is really, again, so directed by the client themselves and knowing that each individual is unique and they have different goals.  And then really encouraging them to seek out a plan that is best for them and then guiding them to the steps they need to achieve it.  And obviously as you said, things may veer off, and we can’t control how baby responds in many things in the delivery process, and even in the pregnancy.  So yeah, it’s been…

Neri:  I think, Kristin, if I may say, I think that the more I keep teaching and practicing transformational birth coaching myself, the more I understand how profound is the shift that we’re creating in the field.  So what we’ve been doing until now as birth support practitioners, whether it’s doulas or childbirth educators, even prenatal teachers, we’ve been doing a lot of informing.  And there was an assumption, you know, that when our clients are going to be informed, they’re going to make informed decisions, and this will change their experience and will help them have vaginal, healthy birth and an empowering experience in which they feel that they were on top of things, they were in control, because they were making informed decisions, right?  But the thing is, you look at the Listening to Mothers survey in California, and even the recent one, you can go on Google, and it will tell you that even though 75% of all birthing individuals in 2019 – I believe the last one that I read was 2019 – 75% of them agreed that they were well-informed.  However, only 5% of them gave birth with no major medical intervention, and I’m emphasizing major.  So that is what I say as the missing link, you know?  And I have this saying that I keep repeating, and I will keep repeating it until I’m blue in my face, until everybody will just see that informing is great if your client is about to deliver knowledge.

Kristin:  Yes.

Neri:  But it is not the best practice if she is going to deliver a baby.

Kristin:  Exactly.

Neri:  For delivering a baby, we better work on the mindset.  And the whole phrase of “informed decision,” I want to ask all of us to take a moment to think about this phrase: informed by what?  I’m saying an informed decision is when the information that you have within is taken under consideration, when you listen to your logic, when you listen to where your emotions are taking you, when you have this internal compass, you know, that is guiding you in the right direction.  This I call an informed decision, not when you are making a decision based on information that is totally external to you, and you’re now becoming your own authority.

Kristin: Right.  Yeah, it’s a huge shift in mindset, and some people don’t want to prepare by doing all the readings, and like you said, it’s as much of a mental preparation, and so it could be, for them, just focusing on reading positive stories and having a positive mindset versus taking every single class that we recommend as doulas.

Neri:  Yeah.  But they will still need to go through a process of clarifying for themselves, what is their preferred birth vision?  So let me give you the – I want your listeners to be able to bring it down to earth, you know, to understand how is it relating to their lives.  In the past when I didn’t have the transformational tools, and I was practicing, you know, with the resources that were available for me, which was informing prior to birth, making sure that my clients are informed, helping them be informed about their choices, write down their birth preference list or birth plan, as some call it, and then supporting them throughout labor with all the labor support techniques that doulas have and also help them make informed decisions when it comes to medical interventions.  So that was my practice before that.  So if a client was interviewing me as her doula, and I would ask her, so what are you hoping, and why are you hiring a doula?  She would say, oh, I really would like to have a natural childbirth.  And in the past, you know, as a doula, as a representative of the natural birth movement, I would cheer for her, and I would say, oh, that is so wonderful.  I’m so happy to hear that.  This is the cheapest way to go; this is the safest way for you and your baby.  This is the most empowering experience.  Our ancestors gave birth like this, and this is the most beautiful and natural rite of passage to becoming a mother, blah, blah, blah.  I would talk until – you know, and I would just cheer for her.  And there was a lot of information and perceptions that came from me.  I was delivering the perspectives and the information.  Nowadays, it sounds completely different.  She comes to me, and she says, I’m hiring you because I really would like to have a natural birth.  And then I go, tell me more about this.  What is natural birth for you?  How do you think it feels?  How do you see yourself behaving?  What do you see yourself doing?  What is your motivation to have a natural birth?  For example, as a transformational coach, you, Kristin, because you took the course, you already know that we have two types of motivations.  We have a motivation that is negative one, meaning I’m running away from.  I’m running away from –

Kristin:  An epidural.

Neri:  I’m running away from the needle; I’m running away from Cesarean; I’m running away from sickness.  Okay?  We have lots of negative motivations that motivate us in some directions.  You can even diet, you know, be motivated to go on a diet because you’re trying to not be sick.  Right?

Kristin:  Sure.

Neri:  But there is different type of motivation that is more on the positive aspect, and we call those aspirations.  What do you aspire for?  Those are a lot stronger because if your client is committing herself to go through birth naturally because she is afraid of the needle, let me tell you something: the moment that her fear of the increased sensation of childbirth, the increased sensation of contraction, the moment that this fear is going to be bigger than the fear from the epidural needle, then this is tilting, and she’s choosing epidural.

Kristin:  Right.

Neri:  But an aspiration can take her all the way to the end.  I aspire to – what is it that you aspire to have?  The vision?  A positive motivation?  We can tap on this in moments of crisis; remind her that she’s not a victim of this pain; she chose it.  The reason why she chose it; what is waiting for her at the other side that lead her to originally choose to give birth not taking an epidural, and this is so much stronger.  These are the materials that are going to take her all the way to the end.

Kristin:  Yes.  It is a different focus.  Some people may be motivated to birth the way their mother did, for example, versus avoiding and running from fear.  Yeah, I love it.  So how would one hire a birth coach versus a doula, or if you describe this for our listeners who are hearing this likely for the first time, and as they’re assembling their team, can you explain between the childbirth educator, the doula, and the birth coach, how they make informed decisions regarding care?

Neri:  So I think that childbirth educators are really helping clients be informed in a structured way.  And so I think that millennials, who are most of the birth-givers nowadays, they have three doctors called Dr. Google, Dr. Facebook, and Dr. YouTube.  And they have so much information at the tip of their fingers, right?

Kristin:  It’s not always the best information, but they have plenty of information.

Neri:  Exactly, exactly.  So what I see as the role of childbirth educators is to actually, first of all, sort out, you know, truth from myth, fears from reality, facts from mythology, and bring it to their students in the childbirth education class in a very structured way that helps them take all the information that they need in, in order to be able to have informed conversations with their practitioners, make informed decisions about their birth plan.  Maybe also advocate for themselves, but the advocacy, it’s really a different skill that doesn’t rely on information.  It relies, really, on your ability to speak up for yourself.  So someone can be well-informed and yet not have the ability to advocate for themselves, and we’re working on this with transformational coaching.  So this is the childbirth educator, and I love them, and I am one.

Kristin:  So am I, yes.

Neri:  And one more thing I may say is that, for me, a good childbirth education class will be one that focused on the coping techniques and really introduce a lot of techniques and allow the couples to practice those techniques, right?

Kristin:  Absolutely, yes.

Neri:  Because it’s really about – as I said, it’s not about knowing about birth.  It’s about being with the experience.  So how are you going to be with the experience, and what are you going to do?  What are you going to rely on, right?  So that’s the role of the childbirth educator, I would say.  Then the doulas – and I am a doula – most of them, if they don’t have the transformational birth coaching strategies, they will mostly meet with clients two times prior to the birth, help them finalize their birth plan, check in with them about what they want, what they want to avoid, how the partner would like to be involved, and then most of the work is then done throughout the birth experience: being hands-on, supporting, being verbal with encouragement, helping your clients maybe make informed decisions.  If you have a way of hearing the medical staff and then take a little bit of time to consult with you so that you can give them the tools.  But you’re not going to do the advocacy for them.

Kristin:  No, not at all.

Neri:  This is going to kick you out of the room, right?

Kristin:  Right.

Neri:  But what you can do is help them think, you know.  We’re using the brain model the doulas are working with, and we help them think, you know.  But the thing is, most doulas still remain within the decision-making process that relies on facts and information.  And what transformational birth support coaches do, is they send the client in.  They help the client reconnect with her own internal authority, her own internal compass and her belief system, and then we can actually make an informed decision that informs from within and is based on what’s right for me.  And I would say one thing about this, one additional thing that maybe your clients want to know, and maybe it will actually make them see how transformational birth coaches are a lot more aligned with the medical system, okay?  The medical system actually knows and embraces the idea of patient-centered care as safer and superior care.

Kristin:  Absolutely.

Neri:  So they are actually looking for ways to implement patient-centered care, patient engagement, and create partnerships between the medical staff and the patients.  And this is true to the general healthcare and in maternal care.  However, they don’t always have the tools because the medical teams are not trained with transformational coaching strategies.  When a doula walks in the room and she has those tools, and she knows that the medical systems seek this kind of care, she can lead everyone in the room.  She can actually facilitate this partnership.  She has the strategies to build the partnership between the client or the patient and the medical teams and to create a teamwork.  She has the strategies to engage the client.  She has the strategies to lead the nurse and allow the nurse to provide patient-centered care, and this is so embraced and welcomed by the medical staff that no doula that practices like this is ever going to be in conflict with the nurse.  So there are some doulas who come to the course and then they implement a series of – and you probably do that – they implement a series of prenatal coaching sessions with their clients, and so they will shift the focus off the work from supporting during birth to providing this series of prenatal coaching, creating the mindset, the confidence, the clarity, eliciting clients’ accountability, and then guess what happens?  A miracle happens, right, Kristin?  We know that.  Our clients actually spend very little hours in active phase and in transition, and they go through birth like bam, bam, bam, because the mindset allows what needs to happen.

Kristin:  Mindset is so important, yes.

Neri:  It’s everything.  And they have those shorter births that are progressing in a timely manner, and they don’t need you for 36 hours.  You get to be with them for five, six good hours, and bam.  And it’s like magic.  And there are doulas, I discovered lately – I think Naima was in the course with you, but I’m not sure –

Kristin:  Yes, she was.

Neri:  But there are more of them now that actually told me, well, you know what, I’m done being a doula.  Because the past few clients that actually hired me as a doula didn’t even call me for the birth because they were so well-prepared, and the birth went so fast.  And I actually decided that I’m not doing doula work anymore, and I’m becoming only a transformational birth support coach, which is something I didn’t even think of.  I didn’t even dream that it was going to happen, Kristin, really.  That’s like, oh, my God.  I wasn’t even ready to, you know, just stop doula-ing my clients and just provide that.  But now I am.  Now I’m saying to my clients, you know, you can hire me as a doula, and we will have those four to six sessions, prenatal sessions, because these are the sessions that are going to make your experience so much more empowering and go well and smooth and healthy.  Or you can just hire me as a transformational birth support coach, if you don’t even want to have a doula with you.

Kristin:  It’s all about options, so of course.  Yeah.

Neri:  Yeah.  Giving them the options, yeah.  How do you feel about that?

Kristin:  I, you know, am so new in the process, I haven’t gotten to that point.  I’m newly certified and really establishing that end of my practice, so I certainly, you know, early on in the course, started implementing techniques through prenatals.  Yeah.  But I love hearing what other coaches have been doing with their own businesses and what their clients are saying about it and what your own clients and how they’re responding.  Yeah, and for our listeners, since they’re located all over the US and the world, how would one find a certified transformational birth coach if they’re looking?

Neri:  Absolutely.  Great question, Kristin.  I didn’t even think about it.  So birthcoachmethod.com, and we have links on our website for a directory of all of our certified coaches.

Kristin:  And that will be growing!

Neri:  That is growing, and I’m so honored to say that we’ve had students from so many countries: South Africa, New Zealand, Australia, Israel, the Netherlands, Cypress.  I can continue – Japan.  We just had the first one in Japan.  I feel – Qatar, Dubai, Egypt.  This is really growing.  It’s amazing.  No one can stop it now because this was the missing link, Kristin, really.

Kristin:  I agree, Neri, and certainly as far as – you know, we do have doula listeners as well, including our own team members, so how – if someone is a birth worker, childbirth educator, or doula, and they’re interested in this program, how do they find out more information?

Neri:  Okay.  I’m announcing it for the first time: we are having a free event for birth professionals that will take place September 20th, and it’s going to go for five days.  We’re going to be – yes, we’re going to be on Zoom for 90 minutes each day, and we are going to go through the five game-changing principles and strategies of providing impactful and successful birth support.  And right after the event, they can go – or even before, they can actually go online, find our course, Transformational Birth Support Coaching, and enroll in the program.  And we have yoga teachers, midwives, childbirth educators, doulas, that are joining the event and that will join the course.  And as I said, our next session is going to be the first time that we’re actually going to lead a four-month program with one day of studying and then the next week, implementation day, so that you really get to implement all those new strategies and make the shift.  It’s a huge shift, right, Kristin?

Kristin:  It is.  Yeah.

Neri:  It’s really a shift.

Kristin:  And I’m thankful for the group that you created and the fact that we can have collective calls together and the Facebook community.  So I know as you evolve, we’ll also be able to keep up with the information and grow our practice.

Neri:  Absolutely.  I look forward to this, and I am so committed to doulas’ success, because here is the thing, you know, Kristin: when doulas are successful, their clients are having amazing experiences, right?

Kristin:  Yes!

Neri:  So that’s all I care about.

Kristin:  And like you said, we can’t control medical emergencies and outcomes, but as you were explaining in the grocery store experience, it’s the other takeaways.  And, you know, and their perception of being responsible for their choices and feeling empowered versus birth happening to them and feeling like everything is out of control.  So just shifting that mindset.

Neri:  Absolutely.  And being informed from within, from their gut, having this compass, saying, this is who I am.  I am not going to commit to any birth experience because I perceive it as superior or ideal or the best.  This is who I am.  This is what I want.  I’m going to try and have it my way because it’s my baby, my body, and no birth practitioner can tell me that’s a better experience for you.  I know what’s right for me.  And that is a very new position for birth workers that, until now, all of us, including me, Kristin – I’m going to be the first to admit that – we were all associated with the natural birth movement, and we were having an agenda that says that natural, unmedicated birth is better for you.

Kristin:  That is the movement, certainly.  Yeah, my practice is – we focus on judgment-free support and work with a lot of planned surgical births and clients who want an epidural right away, but when I started out as a birth doula, my clients – I would say 80% of them wanted a natural birth, either out of fear or out of, you know, just more aspiration.

Neri:  Right, or they think that it’s superior.  Someone told them that it’s the ideal birth.

Kristin:  And I said great, and I’m with you on that.  It’s like, oh, wonderful, that’s the way to go.  And – yes.

Neri:  My recent thing is to totally ditch the term “natural birth” and start talking about “positive birth experience.”  That’s it.

Kristin:  That’s it.  Yeah, that’s the goal.  A positive birth experience.

Neri:  A positive birth experience.  I’m not – every time that someone just starts talking about natural birth, I say, there is nothing like that, just like there is no natural climbing on the Everest.  So let’s skip the whole concept and go with “positive birth experience.” That’s what we’re here for.

Kristin:  Love it.  I agree.  So before I let you go, I would love for – you know, we talked about your book, The Art of Coaching for Childbirth.  How does one purchase a copy of that?

Neri:  Well, it’s on Amazon, or it’s on my website.  This is more a book for the professionals.  I don’t want your clients to be confused.  The Art of Coaching for Childbirth is actually for the professionals, but I do have a wonderful product for your expecting individuals that are listening to the podcast, and it’s called Practicing for an Active Birth, and it can be bought on Amazon, either as a DVD or a USB.  And there’s also, on my website, there’s also a version for streaming.  And we can even create a coupon that you can send your listeners so that they can get it.  It’s really two and a half hours in episodes that will enrich them with a variety of labor support techniques that they can practice.  And you know what?  In birth, practice makes better.  Just like in everything else.

Kristin:  In life, yeah.

Neri:  I tell my clients, when I try to explain to them why it’s so important that they will have a regular practice of their labor support tools, I say, hey, did you have a wedding dance?  And they go, yeah.  And I said, well, how long did you practice the steps for your wedding dance in order to know that once you hear the first notes of the music, you’re going to just own it and you’re going to rock this dance, and they go, about three months.  And I say, okay.  I want you to get to your birth day just like this.  Contractions are going to begin, and you’re just going to know exactly how to respond to them because you already have the muscle memory and you practiced those techniques.  So it’s called Practicing for an Active Birth, and three options: streamed, from video, you can purchase it on the website or the two other options are a USB or DVD on Amazon.

Kristin: Wonderful, Neri.  And so do you have any final words for our listeners as we part?  Any advice?

Neri:  Yeah.  Maybe one tip that is another thing that is a major shift that I think I am trying to lead the community: I think that we’ve been focusing a long, long time on what can go wrong.  Generally speaking, I think that all the abundance of medical exams that women go through throughout their pregnancy is setting up for a mindset of, this can go wrong, and that can go wrong.  They keep getting these messages of what can go wrong throughout the whole pregnancy and also throughout birth, you know, being hooked to the monitor.  It’s creating the mindset that, oh, we think every moment something can go wrong.  So we’re putting you on the monitor to be sure everything – you know, if it does go wrong, we can catch it on time.  I think that it’s creating a level of fear and anxiety, and it is in our hand to reverse it.  So expecting individuals will do themselves a big favor and will set themselves for the most positive and empowering experience if they actually sit down and say, if a fairy was entering the room right now, and she would have grant me my wish, what will I ask for?  What is my optimal desired birth experience?  Start writing it down.  Fantasize.  Go to fantasy land.  Don’t think about what can go wrong.  Don’t think about that.  Just really allow yourself to talk to fairies.  Sometimes it’s different than a conversation with a human being.

Kristin:  Of course.  That makes sense.

Neri:  So talk to the fairy.  Just ask her for what you want.  Write it down, and start rehearsing this scenario instead of rehearsing what can go wrong.

Kristin: Yes.  It’s all about mindset.

Neri:  There we go!

Kristin:  Thank you for your time, Neri.  This was eye-opening, and I’m so excited about the movement that you’ve created.  I’m honored to do this work.

Neri:  I’m honored, and hopefully it will really, really facilitate positive birth experiences.  Thank you, Kristin.

Kristin:  Thank you!  Take care!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

Alyssa talks with Amanda and Katie, Women’s Health Physical Therapists at Hulst Jepsen Physical Therapy, about postpartum physical therapy and what pelvic floor physical therapy looks like after having a baby.  We talk about incontinence, diastasis recti, symphysis pubic dysfunction, constipation, and so much more!  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Alyssa:  Hello, Amanda and Katie!  Good to see you.  Today, we are going to talk about postpartum physical therapy.  You are both women’s health physical therapists at Hulst Jepson, and we’ve had some beautiful conversations in the past.  And I think we haven’t really covered what physical therapy looks like yet specifically in the postpartum period.  So, yeah, let’s get started.  What does that even look like?

Katie:  Yeah, let’s dive right in.  I think the first thing that women think about is probably their six-week follow up with their doctor.  Usually it’s at the six-week mark that they talk to their OB-GYN.  And we would love to see this visit be standard practice and standard practice for referral to pelvic floor physical therapy.  That’s common in a lot of countries.  I think France is the one that is often cited.  But often there’s a really quick check of you and baby, and you’re told, okay, you’re good to go, without a lot of other details.  So this can be a great time to talk to your doctor about a referral to see a pelvic floor therapist.  That visit should be about the baby but also about you and how your body is doing, too.  A couple things that might be red flags that you need to see a pelvic floor therapist would be any urinary leaking, any continued constipation, any pain with sexual activity, any pelvic heaviness, just to name a couple.

Alyssa:  What is pelvic heaviness?  What is that?

Katie:  People that will describe that it feels like my organs are falling out; like, it feels like there’s a lot of pressure there, or it just feels like there’s a lot of tissue there, and I just don’t have a lot of sensation around it.  Or things just feel loose.  Like, my body doesn’t feel like it felt before I was pregnant, and it felt like everything was held together more.  It feels just kind of fluffy.

Amanda:  Yeah, I’ve heard that one a lot.  Like it feels loose or feels like a golf ball is kind of hanging there.  And that’s typically – definitely your OB-GYN will take a look, we hope, to diagnose or say, hey, there’s prolapse; you know, the scary word for postpartum.  But it shouldn’t be, definitely not, because that’s something we can help with.  But that pressure sensation can be because there is some prolapse there, and that will definitely kind of – when we dig into different diagnoses we see postpartum, we’ll dig into that one a bit more because there’s a whole series of things that people come in with that they already know they have or something that we find.  And the diagnosis that we describe obviously can happen if it’s a vaginal birth or a C-section.  Obviously, it’s a different experience for mothers, and in some ways, we treat that differently, but in some ways, some of the symptoms of it can be very similar.  Obviously, a C-section, with the abdomen we pay a little more attention to that area and healing and scar massage and whatnot to kind of get the abdomen to activate, and then that vaginal delivery, it’s like, okay, questions regarding, like, kind of lochia, like that discharge and stuff.  Where are you sitting with that?  How active can we be?  To kind of help you in every part of that journey.  As Katie said, six weeks out is a great time.  Obviously, if you’re having symptoms of incontinence or heaviness feeling, discomfort in that pubic bone in the front, or if you’re feeling pretty good but just really want to get back to running or that high-intensity interval training or just walking, if walking is uncomfortable.  We love partnering with new moms or could be your fifth kid or second kid to say, hey, yeah, let’s get you back in shape for the life that you live.

Katie:  And if you don’t feel ready at six weeks, that’s fine, too.  A lot of women are overwhelmed.  There’s a lot going on.  They’re getting used to a new baby and a new lifestyle.  So it doesn’t have to be six weeks.  It can be months later.  It can be years later.  And we’re going to take into account what’s going on at home that you’re telling us, too, and try not to give you a million more things to do at home.  We’re going to try to integrate things you can do into just what you’re doing anyway for you and for baby.

Amanda:  Yeah, I just had a mom.  I asked her if she could do things at home for her low back.  She says, oh, every time I go on the ground, my three kids run and jump on me.  I’m like, well, that may not help your low back, so let’s try maybe before they wake up and after they go to sleep or during nap time.  We’ll kind of navigate that with every individual that comes in our door.

Alyssa:  That’s really good to note because, you know, life with kids is so busy, whether you have a newborn or a newborn and three other kids.  Knowing that, okay, I’m not ready at six weeks yet, but I can come in a couple months and I’m not going to ruin myself.  Or I can do these – maybe I need to get up – like, I even find personally I need to wake up at 6:30 in the morning before my daughter wakes up at 7:00 and leave the dog in the crate, because same thing, if I’m on the floor doing yoga, I have a kid and a dog on me, without fail.  So as much as I love them, I need to do that alone to get an effective workout.  So allowing moms to say, okay, this isn’t going to work for me, so here’s my lifestyle.  What can you give me to fit into that?  That’s great.

Katie:  Exactly.  I think another great example is with diastasis recti.  So you’ve heard of “mummy tummy” or the splitting of the abdominals.  A lot of people get really nervous about that.  That’s something that we can easily assess.  We can look at your core strength.  We can show you how to close that gap in your abdomen, and that can be as easy as doing a little contraction that we teach you to do while you’re picking up your baby.  Or, you know, while you’re putting your baby into the crib.  So you’re getting a workout with stuff you would be doing anyway.  You’re just slightly modifying it, like we instruct you to do, to get the most out of that routine in your day.

Amanda:  That’s huge, and that one, with the diastasis recti, there’s always going to be some sort of separation.  There has to be, because your baby has to grow.  Your belly will grow.  But what we kind of dig into is to say, okay, how is the tissue?  How does it feel?  We can diagnose it with finger widths.  We take a look at that at the belly button, above and below.  But then we take at look at, is it firm?  Is it boggy?  How is the integrity of that tissue?  And based on that, okay, you’re ready for level A type of exercises, let’s say, or hey, you can – yeah, go jump on that bar and do some pullups.  It’s fine.  Your abdomen has good integrity.  You’re not going to have any sort of herniation or anything like that.  So it’s nice to work with the patient to help them get to the level they want to be and then also kind of meet them where they’re at and say, this is where we need to start, based on our findings.

Katie:  Yeah, a lot of women will come in and say, oh, my doctor told me the diastasis would heal up just fine.  Just do some planks.  And that works for a lot of women, but not for every person.  That tear in the abdomen sometimes isn’t straight.  And so I’ve seen women where sometimes they can do, like, one half of a bicycle, like maybe the right arm and left leg, but if they do the left arm and right leg, then it will actually open the diastasis more.  So that’s why seeing us, we can help you figure out what exact exercises are going to be the best for you so that you can get quicker into whatever workout you’re interested in doing.  Plus, it has the nice side effect of flattening the stomach muscles of that abdominal canister.  And if that wall isn’t as firm as it’s going to be, then we can see some more dysfunction in your pelvic floor, since that’s also part of that.

Alyssa:  I think that’s an important note, that just because one exercise might work for most, you could actually be doing your body damage and making things worse if you don’t actually have a professional assess, hey, this is what your muscle is doing, and this is the exercise you need to do to fix it, not just this – you know, the blanket statement of, do some planks.  Right?  That’s like – everyone calls – I get calls all the time.  I have a six-month old; how do I get them to sleep?  Well, there’s no one answer just for you.  If it was that easy, I would write the book and become a millionaire.  But there’s not just one answer.  So I think knowing, especially with our bodies and different exercises, that we can really do our body harm if we’re doing – trying to do the wrong things.

Amanda:  Yeah, and I think after pregnancy, that’s a change on your body, and then labor, that’s a huge change.  I mean, your body is kind of relearning how to walk again in some ways.  So picture those muscles as just kind of a baby itself, trying to relearn, and that’s where you want to make sure it gets that neuromuscular control in the proper way.  And that takes – it definitely takes help from a professional to help you through that.  Not everyone’s the same, and just to get that repetition of the correct way, the correct cueing, the correct postural form for it.  And as Katie mentioned, the correct pressures, too, because obviously, with delivery, whether it’s C‑section or a vaginal, the pelvic floor is probably going to change a little bit.  We know that it stretches over 100% during delivery, and then baby, when you are pregnant, it has to hold up baby during that time.  And that’s where we kind of mention, hey, that pressure sensation, that that’s not – the pressure right in the canister, it can lead to pressure pushing down into the pelvic floor, and that’s where we come in and say, hey, did your – you know, with your medical exam, did they say anything about any prolapse, I guess you could say?  And if they did,  awesome.  Let’s check it.  Let’s see how you’re doing.  So that’s where we can come in and check that.  We don’t necessarily medically diagnose.  Physicians don’t love it when we do the diagnosis, but we can definitely check the integrity of the pelvic floor, if it’s kind of a boggy sensation.  And we can do postpartum via internal assessment or we can definitely kind of externally get a sense where, if you try a pelvic floor activation, do we feel pressure into our hand, or do we feel lift, and that’s really nice to do externally.  If you had a kid six weeks ago, maybe internal isn’t what you really want to go through at that point.  And then help you with breathing patterns, core activation, to help kind of get those pressures proper again.  And typically if you don’t have pain, we can help you kind of reactivate that pelvic floor to make, basically, the base of that trampoline strong again and bouncy again to get that pressure sensation off.  And that’s fun to work with females on whether they say, hey, as I walk with my stroller, ten minutes in, I get that pressure.  All right.  We’re going to train you.  I want you walking for ten minutes not feeling that pressure, and then take it from there.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Katie:  Yeah.  Going back to that prolapse, that’s when your bladder or your rectum or your uterus are collapsing into the vaginal canal, and because they’re kind of falling lower than they should sit, that can cause some pressure.  But just because you feel pressure doesn’t mean that is what’s going on.  And your doctor is the best one to assess that, but we can easily see it, too.  Like Amanda said, it doesn’t mean that we’re going to necessarily diagnose it, but we could send you back to the doctor to see if you needed some more support than what we can give you.  So we can help support, like with what Amanda said, teaching you how to do exercises that will help push those organs back up where they should be.  But some women, the exercises are going to help, but they also might need a little bit more support from something like a pessary, which is going to be like a plastic platform pushing things up in place, too.  So that’s once again where we work closely with your gynecologist to help you figure out the best solution, and not everyone has that.

Alyssa:  Because there’s obviously different severity levels?  Prolapse is, like, a horrifying word.

Amanda:  As I said it, I was like, do I dare say it?  I don’t want to scare people.

Alyssa:  No, we do have to say it because it’s a real thing, right?  It’s a real possibility, and there are different severities.  I don’t know; just knowing that it could happen, what to look for, and that physical therapy might easily help what you have.  And if not, you can work with a medical team to figure out, like, okay.  They’re going to do this, but we can also continue to work on exercises to continue to build strength.

Amanda:  Oh, 100%.  Yeah.  Definitely don’t get discouraged if they’re like, oh, we think you’d benefit from a pessary, because we work with women with pessaries to get the pelvic floor stronger to say, hey, can we live without that pessary now?  So definitely, definitely ways to make things stronger, for sure.

Katie:  Yeah.  If you hear the word prolapse, it doesn’t mean that you can’t return to HIIT workouts or can’t return to running.

Alyssa:  I think we all think of the worst; like, literally something falling, like an organ falling out of the vagina.  That’s instantly where our brain goes, and it’s like, oh my God.

Amanda:  That’s not the case!  No, no.  And then other things that we see come through our doors is obviously leakage.  That’s one that we’ll get postpartum, and I know we talked about that in a previous podcast.  We dug more into that, about helping females through that process, too.  And then constipation.  I know, Katie, you’ve had a little bit more on that.

Katie: Yeah.  So constipation is pretty common during pregnancy, after pregnancy.  I think that’s maybe something women talk to each more about, preparing themselves for that experience.  But I mean, I’ll have people coming in with constipation who are like, I’m taking MiraLAX.  I’m taking a lot of other things, and I’m still having issues, and I don’t want to be on these medications, and I’m feeling a lot of pressure.  What can I do?  And it’s amazing.  After one visit of talking about posture on the toilet, things improve so much.  So from a mechanical perspective, there’s a lot you can do to help relieve constipation and that pressure.  So we talk to people about how they’re sitting on the toilet.  Can your feet touch flat when you’re sitting on the toilet?  If you’re short like me, they cannot, and so you might need to use a stool, or I know the squatty potty, that’s been more popular mainstream.  But getting those feet to sit flat and relax is really important.  If we have our toes curled, that can tighten our pelvic floor, and if our pelvic floor is tight, it is hard to get the stool out.  So relaxing our feet and then, for some women, a slight lean forward can help.  And then we can talk about breathing to help also with getting the stool out.  So Amanda’s talked a lot about breathing and expanding the pelvic floor with inhaling, with exhaling.  You can do that on the toilet, as well.  So you can breathe out like you’re blowing on a pinwheel, and you can try to expand your belly out and downward.  And all of that can help open up the pelvic floor, open up your rectum, and make it so much easier and less painful to poop.  So even talking about that for a session makes a huge difference.

Amanda:  Yeah.  I hope some of you are running to the bathroom right now to just try that.

Alyssa:  Do you like the squatty potty overall for anyone as a general rule, even tall people, just to get your – I guess it would be your intestines or your bowel in the right position?

Amanda:  Yeah.  I think – I know for me, I’m taller, and I think just having the knees above the hips, the pelvic position, it does create a little bit more relaxed position just to allow – we tell that not only for bowel movements but for when you urinate as well, to just say, yeah, no rocket peeing.  Relax on the toilet.  Let the pelvic floor fully open.

Katie:  I would say it just depends on the person.  Sometimes, if you’re very tall, or just depending on the positioning of things in your pelvis, because every pelvis is a little bit different.  If you have your knees up way too high, it may actually cause things to compress a little bit more.  So I wouldn’t say that it’s necessary for everyone.  I think a lot of it is based on height, and then oftentimes, I’ll have people try putting their feet up maybe on a pile of books or something they have at home first, and then if they like it, then the squatty potty is a good way to go.  But it doesn’t work for everyone.  Often, the breathing is the key thing.

Amanda:  Just even a laundry basket, I’ve told people to use, too, so they don’t have to buy something new.

Alyssa:  If you have older kids, too, like my daughter has a step-stool just to get to the sink.  I’ve tried that before, too.

Amanda:  Yeah.  And like she said, it doesn’t work for everyone, but it’s nice to give it a shot, for sure.  Yeah, and kind of moving past that constipation piece, another thing we see is that symphysis pubic dysfunction, to pain right in the center of the pubic bone, kind of the center of your pelvis.  And that, we look at a lot of rotation of the hips, what’s going on there.  So once again, this is external, because obviously, those rotations can pull on that pelvic floor.  We talk about, hey, how are you holding baby; what are some postures you’re putting yourself in?  Do you have some unilateral weakness?  And those, when you’re getting back into higher level activity, is there kind of a brace or something that, just for now, could you wear to do some of those higher-level activities?  Not forever, but just during this time when it’s painful and you’re trying to get your muscles back working well.

Katie:  Yeah, that old SI belt you may have used during your pregnancy can actually be really helpful afterward to give a little bit more support to that abdomen, especially if you’ve got some of that diastasis recti or the pubic symphysis pain.  So we can help you adjust that to work for you, too.

Amanda:  Yeah.  Very common, for sure.  And again, the next one is the scarring piece, whether it’s an episiotomy or Cesarean section scar.  Teaching people, hey, it’s good to kind of massage that.  We can help with that, but mostly, hey, start working on that at home so you know where the restriction lies there.  It can affect the muscles’ activation, just resting position, and obviously, pain levels, as well.  So we both do that, too.

Katie:  And it’s never too late to work on scar tissue.  So if you have an episiotomy scar from several years ago and you’re feeling kind of just some numbness or lack of sensation there or you’ve still been having some soreness in the area, that’s something we can still work on years later is just trying to break through some of that scar tissue and get your normal muscle tone back.

Alyssa:  That’s one of the things I learned at your office, actually, is that a scar – I mean, I knew that a scar left scar tissue, but that you can break it up, and I learned that a lot of the pain I was having was from scar tissue that had just – I mean, it didn’t even – like, it wasn’t even a thought.  So I learned how to feel that and break it up, because when she did it, I was like, oh my gosh.  That’s such an intense pain.  Keep doing it because I can feel that it’s actually working.  And then it continued to be less and less painful.  But yeah, I had no idea that it could cause that much pain so much later.

Amanda:  Yeah.  They can be a little sticky.  It’s like the tip of an iceberg sometimes where the tissue underneath just has to get worked on, which it can, which is great, by yourself or with help.

Katie:  Yeah, that’s true for the C-section scar, too, because you’ll see that the scar, usually in the US, is more horizontal.  But even though the scar is horizontal, you’re actually also stitched vertically underneath, too, with the way that you were opened.  So we teach women not only to do the massage horizontally but to look above and below the scar, as well.  There’s probably some tightness in the tissue there, too, deeper.

Amanda:  So obviously a ton of things that we can help with.  We can answer questions; we can explore with someone who’s a new mom, especially where it’s all very foreign.  Or if the postpartum was just different this second or third time around.  Yeah, we can encourage, definitely, hey, exercises at home, exercises here.  We have a great setup in our gym for those returning to exercise, returning to running.  We can take you through a program with that.  Strength training is so important, especially with baby care, or if you have a toddler, as well, that you’re lifting.  We always seem to be in that flexed position, so we really encourage extension, that opening.  Breastfeeding; we can help with posture with that if there’s pain involved, how to set that up; or hey, what exercises should I do before or after breastfeeding to get rid of some of this pain, to avoid the pain altogether.  There’s just a lot of things, which is so fun.  It’s great to partner with females after birth to get them through and back to the body that they’re used to having, function-wise.  And we just have fun with it.

Katie:  Yeah.  And it’s exciting to look at the whole body.  A lot of times, we’ll have someone come in, and they’re really just focused on the leaking, maybe, that they’re having, or some urinary leaking.  Or maybe they’re just focused on some heaviness or some scar tissue.  But it’s really fun to take a look at the whole body and be like, hey, how can we help your neck and shoulders and your midback feel better with breastfeeding?  How can we make your whole body feel more like it’s yours again?

Alyssa:  That’s a really good point with breastfeeding because a new mom who’s doing that every two hours, 24/7, that takes a toll on your body.  And like you said, that position, you just constantly feel – gosh, it seems endless, and the pain in your shoulders from that or your arms.  Yeah, that’s a really good point.

Amanda:  Yeah.  I mean, I hold my seven-pound dog for 15 minutes, and I’m like, I’m exhausted.  I got to step up my game!  But yeah, strength training is huge.

Alyssa:  Well, this is awesome.  I know we’re running out of time.  Do you want to just tell people where they can find you locally?

Katie:  Yeah.  Amanda and I are located at Hulst Jepson Physical Therapy.  We’re at the East Grand Rapids location, although it’s not actually in East Grand Rapids.  It’s just outside of East Grand Rapids.  We are located on Burton between Breton and Plymouth.  So we work well here as a team, and you’re welcome to call and talk to our receptionist, Lexi, and she can definitely set you up with a visit or with a free 15-minute consult.  There’s other locations that Hulst Jepson has that may be more convenient to your home, as well.  I think we have five different locations with pelvic floor physical therapy.  And so looking online at their website to find the best location for you.

Amanda:  Yeah.  We’d love to see you and help.

Alyssa:  Awesome.  Thanks again.  This was another really interesting conversation that we just need to keep talking about.  Let these moms know that you’re here to help!

Amanda:  Awesome.  Thank you!

Katie:  Thanks for chatting with us!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

 

Kristin talks with Sarah Baker, a current client and student in our BECOMING a Mother course, about her concerns with her second pregnancy/delivery and why she chose to hire a birth doula as well as invest the time in a 6-week online course.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello, hello!  This is Kristin, co-host of Ask the Doulas, and I’ve got Sarah Baker with me today.  Welcome, Sarah!

Sarah:  Hello.  Thank you!

Kristin:  So happy to have you here!  And Sarah, you are currently in our six-week online course, Becoming a Mother, so I have you here today to discuss, you know, how that series worked for you during your pregnancy, why you decided to join, and so on.  And for those of you who don’t know what becoming a mother is, we just launched our beta version this spring of the course, and our next series comes out on August 2nd.  It is six weeks of preparation for having a confident pregnancy, birth, and also newborn phase.  So, Sarah, why did you join the class?  I remember seeing you on our webinars that were promoting the class initially.

Sarah:  Yeah, so I have actually had a child already, and during that first delivery, everything was wonderful, but I was always interested in having a doula or interested in learning more about doulas.  And so when I talked to my sister, who had a doula for her third child, she had recommended Gold Coast Doulas and I had reached out and heard that there was this upcoming course.  And I thought, wow, what a great way to learn about so many things all at one time and just kind of get all of my information to kind of make my decision whether, you know, how I wanted to build my team, how I wanted my labor and delivery to look, and then even assessing the postpartum care, as well, which I learned that there are postpartum doulas and got to learn that, and that was super exciting because you’re not in it alone, so you can definitely get all the different resources.  So it was just really interesting to learn about the different themed weeks that you guys have for sessions.

Kristin:  And it is so interesting that I feel like the interaction component, with COVID, is so important, even in a virtual format, like the online private Facebook group.  That has been really the reason that we launched Becoming a Mother, because our clients were feeling isolated and our students in our classes that went from in person to virtual.  So Alyssa and I figured, you know, this is the perfect time to better support women, not only in West Michigan, but throughout the country, who are feeling isolated and anxious due to COVID and really needing to get some resources since a lot of things that used to be in person changed to virtual, including fitness classes and even some provider appointments at different points in COVID were virtual.

Sarah:  Right, and you bring up a great point with building the community.  You know, it has been isolating and it has been nerve-wracking, and you don’t know what to do, where to go, or you don’t want to socialize too much.  But having that Facebook group has been a huge connector with the option to reach out to other moms and other soon-to-be moms and just ask candid questions.  It was just really fun, and that was kind of before everything started and the Facebook group had launched, that was kind of – I don’t know, because I had time, sort of like before classes start, everyone’s kind of getting to know each other and throwing out questions and just those ice breakers.  It was just a really cool way to see who else in my area, and I think it is just really great to have some kind of online connection to then stay connected, because even after the six weeks are over, I can still pop on and say, okay, question about this; now I’m experiencing this.  What are you guys doing – it’s so hot, what are you guys – I’m seven months or, you know, you’re eight months pregnant in summer, and how are you guys dealing with the heat?

Kristin:  Yeah, exactly, or your baby’s teething or going through a growth spurt, and this group, the women in the course, can come and go from it but have lifetime access to all of the videos and the Facebook group.  So, yeah, to have those, not only experts like Alyssa and myself as birth and postpartum doulas but also, you know, learning from each other.  And you’ve been able to guide a lot of the first-time moms based on your experiences and other seasoned moms who are in the group, so that connection has been lovely to learn from each other and get advice about different wellness practitioners that you’ve all seen in your own communities.  So that is a lovely bonus out of all of it.

Sarah:  Absolutely.

Kristin:  So what would you say overall as far as what you – the official six weeks have ended, but we’re still connecting and asking questions to each other in the group.  What would you say were the highlights of what you got out of Becoming a Mother overall?

Sarah:  That is a great question.  I think for sure the Facebook group and just the fact that I can post a question.  I mean, like we had mentioned, I have a toddler at home, and so even just asking the question of what are you guys doing – like, how can I make sure that my older child still feels special, or what can I do when we bring baby home, and so it’s just been nice to have other moms who also have other children who have given their recommendations or have given what they’re planning on doing, as well as the live Q&A calls were really helpful, even just to listen what other mothers or expectant mothers are experiencing as well.  So it’s just been nice, again, not feeling alone in such a kind of isolating time that we’re having, and even when things kind of settle back to normal, it’s just another cool opportunity to have access.  I live close enough to Grand Rapids, but I may not be able to make the commute, you know, if it is an in-person class, if it were a six-week course or something, so it’s just cool to have a virtual option, as well.  But I just think that the course really reminded me of a lot of things that I wanted to have top of mind, like the self-care aspect of things, and the biggest things for me were understanding the doula-client relationship and what we can expect or what a doula does, and then I also laughed about the sleep training information.  So I think that was – like, what was that, week two and three for assembling your team, and then week six, so I was very excited about those courses because that’s definitely what I had struggled with the most with my first, with sleep training, and again, it’s the situation of asking for help and knowing that there are plenty of resources, and it’s not an insurmountable task.  There are local resources and very wonderful people who are out there to help.

Kristin:  Yeah, and it’s been great because we have a student from New York and one in Detroit area and one out in Seattle, so I’ve been able to connect them with resources in their communities, as well, but of course, we have a lot of West Michigan trusted providers.  So as far as – you know, you had joined at a good point in pregnancy, but if you were to give advice to any friends who are interested in potentially taking this course, at what stage in pregnancy would you say would be ideal to join a course like this?

Sarah:  So probably – I mean, I did it early.  What was it, like 10 or 11 weeks or something?  It was pretty early.  And I thought, oh, is this too early?  Like, should I not have done this?  Definitely, the second trimester and when you’re thinking about, do you want a doula – and even if you don’t, I think there’s so much information – or if you decide that that’s not the route you want to take, there’s so much information and so many tools to use throughout the pregnancy, and like you said, during pregnancy, then labor and delivery, and postpartum care.  I think there’s just so much information that whether you’re on the fence about having a doula or not, that it’s just such a great tool or such a great workshop or course, you know, to take.  And I think probably, yeah, in the 20 weeks and beyond – I don’t know if there’s too late of a time, because if you do want to get a doula, it’s probably – I can’t remember what weeks you recommend having someone like that picked out, but that –

Kristin:  Ideally, first or second trimester because we booked up.  If you want a particular doula, we tend to get booked up, but our agency is big enough at Gold Coast where we can find – we’ve had clients hire us at 40 weeks in the past.  So it can certainly work out, and as you mentioned, not everyone who is in the course plans to have a doula, but it’s also other, you know, related professionals and understanding with some of the expert videos and what we go through in week two of assembling your dream team, both personally with family and friends and also professionally, so getting into physical therapists and having videos from Webster-certified chiropractors, for example, and fitness videos and some nutrition-focused content, so figuring out in that – and I know you worked through that planning and budgeting workshop of what your insurance might cover.  Do you need a referral from your provider for, say, a physical therapist, or after having baby, pelvic floor therapy, and what might be covered if you have a health savings or flex spending.  What are your priorities and what is your budget?  Like planning a wedding, you have a budget you work with, and what are the key things?  Is sleep key or is breastfeeding support with a international board-certified lactation consultant, or is having a doula that you’re using a health savings or paying out of pocket for?  And all of those things, and if you prefer to have a homebirth midwife that you’re paying out of pocket for versus having a certified nurse midwife or an OB and delivering at the hospital.  And so factoring all of those things in has seemed to be helpful for a lot of our students to just figure out what resources are available in their own communities and then just prioritizing based on needs.  Some people want a birth photographer and pictures are very important, or newborn photos.  And so figuring that into the budget.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Kristin:  So what are your thoughts on getting through some of that planning?  What did you learn through the expert videos or even the course content in week 2 that you hadn’t known before with your first child?

Sarah:  So definitely the variety of doulas.  I mean, I think I knew of them, but I didn’t really think about it, that there’s the bedrest doula.  There’s a birthing doula, and then a postpartum doula, and it just kind of clicks, like a lightbulb went off, where it’s like, wow, yeah, if I had to be on bedrest and here my husband still has to work and there’s a toddler, how do you figure that out?  So it just gives you more to think about, as well, just to kind of overall think, okay, if something should happen, yeah, what would that dream team look like?  Would it be family, or could I have someone come in, or even just having someone, if it’s hiring someone to do some housecleaning or housekeeping while you’re expecting or after?  So it just really gave me a good opportunity to sit down and say, okay, so what do I think I need, or what do I want – kind of needs versus wants, and what do I want it to look like, and for me, the hospital room, my hospital has changed to where now any doctor – which probably could happen anyway, but any doctor could be delivering my baby, and I was thinking, okay, so you establish this relationship with a doctor for all these prenatal visits, and then Dr. Smith is going to walk in and deliver the baby, which Dr. Smith is absolutely capable and wonderful, but I don’t know Dr. Smith, and so that really is what drove me to look at having a doula who could be there, you know, throughout the pregnancy, having questions and texting and just building that relationship where it’s not so scary to go into this hospital room.

Kristin:  Right, because you don’t know your nurse, or your nurse might have a shift change and then you need to establish a new connection.  But you know your doula, so it is lovely just to have that reassurance and connection and know that they understand what your birth wishes are and regardless of who’s in the room, that you will be fully supported emotionally and physically.

Sarah:  Right.  And then when I was interviewing the doulas, it was also great to hear just the support for the partner or whoever’s going to be in the room for the delivery, so it is kind of like, yeah, you could have a really long or a really short delivery, and if it’s a really long one, you know, your partner will need a rest, too, or may need to step out for something.  So it’s just nice to have additional support that they can kind of trade off or take turns on different things.

Kristin:  Yeah, exactly.  So earlier in our conversation, you had mentioned the self-care component, so that’s part of week one, when you’re processing your feelings about your pregnancy.  And women in the course joined at all stages, like we had some women that had their baby shortly after the course began, so we’re already hearing birth stories, and some women are newly pregnant.  So just regardless of the stage, thinking about what you’re doing for self-care and what you’re doing to connect with baby and, you know, how you are taking time, especially during a pandemic, to truly care for yourself and help prepare for the upcoming birth.  So what did you get out of that first week?

Sarah:  I definitely got out of the first week that, again, you know, self-care is important, and being a mom already, you’re kind of wanting – you know, you want to make sure that your child or children are taken care of and all set, but then making sure that you know to take the time to go to bed early if that’s what you need, or take a bath if that’s what you want.  And so I definitely took some more time to go on walks and really kind of re-engage in my yoga practice, and wanting to – kind of doing sort of like the – I will do, like, a good morning baby belly rub, and if I’m putting on any kind of lotion or vitamin E oil or something, just to kind of be like, okay, good morning, baby.  And I did that a lot for my first, but as we talked about, the first, you know, it seems like, oh, there’s so much time, and then with the second, it’s like, okay, you’re running.  You’ve got all these different things.  So not wanting to let so many things slip away, and my husband and I have made an effort to take bump pictures and make sure that it doesn’t just slip by, you know, all of a sudden.  I’m like, oh, you know, when I start showing, and then it’s like, oh, wow, I’m showing already.  Like, I am showing faster than I did for my first.  So it’s like, so we’ll have more pictures, but maybe we won’t.  So a lot of that, and I think just giving myself the space and the time, that I don’t have to get it all done, either.  I think that a lot of times, you’re trying to nest or you’re trying to make sure that all of this is taken care of, and I’m like, okay, that laundry can wait until tomorrow.  So that’s been a little bit of self-care for me, as well, where I’m just like, okay.  I’ll run – you know, I’ll have my husband run the dishwasher while I tag team something else.

Kristin:  And we chatted more about assembling the team, but in the final week with me in the pregnancy and birth portion of Becoming a Mother, we talk about your actual birth prep.  So that covers everything from positions to the environment in your birthing space to, you know, a bit about your birth preference sheet or birth plan and having discussions about who will be in the room, whether it’s a doula, or depending on visitor restrictions, if you plan to have family and so on.  So, again, being a second-time mom, what did you learn from that segment that you didn’t think of with your first birth?

Sarah:  A lot of it was the environment piece, because I think so much or so often, I go places, and I think, I am the client or the guest, and they know – they do this all the time.  They deliver babies all the time in the hospital.  So I’m not going to put them out, if that makes sense.  So if the lights were too bright, I didn’t think to say, hey, can we turn the lights down.  Or if the environment wasn’t a certain – it just gave me more of an empowerment to say, okay, this is my experience, and I’m going to deliver a baby, and so I want – it needs to be good for me.  So I think that was probably the biggest thing, my biggest takeaway.  And I don’t think that – well, it’s been a few years now, but I’m trying to look back with my first delivery and how all of that went down.  But, again, I didn’t ask for a lot because, oh, they’ll let me know or they’ll tell me this.  And I’m thinking, oh, you know, I brought different things.  Like, I think I even had a diffuser or something that I brought along with me, or there were things that, you know, trying to make it more of my own space.  But again, coming into the environment, I didn’t realize how that would directly impact.  Like, if I’m having solid contractions on the way to the hospital and then I get there and now they’re ceasing, and it’s because, okay, now I’m in a weird space and my body is stopping and slowing down, and no one really – like, I didn’t think about it as, oh, your environment’s changed.  Your body’s now going into a weird, like, I don’t know where I am.  And the nurses, you know, would help as they could, but, again, I had shift change after shift change for my nurses.  So that’s been my long answer of, it was definitely kind of an empowering thing to say that this is your experience, and however you want it to be.  So I’m very much looking forward to having my doula come, and she mentioned that she brings LED candles.  And I think that it just – and to have music.  You know, we had kind of the generic hospital room experience where the TV turned on, and I was on an exercise ball, and there were just different things.  And I tried to move around, but I realized I didn’t move nearly as much as I should have been, just kind of waiting for it to happen to me instead of working with it.  So that was eye-opening and, like I said, an exciting thing.  So now I can feel more active in the event.

Kristin:  I love it.  And then getting into the overall investment in your time with the weekly – we have the live calls, which are recorded for those who miss them.  There are video lessons that are short, but there’s usually two or three videos per week, and then worksheets.  So what was that, as far as your weekly commitment, and how did you budget that time, knowing that you didn’t need to stay on track each week, although it certainly is helpful if you want to get on the live calls to have those questions answered.

Sarah:  For sure.  So the videos, I feel like, posted pretty early on, too, in the week, so it was for sure every Monday – at least by Monday, they were posted.  So I would try to jump on either Monday to download the worksheets and then take a look at the worksheets or watch the videos.  I definitely would watch the videos no later than Thursday, and a lot of times, in the evening, and I would kind of get a notepad out and jot a few questions down or take some notes.  And then I would print out the worksheets, and sometimes I would be really diligent in doing all of those worksheets, and then other times I would just kind of look over them and be like, okay, here are questions I have for it, or these are my thoughts, because I did want to join the live calls and make sure if I had questions that I was able to get them answered.  Another thing I wish that I had kind of done was, like, submitted my questions earlier, too.  That wasn’t something that I really had thought of, if I had questions, to send them in case I missed the call, so then they still would have been asked.

Kristin:  That’s a great tip, and some people who knew that they weren’t able to make the call would ask questions in advance and we’d answer them in the recorded call or within the Facebook group, if they thought of them after the fact.  So that is also helpful.  So would you say you spent maybe 30 minutes to an hour a week prepping for the calls, or what would you say your time was?

Sarah:  Yeah, probably 30, 45 minutes or so to watch the videos and do the worksheets to, yeah, prep for that live Q&A call then later at the end of the week.

Kristin:  Great.  And then the calls, depending on how many questions and how many people are on, they’re about an hour in length, just so our listeners and clients understand that.  And then getting into the final three weeks, Alyssa leads everything about baby and postpartum planning and feeding options, as well as sleep.  So what did you get out of that, again, being a seasoned mom, not a first-time mom?  What did you learn through those last three weeks that you hadn’t considered before, or what tips were helpful to you?

Sarah:  My biggest takeaway was definitely about sleep – and I hope I get it right.  I should have looked it up to make sure that I have the routine down.  But with sleep, you know, baby wakes up, feed baby, play with baby, and then put baby down again.  For my first, I definitely got into the habit of feeding to sleep, and you kind of have this close bond, and it’s sweet and it’s lovely, and it worked for a while, but then we laughed in the Q&A call where it’s like, it works until it doesn’t.  And then all of a sudden, you’re going back to work, and you have to wake up all the time, or you’re the only one who can do the bedtime routine or whatever.  That kind of starts to put a strain on things, and so for me, that is kind of an uplifting or an exciting – the ah-ha.  Like the ah-hah moment, the awakening of, oh my goodness, that just makes sense, that you wouldn’t – you know, if you want to disassociate it or not have your baby always associate it – again, I didn’t mind it, but come down the road, it’s one of those things.  So for me, the sleep was probably the most educational and just important one for me because, again, with my first, it was a totally different experience.  However, with different kids, you could have a totally different experience.  The other thing that I really liked was when Alyssa kind of did some debunking of, you know – I think there were, like, three common misconceptions or three common myths, like never wake a sleeping baby, kind of thing.  And so it’s just, again, great tools and just good information to kind of give yourself that – the approval in, like, saying that no, there are times when you will have to wake a sleeping baby.  You’re not going to let your baby sleep for all this time, and your baby needs to eat.  So that was good to hear, as well.

Kristin:  And then as far as the expert bonus videos, you all helped us create some of that content based on feedback, which was great because all of the future students are able to benefit from it, but we had noticed that a lot of the course participants had wanted more resources and support for dads, so we had an author come in and talk from the dad perspective about how to engage the father and some helpful tips, so that was one.  And also car seat installation; we added that one later in.  So as far as expert videos, give us your thoughts on some of that coming from the professional perspective versus us relaying information directly to you.

Sarah:  Again, I just think so many great tools and resources, and to be able to jump on the website and watch them and get the tidbits and get the information that you need.  And then go back and rewatch them.  There were quite a few that I watched, and I was like, these are excellent, but I don’t necessarily retain everything, so the fact that you have access to them throughout – forever, and now I can go back, and I can have my husband watch the dad author…

Kristin:  Welcome to Fatherhood.

Sarah:  Thank you, yes.  It was the WTF, that’s right.  So, yeah, I can have my husband watch the author of WTF, Welcome to Fatherhood, and same with sleep training.  Again, if there’s anything that I find helpful, it’s just a great resource that I can keep going back to, as well.  Or if I think, oh, I don’t need this right now, and then all of a sudden, oh, wait, I do actually need this now.  I need to know how to pump before going back to work or those kinds of things.

Kristin:  Exactly.  And then our HypnoBirthing instructor, Ashley, has one on breathing, and that was based on feedback that we received after the birth prep group of just, how do we get more resources in planning, especially for first-time moms, but some moms, you know, didn’t really know what to do with the pushing stage for breathing or even in the early labor.  So did you watch that one, and did that affect how you plan to focus on your breath during labor?  Especially with COVID, where until you get admitted, you’re wearing a mask through part of your labor.

Sarah:  Right.  Well, and I think – and it may have been more in conversations with you.  I may have watched the video, but again, I’m trying to remember all the different ones that I watched.  But even just not having it be – like, to breathe with it, or again, you know, kind of working with it.  I think a lot of times when you’re experiencing a contraction, it’s, again, happening to you, or you’re feeling like it’s no, ride it, or breathe with it.  I’m trying to think of the words that you may have used before, but it’s just sort of like, take it on and don’t tense up.  Just kind of – so, yeah, definitely helpful and something that I’ll be watching, even if I have rewatched it, rewatching.

Kristin:  Oh, yeah, as it gets closer, for sure.

Sarah:  Right, because again, just those reminders.  And, again, excited to have a doula on my team to then also remind me and to help me through that, as well.  Because, again, in the heat of the moment or when things are happening, sometimes things get kind of lost in the shuffle.

Kristin:  Right.  Exactly.  So, Sarah, thank you for filling us in your experience with the Becoming a Mother course, and we’re so thankful that you joined us in the early beta stage so we’re able to use your feedback as we create the next version of the course that comes out in August.  Our goal is to have them quarterly so women will have options to at least take one class during their phase of pregnancy throughout the year.  As far as what you would tell someone who’s interested, I know you had mentioned to me before we got on this podcast that you had some friends that you were planning to tell about the course.  What have you explained to them, and why should they invest not only their time but also their money into an online program?

Sarah:  Again, the community is just so incredible.  You mentioned it yourself, you know, having the experts, as well as just fellow moms-to-be, has just been an awesome resource.  And like I said, now you have this virtual community.  I really think that whether you are looking at having a doula or not, there are so many resources and, again, those expert videos are fantastic.  It’s just gaining so much information that you have access to throughout your pregnancy and then after, and any future pregnancies.  And so I think it’s just such an awesome way to go through learning – you know, I do love learning, and I love getting as much information as I can, so it’s just really helpful to have it kind of all in one place, as well.  You know, you can buy a ton of books, which you also recommend, but you can buy a ton of books and read as many books, but again, having those live Q&A calls and having someone on the other end if you’re sending an email or posting something on Facebook.  It’s just that real time connection that’s been huge for me.  And then, again, just having the experts that can give answers or provide you resources and connect you with the people who can help.  So it’s just been awesome.

Kristin:  Thank you so much for sharing, and I look forward to continuing to connect in our Facebook group.  I can’t wait to hear your birth story down the road.

Sarah:  Yeah!  Well, thank you so much for having me.  It’s been a pleasure.

Kristin:  Thanks, Sarah.  Take care!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

 

Kristin & Alyssa talk with Amber Shaw, a recent student in The BECOMING a Mother online series of classes, about some fears she had with her second pregnancy and why she took this course.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Alyssa:  Hi, Amber!  Thanks for joining us!

Amber:  Hello!  Thanks for having me!

Alyssa:  We’re talking to Amber Shaw today.  She’s a past and current client, and then you also just completed our very first beta launch of the Becoming a Mother course.

Amber:  I did!

Alyssa:  So we kind of want to talk to that, and Kristin’s here with us, too, today.  As you know, she teaches the first three weeks on pregnancy and birth, and then I teach the last three weeks on postpartum planning and sleep.  So we just kind of wanted to get first-hand experience for other people who might be thinking – other moms who might be thinking about taking this course, and maybe ask you some things about what you got out of it.  Kristin, do you have any questions to start it off?

Kristin:  Yeah.  So, Amber, I would love to – I know when we approached you about the concept – I would love to hear your thoughts on why, being a second-time mom, you decided to invest six-plus weeks during your busy life and pregnancy to join us in this brand new online course.

Amber:  Well, I feel like you kind of black out a little bit.  After your first child – you know, I got pregnant again.  My son is almost four, and I feel like there was a lot that I just didn’t remember about, you know, when he was a newborn, particularly.  I think your mind kind of, you know, forgets some things to protect you a little bit and make sure that you have the opportunity to have a second.  And there’s so much new information out constantly and just a million different places to get it, but I think that in general can be overwhelming to a new mom or even a second-time mom.  So, you know, I love you guys.  I used you for my first birth, so it was kind of a no-brainer to work with you again and just kind of get a brush-up on everything, and I got a lot of new information out of it, too.  So it was nice just to kind of have everything in one space from trusted sources that I can reach out to if I need to.  It’s not just like you’re getting information and then that’s it; go run with it.  So, yeah.  I like the whole concept of it and just the fact that you guys are available for questions, too.

Kristin:  And even working with doulas currently, have you found that it’s still beneficial to get that information from Alyssa and myself in different areas that maybe your doulas may not be talking to you about on the regular?

Amber:  Absolutely.  I love my doulas a lot, but I don’t want to reach out to them for every little question I have.  I don’t want to ask them about safe sleep and kind of brushing up on that stuff, so I think there’s just some things that you kind of want to do research on your own time about.  I kind of save my texts for the doulas, especially at this point, to, like, hey, is this sensation normal, not asking them about, you know, breastfeeding and all of that stuff.  So it’s a different type of – like, a different type of information area, I guess you could say.

Alyssa:  And added on to that, I think – you know, so you have a four-year-old, and now you’re pregnant again, but even if you would have remembered all the things, you’ve never birthed during COVID before, so I think that’s its own huge part of – you know, and until COVID goes away, which who knows how long we’re going to have parents and mothers in particular really nervous about giving birth during a pandemic, you know, that is a big piece of what your first or second week – probably your first week you go over that?

Kristin:  Yeah.  Well, we go over, you know, just pregnancy expectations and fears and feelings, and I think it applies no matter what stage of pregnancy a woman is at.  Obviously, with anything, it’s better to join a course like Becoming early in pregnancy, but we’ve had clients deliver their babies shortly after the class started, and they still got benefit and are interacting and have lifetime access to the videos if they have more children.

Amber:  Well, I think the good part about it is how you guys break it up so much.  Like, it’s easy to go in and find the information that you’re looking for, which I think is really nice.  You don’t have to, like, watch a whole video to kind of – you know, if you remember what section something is in that you want to brush up on or needed more information about, you can go right there.  I loved that about it, and I think it really broadly covers, like, yeah, you’re pregnant.  You know, now what do you do?  You’re faced with all these questions and decisions, but now the baby’s here.  So it’s kind of both ends of it, which I think for my first time around, being pregnant, I focused so much on preparing for birth that I don’t think I prepared enough for postpartum and what really happens when you’re bringing the baby home, and I think that probably happens to a lot of people because you’re just so angsty about the day and just thinking so much about the day of your birth but, like, that’s just the beginning of it.

Kristin:  So true!

Amber:  There’s so much that happens after that you’re constantly like, is this normal?  What do I do if this arises?  And, you know, you can’t constantly be calling your pediatrician or – well, for me, it was just the pediatricians because I didn’t have a postpartum doula, so I think that really having solid information and resources for when baby comes home is so important and something I wish I would have spent more time on my first time around.

Alyssa:  You’re not the only one.  A lot of parents say that.  Like, oh, my gosh.  We read all the books – well, it’s the exciting part, right?  Like, you find out you’re pregnant, and you’re so excited, and your brain can’t even go there yet.  You’re so focused on a healthy pregnancy, and then you get to the – oh, my gosh.  What is labor and delivery going to be like?  And then you never even get past that.  Like, once you bring the baby home, then what?  And that’s the hard part, right?

Amber:  It really is the hard part.  You’re so – it’s so overwhelming, and especially your first time around, I just questioned.  I questioned every mark on his body.  I questioned his baby acne, what it really was.  You know, if I had enough supply; is he even getting anything out of me?  It’s a really intense time.  I think the fact that you guys have so much content focused on that, and also resources.  That is huge, especially the second time around, I really, I think, focused on those because when I started the class, I already had my doulas and everything like that, and I knew that I wanted a vaginal birth, like a VBAC, so I kind of had a good idea of my care team and all of that stuff.  So I really focused on the second half of the course and the bonus videos and being active in the Facebook group and stuff like that.  That’s been really beneficial to me.

Alyssa:  Let’s talk a little more about the Facebook group because that was a big part of, when we put this class together, especially, again, during a pandemic when moms can’t get together and have that community, to have a really safe and open space where you can ask these questions that you might not feel comfortable asking in a big open Facebook moms group with thousands of people in it, and to know that you’re going to get support and answers and responses from Kristin and I that are like, hey, here’s what the evidence says, or hey, here’s a trusted resource in our area or your area who can support you.

Amber:  I think that’s invaluable.  There is too much – there’s too much out there.  It’s overwhelming.  You don’t always know if you’re reading somebody’s opinion or if it’s evidence-based.  Everybody has an opinion about everything when it comes to parenting and motherhood, and it’s really – like, you’ve got to really sift through all of that stuff and find clarity, especially when you are postpartum and already emotional.  I remember coming across so many resources when I was up in the middle of the night questioning things that just sent me down an even worse rabbit hole of thinking I was doing something wrong or making me even more paranoid.  So just to have a couple places that you go to for – where you just – yeah, you know that you’re going to get a reliable answer that’s evidence-based from somebody that you know.  It’s invaluable, like I said.

Alyssa:  Well, good.  That’s what we wanted!

Kristin:  And you’ve all helped up shape the course based on feedback from the live Q&A calls and in the group.  So we added an expert video on car seat installation.  We had the author of Welcome to Fatherhood do one for dads specifically, since dads are not in the group.  Dads and partners, I should say.  So to have something that they can look at and get involved in the pregnancy, birth, and parenting aspect of things.

Alyssa:  Yeah, we were very intentional about not having – literally, all of our other classes are for couples, and we think that’s really important and we love it, but then it’s like – I think mothers wouldn’t be so open about asking specific kinds of questions or talking about, you know, especially in the postpartum one, we talk about some – you know, the nitty gritty, like what happens to a female body afterwards, and males aren’t going to want to either listen to that or hear about it, and we’re not going to want to talk about it in front of them.  Like, as much as I love my husband, I’m not going to tell him about what happens to my body every month when I get my period.  So we were very intentional in that, too, of like, let’s just make this only for mothers.  Birthing persons only, and let them feel really safe and comfortable here.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Amber:  I was actually just watching that one the other day because I had a Cesarean with my first birth, so in a way, I feel like this is my first birth, in a way, because I have not experienced any type of labor at all.  I haven’t experience postpartum with a vaginal birth, and that was really great to hear about all of that stuff because it’s going to be my first time experiencing it, even though I’ve had a baby before.  So no matter what birth you’re on, they’re all different, and I think this information is always good to have as a reminder, even if somebody has had a vaginal birth before.  Just the reminders of prepping yourself to, this is what’s going to be happening because to not know – yeah, the more you know, the better you can go in and just be mentally prepared for whatever happens.

Kristin:  And I know you were very interested in the sleep aspect of things, and that live call was quite well attended.

Alyssa:  Yeah.  I mean, every time I talk about sleep, I remind myself I need to create a class specifically for sleep, and actually, from this beta group – and I’m almost done writing it.  Like, I feel like it would be great – because you all are pregnant around the same time.  You’re going to have children in the three- to six-month age range around the same time.  Like, this group of women who go through the course together could then, if they wanted, go through this sleep class.  It’d be, like, four different sessions for four different age groups or something.  I’m trying to work through how that would be, and then you could commiserate together of like, oh, my gosh, this is how naps are going.  But then I could be there to be like, okay, based on what you told me, here’s what you all need to do.  So I’m working through that in my head, because I know sleep is a really big issue for parents, whether first time or like you, with a toddler – I guess he’s older than a toddler at this point, but a lot of people with a one- or two-year-old at home, it’s hard, especially when they’re not sleeping well yet.

Amber:  Yeah.  I’m actually way more concerned about sleep this time around because I have another kid.  Like, the first time, you really can nap when they nap, and doing all of that stuff, and luckily Parker has always been a really good sleeper, but man, I feel like my second time around, I want to work harder at getting to know his sleep schedule and working on that, because it’s just – I just don’t have the flexibility to just be focused on him and to be sleep-deprived all the time.  So that would be so beneficial and so helpful, I feel like, for people, because I didn’t do any type of sleep training the first time around at all.

Alyssa:  Yeah, you got lucky with a kid who liked to sleep.

Amber:  I did, yeah.  Yeah.

Alyssa:  And who knows, maybe the second one will, too.

Amber:  We’ll see.  He’s very active at night already.

Alyssa:  Well, my intention with week six with sleep was just to give everyone enough info that you go, oh, my gosh, I can do this.  It’s not impossible.  I can start from the beginning creating these really healthy sleep habits so that when my baby is ready, it’s not such a problem.

Amber:  Right.  And then too, I think, remembering that just the beginning, there is no – you’re just kind of at the whim of the breastfeeding, and you are up all the time, and you can’t even look for those patterns yet.  So even just for the reminder of that, because I think you kind of forget about that time, as well, just because it’s all a blur.  Like, night is day; day is night.  It’s a very strange time.  So even just being ready to jump back into that and setting yourself up for support, I think that, like, I’ve had a lot more conversations with Ashton this time around, and this is what we’re about to be in again, and we have another kid, so I’m fine getting up, obviously, all night long, but you’re going to need to step in a little bit more in the morning hours with Parker and letting me nap throughout the day.  So I feel like good conversations have happened with Ashton and I more than they did the first time around, too, based on some of these classes and just the reminders.  And having those talks now and not later when it’s more emotional because you’re just exhausted and just trying to survive.

Kristin:  So true.  We communicate both in my section about planning and also in the postpartum section, that communication is key and setting that expectation, especially with your partner, but also with family and what their expectations are.

Amber:  Yes.  Once again, something I did not really focus on the first time around, but I am now.

Alyssa:  We’re so glad you took the course and that you enjoyed it.  And then as you know, this course is just going to keep growing and evolving, and as videos change, and who knows, baby number three comes, you’re still going to have access to all this stuff, so we can keep reminding you, and if you want to stay in the Facebook group, you can.  If you want to get out, we won’t be offended.

Kristin:  And we’ve had some great conversations in the group.  I’ve loved seeing birth stories shared as people are having their babies.  It’d be great to do some sort of virtual reunion in the group.

Amber:  It’s nice too that everybody pretty much in there at this point is local, as well.  So it would be great to kind of form some play groups from it or just actually meeting each other at some point, since we are coming to some kind of normalcy in the world.  So actually having a mom group – you know, I’m obviously part of a few of them on Facebook.  I’ve got a love/hate with all of them.  I kind of just use them when I need them and don’t scroll and don’t get into anything in there, but having women local in your area that you can reach out to and possibly create relationships with is really awesome, too.

Kristin:  Yeah.  We have a few students from other states and one from southeast Michigan, but you’re right, the majority in this one are local, so it is cool to have that connection.

Alyssa:  As the course grows, it will have a wider and wider reach, but I think that’s maybe an advantage you have with this beta course is to maybe reach out to some of these moms and say hey, you know, now that the weather’s nice, let’s plan a meet-up.  Like, let’s meet babies.

Kristin:  So what advice do you have, Amber, for women who are on the fence about investing the time and money into an online program?  And if they’re deciding or even looking at their budget as we go through kind of your budgeting and your goals, why would you say this would be important during someone’s pregnancy and newborn journey?

Amber:  Well, I think, just like with anything, being prepared is just the best way that you can set yourself up for success, and as a first-time mom, I wish I would have had something like this.  I did have doulas, so I did have support, but even with women who don’t bring doulas on, you know, just to have a place that kind of gives you a roadmap of some kind of plan to have, people, to reach out to, like a place to start, is super important because it’s all just – it’s a very overwhelming experience, especially for a first time mom, and especially during the pandemic, because a lot of in-person classes really aren’t happening anymore.  Maybe they’re starting to now, but I think just having one place to be able to get all of your questions answered and that kind of touches on everything is just – you know, it’s a huge investment in yourself and your family and the future of your sanity and how things are going to go and just kind of having an idea of what to expect, I think, is really important getting into this because there’s a lot of unknowns, even if you have done all the research.  So it’s absolutely worth it, and it’s nice because you can just do it on your own time, too.  You know, it’s not like you have to show up to a physical class every week.  I did the HypnoBirthing the first time around.  I actually did quite a few classes through you guys, but this is nice because you can just kind of sit in bed at night and watch as much as you want to, so it’s really flexible, too.  I really love that about it, as well.

Alyssa:  Well, and when you took HypnoBirthing, you were pregnant with no other children, so you could basically – you know, your schedule was your own, but now it may be really hard to get away, as much as we would want to get away every week and have something to do…

Amber:  It’s just not feasible.  Not feasible all the time.

Kristin:  And that’s why we break out the videos into short content so you can watch one video on this particular topic rather than doing a longer 30-minute to an hour-long video.  Digest information at your own pace and access it whenever you need it.  Some women got into the first couple of weeks quickly and then had things going on with spring break and so on and took some time to get back into it, so that self-paced aspect but being able to get on calls, where live, or ask questions after watching the recording, I think, has been very helpful for the group to be able to look through it and then ask questions directly versus a self-paced course where you don’t have the interaction component that we do in Becoming.

Amber:  And so many things come up during pregnancy.  It’s so important just to have that connection with people where you can ask those questions.  That’s super important, and I think something else I wanted to say, too, that I really liked about it is I feel like all of the classes go over things, and then you have resources on top of that.  So it’s like you have the breastfeeding class and then you have a lactation consultant that you guys work with.  So I think everything is paired really well, too, so it’s not just like a little bit of something and then you’ve got to figure the rest of it out.  You have all the resources in one place, so people don’t have to go looking for that stuff if they have more questions or need more clarification or support on something.  It’s right there.  So that’s also a huge added value.

Alyssa:  Yeah, I feel like we tried to do that, and we probably – I mean, we – as doulas, that’s part of what we do, too, right?  Like, we offer support but then also accompany that with resources because we know that the two go hand in hand.  So I think either intentionally or unintentionally, it just happened in this course because that’s how we live and breathe.  We want to support you in the best way we can, but we know we can’t do everything.  And then like you said, there’s way too many places to get information, so we’ve already done it; we do it all the time for our clients, so let’s just put it in one place so that it’s easy for you.  To take one thing off of a busy mom’s plate –

Amber:  Oh my gosh, yeah.  Worth its weight in gold, for sure.

Alyssa:  Awesome.  Well, thanks for taking the time to do this.

Amber:  Thank you guys!  I loved it.  I feel definitely much more prepared second time around, especially for the breastfeeding, the sleeping, and just postpartum stuff in general.  That was huge for me, so yeah, it was great.

Alyssa:  Good.  Glad to hear it!

Kristin:  Thank you so much, Amber!  We appreciate it!

Amber:  Thank you, guys!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

 

Kristin talks with Megan Michelotti CD (DONA) about the lymph system and manual lymphatic drainage (MLD) and how it can be helpful prenatally as well as postpartum.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin: I’m Kristin, co-host of Ask the Doulas with Gold Coast Doulas, and I’m joined today by my dear friend Megan with GR Birth and Wellness.  Welcome!

Megan:  Hi, Kristin!  Thanks for having me!

Kristin:  So I’d love to have you tell our listeners a bit about your business, what you do, and, of course, our focus today is on some of your massage-specific services.  But I’d love to chat about your journey, since you and I started out as doulas about the same time.

Megan:  Yeah.  It seems like forever ago now.

Kristin:  Yes!

Megan:  It’s amazing when you kind of take inventory of that time.  Yeah, my background is in birth work.  I’ve been a doula for going on eight years.  I’m into my eighth year.  And did some placenta encapsulation for a few years, and got into massage largely because of my work in placenta encapsulation and being more a part of that postpartum period and getting really passionate about health and planning for health, mental and physical, in the postpartum period.  So it transitioned really nicely into massage.  Massage is something I’ve been a lifelong consumer of.  I say consumer, but it’s really, like, completely obsessed.  It’s my job to get massage, frankly.  So I’m always chasing my next massage appointment.

Kristin:  It’s so good for you, so it makes sense.

Megan:  So, yeah.  I am focusing still on the childbearing year.  It’s funny that people come to me, like, oh, do you do prenatal massage, and I think, yeah, I totally work on pregnant women, even though my heart, again, like I said, was led to massage really through a passion for the postpartum period.

Kristin:  Yeah, and with placenta encapsulation, you do get to see your clients in a raw and vulnerable way, and we realize, you know, when we added postpartum support to Gold Coast, like, how it is lacking.  And women are just feeling overwhelmed, and the focus on traditional healing is not where it needs to be in the US, in my opinion.  So some of the services you provide to get them back to the warm state after being in the cold state and delivery is so essential.  Postpartum massage, and I know that you have a passion for the manual lymphatic drainage service, especially for women who are recovering from a Cesarean birth.  So I’d love our listeners to learn more about the benefits of lymphatic drainage and how you work with them, what it’s like.  If you can paint a picture for us, that would be great, Megan.

Megan:  Sure.  It’s really interesting how I stumbled upon this.  An answer to some questions, actually; some health issues I had from long before I went to school for massage therapy.  But I took a certification program.  That was – I want to say it was – I can’t remember how many hours it was, but it was broken up into a couple days.  I want to say it was, like, seven different two-day courses.  So I took that in conjunction with my licensure prep.  And one of the two-day breakouts was Mommy and Me MLD.  And I was like, ooh, what do we have going on here, because here I’m learning about this awesome therapy that is highly utilized in the plastic surgery community.  It’s getting more utilized within the NFL because of the focus there on the concussions.  And I’m learning about the use on horses, like high-performance animals, and just bodies that are needed to recover quickly and perform.  And all of a sudden, we have Mommy and Me MLD.  And I’m thinking…

Kristin:  It’s perfect!

Megan:  How does this get into these other formats of using this therapy?  So I was the first person at class that day.  And I just was blown away by all the questions and things that don’t make sense and things we just don’t have an answer for that we do.  We do have an answer for it.  It’s largely the lymph system, while in pregnancy, with healing in pregnancy, breastfeeding in postpartum – the lymph system is integral to all of those things, and we learn not performing at our highest, which we aren’t during pregnancy.  The lymph system is taxed during pregnancy and in the postpartum period.  So we’re asking it to do so much at its most vulnerable.  So lymphatic drainage really helps optimize that system to make all of those little steps along the way a little bit easier.

Kristin:  Now, for a client who has a planned Cesarean birth, is it beneficial to get work done pre-surgery and then schedule post-surgery, or how does that work?

Megan: To get the most benefit out of the therapy, the protocol, the recommendation, is definitely before and after.  But either/or is also beneficial.  Because we’re talking about optimizing a system that naturally works with our body, there’s not really a wrong way to do it.  I mean, barring contraindications.  But generally speaking, if you can plan to do a series of three before surgery, you’re getting your lymph system really up and running, and you’re increasing white blood cell count, and you’re increasing the system and getting it all ready to clean up the humongous trauma that it’s about to have.  And I mean the specifically physical trauma of what happens during surgery.  To then revisit afterwards and keep the lymph system up and running is going to help further as you begin healing.  But, again, before or after is optimizing the system to meet that adversity.

Kristin:  And how long after a scheduled birth?  I mean, obviously, there’s that six weeks of healing.  When do you recommend a client come in to see you?

Megan:  So, 40 to 72 hours.  The main thing is that we just want someone who has undergone surgery to be stable, right?  So we’re taking a system that works relatively slowly and we’re bringing it up to ten times its normal speed.  So we don’t want to send this system whose job it is to clean out everything, to send all the waste products at organs that are not stable.  So after a surgery, 48 to 72 hours, and I like to get a doctor’s note, just because of that.  But yeah, that’s the window where you can start, and that’s a lot of times where swelling starts to be at its worst, too, after a Cesarean.  So it kind of works out well that way.

Kristin:  Yeah, that makes a lot of sense.  And I know I’ve seen you post on social media about having even baby with mom during the massage or lymphatic drainage.  Is that something that you are still doing, if their partner is back at work already and they want to see you?

Megan:  Yeah, absolutely.  I do mobile massage.  I try to keep my practice very diverse so I don’t even get bored.  So I do work in my studio, and then I also have some mobile clients.  But either way, because I have my background in doula work, I assume that babies are going to be with new mothers.  Right?  And that’s not necessarily something that a lot of our culture and society thinks about when we’re sending moms to certain appointments after a baby is born and having expectations after a baby is born.  So stunningly, some babies are real cooperative, and I’ve been doing MLD weekly with a post-Cesarean mom for five weeks now, and I’ve never seen – her baby is always sleeping when I’m there.  It’s always amazing.

Kristin:  Must be the atmosphere that you have set up.  The low lights, the music – chill for the baby.

Megan:  But for the most part, I’m assuming that there will be a baby, and frankly, for moms who are breastfeeding, I’m assuming there will be breasts around.  So with my background, that’s my norm to be around new moms with their babies in their natural state, and to come to them and be a tool that is working around their world in that time and not asking them to do something that’s, frankly, unreasonable, immediately postpartum or even in that first month, really, after baby.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Kristin:  And you mentioned one client that you’re working with who’s five weeks in.  What is the typical length to really see improvement?  Is it based on the client and their health, or how does that work?

Megan:  So it’s relative to kind of where you’re starting out.  So if we can backtrack and just do a little education, the lymph system is the width of a human hair.  It’s a really tiny system, and it sits between your skin and muscular system.  So it’s a very delicate system, and it doesn’t have much room as it is.  When you’re pregnant and gaining what’s considered the normal, healthy, 20 to 30-ish pounds during nine months, that’s still considered a rapid weight gain, and your adipose tissue is fighting for that space and really taxing the space that the lymph system already has.  And that’s why we see more swelling and more fluid retention in pregnancy.  Additionally, as your belly gets bigger and it’s compressing the cisterna chyli, which is a main lymph drain kind of right in the center of your body, baby is compressing that.  If you’re working in a job where you’re sitting and your belly is sitting kind of over onto your groin and you’re compressing into all the lymph nodes in your groin, huge filtration going on there, and that’s taxed, then, when you have a belly that’s sitting on that very delicate system.  So some women’s lymph systems are up to this job of doing this, and if you’re moving more, you know, the lymph is moving on your muscular movement, so if you’re moving more and you’re drinking a lot of water, then your lymph system is already optimized, right?  You’re already doing what you need to be doing to keep it going, and maybe it can handle what your body is producing and you don’t see a lot of swelling.  So depending on where you are or where your baseline is, it depends on what kind of “results” you’re going to see, and I use those terms, you know, just for the sake of an understanding, but it’s hard to see, right?  It is a system that you can’t see, and if it’s already optimized and you optimize it more, you might not see results.  But it’s clinically noted and it is happening, and the results are truly amazing.  But when you do have a lot of swelling, results are very obvious and pretty quick, because we’re taking a system that runs about 10 to 12 beats per minute – we’re taking that up to ten times that.  So you’re taking something that’s moving very slowly and moving it very quickly.

Kristin:  So it sounds like your touch is very gentle with this procedure versus regular massage, then?  What would a woman expect to feel?

Megan:  Right.  So I’m really careful not to call it lymph massage, which a lot of – I see that a lot of places.  I don’t even like to use the word massage with lymphatic –

Kristin:  So MLD or manual lymphatic drainage?

Megan:  Yeah, or just calling it lymphatic therapy, because if someone has it in their mind that they’re going to get a massage, they will be quite disappointed.

Kristin:  Different technique.

Megan:  It’s a completely different technique.  We use the weight of a nickel.  We don’t want to crash past the lymph system into the muscular system, which is where you get those great feelings of traditional massage is getting into that muscle and softening.  So we’re really moving skin.  It’s a very light touch, and we’re trying to move the lymph through that system, like I said, that’s just between the skin and the muscle.  So it is light touch, and it’s done in a way kind of – like if you picture this system, it has valves going both ways, so it’s not like your vascular system.  So you work from right to left, and then you work back left to right.  You work from up to down, and then you work again going down to up.  So it has two-way valves, and the system moves the lymph kind of like if you can imagine batting a balloon.  So it moves kind of like that, just slowly, puff, puff, puff, and then as you move the skin, those valves are forced to open more forcefully and stay open a little longer and then close.  You’re patting that balloon forward, if you will, those little sections of lymph.  So it’s a really different therapy.  It’s a very specific protocol where when I’m doing traditional massage, I’m kind of just letting my hands feel what I can and I let the body kind of guide me.  Where manual lymphatic drainage, the protocol is very specific, and it’s going to be the same protocol every time.

Kristin:  It sounds like when you had mentioned swelling, I’m guessing – I mean, obviously, it’s great for post-Cesarean clients, but if someone had a lot of swelling – say they had preeclampsia and had swollen ankles and had an IV.  Is that – are you seeing any clients with other issues that they’re trying to heal from?

Megan: Specifically, preeclampsia would be a contraindication because it does deal with high blood pressure.

Kristin:  Say a client was on an IV for an extended time, had a lot of fluids, and had preeclampsia.  They’re back to normal health after delivering baby, and they’re still seeing a bit of swelling.  Their blood pressure has normalized.  Is that a condition, or even just general IV fluids or general swelling that is taking its time to work itself out?

Megan:  Yeah, definitely.  Again, especially after Cesarean, where the incision is made goes directly across two main highways that connect your axillary drains, which are in your armpits, and your inguinal drains, which are in your groin.  So if you can kind of draw an imaginary line from your armpits to both sides of your pubic bone, those are main, main highways where your lymph system is getting a lot of efficient movement, and when you make an incision for a Cesarean, you are cutting right through that system.  And a surgeon repairs many, many layers, but they don’t repair the lymph system.  That lymph system is damaged for life.  And the lymph system is great.  It’s a beautiful system.  It’s made as part of our human body that orchestrates so perfectly.  So the lymph system finds another way.  It’s not like oh, lymph is going to sit there for ever more.  It’s a broken chain.  The lymph will find its way into lesser-used highways, if you will, but that is a really big highway that they just shut down, and it will be taxed for life.  So that is one issue when it comes to Cesarean.  Two, you’re not moving a lot after you have a Cesarean.  Again, the lymph system moves on muscle movement, so when you’re not moving much, again, your lymph system is not doing the best it could.  It’s also trying to heal you, so its focus is on getting white blood cells and your immune system fighting off infection.  It’s not necessarily focused on just moving out all the stuff that was pumped into you.  So it’s just got a lot of jobs after a surgery, and again, it’s at its most vulnerable.

Kristin:  That makes sense.  How long is an average session?  Is it similar to the length of a massage?

Megan:  Yeah.  You can kind of just decide how many passes you want to do.  So the protocol is to open the main drains and then kind of move up every limb toward the drain and move along those main highways, and you can do 10 passes or you can do 30 passes.  Sometimes I’ll add a mini lymph into some of my clients who are there for traditional massage if they mention swelling.  I might say, you know, do you want to try that?  We can do that for 20 minutes of your hour.  So you can do it at whatever rate you would like to, but generally speaking, yeah, just an hour treatment is what I would consider normal in a series before or after surgery.

Kristin:  That makes sense.  So do you have any other tips or advice for our listeners who are either preparing themselves for the postpartum phase or are already in that phase of healing?

Megan:  Well, I have all kinds of great tips.  The lymph system, it’s so amazing to me.  I just get so fired up and passionate about it because, again, it answered some questions for me about some things that I had experienced, but it’s truly one of these things where, for instance, we hear all the time, make sure you drink enough water.  Your body is 98% water.  Drink your water.  Drink your water.  But then when you really focus in and research and learn why and you learn how important it is for your lymph to flow through this tiny system – drink your water!  I can’t underscore that enough.

Kristin:  Especially with breastfeeding.

Megan:  And with breastfeeding, your system is competing with even more things competing for space.  When you have your system when your milk comes in, all those ducts and that whole system is also competing with some of your main lymph drains under your armpits and under the breast tissue.  So that’s where that comes into play with breastfeeding.  A lot of the things that are just normal – like, we know what to do to keep ourselves healthy.  Those are the things that will keep the lymph system healthy: movement, drinking water, deep breathing.  It’s an influx of oxygen and helps move the lymph system.  So all good tips there, but here’s my other tip, and my kids will echo this a lot: don’t wear underwear and bras to bed!  Your bra and underwear cuts off your  main lymph drain highways.  So as they get tighter through pregnancy and you’re like, oh, I’m not going to buy a bunch of new underwear and bras; it’s temporary.  They are compressing it even further, and even in people who are not pregnant, it’s a great time to let your lymph system breathe.  So my kids and my family does not wear underwear and bras to bed because we love our lymph systems.  So those are my great tips about the lymph system and keeping it optimized as best you can.

Kristin:  What about, since you mentioned bras, what about someone who just sleeps and pretty much lives in different nursing tanks?  Is that a different kind of pressure, or what do you advise for that?

Megan:  Well, I understand that for many of us, bras are a necessary evil.  So just being aware of where it’s hitting you and how tight it is, you know.  So if you’re wearing compression, like a tank, that’s great.  You’re not hitting across that – pretty much right where your band of a traditional bra would be is the main lymph highway around your back.  So trying to have it hit a little lower like with even a sports bra that’s not super tight or a tank is going to be more helpful.

Kristin:  And then how do our listeners find an MLD therapist in other areas?  You’re our go-to expert in West Michigan, but is there a directory, or how does one search?

Megan:  You know, that is a great question.  I mean, it’s not a very regulated certification, so there’s many different certifications for MLD.  It can be a little hard on the consumer that way, like anything that’s not well-regulated, but I would say a Google search is going to reveal some practitioners, and then asking those practitioners where they were certified, what their certification program was like, just their knowledge and their foundation, will give you some more information about what kind of lymph therapy they’re getting into.  I think it’s important to note, too, there are some other kinds of lymph therapy that I’m not exactly familiar with.  There are people who are expecting a very painful protocol, so there are some practices out there that people have experienced that are not my knowledge of lymph therapy, and that’s something that I always clarify with my clients, expectations versus reality, and that’s something we cover ahead of time.  What’s your familiarity with this therapy?  What are you expecting?  Here’s what I’m actually doing.  Especially from outside of the US, I’ve heard some really interesting stories about really, really painful lymph work, and like I said, I’m not familiar with exactly what these people experienced, but it just can’t be further from how I would describe what I do.  It’s such a gentle, light touch therapy.  So just asking follow up questions of the practitioner of what exactly are they practicing and who their certification was through, I think, would be – I mean, just like hiring any practitioner.

Kristin:  Yeah, like hiring a doula, the kind of questions you ask, yeah.

Megan:  Right.  Exactly.

Kristin:  How were you trained?  Are you certified?  Yeah, those type of questions.  Do you have insurance?  So, Megan, how do we find you?  What are the best channels?  How can our clients or listeners reach out to you if they’re located in West Michigan?

Megan:  Well, you can always find me with GR Birth and Wellness, and then I also have MLD Therapy of Grand Rapids, so I market it as a completely separate business, again, to really kind of fight against that unmet expectations.  It’s really so separate from what I consider to be traditional massage and what the consumer is thinking.  So I have the completely separate MLD Therapy of Grand Rapids.

Kristin:  Can you give us both of those websites, then?

Megan:  You can find me at GR Birth and Wellness, as well as MLD Therapy of GR.

Kristin:  Well, thanks so much!  You’ve educated me and I’m sure many of our listeners will look into this more, because it isn’t something that’s talked about.  I’m so glad you brought this topic up in our local doula group and that we had the opportunity to dive into it.

Megan:  Thanks so much!  I love talking about it.  I hope you can tell!

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

Kristin Revere, co-owner of Gold Coast Doulas talks with Cynthia Gabriel, author of Natural Hospital Birth, about her experience as a doula and health care provider for women, supporting natural hospital births.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello, hello.  This is Kristin, co-host of Ask the Doulas, and today, I am joined by Cynthia Gabriel.  Cynthia is the author of Natural Hospital Birth.  Welcome!

Cynthia:  Thank you!  It’s great to be here.

Kristin:  Yeah, it’s good to connect with you again.  I know in my early days as a doula, you were inspiring to me.  I’m looking at my signed copy of Natural Hospital Birth as we speak.  So, Cynthia, please fill our listeners in, a bit about your personal journey as well as professional journey to becoming an author.  I know you’re a birth worker and educator and researcher.  I’d love to hear more about your story.

Cynthia:  Sure.  I came to birth work through academia.  I was studying families, and families in Russia, in particular, and I ended up working in a birth hospital for a year.  And I just fell in love with birth through that time.  But I also am really grateful that I did come into birth work the way that I did, because I got to see a very, very different kind of birth as my first exposure, and at that time, in that Russian birth hospital where I worked, I got to see 65 vaginal births that happened in a row, with only one birth turning into a Cesarean.  And not one of those people had an epidural or any kind of artificial pain management.  So I just started my birth work with this experience that showed me that birthing people can, generally speaking, just give birth, with very, very little intervention and without expecting pain medication, and that was the expectation there and nobody there expected pain medication.  Things have changed in Russia in the past 20, 25 years, so that may not be the case there, but it was at the time that I was there.  And then I came back to the United States.  I’m a medical anthropologist.  I teach undergraduates.  I teach a lot about reproductive health and birth.  But I also continued working as a doula because I just loved it so much.  I love being at births.  And I realized how unusual my experience was, that most doulas, midwives, doctors, and labor and delivery nurses in the United States can’t say that they have ever seen 65 vaginal births in a row with no medication and only one Cesarean.

Kristin:  No.

Cynthia:  I realized that it was this unique window into the way that I saw birth in the United States.  And the other thing that was happening at that time, the late 1990s, early 2000s, was that if I talked about natural birth, people assumed – they would say, well, you can’t do that in a hospital, as if the hospital itself somehow made it impossible to have a vaginal birth with no pain medication.  And I was like, well, it’s not the setting, because I saw a lot of them happen in the hospital setting where the care providers trusted that things would go fine and didn’t rely on these other ways of doing things.  So it’s not the hospital itself; it’s the attitudes that we bring to birth.  And that made me really start thinking about, what would it take for – you know, what does it take?  Because lots of people manage to have natural hospital births, and what do they do differently than people who do not end up with that experience?  And I do think that we live in such a medicalized environment that it becomes very difficult to pull apart necessary interventions from unnecessary ones, and that makes me very sad, because people who need interventions should absolutely be able to get them, but they should believe that they’re necessary, and I don’t think we have that here.

Kristin:  Yeah, I’d love to hear how that experience then translated into writing Natural Hospital Birth.  I know you mentioned you have two editions now.

Cynthia:  Yeah.  I wrote the first one after coming back from Russia and thinking, you know, sure, I could write some academic articles that a bunch of academics would read, but really, this is information that I hope a lot of birthing people could use.  And so I interviewed about 200 birth givers in Canada and the United States who had had natural hospital births to find out what they had to say about what they did and how they prepared, and I wrote the first edition.  And then I think about three years ago, two or three years ago, we updated it.  The main updates to the second edition are about – there was a change in the definition of active labor, so active labor now is understood to start at 6 centimeters dilation, and that was a change, so the new edition reflects that.  Honestly, that doesn’t change anything for the actual laboring person.  It doesn’t really matter when someone else decides labor begins; it matters when you start feeling things.  But a lot of hospitals now will encourage you to go back home if you haven’t reached 6 centimeters when you get to triage, and I think that’s a great change because it means more people are laboring longer at home and less time spent in the hospital ends up with fewer interventions, I think.  So there’s that change.  And then I also – I don’t know what your experience is, Kristin, but my experience as a doulas is that there are a ton of inductions that are happening these days, and that’s a big change from 15, 20 years ago when inductions were relatively rare in my doula practice.

Kristin:  Yes.  I would agree with you.  I have seen more inductions in the last couple of years than early in my career as a doula, and some of those, you know, are for medical reasons, of course, and I’m seeing more medical conditions with clients than I had as a new doula years and years ago, so that could be part of it.

Cynthia:  I have seen far more inductions in my area than there used to be.  I can’t say that I see more medical conditions.  I’m not sure if you specifically mean during COVID or not.

Kristin:  No.

Cynthia:  No?  Okay, just in general?

Kristin:  In general.  But I tend to specialize – some of my wheelhouse is high risk clients, so there are or tend to be other medical issues, and I’ve had a lot of clients with preeclampsia, as well.

Cynthia:  Yes.  I feel like as a doula coming into – I started in 1998, so it’s been a while, and I feel like there’s a long list of medical conditions, and I’m checking off all the boxes slowly.  Like, I’ve seen one of that.  Now I’ve seen one of that.  So kind of slowly over my career, I’m getting to see a lot of things that I couldn’t have imagined earlier.  But the inductions, I think, are outpacing changes in actual health of people in my area, anyway.  So I added some information about inductions.  I’m in a lot of hospital birth and birth Facebook groups and things online, and that question comes up very often.  Like, their provider is urging an induction, and they’ll ask, does anyone on here have a good story about being able to have an induction and end up with a satisfying vaginal birth?  So there are some tricks to that that I’ve learned from experience.  And I’ll just say one of them, which is our hospital is very variable.  It depends on which nurses you get and your care provider, whether they tell you not to eat during inductions or not.  And inductions can be very long.  They can be one or two or three or four or five days long.  And you have to eat.  So if you have a care provider who’s absolutely insisting that you can’t eat while you’re on some agent, they usually go through two or three different kinds of induction agents, and when you go off one, before you get on the next one, you have to insist on time off to eat and take a shower and maybe take a two-hour nap before you start the next one, or I think the long haul can just really get you.

Kristin:  That’s a great tip, and my clients tend to – not all of them have the phase that you’re discussing, but yes, having some time to rest and get some normalcy, like a shower, before getting into another intervention is very helpful.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Kristin:  Certainly, I’m seeing more inductions, but I’m also seeing, as you mentioned, because of some of the changes in admission, my clients are getting sent home or staying home longer than they did in my early time as a doula.  The earliest they’re getting admitted, unless there’s a medical reason, is 4 centimeters now, where it was much earlier in labor when I started.

Cynthia:  Yeah, and that is definitely a good thing.

Kristin:  Yes, I would agree!  I’d love to hear more of your other top tips, especially for clients who – your readers who are not getting an induction but laboring on their own and progressing naturally, how they can best avoid any interventions.

Cynthia:  Absolutely.  And I would say my book and my approach is really aimed at people who have already decided that this is what they want.  I don’t really try to convince people they should want this.  I wanted to give birth under my own power and do it naturally and feel everything.  That was really important to me, but I never try to convince people that that’s the way they should give birth.  But if that’s what they want, then there are things they can do to maximize their chances of that, and some of them are things like – I think changing the way that we think about doctors, midwives, and care providers, because I think we are so used to, first of all, being compliant patients, but secondly, we’re looking to them for advice during labor.  But I think that if we realize what their job is, their job is to think of everything that could potentially and possibly go wrong, even if there’s a very small chance that it could go wrong.  So their job is to be constantly thinking of things that could go wrong, and that is a really different job than a doula or your partner or you as the person giving birth, who really needs to not be thinking about every possible little thing that could be going wrong and focusing on just laboring in the moment and getting through this contraction and making progress where you are.  And so they’re just really different jobs, and if we stop expecting our care providers to do the job of cheerleader, of telling us that we’re doing great, that everything is looking wonderful, and remember that their job is to say, well, you know, I’m a little bit concerned about this thing; I would like more information about this in case this thing – you know, if you have a headache and you go to a doctor, they first have to rule out brain cancer before they can tell you that this is just a tension headache; take an aspirin and go to bed.  And it’s the same thing in birth.  They want to rule out all the terrible things that could happen, and so I think it’s a mind shift for birthing people to realize that the people that they should be looking to for advice in the moment are not the hospital personnel.

Kristin:  Right, as far as coping mechanisms and position changes.

Cynthia:  And reassurance that everything is okay.

Kristin:  Right.  Yeah, it’s a different mindset, and as you mentioned, a doula or a family member or certainly a partner or coach in birthing would be a great tool, and of course, advocating for yourself as a birthing person.

Cynthia:  So I think that if you shift your mind about looking for the outside reassurance that everything is going well and develop a team or the internal resources to believe in that, which is hard for first timers.  It’s very hard.  I mean, in cultures where there aren’t doctors attending birth, you know, where it’s a community event and – you know, I’m thinking about gather-hunter societies, where the ideal might be that a person goes off and gives birth by themselves.  Even in societies with that belief system, usually first timers get to have someone with them because everybody knows the first time is more challenging.

Kristin:  Yes!

Cynthia:  So it’s hard to have the internal resources the first time to just believe that, I can do this, everything is going well.  I think other things that people can do are prepare for the specific scenarios where you have time to make decisions, and there’s a lot of things in birth where you have to make, sometimes, quicker decisions than you want to, and actually, you can’t really prepare for them, and you’ll drive yourself crazy if you try to prepare for every possible thing that could go wrong.  But there’s a handful of things that you can prepare for ahead of time during pregnancy, like what if I go past my due date?  What if they tell me my baby is too big in the last two weeks?  What if I’m GBS positive?  How do I feel about being hooked up to an IV during labor?  And there aren’t right or wrong answers, but these are things that you can prepare for ahead of time.  So I tell people that they should really do the research and think through what you would do if your water broke before you felt contractions and what you would do if you went past your due date or they recommend an induction.  And if you have a game plan for that, I think you’re less likely to end up reactively accepting interventions in the moment.

Kristin:  Good point.  So what are your thoughts on birth plans as far as, you know, trying to accomplish goals?  Do you like more lengthy or using a hospital template or having a checklist?  I prefer the term “birth preference sheet” than “birth plan,” but I’d love to hear your thoughts on that.

Cynthia:  Yeah, I think that we actually conflate two very different processes when we talk about birth plans because there’s the process of a person deciding and thinking through what they really want, and then there’s the presentation of that to your care providers.  And those to me are very different things, but people usually use “writing a birth plan” to do both of them.

Kristin:  Yes, to have the conversation with the provider and also let the nurses know what the goals are.

Cynthia:  But also to figure out – like, when they’re writing the birth plan is when they’re figuring out what they want and what would make them feel great; what would make them feel like this was a really satisfying experience.  I feel proud of myself; I feel like I was in control.  Figuring out what makes you feel that way is really important, and I think you have to be as detailed as possible in that process.  But your care providers at the hospital don’t need to know the details.

Kristin:  Sure.  Yeah, they don’t need a five-page birth plan.

Cynthia:  No.  But I think that there’s a lot of emotional work and psychological work in preparing for what kind of labor you want to have.  So for me, I really wanted to feel supported by the people around me, and I’m a social birther.  Not everybody is.  Lots of people are private birthers.  But I’m a social birther, and I feel better when there’s, like, five people in my space cheering me on.  And I love that energy and I just like having a lot of people nearby.  So for me, when I’m imagining a wonderful, satisfying labor, I’m imagining feeling really supported by people.  But that’s not really going to go in my birth plan, the piece of paper that I’m going to give to a nurse or a doctor.  That’s a birth plan that I’m writing for me and my partner and my doula to talk about, like, what I really need.  And also, some people – you really need to think through all the comfort measures.  Like, am I a water person?  Am I words of affirmation person?  Am I a hands-on, massage my back person?  So as a doula, I would say 75% of my clients want hip squeezes and back pressure through their entire labor.  Like, it’s the most common thing people want.  But I don’t even understand that because when I’m in labor, you cannot touch me.

Kristin:  Yeah, with my first labor, I didn’t want to be touch.  But with my second, I wanted hands-on support from my doulas, for sure.

Cynthia:  Yeah, so it even differs birth to birth.   You really have to be open to all these forces inside yourself and trusting of them, and I think in pregnancy, thinking through what feels right for you is a really important process, and probably, for most people, that would be a five- to ten-page document to figure all that out.  And some people are going to talk it out, and some people are going to write it out, and some people are going to draw it out; all the different ways.  But in the end, when you go to the hospital, I think you want something short and sweet that explains your birthing philosophy more than the specific things you want.  So, you know, if you want to have an intervention-free birth with the lowest amount of medicalization possible, then you say that.  That’s your birth plan.

Kristin:  That’s easy enough for any nurse to come in and understand.  And then, of course, most hospitals have the template, so newborn procedures or any other facts can easily be added to that.

Cynthia:  Yeah.  And I think there’ s a couple of things that happen without people asking you, and so there might be a few things you want to put on there to be sure about.  For example – I mean, it depends on your hospital and the area of the country, but in my area, nobody ever does unnecessary episiotomies.  Like, you don’t even need to put that on your birth plan here.  You don’t need to write that because it’s not going to happen.  On the other hand, they are probably going to give you a shot of Pitocin the minute your baby is out to try to prevent a postpartum hemorrhage after the baby’s been born.  So if you don’t want that, you do have to put it on your birth plan because it’s kind of automatic.

Kristin:  Exactly.  Or the difference between delayed cord clamping, cutting it after a minute, to waiting after the cord stops pulsating, and things like that.

Cynthia:  Yeah.  So there are some specific things that are good to put on there because they’re unusual for your hospital or your area, if that’s your preference.  But the things that are kind of standard in your area, you don’t need to write on there.

Kristin:  Right.  Baby-friendly hospitals will have that first hour of skin to skin and feeding time before any newborn procedures, but not every hospital follows that protocol.

Cynthia:  Yeah.  That’s true.

Kristin:  Do you have any final tips for our listeners who are seeking to achieve a natural hospital birth?

Cynthia:  Sure.  I have one more tip that I think is useful, and that is about how to find the right care provider.  And what I tell people is that, if you’re interviewing care providers, you have a choice – not everyone does, but if you have the choice and you’re looking for someone who’s going to support you in a natural birth under your own power, then the way to find that out is not to ask them, what’s your Cesarean rate or what’s your episiotomy rate or how do you feel about this intervention or that intervention.  I think you can cut through all of that, because they all will say, I only do necessary episiotomies.  I only do Cesareans when absolutely necessary.  Nobody says, I do lots of unnecessary interventions.  Nobody.  So you kind of don’t find anything out by asking that question, but what you do, what you can find out, is you can ask them, could you tell me about the last all-natural, unmedicated birth that you’ve attended?  And then instead of paying attention to their words, you pay attention to their facial expression and their body language.  Some people will soften and get a smile on their face and tell you about this lovely birth that they experienced, and other people will kind of tighten up and get defensive and be like, I can’t tell you about any of my clients.  I can’t tell you personal stories, and there’s no guarantee that anything that happened to them will happen to you.  And you’re like, okay.  So to me, the way that they answer that question tells me how supportive they really are.

Kristin:  Right, more than the actual answer itself.  It’s the body language and – yeah.  Yeah, that’s great.  So now as far as navigating COVID, things have changed so much.  What would your advice be since your latest edition came out in navigating a natural hospital birth during this unique time?

Cynthia:  Yes.  So I think that we are not really in the time when they’re telling you that you can’t bring a partner.  I hope we don’t go back to that situation.  I think that a lot of people are – so I think people worry about things like, do I need to wear a mask, which, you know, is just insane in labor.  Like, who can wear a mask and try to labor?  And I’m a very pro-mask person.  Very pro-mask.

Kristin:  But while you’re pushing, it can be challenging.  Sure.

Cynthia:  Yes.  I’m not pro-mask in labor.  I think everyone else needs to be fully protected from you if needed, but you, as a birthing person, deserve to be able to labor without a mask if at all possible.

Kristin:  Right.  Agreed.

Cynthia:  I think people – my clients have really fixed on a lot of the very specific protocols, and I think, really, you know, the larger picture is, how do we help clients and birthing people develop tools so that they can get through a potentially long labor with just their partner?  And that, I think, is way more important than, how long will it take to get the COVID test result back?  Do I have to take a test?  Does my partner have to take a test?  I don’t know.  A lot of the things that people will spend a lot of time trying to figure out, I’m like, yes, these are – I understand that you’re fixating on things that you think you can control, but I think the better place to put the time and energy is to really think through with your partner, if we can’t have a doula there, it’s just you and me.  How are we going to manage when they say, we would like to break your bag of waters to check on the baby?  Like, just gaining more skills than most people have needed in the past.

Kristin:  Right.  I mean, yeah, having that communication, and as you mentioned, for the social birthers, people who want their mother or mother-in-law or want a doula and a birth photographer, having that space of you and your partner, potentially, and luckily, I haven’t seen any restrictions recently on doulas, but we did some virtual doula support for a few of the hospitals that were not allowing doulas for a short while early in COVID, and that worked out, but it’s not the same.  So we were able to give some guidance and get on Zoom or phone calls and try to be helpful, but that in-person connection was missing.

Cynthia:  When I teach childbirth ed, I really try to do as many roleplays as I can, because I think you really have to practice as if – if you don’t have a doula there who’s done this a hundred times, you have to practice to say to the staff, when they’re suggesting something, to say, could we have five minutes to discuss this alone?  It doesn’t come naturally to people to say that.  So I think helping people, or if people – if they’re hearing this and they’re like, oh, okay, that’s something that we could do, if it’s just the two of us or I’m alone, I can say, I need time to think this through, and you could even call someone on the phone if you need to, to get more support.  But to be able to hear a suggestion for an intervention that sounds potentially like an emergency, and so say, I’d like to have five minutes – I think people do that better if they have practiced that.

Kristin:  So true, because it’s not natural to ask for that space.  And if it’s an emergency and they ask, then they won’t have the time, but if it’s not, they can likely make those informed decisions by discussing the risks and benefits and alternatives to whatever is brought in front of them.

Cynthia:  And I think the situations where people later regret decisions that were made, I think they would say that they felt rushed and they had to make those decisions in front of another person.  You know, like in front of the doctor, in front of the labor and delivery nurse.  And I think it feels entirely different – let’s say that they come in, and they recommend going to a Cesarean.  I think it feels entirely different if you’ve sent them out of the room for ten minutes to discuss it, and then you bring them back in and you say, okay, given all the information, we think this is the right way forward.  We agree to this intervention.  That’s different than to have them in the room saying, we think you need to do this, and then you’re like, okay, just do it.

Kristin:  Right.  Yeah, the rushed decision.  That makes a lot of sense.

Cynthia:  So I guess during COVID, I hope that lots of parents-to-be practice saying, “We would like five minutes to ourselves to discuss this.”

Kristin:  Yeah.  That’s a good tip.  It’s been interesting.  I feel like, outside of the mask question that you brought up, a lot of my clients feel uncertain, especially first-time parents, not being able to have an in-person tour of the hospital and being able to ask questions and visually see what their room will be like.  That has been really a big concern with almost every one of my new parent clients.

Cynthia:  Yes.  It is.  You don’t think about how – until you’re facing time without it, like, how reassuring it is to be able to have that mental picture.

Kristin:  Yes.  And, of course, I just have them do run-throughs so they know.  Some of the hospitals have had different parking during COVID, so just being able to get a picture, and some hospitals have virtual tours.  And finding a way where they still feel connected, or calling the labor and delivery nurse station and asking a few questions, if they’re uncertain.  But there have been so many changes, whether it’s partners being able to attend provider visits or hospital restrictions and mask guidelines and so on.  It’s definitely interesting.

Cynthia:  I think, as a doula, the strangest change for me is not being able to just go get food and water on my own and having to rely on the nurses to do that, because in our hospital, you’re not allowed to go in and out of the room.  That feels very strange.  That’s on the doula side, not the birthing person’s side.

Kristin:  Yeah, the coming and going.  Even for visitors; like partners can’t go home and let a dog out and do some of the things that they did pre-COVID.  Yeah, and for inductions, I am missing being able to trade in and out with my birth partner.  I’m pretty much at the hospital as long as my client needs me, until baby is born.  Thankful to be able to support during this time, but it’s very stressful.  I’m seeing a lot more anxiety with clients that I’m supporting and students.

Cynthia:  Yes.  I think we’re all challenged mentally; our mental health through COVID, and certainly, being pregnant and having to, like, do this very big life event with such different restrictions is obviously a huge change for all of us.  I also think that this is a cohort of people who have – my daughter graduated during COVID, and I feel the same way for her and her cohort of people who are – you know, last year and this year, people graduating from high school or college.  You just have a bond with the other people who have gone through this, and if you know that going into it, before you even have the experience, that you are part of a larger group of people, I think that can give you some strength.  I definitely felt that as a birthing person leaning on, my grandmother did this; my great-grandmother did it; my great-great grandmother.  There was only one generation that was medicated, and that was my mother.  Before that, nobody in the entire line, as far as I know, of my life and ancestors – probably none or very, very few of them had serious medical interventions.  So I leaned on that knowledge, and I think that people during COVID, you are doing something amazing that requires strength you don’t want to have to have, but you do, and you are part of a larger group of people who understand it.

Kristin:  Yeah, it’s so true.  And you see all those fist in the air shots with birthing persons with their masks on and holding their baby.  A lot of my clients did some of those poses.  It is a special group of very resilient people, and like you said, our children – my stepdaughter graduated high school during COVID.  She’s had her first year of college virtually.  So just having and finding joy in missing out on some of the things that – you know, the virtual showers and the things that are sort of rites of passage for birthing persons, that they’re missing out on some of that in-person support from family and restrictions with having visitors even after baby in the hospital and in their home, and really wanting to keep themselves and baby safe.  So I know you have a book on the postpartum phage as well.  Do you want to touch on that briefly?

Cynthia:  Sure!  I have a second book that’s called The Fourth Trimester Companion, which is great for people who had any kind of birth, I think.

Kristin:  Yeah.  I would agree.

Cynthia:  And I had a lot of fun researching and writing this book, especially the chapter on postpartum sex.  I used to lead a lot of mother-baby groups in my town, and we would have eight weeks of different topics, and I found the weeks when we talked about postpartum sex to just be so fascinating, healing.  People really just never talk about this.  Your six-week visit after giving birth often is about contraception and, am I ready to have sex physically, but we just don’t really talk about what happens to people postpartum, and it is fascinating.  And so I really enjoyed writing that chapter.  And also writing about all the changing relationships in – I think another thing we don’t think about, especially for a first-time parent, is how power dynamics in families change when you become the parent and you’re no longer just the child.  And people don’t want to think about power as part of family dynamics, but it really is, and it just naturally shifts as new generations get added, and navigating that is really – I would say, some of my doula clients, that’s really what I spend the most time on.  You know, the birth is kind of incidental to helping them figure out how to manage their relationships with their parents.

Kristin:  Yes.  Agreed.  I mean, I do so much, even if they’re not continuing their care with our postpartum doula team, but we have so many conversations about how things will change and having conversation with family members and really preparing for that postpartum phase and setting expectations.  Their roles will change in their families of origin.

Cynthia:  Yeah.  There’s a chapter on sleep.  I think it’s a little different than most of the books that are out there.  I focus – I’ve decided in my life and in my practice as a doula that the problem in our culture is not babies not sleeping enough; it’s parents not sleeping enough.

Kristin:  Agreed.

Cynthia:  I think babies are fine and they get enough sleep, and the problem is we don’t support parents in getting enough sleep.  So I try to help people shift their focus to, how can the parent get more sleep, and stop trying to make the baby sleep longer.

Kristin:  Yeah.  Especially – I mean, newborns need to be feeding, and they’re up, and to try to have them sleep through the night is not doing anyone any good.

Cynthia:  And you can feel like you’re banging your head against the wall.

Kristin:  Yeah.  Some great topics for our listeners, regardless of how they choose to birth.  Everyone can really use a guide to set them up for success after baby.  And I always tell – we have this new Becoming a Mother course that goes through preparing for birth and also preparing for baby or babies, and we discuss sleep and so on.  Really, it’s all about communicating your needs and setting expectations and making priorities and communicating with your partner, because they might envision their role to be much different than what you would like support for.  So asking for help.  So I will definitely recommend this book.  Every week we talk about different books.  I would love to give our listeners and our doula clients and our students some ways to access you personally, as well as your books.  And I know with authors, you might have a favorite site to order books from, so feel free to fill us in on all of the ways that they can order from you or get in touch with you and so on.

Cynthia:  Sure.  So I do most of my posting and online things about my books and work through Facebook, which is Natural Hospital Birth, the name of the page.  That is where I post most frequently.  I’m on Twitter as thebirthmuse.  It’s three words put together, The Birth Muse.  But ordering my book, you know, I like to support my local bookstore or your local bookstores and have them order it.  Usually they can get it in a day or two, most bookstores.  And also, if you ask at a local bookstore, if something like three people ask for a book, they start to carry it, so that’s great for me if lots of people ask for it at their local bookstores because then more people will find it on the shelf.  But I am terrible at mailing books out, so I just direct people to all of the usual ways online to order books because I am terrible at getting to the post office and being a retailer.

Kristin:  Well, you’re so busy.  You wear many hats, so I can understand that.  So obviously,  Amazon and Barnes and Noble and some of the other online book sellers?

Cynthia:  Yes.  And I will tell you that Fourth Trimester Companion is often selling on Amazon for under $5.  The price varies quite a bit, but you can find it there pretty cheap very often.

Kristin:  Great.  Well, thank you for sharing.  I so appreciate your time.  It was great to reconnect.

Cynthia:  Thanks for inviting me!

Kristin:  Thanks so much!  Take care, Cynthia!

Thanks for listening to Ask the Doulas.  If you like this podcast, please subscribe and give us a 5 star review.  Thank you!  Remember, these moments are golden.

 

Alyssa talks with Janna VanderBand, an art therapist in West Michigan.  We learn what art therapy is and how mothers, in any stage of their journey from fertility and conception to pregnancy and postpartum, can use art therapy to heal.  You can listen to this complete podcast episode on iTunes or SoundCloud. 

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Alyssa:  Hello, Janna!  Nice to see you!

Janna:  Hi!  Nice to see you, too!

Alyssa:  Via Zoom.

Janna:  Yeah.

Alyssa:  So we are talking to Janna VanderBand today, who is an art therapist in the West Michigan area, and we spoke probably a few weeks ago now, and I can honestly admit that I know nothing about art therapy.  So I would love – and I’m going to assume many others don’t, as well, and then especially how art therapy relates to mothers, in particular.  So maybe you can just kind of introduce yourself, tell us what in the world art therapy is, but then how do you actually work with mothers, in particular?

Janna:  Yeah, absolutely.  So I am an art therapist, and I guess to become at art therapist, I completed a master’s program in art therapy with a concentration in counseling.  And then I kind of came to Grand Rapids and recently started a private practice.  So it’s very small, but I love working with moms, in particular, during pregnancy and postpartum because I feel like having two kids of my own, my mental health was something that I wasn’t really prepared to think about with my own kids and kind of going through pregnancy and postpartum period, even though I was in a mental health field.  It was just not something I thought about.  So I’m really passionate about bringing art therapy to moms.  But as for what art therapy is, it can be a little confusing.  Like, what does this look like?  What do we do in sessions?  Do I need to have all these art skills?  Is the art therapist going to judge me or grade me on my art skills because I haven’t done art since second grade?  I hear that a lot.  “I haven’t done art since second grade, and I didn’t like my art teacher, so I’m really skeptical about art therapy.”  I like to tell people that the art therapy space is a nonjudgmental space.  Art therapy is an integrative mental health and human services profession.  It’s meant to enrich your life, to help you build a stronger family and stronger community.  We utilize art making in the art therapy session, as well as the creative process, and then also psychological theory.  So I’ve had training in counseling and aspects of human development and the human experience and how to develop a safe and therapeutic relationship while helping you to create art within that relationship.

Alyssa:  So when somebody comes to you, does it start with, like, a regular counseling session?  Or is it that you talk about art right away?

Janna:  It usually starts like any other counseling session might start.  So I do an intake and ask a lot of questions.  Really, the goal is for me to get to know you and kind of get to know your context, like where you are in life, how are you feeling, what are some goals that you have for yourself, what does your support system look like, what mental health struggles and family struggles and potentially traumatic circumstances you’ve experienced, so that I can be as helpful as possible when helping you decide what’s important for you, what should we prioritize in your treatment, and are there some aspects of safety that we’re going to have to consider as far as how can we keep you safe.  Some people come experiencing really scary thoughts, having experienced really scary situations.  So it’s kind of this first meeting to understand what you need.  And then from there, we will start to integrate some art.  And some sessions don’t include any art.  Sometimes, you just need a space to talk about something, and other sessions, I might ask, you know, what is an image that’s coming up for you right now?  Let’s explore that a little bit.  Or I might have some pre-planned.  Let’s create this thing.  Let’s do this.  Let’s see if we can open ourselves up a little bit to what you’re experiencing and kind of understand what’s underneath whatever you’re experiencing right now, and art is a great way to do that.  It kind of reveals things that we don’t even realize about ourselves because whatever we create, whether it’s art or tiny human beings or food or whatever, it says something about us.  It tells us something about ourselves, and sometimes it’s a really good thing that it’s telling us, and sometimes it’s a really hard or scary thing that it’s telling us.  And that’s why it’s important in the art therapy space to have someone who can really come alongside you and walk with you through what you’re discovering as you create.

Alyssa:  So art is kind of a broad term.  Do you decide after a couple of sessions with an individual what type of art you’re going to do?  In my mind, I picture two people sitting next to an easel and painting, right, but it’s probably not always painting?

Janna:  That’s a great question.  I am more of a two-dimensional artist.  I do painting and drawing and some collage, so that’s my general leaning as a therapist, what I will initially bring into the session.  But it really is a journey, and it depends on the person that I’m working with as far as, you know, are they interested in working with clay?  Can I bring in something?  Is clay something that’s clinically necessary, because sometimes there’s some really good reasons to use it for your mental health.  Maybe we’re going to do some weaving.  Maybe we’re going to do some knitting, some sewing.  It really can be a broad array of things.  I even do a little bit of movement in my sessions at times because movement is really important for helping to integrate and process difficult feelings.  So there’s a broad array, and we work up to it, depending on what the comfort level of the person is who’s in my office.

Alyssa:  So I’m assuming you can help moms at any point in their journey, whether they’re trying to conceive, if they’re pregnant; maybe it’s a second pregnancy and they had a traumatic first.  They could kind of see you throughout that whole journey during pregnancy and then even again postpartum?

Janna:  Yes, absolutely.  There’s a broad gamut of motherhood and birthing and hoping for motherhood and maybe not having that hope achieved.  The art therapy space is – my goal is that it will be a really safe space for moms, whether they’re experiencing loss, whether they’re experiencing fear.  Fear of birth, fear of something else related to being a mom, or even after and in the postpartum period when it can feel really foreign to be ourselves because now we have this tiny person who’s all of a sudden relying on us, and not to mention some other mental health needs that can arise after baby comes or before.  So, absolutely.

Alyssa:  It’s kind of – you know, I think – and I’m sure you know the statistics, probably, but the stigma behind admitting you want to maybe go see a therapist or that you might need one or thinking, well, I don’t have diagnosed depression, so why would I need to go see her?  And oftentimes, this is almost preventative.  Like, I’m all about preventative care, right?  If we can nip this in the bud before these – you mentioned two big ones with our clients: loss and fear.  And sometimes it’s just the fear of loss.  Maybe they haven’t experienced loss, but we’re so afraid that we might because miscarriage is so common.  So those are two big ones.  And why not work through that now instead of waiting to see what happens postpartum, because now you’ve got the emotions, the hormones, the sleep deprivation, and a new human to care for, like you said, this new little human that needs you to survive.  That’s not probably the best time to gauge whether or not you can do this.  So, yeah, I’m all about preventative care, and it sounds like something that, even for the people who are like, like you said, I’m not into art; I don’t do art; I’m not good at art.  What do you say to those people who are maybe hesitant for the art part of it who say, why should I go see an art therapist?  Maybe I’ll just go see a therapist.

Janna:  That’s a really good question.  My answer to that is just that being engaged in art therapy, just like any other therapy, is going to challenge you.  It’s going to require you to dig deep in some portions of your treatment, whether or not that includes art.  I find that even for people who haven’t done art since second or third grade, that they gain a lot.  It’s something that I hear pretty consistently is, I was really skeptical of this, and after our session, I really learned something about myself.  I found that it was impactful for myself.  So the biggest thing that you need to come into art therapy is just the willingness to explore and to put yourself out there, which is something that you would do in any therapy situation, whether or not it’s art therapy or more of a traditional talk therapy that might originally come to your brain when you think of, I’m going to engage in therapy.  It’s just a different way to look at ourselves and get a different perspective.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Alyssa:  So while it’s still very relevant, COVID, are you seeing patients or clients in person, or do you have the ability to do art therapy via Zoom?

Janna:  Yeah.  I see clients in person, and then I also am able to see them over – I use Google Meets, but same as Zoom.  And sometimes it requires a little bit of homework outside of the therapy session, which happens if I was seeing you in person, anyway.  Sometimes someone will bring a drawing that they’ve created to the virtual meeting.  Oftentimes, we’ll create during the virtual meeting.  There are some interesting things that happen with having to see the art, but it’s not a huge barrier to do art therapy virtually.

Alyssa:  I think we’re all kind of learning that there are some pros and cons to it.  Things might be a little trickier, but then we found some things that actually work a lot better.

Janna:  Especially for moms right after having a baby, I feel like it’s really nice to be able to just stay in your house and pop on a virtual meeting.

Alyssa:  Yeah, especially like we mentioned if it’s your second kid and you have a two-year-old at home and a newborn.  It’s nearly impossible.  Even the thought of having to wrangle the toddler and get everyone in the car, and then there’s certainly going to be a blowout as soon as you get the baby in the car seat.  Sometimes moms just give up.  They’re like, screw it.  Never mind.  This isn’t worth it.  Done.  So these virtual consults definitely have been very convenient.

Janna:  Absolutely.

Alyssa:  So if any of our clients are interested in reaching out to you, what’s the best way to find you?

Janna:  The best way to find me is through my website.  That has all of my contact information.  The email is just janna@jannavanderbandarttherapy.com.

Alyssa:  Are you on social media?  On Facebook or Instagram?

Janna:  Yes, I’m on Facebook.

Alyssa:  Well, thank you!  Have a great day!

Janna:  You, too!

Thanks for listening to Ask the Doulas.  If you like this podcast, please subscribe and give us a 5‑star review.  Thank you!  Remember, these moments are golden.

Amber and Katie from Hulst Jepsen Physical Therapy talk with Alyssa again about women’s health pelvic floor rehab with a focus on urinary incontinence.  You can listen to this complete podcast episode on iTunes or SoundCloud. 

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Alyssa:  Hello again, Amanda and Katie!  How are you?

Amanda:  Good, thank you.  Excited to talk more about the pelvic floor.

Alyssa:  Yes!  So if any of our listeners listened to their last podcast, we talked about what is pelvic floor physical therapy, and Amanda and Katie are physical therapists who specialize in women’s health at Hulst Jepson Physical Therapy, and today, we’re going to kind of specifically talk about urinary incontinence.  So let’s dive into it!  What is it?

Katie:  So there’s two major types of urinary incontinence.  You can have stress incontinence or urge incontinence, or you can have a mixture of both of them.  So stress incontinence is having leaking with coughing, sneezing, laughing, jumping, running, really any impact or force into the pelvic floor that causes a leak.  Urge incontinence is leaking with a strong urge to go to the bathroom, like hearing running water or trying to make it to the bathroom but not quite making it because you have an urge that’s just so strong.  And like I said, you can also have a combination of those things, too.  It’s not one or the other.

Amanda:  Yeah, and it’s fascinating.  With stress and urge and mixed; there’s the and/or mix – why does this happen is often the biggest question people will have.  Like, why am I leaking?  What’s going on?  I mean, you have this bowl, and at the bottom of the bowl, is this set of muscles.  And there’s more than just one that consists of the pelvic floor muscles.  And they span from the front of your body to the back of the body, so kind of the hard pubic bone in the front of your pelvis to your coccyx.  So they kind of create this trampoline, I guess you could say.  That’s really unique for a set of muscles to do.  Typically, a muscle would maybe be in the front and then another muscle in the back, like your bicep and triceps, your quadricep, your hamstring.  But the pelvic floor goes from the front and back.  It’s all in one.  Kind of like your diaphragm, where it splits you in half.  And why I’m talking about this and we’re talking about incontinence is because these muscles and the diaphragm, this pressure system that’s going on, has to really work together.  So this trampoline that’s holding everything up creates a pressure, and it also kind of squeezes around the openings, like your urethra, where urine comes out of.  If those muscles don’t squeeze around that urethra, well, that is just a freeway for urine to go through at all times.  So you have your bladder above your pelvic floor, and that bladder, when it gets full, it wants to activate.  It wants to contract.  Well, if you are at Target or out to dinner, let’s say, and you don’t want to go to the bathroom quite yet and your bladder wants to contract, well, the pelvic floor should do its job and squeeze around the urethra and create a pressure that’s greater than the pressure of your bladder, and you should be able to sit for a little bit longer.  But sometimes those muscles don’t work very well, and they are weak or too tight, and that urine basically will escape.  The bladder wins.  So it’s all about this kind of pressure system that goes on.  And the same with when you take a jump, right?  You jump; pressure goes down.  The pelvic floor has to say, we are going to beat that pressure coming down.  We’re going to activate so urine doesn’t come out.  Well, sometimes that pressure that the pelvic floor can create isn’t as great as it needs to be, and then you get that stress incontinence, we call it.  And that’s where Alyssa talked about breathing.  Why is that so important?  And it seems pretty simple, right?  Taking a break.  Well, when taught correctly, breath plus thinking about your pelvic floor can be really helpful when you’re struggling with incontinence and other pelvic floor dysfunction.  So when you take a breath in, the diaphragm goes down, and I had mentioned that the diaphragm and pelvic floor both cross the body, so if the diaphragm goes down, if the pelvic floor doesn’t move, that creates a lot of pressure within your body.  So when you breathe in, the diaphragm goes down; the pelvic floor should go down, as well, and just kind of relax and soften.  And then when you take a breath out, the diaphragm goes up, and your pelvic floor should lift a little bit.  And this is something we love to teach patients.  Basically, that pressure system, something happened where it’s no longer working in that way, and you just have to relearn it.  It’s like riding a bike.  Sometimes it’s a little harder; maybe rollerblading or something.  But basically getting that ebb and flow of the diaphragm and pelvic floor, and some people, when they’re here, we teach them and they feel it; they’ve got it.  Others, it takes them a week and they come back and see us and say, oh, it took me a couple days, but now I can start to feel that difference.  And then we use that to basically help with the incontinence issues.  Like, hey, when you take a jump, let’s have you breathe out.  That will help lift that pelvic floor.  And that’s what’s fun, training people, if you’re at the clinic, to basically use a breath; use a pelvic floor activation, or use the breath to actually relax that pelvic floor if it’s too tight.

Katie:  Yeah, so the pressure system that Amanda just talked about is really important for the stress urinary incontinence, that jumping, any sort of impact like coughing, sneezing.  Being able to relate that pelvic floor and diaphragm together.  For urge incontinence, looking at how the brain and bladder connect is super important.  So with urge incontinence, sometimes we feel the need to go to the bathroom when we really don’t need to.  There may be a strong urge, and then when we get to the bathroom, there’s not much urine that comes out.  When this happens, there’s often a disconnect between the brain and the bladder.  The bladder is telling the brain that it’s full and emergency bells go off, and your brain says, we need to get to the bathroom right now.  But really, the bladder may not be full.  And so we can calm those signals to the brain and lessen that sense of emergency.  And so one of the ways that we can figure out what’s going on and see if we need to kind of work on that brain-bladder connection is having a patient fill out a bladder diary.  A bladder diary is just basically something you fill out for two or three days, and you just write down what you eat, what you drink, how many cups of fluid you’re drinking, and then when you go to the bathroom, you write down what time you go to the bathroom, and you just count how many seconds your urine stream is.  And then you can bring that information back to us, and we can look at it and say, like, hey, does this look like normal activity, normal habits, or does it look like we maybe need to look at that brain-bladder connection and retrain things a little bit?  We like to see people going to the bathroom every two to four hours, so if you are going to the bathroom every hour, then that’s something that we can work on telling your brain, your bladder, hey, things aren’t quite full yet.  Let’s see what we can do to not go to the bathroom, even though we feel like we need to.  And that bladder diary can also let us look at what you’re drinking, what you’re eating, and we can see if there’s anything that might just be irritating your bladder and making you feel like you need to go, too.  For example, coffee, citrus juice, alcohol, spicy foods, and many others can be irritants to the bladder, and maybe even just cutting some of those out or reducing the amount of coffee you’re drinking might be enough to make your bladder happier and you not feel so much urgency and frequency and needing to get to the bathroom.

Amanda:  Yeah.  That’s a huge piece.  I have a lot of women who go through and we say, hey, yeah, what kind of fluid are you taking in, and it might be like, oh, I have soda every day.  Just cutting that back can help so much.  Or even looking at the acidity in your coffee.  I know that low acid coffee can be beneficial, definitely, for the bladder.  Caffeine is one thing, but then you get the acidity of the coffee plus the caffeine, so even if it’s decaf coffee, I know it can still be an irritant.  If you look at something that’s low acidity, it can definitely be helpful to not piss off the bladder so much.  It’s hard to give up that coffee in the morning; even if it’s decaf, we have our habits, for sure.  Another big habit people have is that just-in-case peeing.  We grew up doing this all the time.  “Go to the bathroom just in case!”  When you’re an adult and you have control of when you do go to the bathroom, definitely you want to try to avoid those moments.  Say you’re traveling to a friend’s house, and I know with COVID it’s a little bit tricky because, obviously, we try to stay away from public restrooms, probably, to an extent right now, but ideally, if you’re going somewhere, try not to go to the bathroom beforehand if you don’t really have to go.  Let that bladder fill because if you’re always going just in case, that bladder is never going to full to its full extent, and like Katie said, the brain will start to learn that.  It’s amazing.  There’s a whole neurological loop, and it will just start to pick up on the fact, hey, I only have to fill to 100 milliliters and then I’m going to go.  But you’re really got to get that to fill a bit more to just allow that bladder to expand.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Amanda:  Typically, I tell patients, too, when you urinate, you want to make sure you’re urinating more than eight seconds.  Eight seconds or more is ideal.  If you’re going one or two seconds, you didn’t have to go.  You probably should have tried to hold it a little longer.  If you feel that huge urge but you know you just went 30 minutes ago, try to distract yourself.  Try some breathing.  Go for a walk.  Try to really kind of – it takes time.  It might not happen over a week, but try to build a different routine for your bladder.

Alyssa:  It’s interesting.  I’ve never thought about going – I’m definitely a just-in-caser, but that’s only if I’m going somewhere, and I make my daughter do it too.  But it’s good to know that we shouldn’t make that a habit.  I’m assuming it’s okay – like, yeah, we’re going on a three-hour trip, a car ride.  Let’s see if we can just go.  But if you’re not doing it all the time…

Katie:  Yeah.  That’s perfectly fine.  If you’re just going to Meijer and you’re only going to be gone from the house for an hour, and you just went to the bathroom relatively recently, then not a good time to go.  Of course, any time – like, if you’re leaving the house and haven’t gone to the bathroom for two to four hours, please go.  It’s more about that two to four hour window that we really like to hit so that you aren’t constantly spending your life in the bathroom.

Alyssa:  My mother is 71, I think, and she – I don’t even know if she can make it an hour without using the restroom.  Do you work with older women, too, and do you see – what kind of results do older women have?

Amanda:  Definitely.  I’ve treated multiple elderly females, and I would say the results take a little bit longer, just because there’s a lot of retraining.  I find strengthening is a little bit more, in the elderly population, that pelvic floor has just kind of lost its integrity a bit.  I can’t say that for everyone, but the females I’ve treated, it has been more about getting that contraction and strength.  I think the biggest results I have seen, though, is the behavior piece really helps.  So just saying, hey, see if you can distract yourself.  Try some pelvic floor activations and breathing, and try to go 15 extra minutes – try to hold it 15 extra minutes.  And I’ve also seen it really improve at nighttime.  I know nocturia, urination in the night, like getting up to go – I’ve seen females really improve with that, as well, once they start to get control of the pelvic floor again, which is exciting, because that’s tough on the whole body and whole system if at night it keeps waking them up.

Alyssa:  That’s actually the biggest area that I saw improvement was I would always have to wake up once in the night to pee, and I’m a sleep consultant, and sleep is my number one thing.  I want a full night’s rest!  And when I have to wake up to pee, sometimes my brain just turns on.  Like, it is on, and it is so hard for me to fall back asleep, and then my whole next day is just off.  So literally when I remember to do these exercises, I sleep all night.  I don’t wake up at all, and I pee in the morning.  So that is the number one.  I really haven’t – because of COVID, I haven’t jumped a whole lot lately.  I haven’t been to the Y.  So I don’t know how good I am in that regard.  But, yeah, just being able to sleep all night without getting up to pee is huge.

Katie:  Definitely.  And I think going back to talking about retraining and getting success at older ages, too, kind of touching more on what Amanda said, it is a lot about changing habits.  Amanda was talking about doing some Kegels.  We call it the freeze-squeeze-breathe technique to help control an urge.  Like she said, we’re trying to maybe, if we have an urge, try to stop that urge for 10 more minutes.  So that’s a way that we can work with changing those habits.  We’ll have the person, the patient, freeze.  It’s really hard to hold your bladder if you’re walking; it’s much easier to hold your urine if you’re sitting or standing.  So we have someone freeze if they have an urge, and then squeeze, so do a little Kegel, and we’ll train them how to do a Kegel really well while sitting, and then breathe.  Relax.  Give yourself some positive self-talk.  You can make it to the bathroom.  You can control this urge.  You can wait a couple minutes, if you’ve been to the bathroom fairly recently already.  I find that working with this with all ages is helpful to help control an urge.  And then you just work from, like, okay.  Now we can wait for 10 minutes.  Can we wait for 15?  Can we wait for 20?  Now eventually working up to, can we have at least 2 hours between every bathroom visit?  That’s something that can work at any age.

Alyssa:  That makes a lot of sense.  What else about this didn’t we cover?

Amanda:  I think the next point I was going to make is just talking about – Katie mentioned the Kegels.  We talked a lot about, like, with the elderly, especially, can have some tightness in the pelvic floor at that age, too, but thinking about that strengthening, and we kind of term that an up-regulation of the pelvic floor.  And if we find – everyone is different, but if we find that someone’s pelvic floor is weak, and we can do that through typically internal pelvic floor assessment.  We can check not only tightness, but we check muscle strength, as well.  So with your hip, we can check to see, hey, how strong is your hip, 0 to 5?  We’ll grade you on your hip strength.  Well, we can actually do that for the pelvic floor, as well.  Typically, if someone has no pain and they’re having leakage with either urge or more so probably stress like with a jumping jack, let’s say, or a sneeze or a cough, we’ll test the strength of the pelvic floor activation.  Which is cool, and a patient can kind of feel, oh, yeah, I can feel that muscle trying to fire, or, oh, man, yeah that muscle is firing up really well.  We call that up-regulation when we try to get the muscles to fire up.  And we train that in different ways, whether it’s just on the mat table laying down, no gravity, try to find the activation; seated forward, seated backwards a little bit, depending on where the weakness is.  Let’s say you do CrossFit or you’re a runner.  Well, we will definitely have to get you on your feet with a jump rope, with weight, and we’re going to test that pelvic floor.  And that there is more after you really know where your pelvic floor is, because I would never take someone right at initial eval and say, okay, fire up your pelvic floor on a squat.  Who knows what they’re doing at that point?  So when I’m confident a patient knows how to fire up their pelvic floor, and then treating from there, which is fun when you can get to – let’s say postpartum, a mom who wants to get back to weightlifting, get back to running.  When the body has healed and it’s ready to go, that transition is really fun to take them through.  And then those who let’s say maybe do have pain with leakage and incontinence, and we do an internal assessment and we find there is tightness in that pelvic floor.  That’s where some internal pelvic floor treatment, like manual releases – so you could think, hey, if you do a manual release on your upper trapezius because your neck is sore.  Well, it’s gentle.  It’s more sensitive tissue at the pelvic floor.  But, yeah, we work through releases to try to get that pelvic floor to calm down.  Or there are tools and stuff; I know we didn’t touch base about this in the first podcast, but other tools we do recommend for patients if they do have tightness: things like dilators to stretch that pelvic floor outside the clinic where they may see us once or twice a week.  Well, there’s five or six other days that they can then at home work on stretching the pelvic floor or tools like the pelvic wand.  It’s out there, like a trigger point release tool.  So, yeah, there’s a lot of different tools out there that we’ll recommend to a patient.  Or if they need strengthening, pelvic floor weights may be good for them to use for some feedback and for some strengthening of it.

Katie:  And we’ll talk more about those treatment techniques, too.  I think we’re going to cover a lot of those when we talk about pain with sex, as well.  But you can see that everything kind of overlaps.  So you might not just have one problem.  You might have pain with sex and leaking and constipation, or you might just have some leaking.  But because it’s all related to the pelvic floor, a lot of our treatment techniques definitely overlap.  I think the last thing we just wanted to touch on was just Kegels and using them for years to come.  You know, it’s great.  You might not have to do as much of your home exercise program and as much of the intense exercise that you’re doing in physical therapy when you’ve graduated from physical therapy, but continuing to do Kegels, continuing to practice relaxation techniques, continuing to work on your good, healthy breathing techniques that we’ve taught you, even when you’re done with physical therapy, is helpful.  Just as you would strengthen your arms and your legs and you would need to keep doing exercises throughout your lifetime to stay strong, you need to keep working on your pelvic floor exercises to keep your pelvic floor healthy.  Just like exercising throughout life is good for us, paying attention to our pelvic floor and checking in and doing some strength exercises or doing some relaxation exercises is healthy throughout our lifetime, too.

Alyssa:  Awesome!  Thank you so much.  Let everyone know how they can get ahold of you if they want to learn more or set up an appointment with you both.

Katie:  Amanda and I work at Hulst Jepson Physical Therapy, the East Grand Rapids location, so we’re on Burton between Breton and Plymouth.  Hulst Jepson also has several other locations.  I believe they have five other locations with pelvic floor physical therapy.  So you can check out the website and see which one’s most convenient for you.

Amanda:  Yeah, and just give us a call.  You can chat with Lexi up front here at EGR for an appointment, or just say, hey, Lexi, can I chat with one of the therapists there?  Happy to take a call.  Also, we do have free 15-minute consults.  I forgot to mention that in the previous podcast.  So if you have questions and aren’t quite ready maybe to commit to starting pelvic floor rehab but just want to chat with us about anything, we’re more than happy to sit down with you for 15 minutes or so and kind of discuss options, if PT would be right for you.  We can definitely do that, as well.

Alyssa:  Thanks so much.  We will look forward to our next couple podcasts later, so everyone stay tuned for those.  Thank you!

What is eco postnatal care?  Valerie Lynn, author of The Mommy Plan, tells us how to nourish and heal a postpartum body.  You can listen to this complete podcast on iTunes or SoundCloud. 

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  I’m Kristin, co-host of the Ask the Doulas Podcast, and today, I’m joined by Valerie Lynn.  Valerie is author of The Mommy Plan, and she also has a recipe book.  Valerie is an eco postnatal care specialist.  Welcome, Valerie!

Valerie:  Thank you, Kristin.  It’s nice to be here.

Kristin:  Yeah, it’s great to reconnect with you!  I know when we initially connected, I was teaching Sacred Pregnancy classes, and I had some taken some trainings where we used your recipes for postpartum doula work, and so I’ve always loved them.  And I know in the past, you had written a guest blog for me on nourishing the postpartum mother.  So I’d love to hear what you’ve been up to lately.  It’s been many years.

Valerie:  Oh, yes.  Yeah, it has, and you’ve grown your business, which is awesome.

Kristin:  Yeah.  It is.  It’s wild!  We have 20 doulas on our team and 2 nurses, so yeah, loving it!

Valerie:  That’s quite an achievement because that’s not very common.  That’s pretty awesome.  Congratulations to you and all your hard work!  And what I’ve been up to is just spreading the word and reeducating families, you know, as well as birth professionals, doctors, nurses, on the eastern practices of after birth care, because they’re very specific, and they’re applied to the postnatal anatomy and what happens after pregnancy, any type of pregnancy, whether it’s full term, miscarriage, stillborn birth – you know, there’s things that we can do, that women can do, to help their bodies heal and recuperate much faster and restore the womb.  We don’t realize what a drain it is on the female body, and there’s, again, specific things you can do that I’ve studied through the Ministry of Health in Malaysia in the field, and that’s how I came up with the first book, The Mommy Plan.  So that’s been happening, and I actually teach now at the Malaysian Permanent Mission to the United Nations.  I teach my course there in Multicultural Postpartum Recovery Practices.  I had many requests from moms and people who said, oh, what do I do with these food guidelines?  It seems very strict.  And it’s really not.  So from those requests, I started writing recipes six years ago.  I initially engaged brilliant chefs, and then when I got the recipes back, I inadvertently had to change them.  You know, tweak them here and there and change them, even though I sent them the food guidelines.  But what I also did was I adapted it for a Western diet and lifestyle.  And I said, when you break things down to food science, you know, then there’s a lot of core principles that you can follow.  And I took something like that top ten meals here, like pancakes or, like, meatloafs and other things like that, and I put a postpartum twist on them.  So you have, like, for example, like a meatloaf, then you have a healthy meatloaf, and then you have a postpartum meatloaf.  So that’s how I describe that.  That’s called Healing Meals: Simple Recipes for New Moms.  And that’s happened.  I’m developing the course now.  My book, The Mommy Plan, is used by CAPPA for its postpartum doula and new parent educator as a resource, and DONA has approved my multicultural postpartum recovery course for continuing education units.  And I have – I’ve been in California.  I’ve opened up the Post-Pregnancy Wellness Boutique of Los Angeles.

Kristin:  I read that.  That’s wonderful!

Valerie:  Yes, and a pregnancy services collective.  And so it’s nice to have everything spread out, and I can see that, all of my things, and people can come in and, you know, see and experience.  Southeast Asia, again, has the lowest rates of postpartum mood disorders in the world because they have special clinics and they have spas and even wings of hospitals that are dedicated to the recovery of feminine health and women after childbirth.  And I even have a university here in California that is interested in incorporating my work into one of their curriculums.  So it’s been…

Kristin:  Fantastic!  I was intrigued by the work you did in Malaysia.  Was it 20 years that you spent?

Valerie:  Well, and counting, because I still have a family property there.  And I first went to Malaysia in 1996, visiting, and then moved there in 2000 after graduating, continuing my graduate work in Malaysia.  And so since 2000 to 2012, full time, and since then, part time.  So that’s why I have a very deep, regular relationship with the consulate and the embassy staff here on both the east and the west coast, and I’ve been invited to exhibit at the Malaysian Embassy, and it’s – yeah, I just love it.  And I’m really missing my home.  You know, I have a first home and a second home, the US and Malaysia.  Missing it, and so I really created the boutique, and I really redecorated it, bringing Southeast Asia to me because I can’t travel during this pandemic.

Kristin:  Right.  Well, if I get out to the west coast, I’ll have to check it out!

Valerie:  Yes, please!

Kristin:  I would love to see it.

Valerie:  Yes.  That would be awesome!

Kristin:  So tell me more about the definition of eco postnatal care specialist.  I know you offer coaching services as part of your client services, but I’d love to hear specifically about what that means so our listeners can better understand.

Valerie:  Well, eco postnatal care is – you know, eco means natural, and that’s what it is.  It’s natural care for a woman after childbirth to help heal her body because you’re going to support the body’s natural healing capabilities that gets triggered after childbirth.  So it’s all about using – because the body – pregnancy is a natural state of a woman’s body, and birth is a natural event.  But it’s a little bit of a trauma, and a trauma whereby certain functions in the body become secondary.  They were primary, and they become secondary, such as digestion, circulation, and metabolism.  And then they become secondary, and then the postpartum functions of breastmilk production, shedding the retained elements, so the water and fat, and rebalancing the hormones become primary for a time, for that six to eight weeks after childbirth.  So that’s why the eco side of it is completely natural for a natural event in a woman’s body.  That helps that process, and you don’t want to interfere with that.  You want to support that.

Kristin:  Exactly.  Yeah, I talk to my clients all the time about the warm state in pregnancy and learning from you and then after delivery, you are in that cold state, and using some of the nourishing recipes that you have and warm teas can be so healing.  So tell us a bit more about the shock after delivery that a woman’s body goes through.

Valerie:  Yeah, so like I said, because the – and it’s a trauma, but it’s a natural trauma, and that’s why it can heal so quickly in six weeks.  But here in the United States, there’s a huge void still with recovery after childbirth.  I know when I had my son, I always say, he was made in Malaysia and born in America, in New Jersey where I’m originally from, and then went back when he was three months.  You know, I’m realizing that – I was here for about nine months.  I came back October 2006, and he was born May 2007.  I went back to Malaysia when he was three months old in August 2007.  But after childbirth, there was no – because my prenatal education started in Malaysia when I was pregnant.  So then afterwards when I came here, I’m looking for the services, natural products, the body treatments, the wrappings, as well as just the basic guidelines and the precautions of how to protect your body based on the postnatal state because it’s all based on science, the humoral theory of medicine.  So it’s all based on science, and it’s based on evidence-based proof – which is supported with evidence-based proof, I should say.  And so there was nothing like that.  All I got was a sheet: don’t walk up and down stairs – mind you, I did also have an emergency Cesarean.  Typical not-very-nice birth experience in the US, unfortunately.  But, you know, things happen for a reason.  And everyone was safe, including my son.  And so I was told, don’t walk down stairs, and don’t drive.  And don’t vacuum.  But, again, I was a strategic business consultant in Asia.  I ran the American Chamber of Commerce in Malaysia, and so like every Western woman, we’re not going to be like – well, why?  Why?  What is it?  And so when I really started looking into it – oh, and mind you, too, I also had postpartum anxiety and OCD after my son.  I didn’t realize this for nine months because Malaysia was so low, that 3%, the lowest in the room, with postpartum mood disorders.  No one talked about it.  No one – there was not even, like, a psychologist or psychiatrist you would see that would specialize in it.  No one deals with it.  Now, we are more dealing with it.  I’m a postpartum support international country coordinator for Postpartum Support International for 11  years now.  We’re really trying to bring more light to it because there are women that fall through the cracks, like me.  So it’s like a double-edged sword, right?  It’s like the best in the world, the lowest in the world, but there are still people.  So I have women that contact me, and I facilitate them into our online resources and my personal network.  So I’m building ties and more and more resources.  And I do articles and interviews.  So that’s how my journey began, when I realized – I was running the American Chamber of Commerce.  I have all these people on my board: Boing, McDonald’s, Citi Bank, GE, Intel, Boeing, Exxon, and I was having these crazy thoughts about my son and accidentally hurting him or just those thoughts that were very irrational.  I knew Malaysia had very good and very specific, I should say, postnatal recovery practices and techniques, which I liked, and I looked and I saw on Mother’s Day, the penny dropped.  I was reading articles in May 2008, and I was like, wow, I think I’m experiencing postpartum anxiety and OCD.  I was stressed about my job, but I had irrational fear and worry about my son that was disrupting my life.  So that penny dropped, and I looked and saw – we had, like, 20% at that time.  They were – this was 2008.  They were reporting.  Now it’s higher.  And in Malaysia, I looked, and it was 3%.  I was like, well, why is it 3%?  Because I lived in Japan before, and the diet – you know, had a great diet, Japanese diet.  Malaysia, delicious food; not a great diet, right, because it’s delicious curries and stuff like that.  And so I was like, what is it?  What’s the reasoning?  And so long story short, I took out a package and I went and had this whole traditional postnatal spa treatment, and I rebalanced myself naturally in two to three months by body treatments, the herbs, following the food guidelines.  Still, after a year, because you’re out of balance, so you still have an ability to recover.  So maybe like my body, you know, the leftover baby fat or something like that, could not really be helped other than exercise, but the internal rebalancing of hormones, which is where the mood disorder stems from, that could be – that was helped.

Kristin:  It’s amazing that you did all of that research on your own and not having any tools in the West.  And now you’ve made all of your research available to so many women.  The impact is huge!

Valerie:  But we still have a lot more to go, and still in the United States where women, it’s not – in Malaysia, you do have your OB-GYN, and the doctor’s responsibility is birthing, having a safe mom and a safe baby after birth.  And then the culture takes over.  So it’s the same thing here, but we don’t have the culture.  We don’t have the guidelines.  We don’t know why.  And women still don’t have any importance on this recovery because they still feel – and it’s true that, you know, there’s a natural transition back to a nonpregnant state.  But it’s still – it’s like when you break your arm and you have a temporary support cast on it.  You’re not going to wait six weeks and then get your cast.  Here, we’re all about waiting six weeks.  Doctors say, eat anything you want.  Do anything you want.  Well, you’re in a vulnerable state, and it’s based on science, and there’s things that you do and expose yourself to.  Our natural lifestyle and habits don’t support that and interfering with it.  And when we talk about hormones, it’s so sensitive.  The backdrop, also, is the chemicals in our food and the pollution in our air and in our personal products and cleaning products.  They’re all hormone disrupters.  And so that’s why we have a weakened, prolonged recovery in the United States.  There is no doubt about that.

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Kristin:  That makes so much sense.

Valerie:  I’m a developmental economist by study, so I like statistics.  So when I looked at, and you still look at, the numbers, which there are about 4 million births a year here, and roughly about 1 million women, new cases annually, of postpartum mood disorders are diagnosed.  That’s not including the existing 1 to 1.5 million, and you’re on top of the ones that are not even reported.  So that’s what blew me away and got me to seriously look into this.  I just felt the void, and I just knew I went through an awful period.  And I was not pleasant to be around, and I just don’t want that.  Thank God I was in Malaysia.  There are – I had, like, full-time live-in help and a great support system, but if you’re doing it on your own, it’s so hard.  And that’s why I think it’s even more important here.  People say to me, well, over in Asia, you have a better family structure and this and that.  Well, yeah, maybe.  It’s still more conventional.  But we need it more here because there’s so many women that live, a wife and their family.  So you need to know how to help yourself recover.  So it’s even more important because we don’t have the help.  We don’t have the products, the knowledge, the talent, the skills.

Kristin:  Yeah, and I feel like American women just want to – they have all these expectations to bounce back, get back to work, fit into their old clothes, and just versus other cultures where the first 40 days plus, depending on the culture, is all about healing and bonding and family and friends nourishing them and helping them in so many ways, and that is not our culture.

Valerie:  Because no one has explained it the way we need to understand it.  That’s why I took – even when I was doing my research, which I applied to do a self-funded study through the Ministry of Health in Malaysia, and I was granted it, in hospitals and in the field and manufacturers and spas and massage schools.  I pieced it together.  And that’s what we need.  When I explain it to people, then they understand why and what happens in that healing window of opportunity I call the first six weeks.  So people just want the accolades of having the baby and all this, but actually, you know, I always tell people that pregnancy is easy.  By and large, that’s the easy part.  You need your stamina.  You need your well-being, your health, to really take care of the baby the way you want to.

Kristin:  Exactly.  And you had mentioned again that isolation.  And COVID intensifies that isolating time for women, so if they don’t have family support, don’t have a postpartum doula or a nanny, how can you encourage the partner to help in the six weeks?  If it’s a Cesarean birth, it would be longer than that, but in that recovery time?

Valerie:  Well, I like to be very realistic with dads.  Some dads are a huge buy-in but only on these certain things.  And they most likely just like bottle feeding.  And when they can’t do that because Mom’s breastfeeding, they get a bit like, eh, what am I going to do?  So realistically, dads need to understand those first few weeks and what could happen, and then mom has – again, I’m all about the mom.  Most people are all about baby; I’m all about the mom, and a little bit about the baby, which I teach a Malaysian colic massage specifically for colic, which is awesome.  So I just focus on the moms to get them up.  So when I explain to dads, you know, mom heals; it’s going to be easier all around.  And so in the coaching program, I like to have dads on it, which is beneficial, but if not, I do have them on certain modules where I know they can buy in because it’s kind of from a male perspective.  To support breastfeeding – but when dealing with dads, you also need to ask them, like, what’s your roles around the house?  Who has the chores?  Who has what duties?  A lot of people do feel that mom is just being lazy.  Mom just – they don’t realize the enormity it takes to grow a baby and then birth a human.  It’s way, way more.  And some women are great and bounce back, but 99% of people don’t.  So I find, in order to get their buy-in, ask them what are their roles around the house.  What can they do, what are they willing to do, and it’s only a temporary time.  Because dads, you know, they can only take off two weeks and then go back to work.  They also have a lot of stress.  So for example, are they willing – and sometimes they don’t have skills – are they willing to cook?  Can they cook?  Are they willing to do laundry or straighten up?  Are they willing to do these things for Mom and take these chores temporarily away from Mom?

Kristin:  Right.  Like, she shouldn’t be vacuuming, for example.

Valerie:  Vacuuming is really, really bad for the core.  That’s, like, the number one thing that could bring back the lochia.  It’s super bad.  It’s one of the number one things that I say.  They think, oh, it’s just a machine.  I’m going to clean.  But it’s how you’re moving your torso and what happens.  So, again, you have to get back to the condition of a woman’s body after childbirth and then the postnatal anatomy.  So you have to take it back to the science.  Don’t just say don’t do it.

Kristin:  Like, show them evidence.  I love it.

Valerie:  Yeah.  That’s what it is.  I ask them about what their roles are, if they can cook, if they can’t, what they can do.  And then if they’re not, doulas plus Groupon is their best friend.  Say they can’t cook.  You get a doula in that can cook or will cook, a Groupon for some kind of cleaning service or – you know, you can pay local people to come around.  You just go and you hire someone or you pay someone, like, $100 for recipes that the mom can pick – that’s a lot of food.  That’s got to be at least five days’ worth of food.

Kristin:  Right, and there’s now grocery delivery service, and there’s so many different options.

Valerie:  Yeah.  So just for that, and for me too, but coming from the food perspective, then we get kind of into the postnatal nutrition and meals and what you should be eating – what she should be eating.  Again, things are done with a purpose during this time.  You eat with a purpose.  You rest for a purpose, not to be lazy.  Right now, when the body is in an intense exercise, so to speak, and it’s working for you, working for the mom, because it no longer needs those retained elements, or the water, fat, and flatulence, to support the baby or the joints or anything like that, it’s shedding it at an intense rate.  So from my research, you know, the metabolism increased 7 to 10 times higher during that time when it’s shedding.  So the things we’re doing are disrupting that, and that’s why it’s so long.  The body’s just – you know, and it has to do with the digestive system and the activities.  So that’s why I want – what I do, when the mom’s body – like a set, like make a postnatal care set.  There’s things that dad can do to make sure all is healing from day one because it’s a consecutive healing every day.  And we also go over if Mom’s not feeling great and just different moods and things that are longer.  Irrational fears she’s not doing a good job – things that dads shouldn’t say.  Don’t compare them.  It’s amazing how men are just – I will say men are more caring now than way back when in the ’50s or the ’40s, but still they say things that they maybe just shouldn’t say.  And then they want to do things that maybe they think is good, but for mom, it may not be satisfying at that time.  Do something simple.  And then just try to, like, lower their expectations of that time where they all think it’s going to be a holiday or something, but it is not.  I want to get this reading in – it’s absurd.  There’s a lot – I see a lot of moms coming in at the boutique.  They go to the homebirth midwives or the lactation consultant, and it’s always like, oh, I wish I knew.  I wish someone told me.  So I’m about scenario planning because I’ve been criticized a lot in the past.  Don’t scare moms.  Don’t tell them they could have hormonal postpartum migraines or this or that.  But no, it’s scenario planning, like in business.  As long as you know, okay, if you are having a headache and all of a sudden it comes on – my cousin’s daughter gave birth last year, and she had a postpartum headache for three weeks, and poor thing.

Kristin:  That’s a long time.

Valerie:  It is, but it’s not uncommon at all.  So I’m on a lot of natural groups and moms’ groups, and there’s so many things like that that come up that people are like, oh, what do I do for this or that.  So it’s like scenario planning.  What can you do if you have this headache and your doctor is like, oh, it will pass?  Like, if you have a stomachache or you’re constipated and your doctor says, oh, don’t worry, it will pass.  Eat whatever you want until you have a reaction.  I hear that time and time again because doctors aren’t trained for that.  They’re just answering – they don’t have time to answer these kind of really in-depth questions.  It’s the worst advice you could ever give someone.  Like, you’re someone who has a peanut allergy.  Oh, try each nut until you go into anaphylactic shock.  You don’t want to do that.  But this is just our culture.  I’m not blaming them.  We just don’t have that here.  Malaysia – you know, the universe just gave Malaysia its role in the world.  I always say, like, Japan does sushi; Germany does cars; US is innovation; UK does tea.  Malaysia does postnatal recovery really well.  Even their maternal healthcare policy of the government gives each mom three months maternity leave plus each mom that’s given birth, that gives birth in a public hospital, is given six two-hour body treatments, massages, and wrappings.  Six, free, two-hours.  All within the first six weeks, targeting day 5 after childbirth but starting by day 7, and then finishing by day 44.  That’s in their government policy.  The private hospitals, they have that service.  So every woman is entitled.  So they just blow me away.  They really care, and when I first started studying and researching their practices – luckily, my contact was the head of the traditional compensatory medicine department under the Ministry of Health.  And the first time I went into the Malaysian hospital, they had a whole wing for all this eco care.  Whether it was cancer or diabetes or something else, and then you have the maternity side.  I was like, wow.  I couldn’t believe it.  It was just incredible, an eye-opening experience of what this kind of care could be.  And you know what?  It was very simple.  You have, you know, a bed for the mom, a low bed on the floor for the massage and body treatments.  You had a bassinet for the baby.  You had some products.  That’s all you need.  Maybe a little music.  That’s it.  And it’s just – and it really helps the body heal.  And we have to get a start on it because the body starts recovering from day one, hours after the placenta is birthed, internally, because there’s that sharp drop in hormones.  The birth of the baby, the placenta.  That triggers the healing process.  So it starts a lot earlier.  I’m always about day one, so I’m really bringing the honor back to the birthing day where in traditional cultures you have a special meal and it’s honorific for the person to make the meal, and you have that.  And then the first time a mom gets cleaned.  It’s an herbal feminine wash.  It’s not a douche.  It’s a feminine wash because the first four days should be devoted to the perineum and getting that strengthened.  That’s why things are delayed to day 5.  And so if a mom’s had a Cesarean, your perineum still needs TLC because it’s weakened.  You could have hemorrhoids.  You don’t know what’s going to happen afterwards.  There’s so many infections people get, even if they didn’t give birth vaginally, and so herbal products, all the products I import, are anti-inflammatory, anti-bacterial, deodorizing.  It’s ten months of menses lochia that’s coming out full of toxins.  And mentally, moms are like, oh, my God.  It smells so bad.  It’s also helping that.  That’s twice a day for 20 minutes, a sitz bath.  And it does dramatically help with wound healing.  And all the products that I import, the little magic in them, it’s 52 different herbs collectively, but not in each product, has traditional herbs from the jungles of Southeast Asia that are sustainably farmed and grown, and they are known for feminine healthcare, for wound cleansing, shrinking.  They’re known for restoration.  So that’s the magic in the products.

Kristin:  So our listeners can order the products online through your website, correct?

Valerie:  Yes.  They can, on the website.  There’s videos on there and explanations and every single herb.  It’s all baby friendly, breastfeeding friendly.  It’s all good.

Kristin:  Yes, all natural products, and they can purchase your book and your recipe book from the site.

Valerie:  Well, actually, the recipe book at the moment is for my students and for my clients initially.

Kristin:  So they have to be coaching with you?  Okay.  So they can order The Mommy Plan book, and then if they’re a coaching client, then they get the recipe book as part of the sessions with you?  Okay.

Valerie:  Or if they buy the set, like the whole postnatal care set, because it’s really wonderful.  It has videos, printable product use charts, The Mommy Plan, the cookbook, and it comes with a sample of a postnatal group coaching for 30 minutes on a group call at this time.  So I really want moms to use it and to be on the right path because they’ve invested in their recovery, and I have no doubt it will help them.  And say the products – it’s ten products.  It’s a feminine wash; it’s a herbal recirculation oil that helps the water and the retained air and fat be released faster.  So it’s all about stimulation, circulation, and warming, because you’re in that cold state.  There’s a tea that’s wonderful.  I mean, I drink the tea.  And these products are traditional feminine healthcare.  I use them.  I had my son 13 years ago.  You can use these at any time.

Kristin:  That’s good to know!

Valerie:  It is.  They’re really great.  You need all this help, this concentrated help, right after childbirth.  But it’s traditional feminine healthcare.  It’s used any time.  I use these products.  There’ a tea.  There’s really wonderful virgin coconut oil that’s in there.  There’s a herbal bath, those sacred herbal baths.  And there’s a wonderful wrap that actually includes the hips.  Because you open 10 centimeters, got to close 10 centimeters.  You need to also support that weakened perineum floor, so this holds you, you know, holds that in, and helps it close faster because all these practices are about healing the mom faster and getting her on her feet to be a contributing, productive member of the family.  In other cultures, they don’t want someone laying around for months on end.  You can’t afford it.

Kristin:  So taking that time to heal, to get back to it, versus forcing a woman to get back into her regular patterns in the household and work right away and then have depletion and lose the productivity over time, and the mental health declines as well.  So it makes perfect sense to me.

Valerie:  Exactly.  And that’s why dads and doulas help.  Maybe they’ll make the feminine wash or they’ll set up the sitz bath.  You know, they’ll put the oil maybe from the knees down on the mom if their legs are hurting.  Even when pregnant, it’s really great for retained water, as well, and edema.  These are things that a dad can do, as well, to help set up.  Make a tea.  All of this.  He can really play an important role.

Kristin:  Yeah.  Light some candles.  There’s a lot of conversations in the birth world right now about self-care, and I talk to clients about it, and it looks different to everyone.  But it could be a way to have some intimacy as a couple with the transition, whether it’s baby number one or four, to have that intimate time together where the partner can be involved in her recovery.

Valerie:  For example, my cousin’s daughter who had the headache for three weeks, my advice to her was, have your bath.  Her husband made the bath, and when she was in the bath, he’d pour the water over her back.  Then she had the calming paste.  There’s also a calming paste in there that is for postpartum headaches.  That’s a traditional recipe for postpartum blues.  It’s like a masque for the forehead that infuses these relaxation and refreshing herbs into the forehead that goes into that area.  And then she had the oil where he gave her a head massage for that.  So you’re right; you can have some intimate moments that are maybe going to be far and few between, where mom needs this help.  She doesn’t have to have these headaches, but these are things that you can do, and there’s a whole – there’s product usage videos that come with it, printable charts from day one, so there’s lots of support information.

Kristin:  Well, it sounds like a perfect gift for a shower.

Valerie:  That’s why I’m there and I support each mom and family the best that I can so that they have a better recovery.  That’s why I got into this, to help lower the rates of postpartum mood disorders.  But it’s still not happening.  I’m even on a maternal healthcare policy committee member for the state of California, and we are still very much focused on helping the mental health side.  This is all prevention to help the body recovery.  So slowly, slowly.

Kristin:  Well, I appreciate all the work that you’re doing.  It makes a big impact.

Valerie:  Thank you.

Kristin:  Any last words of advice for our listeners?

Valerie:  Yes.  Again, pregnancy is a natural state.  Birth is a natural trauma.  So the transition from the third to the fourth trimester should be seamless.  It’s not like, boom, had the baby, I’m done.  That’s how I was 13 years ago, and it’s not the case.  You have to think about it in a holistic way; first, second, third, fourth trimester.  And the fourth trimester is still dedicated to baby because you’re getting yourself back on your feet, and you’ve been taking care of baby this whole time while you’re pregnant with what you eat and changing your lifestyle.  So the big difference is having a planned versus a random recovery.  Don’t have a random recovery.  And look at your sources, who you’re pulling information from.  Make sure it works for you and your family.  A crazy diet may not work for you because it’s so out of your element.  People sometimes do that.  So it’s something that they should start within – you know, look at from the third trimester, and during the third trimester, probably about week 35, I recommend people to wear a belly support wrap because even if you don’t have pain or discomfort, your center of gravity shifts, and your abdomen is going to be super stretched.  That will help it afterwards to help those muscles contract, even if you’re not having discomfort, wear it.  Your muscles will thank you and your skin.

Kristin:  I agree.  I am all about belly binding and wrapping.  It’s fantastic.

Valerie:  Yeah.  This is the third trimester, the pregnancy support one.  Then you definitely wrap.  That’s a whole other topic.

Kristin:  Yeah, the binding during pregnancy and then the postpartum wrapping, yes.  Thank you so much.  Please remind us again how to get in touch with you.

Valerie:  Sure.  My name is Valerie Lynn, and my company is Post-Pregnancy Wellness.  I am an eco postnatal care specialist, and I’m starting to use the term “the body doula” because people know doulas.  Again, it’s very different from a postpartum doula.

Kristin:  Which you are a postpartum doula, as well?

Valerie:  Yes.  Yes, I’ve trained as that.  And you can find me on my website.  My email is valerie@ecopostnatalcare.com.

Kristin:  Thank you so much, Valerie!  It was great to reconnect.

Valerie:  You too!  It was great to talk to you.

If you liked this podcast, please subscribe and give us a five-star review.  Remember, these moments are golden.

Jaren Soloff RD, IBCLC talks to Kristin about her new book The Postnatal Cookbook and the importance of nutrition during pregnancy and especially postpartum.  You can listen to this complete podcast episode on iTunes or SoundCloud. 

Welcome.  You’re listening to Ask The Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Thanks for listening!  This is Kristin, co-owner of Gold Coast Doulas and co-host of Ask the Doulas, and I’ve got Jaren Soloff with me today.  Welcome, Jaren!

Jaren:  Thank you so much for having me!  I’m excited to have this conversation with you.

Kristin:  Yeah, I’m excited to chat!  So Jaren, you are the author of The Postnatal Cookbook, as well as a nutritionist.  So you’re a registered dietician and an international board-certified lactation consultant?

Jaren:  I am, yes.  I love to be able to combine those two, and I use both of those credentials that I have in my private practice.

Kristin:  That’s fantastic.  So obviously you work with women throughout pregnancy and especially in the postpartum time, so it makes sense that you would be able to give your clients your cookbook and so on.  I know you shared it with me maybe about four or five months ago, and I love all of the recipes.  Everything is easy to do, and our postpartum doulas have even been able to make some of the snacks for their clients, which has been fantastic.

Jaren:  Oh, I love that!

Kristin:  So tell us a bit about your journey with creating the cookbook and about your passion in working with women, especially in the postpartum time.

Jaren:  Absolutely.  You know, my interest in my practice kind of aligns.  They’re all interconnected.  The cookbook is really something that falls so well within what I hope to offer women through my practice, which is simple, evidence-based tools to be able to support postpartum.  And I think like many of us in birth work, we either have always known that it’s something that we want to move towards and maybe we stumble a little bit through different career paths to get there or our own journey becoming a mother really just validates and solidifies that interest.  And I would say it’s kind of a combination of the two.  I studied women’s studies in college and then gradually transitioned to doing my nutrition studies, but I always knew I was going to kind of work in this area.  I wasn’t quite sure what specifically that was going to mean for me, but I knew that I was going to be somewhere along those lines.  And I had my daughter very long.  I had a pretty storied past with a rocky relationship with food and body image.  I struggled with an eating disorder, and my early journey of motherhood was still very early on in my recovery.  So I started to really understand a lot more about that layer of my recovery, of coming to find a new relationship with food, but also understanding how impactful my relationship with food and body image was going to be with having a daughter and becoming a mother, and thinking about not only breastfeeding but having to feed my daughter and how complex so many of those feelings really became when I had my own concerns around food.  So it felt really isolating at the time.  My daughter is 9 now, and I think there were probably people talking about it, but the eating disorder field is still very new, so we weren’t having a lot of these conversations about how postpartum can be a really vulnerable time for individuals in recovery or just any food or body image concerns overall.  So now I think we’re doing a better job of having these conversations, and that’s really my hope with Full Circle is bringing it full circle.  It’s about supporting women in their own healing with food and body image but also if they need support in feeding their baby so that we’re not passing on any of these concerns to our children and we’re really stopping that intergenerational cycle of dieting, of body shame, of food concerns along the way.

Kristin:  Right.  That is definitely a big concern with a lot of my doula clients.  I used to teach an eight-week class where one of the weeks in that was all about body image, and it was amazing how many women really struggle with the changes in their body during pregnancy and then how they perceive themselves or even society in that weight gain and the need to feel like you’re able to lose it quickly.  There’s a lot of stress around that.  I know in your cookbook, you talk about the importance of nutrition and just nourishing yourself, especially for breastfeeding moms.  Can you talk a bit more about the importance of even having some of the snacks and your recipes throughout the day to keep up the endurance dealing the healing time?

Jaren:  Absolutely.  You know, we kind of generally hear, in terms of nutrition for breastfeeding, I mean, all that I heard when I had my daughter is, make sure you’re eating an extra few hundred calories, and that’s about all I got.  And keep taking your prenatal.  Which is so generic and so minimizing of just how important that nutrition really is.  And, you know, we kind of term that postpartum period, as I’m sure you use in the language as well, as the fourth trimester.  And think about how much nutrition information you received during pregnancy.  I mean, every single trimester there’s, you know, focus on these foods and, you know, be mindful of this and be mindful of that.  And as soon as you arrive in the fourth trimester, you don’t really get any of that, when in fact I found in much of the research that our energy needs are just as high, if not higher, in the postpartum period which makes perfect sense because your body just went through this huge change and there’s a ton of healing that really has to happen on top of if you choose to and are able to breastfeed, it requires a lot more nutrition to be able to supply that.  So I’m saying energy needs, and I mean calories, and I don’t typically use language of calories, but more so just to emphasize that your appetite is usually higher during the fourth trimester, which makes complete sense, and it’s really important to — I use the term — I focus on intuitive eating, which I can talk about a little bit more, too, but of course nutrition is really important to me and important that I communicate that to my clients, but I use the practice of what I call gentle nutrition, which is, you know, we can be mindful of making sure we get enough protein, for example, or focusing on our omega-3s or calcium or vitamin D, but we’re also going to be flexible because postpartum, most moms don’t have very much time to prepare meals or eat.  So we’ve got to be flexible with it, as well.

Kristin:   Definitely.  So what about moms who either already have an allergy or need to cut out dairy based on how their baby’s responding?  What tips do you have for them?

Jaren:  Yes.  It’s a great question.  I’m sure that you see it often, as I do now.  It seems like it’s happening more frequently, and it’s hard to know if it’s the chicken or the egg.  Is it because we are more aware of it and we have some sensitivities to being on the lookout for it, or is the incidence really rising?  And I talked about it just briefly in the book because it’s such a common concern that I hear with my clients, and I shared some of the statistics which is the incident of food allergies, true food allergies, in infants is very, very low.  I’m forgetting the percent, but I think it’s down in the less than five percent of babies actually have a cow’s milk protein intolerance or some type of other food allergy during infancy.  That’s not to say that — you know, if you are under that small percentage, of course, that experience is still so difficult and really can be challenging to navigate, but just to point out that one of the patterns I’ve noticed in my clinical practice is that we are so quick to go to our diet as moms to think that that’s the cause of what might be upsetting our babies, but sometimes we’re not taking that full spectrum of, like, well, what’s normal infant fussiness, or could there be other factors we could rule out here?  We tend to kind of go to our diet and see if we need to eliminate anything, and I think that’s really concerning to me as a dietician because it is a very, very stressful process.  I never had any of these concerns with my daughter, but just the clients I’ve supported, it is so mentally stressful to think that what you’re eating could be hurting or harming your baby or is the reason that your baby isn’t sleeping well or is uncomfortable.  So I always say, if there is any concern around food allergies, if you have looked at some of the underlying causes — and I always recommend working with a lactation consultant because there could be body tension.  There could be some body work we could do.  There could be positioning tricks we could try.  There’s lots of different pieces that we might want to rule out first.  But try to work with a dietician and lactation consultant so that way you have the support if you do need to look at your diet and eliminate anything.  Because going it on your own can be so stressful and so isolating, and moms usually don’t come to me until they’re eating only a handful of foods and they are tearful and at their wit’s end because they don’t have anything to eat and they’re so scared of hurting their baby.  So there’s a lot of moving pieces there, but those are some of my thoughts on the food allergy piece.

Kristin:  And then another topic that a lot of my clients have concerns with is related to wanting to have a nutritious diet, and as you mentioned, not having the time or necessarily energy when you’re focused on healing and nourishing baby, but well-meaning friends and family members bring food, but it’s not necessarily the healthiest or best food for them to be having in the postpartum, the postnatal phase.  So what advice do you have to encourage family members, other than gifting them your cookbook, potentially?

Jaren:  I love that idea.  Yes, that’s come up a few times.  We talked about how great would it be to not only gift a new mom the cookbook but for someone else to, like — you know, for mom to tab some of the recipes and share it with her postpartum doula or share it with her family, if they’re offering to set up a meal train.  I think that would be my hope for every mom or new family is to have that kind of support.  But you can also use the postnatal cookbook prenatally and do some batch cooking.  I know most of my clients will start to do some batch cooking towards the end of their pregnancy just to kind of stock up a little bit.  But it’s nice to have the recipes in the postnatal cookbook because they’re already going to kind of meet your needs when you arrive home and you’re in that phase.  So that can be one option that you can consider, as well.

Kristin:  That’s great advice.  So I love the idea of batch cooking, and my clients do that.  They don’t necessarily have those recipes in mind; they’re just finding easy, freezable foods.  So thinking ahead about the nutrition that they need.  So what advice do you have for clients who again are in that — they’re pregnant; they’re nearing — they’re in their second or third trimester, and they’re really trying to keep as nourished as possible?  I know this is a postnatal cookbook, but you mentioned they can use the recipes throughout pregnancy.  So optimizing nutrition — yeah, I’d love some tips on that for my pregnant clients.

Jaren:  Yes.  So, you know, I think overall, in terms of what you can do during pregnancy to prepare for nutrition and for recovering postpartum, what comes to mind is some of the big ones, so making sure that you are stocked up on quick and easy proteins.  Those typically take the longest to cook and are really important, especially during the third trimester, as there’s a lot of growth and development happening.  Usually moms are pretty fatigued at that time and point in pregnancy, too, so having some quick options, and that might mean getting a rotisserie chicken and using some frozen turkey meatballs and having some of those maybe more prepared foods.  And you can be mindful about what you’re selecting, but it can be really helpful and really practical to kind of support that transition over as you’re kind of nearing the end of your pregnancy.  I also really encourage, towards the end of pregnancy, continuing to be really mindful about your omega-3 intake.  Omega-3s are primarily found in our fatty fish, like salmon, and of course you can take an omega-3 supplement, but it’s one of the nutrients that we know is so impactful for brain health for baby and also for mom during breastfeeding as one of the nutrients that can really change in their breastmilk.  So that’s one I really love to help moms focus on, as well.

Kristin:  Do you have any other tips or suggestions for our listeners?

Jaren: In terms of general postpartum, I really think having that support and having a postpartum plan, and you could probably speak to this as a doula and the postpartum doulas that you work with, is really thinking about and preparing for the fourth trimester.  I’m hopeful that we’re doing a better job of supporting moms and parents in moving towards that because I think the focus has been on preparing for pregnancy, preparing for birth, and when moms get to the other side, so to speak, it’s like, wow.  I wish I would have prepared and known what to expect in the fourth trimester.  I wish I would have had a lactation consultant on call.  I wish I would have hired a postpartum doula, and all those different pieces that really help you once baby is in your arms.  So I really think being skillful and mindful about having a postpartum plan and getting that support in place, whether it’s around how are you going to get your grocery shopping done or who’s going to be preparing meals for you, can be so, so, so helpful for that transition to the fourth trimester.

Kristin:  I agree.  We talk about that with our clients, that we do so much planning during pregnancy for the birth, but then thinking about communicating your needs with family and friends and setting up expectations and a plan for support after baby is so crucial.  So I’m glad you mentioned that.

Jaren:  Absolutely.

Kristin:  Jaren, I know that your book came out in December of 2020.  I’d love to hear about how things are going with the release, and our listeners would love to, of course, know how to find it and find you directly.  So if you could share some of that information, that’d be great.

Jaren:  Absolutely.  Yes, it’s going great.  I mean, I’m really enjoying actually seeing individuals cook the recipes and hearing thoughts and feedback.  It’s such a unique feeling to kind of put something out into the world and see how it’s really being received, so it’s been really cool to see how moms are actually using it in this way during postpartum.  So if you’re interested, on my website, I actually am sharing a free sample of the book, just so you can see my recipes and make sure that they sound good to you.  I put in a small excerpt from one of the chapters, as well, so if you’re not ready to buy, you can download that free excerpt first, and then you can also find the book on my website, as well, or you can go on Amazon.  It’s also available at some of the major retailers like Barnes & Noble, Books-A-Million, and some of those stores, as well.  But on my website is the best place to find it and get a little bit more information.

Kristin:  And you’re on some other social media channels, as well, correct?

Jaren:  Yeah, I’m more active on Instagram.  I use it to try to provide some quick tips and little mini tutorials for moms if you’re hopping on there.  So you can find that through my website or directly on Instagram.  I’d love to connect with you there.  Thanks so much for having this conversation with me!

Kristin:  Thank you, Jaren.  It was great to chat, and I hope you have a great rest of your day!

Jaren:  Thank you!

 

Amanda and Katie, women’s health physical therapists at Hulst Jepsen Physical Therapy, give us an intro into pelvic floor PT.  What is it, what does an internal vs external pelvic floor exam involve, and what kinds of symptoms can pelvic floor PT treat?  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Alyssa:  Hello, Amanda and Katie.  So nice to see you both via Zoom!

Amanda:  Hello!

Alyssa:  How long have you two been back working together at the office?

Amanda:  Well, yeah.  It’s been kind of a crazy year, so we were off from the clinic March — end of March through — well, I was through June.  I think you were about Juneish time.  So, yeah, had the summer and some of the fall kind of off and on as well, but we’re back now at it.

I know.  It’s nice to see people again!  So Amanda and Katie are physical therapists with Hulst Jepsen.  I will let you both kind of introduce yourselves, and then we’ll get into it!

Amanda:  Awesome.  Well, my name is Amanda Seymour, and I’ve been a physical therapist for about five years.  Two years, actually coming up in a couple days, with Hulst Jepsen Physical Therapy, which I absolutely love.  I love working with the whole body from toes to nose, but I would say more specializing in the women’s health pelvic floor rehab.  I started taking classes around that topic about three and a half years ago.  Herman and Wallace is a company that a lot of us physical therapists have gotten our continuing education from for pelvic floor rehab, and yeah, it was just one of those things where when I was at school, I never thought I would get into, but talking with friends once I was a physical therapist and realizing, yeah, a lot of my friends have had kids and now have pelvic pain or incontinence and realizing I want to do something to help them, and I don’t have the tools to do that yet.  So, yeah, jumped on board with that about three and a half years ago, and it’s been fun being a therapist and sharing my passion just to help people.

Katie:  And I’m Katie Thomas.  I’ve been a physical therapist for nearly ten years, and I started noticing in my practice that a lot of women with back pain, pelvic pain, tailbone pain, were improving with regular physical therapy but not fully recovering.  It was like that last 10 to 20% of them reaching their goals just wasn’t quite there.  And often as treatment would go on and we would get to know each other, these women would start to mention urinary leaking or pain with sex or other pelvic issues, and I would try to get them into a pelvic floor physical therapist, but the waiting list would be, like, two to three months, which really just kind of broke up their care in an awkward way.  So that’s when I knew I needed to learn more about the pelvic floor and be able to treat these patients myself.  So I’ve also taken classes with Herman and Wallace, just like Amanda has, and I’ve been doing pelvic floor physical therapy for the last two years.  And it’s just been really cool to see women get more control of their bladder, be able to enjoy sex again, and just so much more that we touch on, which is really cool.

Alyssa:  So I think there’s a lot of unknowns with physical therapy.  I always assumed physical therapy was something you went to after you got in an accident or you had surgery.  You know, like you said, like shoulders or ankles.  I never really realized it’s like, you know, you go to the chiropractor; you go to your doctor.  It’s just like anyone can go for any ailment, really.  And then I found about pelvic floor physical therapy, and I was like, what?  Are you kidding me?  How do women not know about this?  So I guess how do you reach people?  Like how do we even — I guess that’s the biggest question for any business, right, is how do you reach your target market and how do you educate people, and I feel like women just need to be educated that you even exist.

Amanda:  Yeah.  That’s a huge point because I know in other countries, pelvic floor rehab is probably much more well-known.  It’s part of, like, the daily — especially postpartum, for example, like their six-week checkup with their OB or gyno.  It’s like, hey, you’re doing good, baby’s doing good, or hey, you have these symptoms, and we need to send you to PT.  And some even, they don’t have symptoms, and they’re like, hey, you need to go to PT, pelvic floor rehabilitation, just to make sure everything is okay down there after baby because things happen and you may not realize it until months down the road or years down the road that we could help with right away off the bat.

Katie:  Yeah.  I think that’s really common in France, but not quite as much here.  And thankfully in West Michigan, we’re getting quite a few more gynecologists, OBs, who are screening for issues and are really good at referring their patients to pelvic floor physical therapy, and there’s been some great pelvic floor therapists in the area who have also done advertising and spoken with these doctors and really gotten things rolling in West Michigan.  And so then I think also women are more comfortable talking to their friends and realizing, like, oh, there are a lot of people who are having issues with their pelvic floor.  I’m not the only one.  And there actually are things I can do about it.

Alyssa:  So what is — you mentioned a screening, like, let’s say, at your OB.  What is a screening — what do they screen for and what does that look like?

Amanda:  At the OB exactly — I think it depends.  I mean, I know I’ve had some patients who are like, oh, we just chatted, and they —

Alyssa:  Asking about —

Amanda:  Asking, yeah.

Alyssa:  — leaking or having pain or anything like that?

Amanda:  Yep.

Amanda:  I think depending on if there’s, like, trauma during birth, they do maybe more of an external/internal screen, and some patients, I know, they chatted, more so, and nothing in regards to, let’s say, an internal pelvic floor assessment was done.  And that’s something we’ll definitely chat on in a little bit here.  Kind of as women’s health physical therapists, pelvic floor specialists, what we can provide that maybe, hey, your 20-minute appointment with your OB, maybe not — you can’t touch on that in that time.  But, hey, we can have a full hour evaluation and sessions after that.  We become kind of a team to work together on what’s going on with your symptoms.  And that’s where I can now, too, kind of even explain what pelvic floor therapy is because I know that, hey, we’re so familiar with ankle physical therapy or shoulder rehab and, actually, pelvic floor, what even is that?  And women’s health physical therapy is another term that we see a lot, and that’s definitely a big umbrella term.  Even males are part of that women’s health therapy world.  We do have a clinic or two — mostly we have, if a patient is wondering — okay, if it’s a male looking for pelvic floor help, just call one of our offices and they can get you into the right clinic.  Here at the East Grand Rapids clinic, Katie and I don’t treat males, but we do have women’s health physical therapists who do within the company.  But, yeah, it includes basically anything in regards to — it can include the low back, pelvis, sacroiliac joint, tailbone, like coccyx pain, pain with intercourse, pain just in the pelvis.  We see patients with, like, endometriosis who have spasms in the pelvic floor.  It can be pregnant females, it can be postpartum, old, young.  We treat here probably anyone above 16 to 18.  We don’t have — I hate to say this, but in the company, I don’t think we have anyone pediatric-certified.

Katie:  I think we do have people who are doing pediatrics out at the Hudsonville office, but we don’t do any pediatrics here at our East Grand Rapids location.

Amanda:  Right, yeah.  So it does touch on every age.  Because the pelvic floor is — they are muscles, and that, I think, I can go into.  I know it’s a lot of information.  But it’s muscles, and we treat any muscle in the body.  And it’s function as these muscles basically are sitting in this pelvis like a bowl.  They provide support for your pelvis.  They provide support for the whole body.  They’re there for sphincter control, meaning they close around any opening — your urethra where urine comes out; it closes around that.  Closes around the vaginal canal, closes around the rectum.  It provides stability on the pelvis, too.  It provides for that sexual experience.  And obviously, with posture and breathing, it’s a huge piece of it, which we’ll touch base on, as well.  So we really try to tell patients that.  Like, hey, you may not have ever heard much about your pelvic floor, but really it is just like bony prominence around this muscle group that’s just the same as your bicep or triceps.  You just can’t see it.  So that’s where it’s more foreign to people.

Katie:  And once again, everyone has a pelvic floor.  But we’re more focusing on women at this clinic, so women who are having urinary leaking for no reason; women who are having leaking with coughing, laughing, jumping; having urinary frequency, constipation.  That’s a big one.  Diarrhea.  Organ prolapse.  So when your uterus or your bladder might not be exactly sitting where it needs to be and you get a lot of heaviness in your pelvis.  Pelvic pain.  We see people during pregnancy, after pregnancy, women of any age.  There are so many different women that we’re trying to reach out to.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Alyssa:  I’m trying to remember what brought me initially to your office, and I think it was — I had some swollen lymph nodes in that pelvic area, and then as I got to talking — Joellen was there at the time.  We started talking, and, you know, you kind of learn, like, okay, oh, yeah, I do have a hard time doing jumping jacks when I work out, or I can’t really run very far or fast anymore.  And I ended up doing some pelvic floor physical therapy with her in addition to the lymph node stuff, and it was kind of mind-blowing, like what I didn’t know about my body.  You know, it’s just amazing what they don’t teach you in school.  But learning about, like you said, breathing, and then she did an internal exam, and I think you two should talk about that, because I think that might be intimidating for some women, but it was really easier than my annual gynecological exam.  But the things she taught me, the techniques she taught me, I can still do any time, and it’s not just a Kegel.  It’s so different from what my mom used to do and told me to do.  And I learned, and correct me if I’m wrong, that you can do Kegels too much or the wrong way and actually have a worse outcome.

Katie:  That is definitely correct.

Alyssa:  Talk about the difference, because you mentioned breathing, and that was a big part of what I learned, the breathing.  And then maybe talk about that versus a Kegel, which everyone else thinks about, and then maybe talk about what an internal exam looks like.

Katie:  Yeah.  So we’re going to get more into some of the breathing, actually, as we talk about incontinence in our next podcast section, so we’re going to talk about incontinence completely there.  So if we can save that question for that, because it’s a pretty big topic, actually, getting into breathing.  But Amanda was definitely going to talk about, like, what to expect from a pelvic floor visit because we do know that it can be a scary experience not knowing what it’s going to look like.

Amanda:  Yeah, definitely.  And the fact that, yeah, Kegels — right, wrong.  I think that’s where pelvic floor therapy can come into play to say hey, yeah, if you really have a tight pelvic floor — and that’s what we kind of help you to discover, to find out during the internal assessment.  Is the pelvic floor tight?  Is it weak?  Is it boggy?  I guess you could use that term.  To know, hey, should you be someone doing a pelvic floor activation, aka a Kegel, or are you someone that should actually be trying to let those tissues kind of stretch and relax, because that’s where I think people get into trouble.  They say, hey, yeah, I watched this YouTube, and I tried all the Kegels in all these different ways.  Well, shoot, actually we need to help you with down regulation and kind of relax that pelvic floor.  And that’s where an internal pelvic floor assessment does have a huge advantage to kind of say, hey, we can teach you about your pelvic floor during the internal assessment.  We learned a lot about the pelvic floor to be able to decide the correct plan of care.  But I will say not everyone is comfortable with an internal pelvic floor assessment, and we are totally fine with that.  There are external releases that we can do on more of the global structures to help release the pelvic floor if it gets too tight or using those global structures to help activate the pelvic floor, too.  But typically when someone comes in for an evaluation session, we get 60 minutes with you, and we definitely take a lot of time for history and getting to know you to build that rapport and to become a team at that point.  We don’t necessarily say, okay, we’re diving into an internal assessment right away.  It might just not be the right day or the right time.  Maybe something about your symptoms is really emotional, and that first day just needs to be comfort level, coming into the clinic and starting you off with a lot of education and with your first home exercise program.  But if we say, hey, if you’re interested in an internal assessment, let’s go for it, and if you feel comfortable with it.  Typically, when you come to the clinic, wear stretchy clothes because we can kind of feel and see — I should say more so feel and get a good glimpse of how the pelvis is moving or the back or the hips.  And then when it comes to the internal part, basically, we set up the physical therapy mat table.  We have a pelvic floor room here at the clinic just dedicated to our pelvic floor patients.  We try to make it really comfortable with artwork, essential oils; try to make you feel as calm as possible.  And we try to make the space yours.  So we don’t have stirrups.  We don’t use a speculum, anything like that.  It is just a gloved hand with a single digit that we actually use to kind of insert into that vaginal opening very carefully, very gently, and we look for your response right away.  Painful, not painful.  If we’re doing okay, we say, okay, here’s the right side of your pelvic floor.  I’m touching that muscle.  And that way you can kind of build a 3D image in your head of what your pelvic floor actually looks like, which I think is really helpful.  During my first lab experience with the course I went to, I was really nervous.  Here’s a stranger just assessing my pelvic floor.  But afterwards, wow.  I just feel so much more confident about how to relax my pelvic floor, how to activate my pelvic floor.  Who knew that I had a deep hip muscle way back there, and someone was able to say, here it is, and now I just have that knowledge of my body so much more.  So I think it’s helpful for anyone, even with someone who doesn’t have symptoms, just to know where their pelvic floor is.  But definitely if you’re having symptoms, I think it’s really helpful, just emotionally, to know where your pain is coming from or why you have symptoms, because it’s overwhelming when you’re leaking or having pain with intercourse, and the first thought is, what’s wrong with me.  And there’s nothing wrong with you.  It’s just, hey, these are muscles, and something’s just not working right now, but we can help you get those to work.

Katie:  Yeah.  I’ve seen a lot of women who are having pain with sexual activity, and it’s starting to feel to them like it’s just kind of in their head, and so doing an internal exam can be very helpful because we can go in and actually touch one of the muscles or several of the muscles that are giving them issues and say, here.  You’re not crazy.  You feel how this is sore, just like your neck muscles can be sore?  You’re normal.  This is something we can work through.  Here’s how we can fix it.

Amanda:  Yeah.  And I’ll say follow-up sessions — sometimes, yeah, we say, hey, I think another internal treatment would be helpful, or, you know, we’ll touch base on a little bit of what other treatment techniques are there.  Because it’s not always just, oh, an internal session every time you come in.  There’s a lot more to it.

Alyssa:  Yeah.  I remember doing stretches and all sorts of other things based on what she found with how my body works.  So if someone wasn’t comfortable with the internal assessment,  you had kind of said you could see how their hips and pelvis move.  What else do you look for with someone who isn’t comfortable with the internal exam?

Katie:  There’s so much to focus on externally, as well.  So definitely like what you said, we want to make sure that the hips and pelvis are even, that the leg length is even, that there’s no rotations in the back.  So we can work on getting everything nice and aligned.  Because the pelvic floor muscles sit in the base of your pelvis and kind of hold everything together, if your pelvis is a little bit twisted or your back is twisted, that’s going to affect the tightness of the pelvic floor.  So there’s so many outside things that we can do first.  So we would just look at their back, look at their pelvis.  We would work on different stretching techniques.  We would take a look more at the groin muscles.  We would instruct just in some self-relaxation techniques, some guided meditation.  And then, I mean, there’s just so many different types of exercises and then a lot of education, as well.  Typically, I would say that on the first visit, it’s pretty rare for us to do an internal exam because there’s just so much to talk about and so much of getting to know your body to do.

Amanda:  And I think functionally, too, if someone’s having leakage with jump rope or jumping jacks, we can definitely assess that, like the performance of it, because that sometimes makes a difference, too.  Hey, if you’re doing jump rope and you keep jumping backwards, it actually kind of shuts off that anterior wall of the pelvic floor.  So some of those more functional things, that’s external and it’s fun to kind of work through with patients depending on their status of activities, too.

Katie:  And if we’re seeing women postpartum and they’re doing breastfeeding, then there’s often a lot to look at also in the midback and neck and posture there, as well.  So there’s so many things to address.  Definitely don’t let any fears or concerns over an internal exam be what keeps you from coming to pelvic floor therapy.  We’re never going to do anything unless you’re comfortable with it.  I wanted to go back to when you were talking a little bit, Alyssa, about how you started pelvic floor physical therapy.  So it sounds like you kind of noticed some stuff and were really in tune with your body, which is super great.  We get a lot of women in like that, too.  But a lot of people ask, like, how can I make a visit?  One option is definitely to see your doctor, your gynecologist, and get a referral to come in to physical therapy.  That’s definitely the easiest route to go for us.  But you’re also welcome to just come into the clinic without a referral, as well.  Just walk in our doors and schedule a visit.  The State of Michigan allows us to see you then for either three weeks or ten visits, whichever one comes first.  And then during that time period if we feel like you’re going to need more physical therapy, we can contact your doctor and get them to sign a referral, or we often do a big — for every patient, we do a big write-up and send it to their doctor just letting them know, hey, here’s what we’re seeing, just to make sure that we’re all on the same page, and as long as they sign that, that counts as a referral, too.  So that’s definitely something that we can help people with for making access to pelvic floor easier, too.

Amanda:  And I would say more and more people, like Katie said, are talking about it, so yes.  Spread the word that pelvic floor rehab is around and that it is really helpful.  I know a patient just came in the other day.  She said, oh, I started following some — I think it was an Instagram physical therapist for pelvic floor rehab, and I was like, that is awesome.  I’m not very good with social media, but I’m glad people are out there spreading the word on social media, too, because hey, got her help and got her in our doors for us to continue to help her hands-on and one on one, which is so exciting.  But, yeah, definitely, that’s a big push to make that more the norm for females, to get them in.

Alyssa:  So for our listeners in particular who are probably either planning to get pregnant, are pregnant, or are early postpartum, I would guess, what would you say would be your ideal time to see them?

Amanda:  I would say during pregnancy, whenever I’ve seen people with stages prenatal way at the beginning, and they say, hey, can you help me make, like, a plan throughout my pregnancy, and I’ll see them once a week.  I even had someone I saw, like, kind of every two weeks just to kind of check in, how are things going.  Checking alignment, exercises.  And sometimes I have females who come right before they give birth, too, because pain can become a factor, for sure.  It’s fun when someone’s here earlier because you try to keep them from that pain level maybe later in pregnancy.  And then postpartum, I would say really — I mean, six weeks out is a great time to come.  I realize that time goes really fast when you just have a newborn, so we always say, hey, when you feel ready to commit to physical therapy, because obviously we’d love to have more than just — I think the eval is great, but then the follow up, too, I think is just as important for people to attend, and I know I’ve had patients who have tried physical therapy, you know, pelvic floor rehab, like four weeks postpartum and was just overwhelmed, really overwhelmed.  So she came back at ten weeks, and it was all good.  But I think, yeah, it’s fun to get six weeks out because then those muscles are ready to relearn what they’re supposed to do.

Katie:  And we often say the six weeks because that’s normally when your follow up is post-birth, so you’ll have seen the OB and they can even give you a referral for pelvic floor physical therapy at that time, so that can be a great time.  But it doesn’t have to be six weeks.  I’ve seen a lot of women who tell me, oh, I saw another pelvic floor therapist six weeks out, and I just didn’t have the bandwidth to take care of myself and do this right now in the middle of trying to figure out how to be a parent, too.  And that’s perfectly fine.  Sometimes then we see women a year later or two years later or ten years later.  It doesn’t matter.  There’s something that we can do at any time.  Honestly, it’s so important just how the woman feels and what works best for her and her lift at the time.

Amanda:  Pelvic floor rehab is definitely needed.  It’s the symptoms of kind of a pelvic floor dysfunction are really, really common.  We know that 25% of even young women experience urinary incontinence.  Just a few other stats here I just thought were mind-blowing as I was taking courses.  One in seven American women ages 18 through 50 experience pelvic pain.  So that’s — yeah, 1 in 7.  That’s like, ask your friends.  Ask your mom.  Someone’s bound to probably share that same experience but just hasn’t brought it up in conversation.  And more than 25 million people in the USA experience bladder leakage every day.  Overall, pelvic floor disorders, whether that’s prolapse or incontinence, affect one in five women in the United States.  So these are definitely muscles that need more attention.  As we say, if you don’t use it, you lose it.  And with birthing and whatnot, that’s some stretching of that pelvic floor, so to relearn how to use it — it’s like, hey, if your biceps has been stretched, like, a hundred percent, you probably need a little help knowing how to get that bicep back working again.  And that’s what we’re here for, which is fun.  It’s fun to partner with women and get them back to what they love doing, back on their feet with their kids.  Definitely that’s the next podcast, to dig in a little bit more to the nitty-gritty of what the pelvic floor can do and Kegels and stuff.

Katie:  Yeah.  We definitely have more coming.  Like I said, we’ll talk more about the breathing with urinary incontinence issues, and then we definitely want to talk more in depth about pain with sex and talk more in depth — we’re going to do an entire separate podcast just on postpartum concerns, as well.

Alyssa:  Yeah, I’m excited to talk to you both a few more times.  So anyone listening, we’ve got at least three more podcasts coming with these women.  So if anyone wants to reach out — now, tell us, if anyone’s in the West Michigan area, how do they get ahold of you?  But can anyone nationwide get ahold of you via Zoom?  Or maybe not Zoom.  You probably have a HIPAA — do you have something —

Amanda:  Yeah.  So we do have Telehealth with Hulst Jepsen.  Right now, and I can double check, but when I’ve done Telehealth sessions in the past, it has to remain in Michigan.  So we can treat anyone in Michigan, but they’re — you know, behind the scenes of why it’s just Michigan, I do not know.  I’d have to talk to our HR.  But as of right now, anywhere in Michigan, we can definitely do a Telehealth session, which I have done for a pelvic floor patient.  I saw her in person and then because of the virus, she said, hey, I’d love to do Telehealth instead, and that’s worked out great for her.  But otherwise, definitely going to our website, and you can take a look at all of our locations.  We have about 19 different locations for general physical therapy.  We have about five or six now clinics that offer pelvic floor rehabilitation, and it’s going to note it right there with the location with the phone number when you click on it.  For Katie and I, we’re at the EGR location.  We are here.  Give us a call, and Lexi up front can definitely get you scheduled with one of us.

Alyssa:  Great.  Well, thanks for joining us today!  We will record again about urinary incontinence.

Amanda:  Cool.  Thank you!

Katie:  Thank you!

Thanks for listening to Ask the Doulas.  For more information about Gold Coast Doulas, visit us at our website.  We’re also on Instagram, Facebook, and YouTube.  If you liked this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

Kristin talks with Dr. Annie of Rise Wellness Chiropractic about how to keep yourself and your family healthy during pregnancy and a pandemic!  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  I’m Kristin, co-host of Ask the Doulas with Gold Coast Doulas, and I am joined today by Dr. Annie.  She’s here to chat with us from Rise Wellness Chiropractic.  Welcome, Dr. Annie!

Dr. Annie:  Thank you so much for having me, Kristin.  I’m so happy to be here!

Kristin:  Yeah, it’s been a while since we’ve chatted with you on the podcast!

Dr. Annie:  Probably since pre-COVID.

Kristin:  Yeah, and now we’re doing our podcast virtually versus in our office studio space.

Dr. Annie:  It’s weird not sitting across the table from you but being across the table from my computer, instead.

Kristin:  Exactly!  I’d love to you fill in our listeners and clients a bit about your specialties, your practice at Rise, and then we’ll get into talking about pregnancy and stress.

Dr. Annie:  Awesome.  Sure.  I am a pediatric certified chiropractor, and I’m also certified in Webster technique, which is a special technique for pregnancy.  So we practice basically mostly around pregnancy and perinatal care and then also see kiddos and helps with them with their spines as they grow, also.  So that’s kind of what we do.  We adjust really gently, and we look at the nervous system and help families improve their nervous system function.

Kristin:  And you are located, of course, in Grand Rapids to serve West Michigan families, and just to fill in our listeners a bit about Webster and how that’s different from general chiropractic care, could you give a little bit of background about the Webster technique?

Dr. Annie:  Of course.  The Webster technique kind of started being developed probably in the ’80s, and it was focused on pregnant bodies and how the alignment of the pelvis affects the uterus and torsion in the uterus, as well, so that affects baby positioning and everything.  That was kind of how it was developed because pregnant women need specialized care.  We can’t just adjust them like any other adult body.  There’s relaxin in the system, so we need to be very specific and very gentle when it comes to adjusting pregnant bodies, especially as baby is growing and as mom becomes more uncomfortable in the pregnancy.  And then that also kind of translates into different specialized care for postpartum bodies, as well, and also for infants and kids, too.

Kristin:  And ideally, like with our clients, they like to come to you as early as pregnancy — it’s optimal to see you early, but also, you always take last-minute patients, especially if baby is malpositioned and we need to do some work positioning-wise.  So how does that all translate into — since it is a specific technique, can some of the work you’re doing as a Webster-certified chiropractor also help the nervous system and — or would that be different chiropractic care in addition to seeing you for prepping for birth?

Dr. Annie:  That’s a great question.  I think there’s a little bit of a disconnect with how we think about chiropractic care as a musculoskeletal alignment approach and a nervous system approach.  All chiropractic is centered around the spine because that’s what protects our central nervous system.  That’s how our brain communicates and coordinates everything that happens in our body.  So the benefits of any adjustment, whether it is for a pain basis or a musculoskeletal approach, is affecting the body through the nervous system, and that’s how we heal.  And so that better alignment affects the nervous system from a basic standpoint, but then with Webster technique specifically, because we’re looking at the alignment of the pelvis for birth, that is also going to influence the nervous system and how labor happens, basically.  So the communication between the brain and the uterus during contractions, that is all going to be affected, also, by the alignment of the pelvis.

Hey, Alyssa here.  I just wanted to hop on real quick and let everyone know about a really exciting new course that Kristin and I have been working on called Becoming.  It’s all about becoming a mother, and in six weeks online, we will be giving video lessons and live coaching calls weekly with Kristin and I, along with a private Facebook community to offer encouragement and support.  This six-week online class will actually be launching beta, which is our first launch, on March 22 with our live call on March 26.  You can get into this beta program at a really, really super reduced price, so check us out on our website to join.  We’d love to have you join us and learn all about pregnancy, birth, and early parenting and especially during this scary time of COVID.  Let us be your expert guides.  We hope to see you there!

Kristin:  Obviously, especially during COVID, women are under a lot of stress and strain in their pregnancy.  How can chiropractic care help them reduce their stress and stay healthy?

Dr. Annie:  This is a big question, a big multifaceted question, I feel like.  So the stress of COVID is just — I mean, it’s insane.  I feel like we all are really good at adapting, as human beings, to doing Zoom calls instead, limiting who we see and limiting our time outside, and jobs have pivoted and all of that stuff, and we’ve gotten used to all this background stress in our lives, right?  For pregnant women, too, we’ve kind of shifted how women are being seen for their prenatal visits, who they can bring with them, even what their birth process looks like, whether it’s in the hospital.  We’ve had a lot of moms who have switched to doing home births because of regulations in the hospital, too.  So it’s just layers and layers of stress, right?  Especially if you’re trying to plan for bringing an infant into the world.  That is also compacted with jobs being shifted to being at home.  A lot of people are working at home, sitting a lot more, especially when it’s below 10 degrees outside here.  So they’re sitting more; we’re not moving as much as we normally do.  There’s all this background stress, and a lot of times, we’re sitting and working on laptops because who has a desktop computer anymore?  So ergonomics: there’s a lot of biomechanics that are shifted into this, and then we also have the stress component, too, on top of it.  So, again, layers and layers and layers of stress on our bodies, especially if you’re a pregnant body and tend to be more hypermobile because of the hormones that are going on.  So lots going on there.  How we address that from a chiropractic approach: we measure nervous system stress.  We use electromyography, which is the electrical activity in muscles that support the spine, and then we also measure heart rate variability, which is a specific stress outcome measure.  So we can see if your body is super stressed out, if your nervous system’s stressed out, or if we’re super burnt out, too.  Those are the things that we measure in our practice before we even start care so we can see, like, how is this mom doing, and how is this baby doing, too?  We’re seeing some really stressed out babies, too.  We can measure that as we’re adjusting and as we’re going through care to make sure that things are functioning better and that our resiliency is raised so our stress outcomes are better.  It doesn’t mean that we’re not going to have all of the stress on our bodies because it’s just kind of the reality that we’re living with right now, but it makes us more adaptable and able to better combat that stress and switch back into parasympathetics.

Kristin:  And I’ve even been in your office when you’ve instructed patients to do different stretches, and you’re looking at, again, what their day-to-day looks like as well as assessing their body and giving them tips.  And you had talked a bit about the isolation, and your practice has this wonderful sense of community with your online space, and women are able to connect.  And you also give tips out every week on your Facebook page, and so you’ve done a great job of trying to connect your patients and reduce some of the isolation that COVID has caused.

Dr. Annie:  Thank you so much.  Yeah, it’s hard.  I mean, I’m an extroverted person.  I feel so grateful that I get to still see my patients, you know, and that we were able to stay open through the pandemic.  I’d go crazy sitting at home by myself.  And I know that so many people feel that way.  Especially with birth, bringing children into this world.  We always say it takes a village, and that community and village is nonexistent right now, and that breaks my heart because I think that’s something that we don’t talk about as a society enough.  It’s the social and emotional impacts of the stress and not being able to have that sense of community.

Kristin:  Exactly.  And we have so many people who are not originally from Grand Rapids that even, you know, taking the COVID factor of isolation away, if they’re new to the community, it’s like they need that sense of support.  And going to some of your general healthcare professionals, like a chiropractor during pregnancy, can create some of that community.  Even the virtual classes that we teach, we’ve had students exchange emails and wanting to go on walks, safely distanced with masks, and find a way to connect with people who are going through the same exact thing.

Dr. Annie:  Yeah, I think that’s incredible.  We had two families come in kind of back to back in our office last week, and it was so cute because they we both kids and they both, like, went and grabbed toys and kind of played six feet apart but were shouting back and forth to each other.  Kids need that, too.  They need that sense of community.  We’re social beings.  We have a vagus nerve, and that is, you know, that’s our brake pedal.  That’s a lot of our parasympathetic activities in our bodies, and that is all — you know, we need that social engage to help with our stress, too.

Kristin:  Yeah, what was that study — I saw an article about the number of hugs the average human is supposed to receive in a day, and it’s surprisingly high, like 12 or 13, from what I recall.

Dr. Annie:  Yeah, but with kids, it’s in the 60s or something like that.  Yeah.  That’s all polyvagal theory.  That’s how we socialize and how we — that touch and human interaction is so important.

Kristin:  Yes!  Getting back to the topic of stress and pregnancy and COVID, what tips do you have for our listeners to reduce stress and what resources to you recommend connecting them with?

Dr. Annie:  Yeah.  Anything that we think of, just kind of generally, if we’re reducing stress.  Like, we often think of yoga, medication, deep breathing, those kinds of things.  Those are all good because they help stimulate that parasympathetic side of our nervous system, which is like our rest and digest — like I said earlier, it’s our brake pedal.  If we think of sympathetic, our flight or flight, as our gas pedal; it’s like the go-go-go.  We’re being chased by a tiger.  Our parasympathetics are to unwind, be able to sleep at night, that kind of stuff.  Digest our food; that’s all normal parasympathetic activity.  So anything that we think of as stress-relieving — deep breathing, all of that — helps stimulate our vagus nerve, and that is our brake pedal, so that stimulates our parasympathetic activity in our bodies.  So, like I said, yoga, deep breathing, all that stuff is really good.  Chiropractic care is super important about maintaining that balance, too, between our sympathetic and parasympathetic activity, and that’s one of the reasons that we measure heartrate variability in our office is so that we can, again, make sure that people’s stress resiliency is changing.  Other things, I mean, having that sense of community.  It feels like we’re so busy, even though our time is spent mostly at home.

Kristin:  Right.  I feel that, for sure!

Dr. Annie:  Making time for Zoom calls with friends, phone calls, Facetime, that kind of stuff, maintaining that sense of community and friendship is so, so important.  I can’t tell you the number of the people that come in and say something like, I just had a two-hour phone call with my best friend, and after that call, I just felt so much better.  I felt awake and alive and felt rejuvenated afterwards.  That’s because we need that social interaction.  We have community and friends for a reason.  Even though it feels a little inconvenient or it feels like — I don’t know; I get in ruts where it feels more stressful to set time aside to have a call or something like that, but I always feel so much better afterwards.

Kristin:  As an entrepreneur, there’s always work to do, so to carve out that time does seem like a lot, but it’s worth it.  I totally agree.

Dr. Annie:  And having conversations with people.  It’s all — it’s so good.

Kristin:  Especially when — I mean, again, you’re pregnant; you’re isolated; you’re trying to hear positive birth stories and surround yourself with people who support you and your baby, so yeah, finding a way to connect and to move your body, as we talked about; yoga or walking.  Just connecting with nature in some way, even though it’s cold; finding ways to move versus being stuck at a desk all day.

Dr. Annie:  Exactly.  All of that is super beneficial.  And, I mean, we’ve been telling our moms, you know, if you take some kind of online birth class, try to meet other moms.  Especially with first-time moms, they need to bounce ideas and, like you said, hear positive birth stories.

Kristin:  Exactly.

Dr. Annie:  With other women that are going through the same things that they are because there’s a lot that’s not talked about with pregnancy, just kind of in general, until you get into a conversation with a mom and they’re like, oh, yeah, you know, I get vagina lightning.  Where it’s like, I didn’t know that — I thought that was just me.

Kristin:  Yeah.  The things your friends don’t tell you.  Yeah.  Unless you’re in a class where it’s openly discussed or in some sort of a mom’s group, but yeah, it’s not anything that my friends ever passed on to me, and most of them had kids before I did.

Dr. Annie:  Well, and some of the things, you don’t think about until somebody’s like, you know, this has been hurting me a lot; have you had this?  Have you felt this?

Kristin:  Right.  So how can our listeners connect with you, first of all?  My second question would be, how can they find a Webster-certified chiropractor in their area?

Dr. Annie:  Good call.  We’re based in Eastown in Grand Rapids, West Michigan.  We have a website or you can find us on Facebook and Instagram at Risewellnesschiro.  They can find us that way.  We schedule people over Instagram and social media.

Kristin:  Yeah, you’re very active on social media, so people can message you and reach out if they don’t directly contact you at your website.

Dr. Annie:  Yep.  We also have our email addresses and stuff on all of those things.  Everything is interrelated, so — and it will be Rachel, my partner, or I reaching back out to you.  Even if you just have questions about general pregnancy stuff, too, if you’re having trouble finding a chiropractor in your area, we’re more than happy to help with that, too.  The best way that I would say to find a Webster certified chiropractor if you don’t live in West Michigan or if you don’t live in Grand Rapids — West Michigan is huge — is to go to the ICPA website.  That’s the International Chiropractic Pediatrics Association.  That’s who I’m certified through.  That’s who does the Webster does the Webster certification, and actually, it was all started by Larry Webster.  On their website, the very top link is to find a chiropractor near you, so you just type in your ZIP code and it will take you to the search.

Kristin:  So helpful!  Thank you.  We appreciate your time today, Dr. Annie, and I hope we can chat again soon in person!

Dr. Annie:  I hope so, too.  I miss seeing you guys.

Kristin:  We miss you, too!  Take care!

Author Lily Nichols talks to Kristin about gestational diabetes during pregnancy and how eating has such a profound impact on our health and energy levels.  You can listen to this complete podcast episode on iTunes or SoundCloud.  Be sure to check out Lily’s book!

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hi, Lily!

Lily:  Hello!  How are you?

Kristin:  Great!  How are you?

Lily:  Doing well.

Kristin:  I’m excited to have you join us !

Lily:  Yeah, happy to be here!

Kristin:  So I would love to, first of all, introduce your background to our listeners and then hear what you’ve been up to since we last connected.  So for those of you who aren’t familiar with Lily’s work, Lily Nichols is a registered dietician, a specialist in prenatal nutrition, and best-selling author of the Real Food for Gestational Diabetes book, as well as Real Food for Pregnancy.

Lily:  Yeah.  I think you kind of summed it up really briefly.  As you gather from the title of my books, my focus is very much on how we can use real food and nutrition to optimize pregnancy outcomes.  So, you know, it’s right in the title of the books, right?  So I’m happy to chat more about and any questions you have about my background, of course.

Kristin:  So I’d love to know how you got into this line of work as a dietician, and then what you’re working on now outside of the books you’ve put out in the past.

Lily:  Yeah.  Well, I got into this work in a way a little bit by accident.  I mean, I think things always end up working out the way they’re meant to, but regarding how I got specifically into the prenatal side of things, it was a bit happenstance, that there was an opportunity to work with the California Diabetes in Pregnancy program, which is a state-funded organization that helps put out guidelines on diagnosing and treating gestational diabetes.  And California tends to be a bit progressive, and so their guidelines are also generally pretty progressive, although I’d say mine are a bit more so now.  But in terms of diagnosis, for sure, they are much more progressive than what the rest of the United States follows.  So I’ve worked with them.  I’ve worked with a number of different clinicians, including perinatologists who specialize in gestational diabetes, so a lot of clinical work on top of the public policy work, which then just sort of naturally led into training other professionals on managing and treating gestational diabetes.  And it’s kind of – you know, this work, from seeing it from all different angles and getting pulled into different, you know, research projects, it just kind of snowballed into the focus of my career, and particularly, I’d say my clinical work, where I was able to see, you know, how well do the nutrition guidelines work in real life versus how they proclaim to work on paper was much different than I had anticipated, and that ultimately led me to really investigate, you know, how our nutrition recommendations were set.  Like, what’s the strength of the evidence used to set those guidelines, and how can we do better?  And ultimately, that’s really the reason that my books exist.  If there was no issues with the guidelines, I wouldn’t write books.  I mean, I write them because I take a very critical look at them and personally find that the evidence, particularly the new research from the past 20 years, has very much expanded our understanding of both pregnancy guidelines as a whole but also blood sugar management in pregnancy.  And we can just do so much better and have so much better outcomes if we really put that evidence into practice.

Kristin:  Well, I am so thankful that you put those books out into the world.  My clients appreciate – I refer all of my clients to your books, so it has been very helpful to have you as a resource.  So for those of our audience members who do not understand the difference between gestational diabetes and type 1 and type 2, could you give us a quick rundown of the differences?

Lily:  Sure.  Yeah.  So gestational diabetes is diabetes that either first develops or is first recognized during pregnancy, which is a bit of a nebulous definition because it can also encompass undiagnosed diabetes that was going on preconception or undiagnosed prediabetes that was going on preconception that we’re just identifying because during pregnancy we actually are checking your blood sugar, right?  But I think the classical definition, which I think is being challenged a lot, is that it’s something that just develops during pregnancy.  It is solely a response of the weight gain, placenta changes, changes in how your body responds to and produces insulin, that makes your blood sugar higher than would be expected and more difficult to manage.  I think we’re seeing now in the research that actually quite a large proportion of the cases are actually undiagnosed prediabetes that we’re just identifying the blood sugar issue during pregnancy, which makes sense because there’s been an absolute, exponential rise in gestational diabetes in the past 20 years or so, where now it’s affecting in some populations up to 22% of pregnancies.  Pretty sure I quote an 18%.  That was a bit on the higher end from back then, but I think I quote 18% in my book, and some other sources will say it’s only 5% of pregnancies.  But it has absolutely been on the rise as we’re seeing other forms of diabetes population-wide also on the rise.  As far as how it differs from other types of diabetes, now that I’ve probably confused everybody, when you’re looking at type 2 diabetes, that is a form of diabetes that at least historically developed in adulthood, and it’s essentially your body becomes unresponsive or less responsive to insulin, a hormone that helps you manage your blood sugar, and it can progress to the point where you produce less and less insulin over time and made need supplemental insulin or medication to manage it.  However, it can also often be well-managed or at least co-managed with nutrition and lifestyle.  With type 1 diabetes, that is an autoimmune condition where your pancreas stops producing insulin or produces very, very little, to the point that you will absolutely require supplemental insulin.  So, like, insulin shots to manage your blood sugar, and that is a lifelong condition.  It’s not something that is reversable, whereas with type 2, if you catch it early enough, sometimes it actually can be.  It’s arguable to call it reversable, but it can be, like, managed to the point that your blood sugar is normal.  So is that reversal or what?  I don’t know.  But with type 1, it is something you live with for the rest of your life, and so it’s a much more challenging one to manage because you’re trying to, like, mimic a functional pancreas in your dosages of insulin, and it takes a lot more careful management.  But absolutely can also be well-managed, and there’s many people living with type 1 diabetes to show that that is the case.

Kristin:  And then for gestational diabetes, most of the time but not all, it goes away after delivering baby, correct?

Lily:  Yeah.  So in about 90% of cases, blood sugar will normalize postpartum, at least early postpartum.  However, that can almost be kind of like a honeymoon period because there is a lifetime higher risk of developing type 2 diabetes.  They call it converted to type 2 diabetes, actually.  So in about 30 to 70% of cases, type 2 diabetes will ensue in the coming 5 to 10 years after delivery.  So it is the strongest independent risk factor for developing type 2 diabetes in women that we know of, is having gestational diabetes in pregnancy.  Now, to make – of course, that sounds very doom and gloom.  But I’m always flipping it to the positive, which is that it can absolutely be prevented, as well.  I see gestational diabetes as, like, the warning light coming in on your car.  It’s like pregnancy is a stress test on your system.  Your pancreas is required to produce double or triple, sometimes even more, insulin.  You’re naturally dealing with an insulin-resistant state of pregnancy, and so it’s like, can your body, like, step up to the challenge, right?  And so if your blood sugar is becoming more difficult to manage in pregnancy, it’s actually a sign that probably you want to keep an eye on this for the rest of your life.  It’s like, okay.  There’s a bit of a weak link in my blood sugar management, and I should keep an eye on this.  And if you do keep an eye on it, in many cases, it can be sort of – you can prevent it from actually progressing to type 2 diabetes.  Like, let’s be kind to your pancreas.  Be kind to your blood sugar management system.  Oftentimes, if you can continue with the same diet and lifestyle things that helped you during pregnancy – again, it depends on when you’re actually catching this.  Like, have you been insulin-resistant for, like, 15 years before getting pregnancy, or is it literally something that developed, like, right before or during pregnancy?  Like, depending on when you’re catching it, oftentimes it can be managed and in many cases prevent that conversion to type 2 diabetes.  So I always like to throw that out there because I think people see gestational diabetes as, like, this – just a very, you know, stressful and – it’s a stressful diagnosis, right?  Since I’ve worked one on one with hundreds and hundreds of clients, I mean, you know, even as the clinician, how you approach the topic with your clients can impact how they see the diagnosis.  And it’s like, okay, we want to, yes, take this seriously and talk about how blood sugar management can impact your pregnancy outcomes and your experience of pregnancy, but we also don’t want to scare you to the point that it seems like, oh my gosh, no matter what I do, this is horrible.  And that’s actually not the case.  And a lot of times, I do hear from people that there’s a bit of a silver lining to it.  You know, wow, I had no idea that food impacted me in this way, and when I eat for better blood sugar readings, I also have so much better energy.  And I’m not, like, gaining weight as rapidly, speaking of during pregnancy, as I was before.  And I no longer have that swelling in my ankles that was going on.  Like, you just feel better, and sometimes that’s motivation enough to continue these things long-term.  And you do continue to reap the benefits well beyond post-pregnancy.

Hey.  Alyssa here.  I just wanted to hop on real quick and let everyone know about a really exciting new course that Kristin and I have been working on called Becoming.  It’s all about becoming a mother, and in six weeks online, we will be giving video lessons and live coaching calls weekly with Kristin and I, along with a private Facebook community to offer encouragement and support.  This six-week online class will actually be launching beta, which is our first launch, on March 22, with our live call on March 26.  You can get into this beta program at a really, really super reduced price.  So check us out!  We’d love to have you join us and learn all about pregnancy, birth, and early parenting and especially during this scary time of COVID.  Let us be your expert guides!  We hope to see you there!

Kristin:  So I have a client I’m working with who is about to have her glucola test, and she is very nervous.  And, you know, she’s got a healthy pregnancy, but as you said, it’s stressful.  You know, the potential diagnosis can cause stress, and during COVID, you know, women are facing so much stress as it is.  So what advice do you have for her going into her test?

Lily:  Well, there’s not a whole lot you can really do going into the test.  I give a few notes, which is, pay attention to, like, the type of the test that you’re doing.  So there’s different ways that the glucola is done.  In some countries, and in California, which may as well be its own country, I guess, they do a 75-gram glucose tolerance test that is performed fasting.  So if your doctor says, like, come in fasting, absolutely, come in fasting because that will make or break the accuracy of the test.  There are other ways of doing the test, and this is most of the rest of the United States and rarely in other parts of the world, where they do, like, a two-step method where you come in for a smaller glucola or glucose tolerance test, and then if you don’t pass that screening test or challenge test, they sometimes call it, you’ll come back for a three-hour test with a larger amount of glucose.

Kristin:  And that’s what we’re seeing in Michigan.  Yes.

Lily:  Right.  So that first step, the 50-gram glucose challenge or glucose screening, is generally not performed fasting.  So they don’t check your blood sugar before.  They only check it one hour after you’ve had your drink.  So you don’t need to come in fasting, but I would just caution people to not show up, like, immediately after having a large lunch or immediately after having a smoothie or candy in the car.  I mean, I’ve had people come up with false positives on that test because they came in right after lunch.  And if you come in on a full stomach, you are – already, your blood sugar is at its peak, and now you’re going to add insult to injury, so to speak, by adding 50 grams of sugar on top of that?  Yeah.  Your reading is probably going to come back high.  Part of the reason they do this two-step thing and that they don’t perform it fasting is that they just want to lower as many barriers as possible to actually getting people in to do the test.  However, it can result in false positives and sure, you do the three-hour screening that’s fasted afterwards; however, you have all that stress in the interim of, oh my God, do I or don’t I have it?  Which is why many people have been moving towards just doing this single-step 75-gram test which is fasted.  It’s just a bit more of control over your test.  So I’d throw that out there.  Like, don’t have a bunch of sweets right before you come in, and don’t come in immediately after a meal.  Come in, do your test two hours or so after eating, and if you’re hungry in between, have some sort of a protein snack like some nuts or something or some cheese, just so you’re not already starting your test with elevated blood sugar.  The second thing I would say is, if you err on the low carb side of things, so if you happen to just naturally eat a low-carb diet, you might consider increasing your carbohydrate intake in the week prior to the test for people who consistently eat below about 150 grams of carbohydrates per day.  You can also get a false positive on the test.  And speaking as somebody who falls into that category, that actually happened to me in my first pregnancy.  So I wrote all about it on the blog.  I was one point over, but still.  It’s important for people to know, and I was kind of doing that a bit on purpose.  You know, we’ve known since the 1960s at least that if you restrict carbohydrate intake prior to a glucose test, your pancreas is not adapted to pumping out large boluses of insulin at a time to lower a huge spike in your blood sugar very rapidly.  It’s just become adapted to pumping out just very small, tiny amounts, just sort of pulsing out small amounts of insulin as needed over the day, not huge amounts.  You give those same people a high carb diet for a week prior to a glucose test, and their body adapts, assuming they don’t have diabetes, and you don’t have that issue.  You don’t have the false positives.  So the same is true with general population and pregnancy, as well.  If you eat low carb, your body’s just not adapted to that at this moment.  Now, if you’re somebody who always eats high carb, you should have no issues passing the glucose test.  You know, unless there’s obviously an issue with your blood sugar management.  But for people who are low carb, you know, if your body has the capacity to adapt to it, then you will know if you eat high carb in the week prior to the test.  That should eliminate your concern about a false positive for the most part.  So I always do mention that because the guidance on eating more carbs prior to a glucose tolerance test was eliminated, I believe, in the 90s, and that’s because most people are already eating well over 200 grams or more of carbohydrates per day because that’s what our dietary guidelines tell us to do, and we really didn’t need people eating more bread and more juice and more cereal prior to doing these tests.  But for people who – now that keto and low carb are a little more popular, it has returned to being important to at least mention that.

Kristin:  Yes, that’s very helpful.  So for our listeners and clients who do test positive for gestational diabetes, what tips do you have for nutritional management?

Lily:  So first things first is, you know, everybody’s body responds to food differently.  So there are some rules that would apply to anybody in that the way our body processes carbohydrates versus protein versus fat and how those impact blood sugar.  There’s some constants there, right?  But as far as the absolute details and how much of all of those foods you can consume and expect a certain blood sugar reading, that actually comes down to you testing your own blood sugar and fine-tuning your diet in response to what you’re seeing in your post-meal blood sugar readings.  So the most important thing is that you get a blood sugar meter and start testing to see where you’re at.  Otherwise, we have really – we’re flying blind.  So I can give general guidance, but until you have those blood sugar readings, it can be a bit challenging to know for sure what you should be doing.  Now, of course, generally speaking, it is very helpful to understand that certain foods raise your blood sugar more than others.  So carbohydrates are the foods that break down into individual sugars in your body and then raise your blood sugar or your blood glucose, whereas protein and fat do not necessarily raise your blood sugar.  There are some nit-picky details and exceptions to the rule, but generally, protein and fat just keep your blood sugar stable but they don’t spike it like carbohydrates do.  So the key with understanding this, and I do this is Real Food for Gestational Diabetes, is I just break it down: these foods raise your blood sugar.  These foods don’t.  And so focus on not going overboard on the foods that do spike your blood sugar.  So your carbohydrates are your grains and starches, potatoes, sweet potatoes, fruit.  Milk and yogurt will have a little bit of carbohydrates.  Of course, they’re also balanced with some fat and protein.  And legumes – again, they have carbohydrates.  They also have protein.  They have fiber.  So they’re a bit of a better source.  But we’re usually looking at grains, starches, fruits, anything with sugar, would be your main things that you want to be like, okay, let me just tap the brakes a little bit on those foods, and when I do consume them, consume them in a reasonable quantity in combination with foods that don’t spike my blood sugar.  So your protein-containing foods and fat-containing foods would fall into that category.  And that basic understanding of just splitting up foods into elevates your blood sugar / does not elevate your blood sugar can be really, really helpful for people to just simplify things.  I call it no naked carbs.  So don’t have your carbohydrates solo by themselves because you’ll get a larger spike in your blood sugar than if you combined that carbohydrate-containing food with some fat and protein.  So a perfect example of this is an apple, which is of course a healthy, whole food, right?  However, an apple is primarily carbohydrates.  Sure, it has some fiber, and that helps blunt your blood sugar spike a bit compared to apple juice, for example.  However, if you were that apple, again in its whole form would be ideal, right, versus juice – if you combine it with something that has fat and protein, like, say, some almond butter or peanut butter, you’re going to significantly blunt your blood sugar response to that food, so your blood sugar won’t spike as high, which means your pancreas doesn’t have to pump out as much insulin, either, to match it.  And when you don’t spike as high, it’s kind of like a roller coaster.  You don’t drop as low.  And this is very helpful for managing your hunger and cravings, as well as your blood sugar.  So that would be my main recommendation.  And then you can fine-tune the amount of carbohydrates you can get away with by checking your blood sugar after you eat and seeing where you’re at.  Are you falling within range?  Are you coming in a bit above range?  And that can help you fine-tune things.

Kristin:  And do you recommend that our listeners find a dietician to work with, or can they manage this, again, based on how their levels are on their own?

Lily: I mean, in an ideal world, I think it is helpful to work with a dietician or diabetes educator or any clinician who has a lot of experience with gestational diabetes because there’s just so much nuance to it.  I mean, coming down to even how you check your blood sugar, you know, you can mess that up.  You use a soap that has sugar-containing ingredients.  There’s all sorts of gluco-ingredients in soaps and lotions and things.

Kristin:  I didn’t even think of that.

Lily:  Yeah.  I mean, it happened to me.  You understand a lot when you do things firsthand, so I’ve been a bit of a guinea pig on myself.  I had seen this with clients before, as well, and you do – you know, as a certified diabetes educator, you do learn about all this stuff, as well, but you see it in real life when people are like, but I only had XYZ food, which doesn’t spike me, but my blood sugar came out 20 points higher than it should!  First of all, you have people, if they get an unexpected high reading, wash their hands again, test again to just try to verify if it’s accurate, because meters are not perfect.  But there can be so many things.  You can have a meter that is not super accurate, and sadly, there are some brands of meters that aren’t super accurate because their tolerance for variance is based on type 2 diabetes levels, where with gestational diabetes, you’re expected to keep your blood sugar in a much narrower range.  So if you have a meter that is reading 10% higher, if you’re a 50-year-old man with type 2 diabetes and you only have to keep your blood sugar under 140 or you’re aiming for 180 or something – sometimes the ranges are much more liberal, depending on who you’re working with – that’s no big deal.  But if you have gestational diabetes and you’re trying to keep your blood sugar below, say, 120 after meals, than a 10% variance in the wrong direction is a big problem.  So sometimes it comes down to, is your meter accurate?  Are you test strips expired or not?  Are you cleaning your hands properly before testing?  So I gave you the example of soap, but say you just had an orange, and you have a bit of orange juice left on your finger.  That will read as sugar on a blood sugar test.  So you prick your finger, squeeze out a little drop of blood, test, and it comes out unusually high.  That can be a problem.  So some of this nit-picky little stuff, it can be helpful to have somebody there to guide you so it’s a little less scary.  And especially in those first two weeks after diagnosis, I think that’s when it’s the most raw and the most concerning and the most “I don’t know what I’m doing.”  So if it is possible to get a referral from your provider, you can do that.  I have a free video series on gestational diabetes on my website.  Of course, my book, Real Food for Gestational Diabetes, does walk you through this, and I intentionally wrote that book with as simple language as possible to just kind of cut through all the noise so you can focus on what actually matters and not get distracted by a bunch of extraneous details, so that can certainly be helpful.  But there is always, I think, a time and a place for one on one guidance on this if you can get it.  So I’ll throw that out there.  There are, I know, people who just don’t have necessarily those types of providers or providers who maybe are up to date on some of the nutrition information that I give out, so they might go to a dietician and get really not fantastic dietary advice, like very high carbohydrate diet.  I mean, that’s the reason I had to write my book, because the current guidelines are just so far off from what actually works that, you know, I do have my book available.  I also have a paid online course.  We have a private Facebook group where people can ask questions of me directly and get support from other members.  I try to have as many options from free to, you can get the e-book for 10 bucks to a course to just give you as many options as possible because I want to meet everyone where they’re at.

Kristin:  So what is your advice as far as minerals and supplements with gestational diabetes?

Lily:  Like, which specific minerals?

Kristin:  So just looking at if they’re adding supplements to their diet.  What is good?  What isn’t?  You know, outside of the prenatal vitamin that they’re taking.  Should they be doing anything different once they’ve received the diagnosis?

Lily:  Gotcha.  So as far as supplements, I mean, I do think for most people it makes sense to be on a prenatal vitamin.  I would check, if you’re having a screening for anemia, check to see if you actually need the iron because sometimes too much iron can be a bit inflammatory and create more blood sugar issues.  So check for anemia before you jump for a prenatal that includes iron.  You might want to opt for an iron-free one.   I am just much more of a fan of people getting their iron from food that has all of the complementary co-factors for you to use it.  The type in most prenatals on the market, unfortunately, is just not super well-absorbed and sometimes kind of adds fuel to the inflammatory fire.  As far as additional supplements, we often find magnesium deficiency is more common when there’s blood sugar issues present, so that as a supplement, I think, is very helpful.  Minerals usually are more bulky ingredients for prenatal supplements, so most of them, unless it’s like a multiple capsules per day kind of a formula, just do not have very much minerals at all.  So somewhere between 150 to 300mg of magnesium a day can be really helpful.  Magnesium glycinate is the form that I often recommend.  The glycinate means the magnesium is bound to an amino acid called glycine, which has its own beneficial effects on blood sugar management, and it’s also just very well-absorbed, so you don’t have this GI distress, diarrhea sort of reaction that some people get to magnesium supplements, especially when they’re high-dose.  You can also do a foot soak or a warm bath with Epsom salts in it, and you absorb the magnesium through your skin that way, so that’s always helpful.  Another one would be vitamin D.  A lot of prenatals do not include enough vitamin D.  I just put out a blog post about vitamin D in pregnancy on my blog if people want to read that for more.  But much of the research surrounding that nutrient in pregnancy shows that you need actually up to 10 times more than what the current recommendation for vitamin D is.   So I do recommend, if you do not live in a southern, sunny climate where you get lots of sun exposure without sunscreen on, on a regular basis, which is much of the country that’s not possible, then I do recommend supplemental vitamin D.  And so looking at how much your prenatal has and trying to get around 4,000 IUs per day can be really helpful.  We actually have research studies showing that vitamin D deficiency is more common in gestational diabetes, but also the more severe the vitamin D deficiency, the worse blood sugar readings tend to be, and actually that if you supplement it and correct vitamin D deficiency, the blood sugar readings improve.  Same goes for magnesium, by the way.  And then I’ll add just one more.  I mean, there’s other supplements that could be helpful in pregnancy, but specifically for the blood sugar conversation, another nutrient we’re getting a lot more data on is inositol, which is a B vitamin-like compound.  It’s actually used pretty often in fertility and PCOS, which the majority of PCOS cases have some component of insulin-resistance, and it’s actually a risk factor for the development of gestational diabetes.  So we have all of this positive research on inositol for PCOS and for infertility.  We’re now having studies done on inositol for pregnancy and specifically diabetes in pregnancy, showing pretty positive results.  And so they typically do a dosage of 4 grams, which is also 4000 milligrams per day, of myo-inositol.  So that’s something that you can discuss with your provider.  We have a couple studies now on fasting blood sugar and other markers of insulin resistance.  It’s a very safe supplement, very safe.  There has been absolutely no animal or human studies indicating any sort of toxicity in pregnancy including in the very delicate stages of embryogenesis in really early pregnancy, so that’s really reassuring.  If anything, it’s really been overwhelmingly all positive.  So I do throw that one out there because that’s probably one of the more promising and more well-researched nutrients that can impact blood sugar.  You can go on – I can probably list, like, a dozen more nutrients that also impact blood sugar, and the hope is that most of those would be covered by your food intake and also your prenatal, but you can get kind of nitty-gritty on all this stuff if you really want to.

Kristin:  Sure.  So I’d love to hear – this has been very helpful.  Love to hear any last tips that you have for our listeners, and that could be anything from, again, managing gestational diabetes to stress management to postpartum care.

Lily: Oh, gosh, you give me a lot of good leads to go on with that.

Kristin:  So wherever you’d like to go with that!

Lily:  Well, maybe I’ll give a little nod to stress for a minute, and then I probably have to talk postpartum, as well.  So stress is an underrecognized factor that plays a role in your blood sugar.  So your body has a very real physiological response to stress or perceived stress that often makes your blood sugar go up.  So I think its easy as practitioners for us to just sort of dismiss stress and just focus on the knowns of food and movement and exercise, things like that.  But you absolutely see a really significant response to stress, whether that’s personal work stress or even if it’s immune stress.  If you get a cold, your body is under stress, and your blood sugar is elevated as a response.  You see it firsthand for anyone who has worn a continuous glucose monitor, which is probably not many people listening.  But I know I have, if I have a stressful phone call, and a continuous glucose monitor, you can get real-time readings on your blood sugar, and it graphs out your 24-hour blood sugar readings on a chart.  You can see it.  Like, whoa.  My blood sugar spiked 10 points and remained elevated for 30 minutes as a response to that stressful interpersonal interaction.  So anything you can do to just kind of stay calm and even-keeled is absolutely also helpful for your blood sugar.  I don’t think we can discount that.  And then to just give a quick note on postpartum, I’m just such an advocate for a nourished and slow postpartum, and I think it’s really hard as a first-time mom to, you know, even imagine or put much focus on postpartum because it’s all about the big event of birth.  And I know I fell victim to that, as well, my first time around.  I probably should have read a book on postpartum or something.  But you’re so focused on birth.  How can I create the best birth?  I want it to go like this.  Birth is like, at best, you know, it can be a couple hours.  It can be maybe a couple days depending on the circumstances.  But postpartum is a very long period of time, and I think our culture sees it maybe as a couple weeks, up to six weeks, right?  That’s when you go back to your provider and get a check-up to see that you healed okay.  But it is much more than two weeks or six weeks.  It is kind of a long haul healing process.  And a lot of our western society doesn’t really – we’ve lost touch with our postpartum traditions, where many other places in the world still have those intact, and there is extra attention to care and nutrition and other people coming in to care for the new mother, especially in the first month to six weeks.  It’s often 40 days.  And if you do that, having really been intentional about postpartum my second time around – it’s not that I didn’t have a good postpartum the first time.  I felt like I did pretty well, all things considered.  The second time was just so much more easeful.  Like, just everything about it was so much better because I prepared for postpartum.  I prepared meals in the freezer.  I had my mom come up and stay with us.  I really tried to embody and bring in as many of those practices that these other cultures – I mean, it’s so strange.  You go all across the world, and they’re very similar.  You know, like, how do they all – it’s all like similar types of foods with broths and stews and warming foods and teas.  And it’s the same amount of time.  It’s the same, bringing in other women, especially older women who are mothers or grandmothers themselves to care for you.  It’s like, how is it the same in Mexico as it is in the Middle East as it is in China as it is in Indonesia as it is in Mexico and Brazil and Africa?  How is it the same?  It’s all, like, very, very similar.  I think we have to give some credence to, there’s some wisdom there that we should honor.

Kristin:  There certainly is.  Mothering the mother is definitely something that is ignored in the US, and other cultures embrace it.  That’s why our postpartum doulas do not just work within the first 30 to 40 days.  We work with families through the first year.

Lily:  Oh, that’s fantastic.  Yes.  Yes.  Because often you come out of those first three months a bit in a fog, and you’re expecting it to be easier.  And a lot of things are easier.  Things are less intense, but it’s also still hard.  It’s still a lot.  You know, it continues to be a lot.  I have an 18-month old now, my second, and it continues to be a lot long-term.  It gradually does get easier, but just building in the expectation of having help and having support and having that extra focus on nourishment goes a really long way.  So I think I do a better job in my second book, Real Food for Pregnancy, of really emphasizing the postpartum part.  I snuck in a whole long chapter on it because I started writing that book when I was 10 months out with my first.  Whoa, postpartum is important!  I’m going to put it in a pregnancy book because I know I didn’t seek out – as proactive as I am, I didn’t seek out that information when I was pregnant, and I really should have.  So, here.  I’ll throw it into this book.

Kristin:  I love that chapter!  I’m so glad you included it, so thank you.  So how can our listeners and doula clients find you and your books?  I’d love to – all of the different ways you mentioned, videos and one-on-one courses.  Share all of the ways we can connect with you, please, Lily.

Lily:  Sure.  So you can find me on my main website.  That has my blog.  It links out to my books and where you can find those.  It has a lot of different freebies, so you can download the first chapter of Real Food for Pregnancy for free.  You can check out the free video series on gestational diabetes.  There’s a couple others up there.  So that’s kind of the main hub.  As far as courses – at the moment, I’m not seeing one-on-one clients, but I am still supporting course participants in the Real Food for Gestational Diabetes course.  And that’s fully online, and we also, like I said, have a private Facebook group.  So I do office hours in there every week.  Lots of questions on, especially, fasting blood sugar.  So I go into depth on that.  I have a bunch of bonus presentations included in the course.  I just kind of keep adding on to it.  I’ve been running it since 2015.  There was no course on gestational diabetes out there at the time.  I don’t really know if there’s any others, actually.  I haven’t looked.

Kristin:  I don’t know of any, so – there could be, but…

Lily:  Yeah.  Especially on the client level.  I think there’s some on just teaching practitioners sort of the basics on it, and I do, by the way, have a webinar on that over at the Women’s Health Nutrition Academy.  But as far as supporting clients directly, that’s definitely the place to go.  I have a – just did a big presentation on postpartum recovery after gestational diabetes, so lots on this, concerns about type 2 diabetes and when to get screened and what to do, a bunch of information on that.  I have advanced training on lowering fasting blood sugar with food and lifestyle tips.  There’s a lot of things in there that I just really don’t include anywhere else in my work, so that is really geared directly for clients themselves, although I do have a couple health practitioners that sneak their way into the doors.  As far as – let’s see.  Social media, I am most active these days, although not incredibly active, on Instagram, and my handle is the same as my website.  So it’s @lilynicholsrdn.  And I’m about to launch my own online bookshop.  My books are available on Amazon and many different bookstores.  However, I’m also going to be selling, at least Real Food for Pregnancy, direct from my own site.  So if people want to purchase that, for paperback purchases, we’ll be shipping to the US, and every paperback purchased will come with a free copy of a new e-cookbook that I’m putting out that has 30 recipes following all the principles I outline in my books, but they’re not found in my books.  So 30 new recipes out there.  That will be your – it’s available for purchase separately, but as a thank-you for people who go out of their way to purchase a paperback copy from me directly, I’ll be bundling in that e-cookbook for free, as well.  So that should be launching soon, early March.  So you can check that out.

Kristin:  Fantastic.  Well, thank you for joining us today!  Appreciate your time, Lily!

Lily:  Thank you so much!

Thanks for listening to Ask the Doulas.  If you like this podcast, please subscribe and give us a 5-star review.  Thank you.  Remember, these moments are golden.

 

Today Amber Brant of The Coziness Consultant talks with Alyssa about how new moms can create a calm space in their homes in the midst of chaos.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Alyssa:  Hi, Amber.  Good to see you!

Amber:   Hi!  Good to see you, too!

Alyssa:  Zoom glitches and all, great to see you!

Amber:   I know.  Third time’s a charm, right?

Alyssa:  Yes.  I know.  We’re going to roll with this, and I think people understand now that Zoom is not perfect.  So we wanted to talk a little bit today about creating a calm space.  You wrote a piece for our newsletter last month that was about the importance of having a proper environment, a calm environment, especially, for parents and especially for new moms with little babies at home.  Why don’t you first tell people, Amber, about The Coziness Consultant, because that’s what you do, and then it will tell them why I’m talking to you about this topic.

Amber:   So a few years ago – well, it’s been six or so years ago now – when we bought our house, people would come over, and every time they would walk in, they would say, oh, this is so cozy!  When I buy a house, can you help me?  And it was one of those things that, you know, after I heard it for so long, it almost got comical, where people would come to visit us for the first time, and before they’d open their mouth, I would look at Kyle, my husband, and we would just laugh because it was like, oh, they’re going to say it again!  One of those things where it was like, gosh, you know, one day – maybe there’s something to this.  And so I started pursuing helping people interior decorate on the side and then ended up getting certification for it and really pursuing what I have called myself, the business, The Coziness Consultant.  It’s a little different than a lot of people who do interior design or interior decorating because, obviously, people want their homes to be beautiful, and I want to help them get the style, the aesthetic that they’re going for, but I also really believe that our spaces should reflect who we are and our values, but they should also help us live the best that we can in whatever stage of life we’re in.  So it’s about helping people think really intuitively and intentionally about how they use their space and how they want to use their space or, you know, if they have small children, what’s practical and helps them be able to keep toys under control or keep furniture clean or whatever.  How do they achieve, you know, living well in their space now, and then how does that sort of age with them?  And kind of helping steer them right toward the correct priorities and also just realizing, like, there’s just some things you can’t do at this stage of your life with your house and your family, but in a few years, you can.  And so let’s figure out how to make it the best we can right now.

Alyssa:  I think that’s great, that you probably kind of have to get to know that individual family.  How many kids do you have?  How big or small is your house?  And speaking of a new mom with a new baby, it would be really important, I think, for you to help with that space, because she’s a new mom and doesn’t necessarily know what she needs in that space.  And you, you’ve been through this before.  I’ve nursed before.  I’ve had to pump before . Like, here’s what you – you’re probably going to be able to help them create this space with the things that they don’t even know they need to organize yet.  You know, like if you were sitting there pumping, and then you realize you don’t – you’re getting ready to pump.  You’ve already gotten your shirt off.  Baby just went down for a nap, and now you realize you don’t have any clean pump accessories.  So, you know, having a spare set of pump accessories that you keep next to this station or whatever.  Things that they might not even know to think about.

Amber:   Right, or baby is super upset, and you really need to nurse.  You know, you went to the grocery store, and you were stuck out longer than you thought, and you get home and, you know, baby’s upset and you – yeah.  You’re scrambling.  You get your coat off and you get ready, and you have no nursing pillow or no nipple shields.  And I think we’ve all been there.  And no matter how well you prepare your space, you’re still going to have moments like that, but there are some really practical ways to ensure that you have what you need because all of those things, right, like any of those little stressors, they seem like little, but they can impede your letdown, or you’re emotionally so – the baby’s been upset and crying in the car, and you’re in traffic, and by the time you get home, it’s like even trying to relax enough to have a letdown to nurse – sometimes it’s hard.  And so if you can design your spaces even knowing that you’re going to have those moments that are less than ideal, at least you’ll be set up for success.  And you’ve practiced relaxing enough in these spaces and repeating this, you know, practice that hopefully you can relax and calm down.  The space can help you.

Alyssa:  I like the idea of making a space where you either nurse or pump that is almost like your calm space instead of the opposite.  We think about, oh, God, it’s time to pump again, oh, oh my God, we just nursed.  I have to go nurse you again, and I have to go to this space.  And you’re already in this negative head space, which like you said, then affects your mental wellness.  It could make it hard to have a letdown.  Babies can sense things, especially feelings, and then when your baby’s upset, it’s often harder to get them to nurse effectively, so it’s just this spiral, right?  So if you can have this calm space where you’re like, okay.  I get to dim the lights.  I know you’re really into lighting a candle; let’s light a candle, or maybe you turn the diffuser on 30 minutes before you know you have to go in, and it’s this calm space that you can enter and have a peaceful 20, 30 minutes with your baby, and look at it that way instead of it being a stressful time or a stressful space.

Amber:   One thing, too, when we’re talking about those little things that can chip away or grate at it.  I’d mentioned to you before, you know, we’ve all been in the car and there’s that one full water bottle that keeps rattling around on the floor, and you think, oh, I need to take that inside, or oh, I need to throw that away, or oh, when I get gas I’m going to throw that out.  But you don’t do it, and for, like, a week, every time you’re in the car, you’re like, oh, that water bottle!  Those are things that are small but they do just kind of stab you.  It’s annoying, and it takes away too much of your head space.  And I think not having organized pumping stations or designated space that’s a calm space where you always nurse – that’s going to have the same effect.  If it’s like every time you sit down and you’re ready to go and your nipples are sore but you’re like, oh, I don’t have the shield – those are the little annoyances that actually have a much larger impact on your psychological health, and especially when you’re hormonal and emotional, it’s hard.  Those things have a bigger toll than you realize.

Alyssa:  Yeah.  All those little minor annoyances become real big when it’s 3:00 in the morning and you’ve only gotten sleep in 90 minute chunks all night long.  Sleep deprivation can just kind of exponentially make all these things feel monumental instead of trivial.

Amber:   But I think, too, when we’re talking about that mental peace, I think – I’m really sensitive also to including moms that are exclusive pumpers because I think – you know, my daughter was born early, and she just had a really hard time.  She would latch, but she wasn’t sucking.  So I had to pump so much at the beginning.  And a few weeks in, I just felt resentful.  You know, I saw the pump as utilitarian.  It was like – I didn’t feel like it was a bonding activity as much.  And I think that’s another reason why creating kind of a repeatable practice or some of these things we’re talking about, like using your senses, your five senses, to create a space where you pump – that can help that oxytocin release and facilitate that sense of bonding a little bit more when you’re not physically breastfeeding.  I think that’s really important.  And that’s what I had written about for you, that idea of using the five senses to design your space.   And this could apply to pumping or breastfeeding, really, but kind of going through a mental checklist.  You know, if you have a space that’s not working, or you’re regularly just sitting in front of the TV to pump or nurse, or you’re in the middle of the night just scrolling on your phone while you’re nursing – if that’s working for you, it’s not really worth changing, but for the most part, I think those things make it really hard to go back to sleep afterward, and maybe you have trouble getting the letdown.  I think going through that checklist of your senses: what are you seeing?  Are you in a space where there’s a ton of clutter, or is it a cozy room that you recently painted with a fresh coat of pain or a piece of art that you love on the wall?  Is there dim lighting or is it dark?  What do you smell?  Like you said, having either a scented candle or you’re diffusing something in the air.  You know, you’re not next to the diaper pail.  What do you see?  What do you smell?  What are you touching, feeling?  Is it important to have your slippers on?  Are your feet cold, or having a cozy blanket there or a good lumbar pillow support?  You know, all of those things, I think.  And thinking about taste, too.  Is your water bottle nearby?  If you’re getting up during the night, do you need – I remember at times, like 4:00 a.m. feedings or pumps, I would have fresh fruit cut up in the fridge, and I would have a few bites of fruit or a granola bar.  And also, what are you hearing?  Is there a noise machine or silence or a little water feature?  Or maybe a medication app on your phone or relaxation.  Any of those things, if you have a space that isn’t working, I think that’s a good place to start is to check in with each of those five senses and figure out how you can make tweaks to your space to make it more calming and relaxing.

Alyssa:  Yeah.  It’s a great place to start, and some of the senses might be more triggering for others.  Like you said, is your chair right next to that diaper pail, and every time you sit down, you’re smelling dirty diapers and then you’re trying to be calm and bond with your baby?  And when you eat that food, now the food tastes gross because you’re smelling poop.  You know, and for me, smell is a big thing.  I love – to me, diffusors with the right scent is just so calming.  And obviously, you have to be sensitive with a baby, and they could have – it has to be very mild, I guess, is my point.

Amber:   Yeah.  What are your triggers, and then the flip side, what brings you joy or relaxation in your every day life, and making sure that there’s some representation of that in your pumping.  I think, too, also just being aware of your body in the space because I think, you know, like let’s say if you have a clog or you’ve been hunched over and so you’ve got that one spot in your back that always hurts or whatever.  I think we’re so inclined to think, like, oh, baby needs this.  Oh, it’s time to pump.  We’re not often aware of our own physical needs, and then we also don’t feel like there’s enough time to fix that need.  And so it gets into this space of also realizing your capacity.  For somebody who – I mean, obviously, now we have Shipt and we have options like that, if you need baby Tylenol or nipple cream.  But, yeah, anytime you sit down, you immediately remember, oh, I didn’t do that thing that I needed for my own body, or I’m out of diapers or whatever.  Having somebody that you can, say, right then text or holler out to, hey, put on the list, XYZ, we need this.  Or I need you to run to the store.  Or can you just help me?  Can you bring me an extra pillow, instead of struggling through that pumping session wishing you had that thing, advocating for yourself and taking care of and being sensitive to even those small needs that you kind of just keeping letting go unnoticed because you’ve got things to do.

Hey, Alyssa here.  I just wanted to hop on real quick and let everyone know about a really exciting new course that Kristen and I have been working on called Becoming.  It’s all about becoming a mother, and in six weeks online, we will be giving video lessons and live coaching calls weekly with Kristen and I, along with a private Facebook community to offer encouragement and support.  This six-week online class will actually be launching beta, which is our first launch, on March 22 with our live call on March 26.  You can get into this beta program at a really, really super reduced price, so check us out.  We’d love to have you join us and learn all about pregnancy, birth, and early parenting, and especially during this scary time of COVID.  Let us be your expert guides! www.thebecomingcourse.com/join.   We hope to see you there!

Alyssa:  Lists have never been so important to me until after I had a baby.  Your mind – you know, they call it pregnancy brain, but I don’t believe that.  I think it’s mom brain.  It just never goes away.  I’m always focused on, what does she need, and what do I have to do for her?  And it just changes.  You know, now she’s almost 8, and it’s what school stuff does she need?  It’s snowing out; did she grab her boots?  It’s not me.  Like, did I remember my gloves?  No, did she remember hers?

Amber:   It’s true.  I know.  And it’s that thing.  We do it in other ways, right?  Like for me, my daughter is three and a half now.  Anytime she says something funny or she’s doing a new thing, I try to grab my phone and put it in a note right then because I know two minutes from now, I’ll literally be like, oh, shoot.  What was it that she said?  And I think having that kind of attention to your child, obviously, is necessary, and once that switch is flipped in your brain, it’s like it never shuts off.  But you always are secondary for your own needs, and I think if you keep bumping up against a frustration every time you pump, or when baby gets up from a nap and you change their diaper and you’re nursing them, and you don’t have what you need in the nursery at that minute because it’s downstairs, those are really frustrating things.  So I think if you can make a mental note or text someone or ask for help – and make sure you have those stations.  Make sure you have things set up more than one place so that you can try to eliminate some of those simple frustrations.  I think overall, incrementally, it will really, really help.  I mentioned the difference between feeling, some of this practice, and utilitarian and necessary versus bonding, and I think any time you can think about your spaces as kind of this checklist of, yes, thinking about your space in terms of those five senses, and also how are you orienting that space so that it’s pulling on that emotional part of you, the love hormones, and helping you get in a mindset where you feel bonded and you’re helping your body relax and have that letdown, but also for your own piece of mind, and taking the time to invest in your space even though you have very little capacity, knowing that that’s an investment in you and your baby and your emotional health and your mothering, by taking the time to do those things, even if they seem simple.

Alyssa:  We know for a mom who had to exclusively pump or pump for a long time like you did, and like you said, it felt very utilitarian – like, creating a space where maybe they, when they’re sitting in that chair pumping, they’re looking at a photo of their baby right when they were first born, or things that will help you get that oxytocin going that you’re not getting from physically having your baby skin to skin.  Thinking ahead about things like that, and not just sitting there, dreading it, looking at your phone and wondering why you can’t get a letdown, but actually thinking about your baby and looking at photos.  A photo on the wall of your baby, or your whole family.  Things like that, to make this space just more cozy and less utilitarian.

Amber:   And I think, too, for me it goes back, it’s that personal piece of taking care of yourself because I was nursing her, but I was also pumping a lot, but I dealt with a lot of clogged ducts and I had a lot of pain, and she had an undiagnosed lip and tongue tie until she was eight months old, so I was doing all of those things with an intense amount of pain.  And so I think for me, there was – a part of it, too, was a resentment toward the whole thing because things were not right for me, and I was having trouble with people hearing me when I kept saying to my pediatrician and to whoever, I think she has a lip and tongue tie, and they would say, well, her latch looks good, and I’m like, well, I really hurt!  I think finding somebody who would listen to me and help solve some of those problems, that also was a huge piece, because even if I had my spaces totally oriented – and I did have stations set up for success – I was still needing special care and needing to be heard to fix that circumstance, too.

Alyssa:  Right.  I think a big piece of this is, as you had mentioned, just ask for help.  Whether you’re sitting in that chair and need a pillow and you need to text your partner or spouse in the other room, it’s asking for help.  But we so often feel like we’re putting someone else out.  And then if you know, it is not supposed to feel like this when I nurse.  This is huge pain.  You have to find someone to help you!

Amber:   Yeah.  And little shout-out to our doctor, that having someone finally take me serious and refer us was just lifechanging because at that point, it was eight months in, but I nursed her until she was 16 months old after that.  So the literal first half was pretty rough, and the second half was really good.  Taking care of me and having someone hear me made all the difference.

Alyssa:  So if any new mamas want to get ahold of you – let’s say someone’s pregnant and hears this and wants to put a space together, or they just had their baby and need help with space or they have a houseful of kids, who knows – tell them how to get ahold of you, but also how are you working right now during a pandemic?  Are you doing virtual consults?  Are you doing some in-person?  What does that look like right now?

Amber:  So the best place to find me is my website, and I’m active on Instagram @thecozinessconsultant, and the same on Facebook.  The quickest way to get a response from me is a DM on Instagram.  And I am doing some in person with masks and socially distanced, but I have done much more virtual.  I had done a few virtual appointments before the pandemic, but it wasn’t something that I was putting a lot of effort into because it’s obviously easier to be in a space, and I like interacting with the people and being able to observe them in their home and with their family.  It also gives me clues of recommendations I can make.  But since the pandemic has kind of forced us to be a little bit more creative, I’ve found that it actually works really, really well for consultations.  So my standard consultation is two hours, and that was kind of a trial by error.  I only started at an hour, and we were always pushing an hour and a half.  It never felt like enough.  Yeah, if anyone wants to reach me, social media or my website is the best.

Alyssa:  Awesome.  Thanks for doing this!

Amber:   Happy to!  Thanks for having me!

Today Kristin talks to Jenn Gavin, owner of A Pleasant Dog in Grand Rapids, MI about when to prepare your dogs for the arrival of a new baby.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa:  Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Well, we are thrilled to have Jenn Gavin join us today.  Jenn is another female entrepreneur in the local Grand Rapids area, and Jenn owns A Pleasant Dog.  Welcome, Jenn!

Jenn:  Thanks for having me!

Kristin:  So feel free to fill our listeners in about your business, and I’d also like to hear a bit about how you’re adapting to COVID.

Jenn:  Sure!  I am the founder of A Pleasant Dog.  We are a local dog training facility.  We’ve been in business seven years now, and we really cater to — especially to families with dogs living in the city of Grand Rapids.  We focus our practice solely on using positive reinforcement to train and modify behavior in dogs.  We have a school for dogs on Knapp Street on the northeast side of Grand Rapids, and we offer everything from puppy 101 and puppy kindergarten classes to more advanced training and help with behavior consults for dogs who are struggling with problem behavior.  So that’s a little bit about us.

Kristin:  That’s fantastic.  I know you’ve posted quite a bit about behavior issues during COVID because families are home more?

Jenn:  Yeah.  It’s really — you know, my part of the practice, I’ve got 8 really talented trainers working with me, but the particular cases that I see are those cases where dogs are really struggling either with their people or other dogs or with stimuli that they see in the community.  And I think — I saw a statistic somewhere that there’s been a 20 percent increase in bite cases since COVID started, and I think it’s kind of been a challenging time for a lot of people who are living with dogs who maybe were a little bit uneasy living with their people or living with children and now that everybody’s home all the time, there’s kind of a spotlight on those issues.  So we’re seeing a lot of really stressful situations that we’re trying to help our clients and their dogs through.  If anything, COVID has made our practice much, much busier, not only because of an uptick in behavior issues, but also because, boy, it seems like everybody wants a dog now that they’re home.

Kristin:  I’ve noticed that!  So many of my friends have gotten puppies in this last year.

Jenn:  Yeah.  So we are busier than ever, but you know, it’s been a really kind of fun time, too, because our practice has expanded from just seeing the occasional behavior consultation or a client virtually who was outside of our area to really, we’re seeing a lot, a lot, a lot of clients virtually, and almost all of our behavior cases at least start out with an initial virtual consultation.

Kristin:  That’s great.  So for our listeners who live in other states or cities, they can contact you and have virtual consultations, correct?

Jenn:  That’s right.  I see a lot of — like I said, I see a lot of challenging behavior cases, and I’ve always had the possibility of seeing those cases virtually, so it’s just a nice opportunity to practice that, to help more people.

Kristin:  Are you doing anything in person at the moment?

Jenn:  We sure are.  All of our drop-off services that we offer — so we have a puppy day camp where, if you’ve got a COVID puppy and you’re trying to socialize them, you can drop them off with us for a half-day camp where we introduce them to a variety of novel stimuli and play with other dogs.  Sometimes we have kids come in or different types of vehicles, things like that, so that we can get them used to things that they might see when they’re grownups that they might not see if they’re in quarantine with their owners.

Kristin:  That makes sense.

Jenn:  Yeah.  All of our group classes are offered in person.  We’ve just reduced the number of people who are allowed in the class to four, so we only have four puppies and four people, and we’re using social distancing and requiring masks.  And then we are also still offering our house call services, as long as, you know, we’re respecting social distancing and masking requirements.  So we’ve kind of slowly ramped back up to offering the bulk of our services in person, but we also, like I said, offer almost all of our services virtually, including our group classes.

Kristin:  So I get asked, as our clients are preparing for a transition, whether it’s their first baby or adding a baby to the family, we talk about pets.  And I often send them your way.  But I’d love to hear your tips on dog training specifically to prepare a family for a new baby and also, you know, just any advice you have for expecting families, even beyond the training with the change, not only for the family, but also for the dog.

Jenn:  Thank you.  I appreciate it!  We do see your referrals, and we appreciate seeing them.  You know, I think the tricky thing is, a lot of people are worried about how they’re going to introduce the dog and the baby after baby is born, whether baby comes home from the hospital or the birth center or is born at home.  And that’s really not the trickiest part.  I think it’s really important to take an honest look at how your dog feels about children, babies, novel stimuli, before your baby comes home, and to begin to prepare a plan for your dog to be comfortable with your baby or your child before they get home.  And, you know, everybody knows that you’re not supposed to leave dogs and children unattended together, but how that practically plays out takes a little bit of finagling.  I think it’s easy in the newborn phase when you get done feeding your baby and you’re going to go jump in the shower and you can just pop baby in with you or stick baby in a carrier and shut the bathroom door.  But it’s useful to have a dog who can settle either in their own room or in a crate or behind a baby gate so that you can have a physical separation between baby and dog when you can’t directly supervise them.  So that’s a skill that I really like to teach well before baby’s going to come home.  If you have a dog who isn’t accustomed to being crated or stuck behind a baby gate when they can’t be supervised, that could cause stress, and you don’t want to be causing stress to the dog right when baby comes home.

Kristin:  Sure.  That makes sense.

Jenn:  Yeah.  Teaching comfortable separation is really important.  If you have a dog who startles easily with novel stimuli, the kind of dog who’s afraid when you bring a new box in or when they hear a loud noise, getting the dog used to baby-type apparatuses early on is important, and there’s a lot that we do with just classical conditioning, pairing a baby swing with treats.  But it’s definitely something you’re going to want professional help with because, at the same time, we don’t want to magnetize your dog to your baby or vice versa.  We don’t want to draw a dog in to smell a baby.  We don’t want to bring a diaper home from the hospital and have the baby’s diaper be smelled by the dog.  We really want to associate perceiving that baby with good things but also build independence and space between the two.  There’s usually not a big problem when baby comes home.  It’s usually when baby starts to toddle and pull on hair and pull up that we start to see a problem between babies and dogs.  So I want to practice teaching independence and mutual respect between the two parties from the get-go.

Kristin:  That makes sense, and when babies start to pull on ears and tails and so on, that the dog is trained and is used to that kind of behavior.

Jenn:  That’s a common misconception.  So we never want a dog to get used to those behaviors.

Kristin:  Okay!

Jenn:  We try to really keep baby and dog pretty separate until baby is old enough to have the skills to use gentle touches and to understand canine body language and parental direction to move away from the dog.  You know, dogs will often tolerate being pulled on and climbed on for a very long time until they can’t tolerate it anymore, and that’s unfortunately when we see bites happen.  So, yeah, a lot of people think, how do I train my dog to tolerate baby in the food bowl or to tolerate baby climbing on him, and that’s not ever a goal that we have.  It’s not fair to baby and it’s not fair to the dog.  You might have the world’s most tolerant dog, but if you teach your child that it’s okay to climb on a dog, and your child then climbs on another person’s dog who is not so tolerant, you could really be setting your kiddo up for failure.

Kristin:  What about families who have a toddler at home and then all of a sudden, especially during COVID, want to transition a puppy into the home?  So instead of bringing a new baby in, how does that work?

Jenn:  It really kind of depends on the toddler and on the family.  There’s so many different variables there.  But I think if  have a family with young kids and they’re thinking about adding a puppy to the home, I think it’s important to know that puppies are not a blank slate.  So it’s not all in how you raise them.  Just like with people, personalities are the product of both genetic predetermination and early husbandry.  So you might be tempted to rescue a puppy that’s coming up from a shelter in Texas that came up on a rescue train, thinking that at 8 weeks old, you can mold that puppy into your baby’s best friend, and that’s not usually the case.  More often than not, those puppies that are coming from rescue, while they can be wonderful companions, probably not the very safest choice for a family with toddlers because we don’t know what kind of trauma they’ve been through.  And we don’t know what their adult temperaments will look like.  So while I love rescue — I have rescue dogs myself, and I came to training through rescue — if you’ve got toddlers and you’re thinking about a puppy, probably best to find a puppy from a reputable breeder.  And that’s a whole trick in and of itself in this day and age.  With the internet, people can go online and think they’re dealing with a reputable breeder and found out later on down the road perhaps they weren’t.  So reputable breeders will have you out to visit the parents, at least the mom.  The mom will be outgoing, come up and want to hang out with you, be seeking petting, will be seeking petting from your children, will be engaging with you.  The puppy should be raised in the household.  They should never come home before 8 weeks.  We know that early maternal separation causes a lot of anxiety and can be one of the bases for aggression later in life.  And, you know, we want puppies to be clean and healthy and also outgoing.  It’s normal for puppies to be bouncy and excited and engaging with you and happy.  A little bit less normal for a puppy to just kind of sit back and watch quietly.  Oftentimes, that’s an indication that the puppy’s a little bit fearful.  So you want that bouncy, happy, snuggly puppy.

Kristin:  My kids are wanting a puppy, so I’ll have to chat with you offline sometime about breeders.

Jenn:  Yeah, and I was going to say, probably your best bet is to find a trainer who has the same philosophy as you do and have them help direct you toward breeders that they see having puppies with really great temperaments for kids because it is really challenging for a dog to live with a toddler, because toddlers just — you know, they don’t have great control over how hard they’re pulling on tails or how they’re moving and running around.  And so you really want a puppy who not only tolerate that but really is drawn to and thrives on the company of children.

Kristin:  Jenn, can you walk us through what a typical group class would look like and preparing families for the baby?  So they have an existing dog, and they want to do an in-person group class.  What would that look like?

Jenn:  Yeah.  So I think our in-person group classes that you would bring a dog to are really basic skills classes.  Those are skills that are designed to teach your dog to go lie down on a bed, walk nicely on a leash, come when he’s called.  We do offer workshops and seminars for getting ready for baby, and those are really designed for parents.  And typically what we’ll do is we’ll bring in a Family Paws certified parent educator.  It’s a fantastic organization.  You can check them out online.  And they have a whole Dogs & Storks or Dogs & Toddlers program that’s geared toward setting families up for success with babies.  We’re hoping to do one of those this spring, if we can make that happen.  It might end up having to be virtual.   But if we’re working specifically with a particular dog and setting that particular dog up for success in a family that’s adding children, we really like to do that on a one-on-one basis because every dog is so different, and their capabilities and sensitivities are so different, and every family is so different.  That really needs to be catered to one-on-one.  You know, even my own dogs, each would need something different in order to adjust to a new person coming into the house, so it’s not really something that we can do well in just a group class.  Things we’re going to think about are, you know, where does your dog eat?  Where does your dog sleep?  Do we need to change that to accommodate baby?  Is your dog crate trained?  Is your dog comfortable going behind a baby gate?  How does your dog do with noises?  Do we need to do some counter-conditioning with baby crying sounds?  You know, does your dog currently sleep on the couch?  Is that going to be a safe spot for your dog to sleep when baby comes home, or do we need to transition your dog to his own dog bed?  So it’s really individualized I guess is what I’m saying.

Kristin:  So it seems like it would be best in person, ideally, in their home?  But potentially also virtually?

Jenn:  We can do them in-home; we can do them virtually; we can do them at our facility.  A lot of it is kind of taking a history and finding out where you’ve been with your dog, what you’ve done already, what your dog knows, what your dog is sensitive to, and then constructing a plan that’s individualized for you and your dog.  So I’d say about the first third of that session is taking a history and finding out how we can best help you and then coming up with a plan specifically for you and your dog.

Kristin:  I am so excited to chat with you about a project that Alyssa and I have been working on during the pandemic.  We took this time and pivoted, as many businesses have, and decided it was the time to launch some online programming to better serve expecting families.  So our first step in that first stage is we created a download for you about how to birth confidently in a pandemic.  We also have a free course coming up on both February 23rd and 26th, and you can find all of this at our new website, www.thebecomingcourse.com. 

Kristin:  Do you have tips for our listeners who are planning a home birth and have strangers, essentially, entering the home between, say, doulas and family members and midwives?  Have you encountered that situation with clients in preparing a dog or multiple dogs for that situation?

Jenn:  Absolutely.  You know, I think if you’re planning a home birth and you’re concerned about strangers coming into your home, we probably need to talk more about how to help your dog when baby comes home, too, because that tells me that your dog probably has some fears and anxieties that we need to deal with.  So I don’t think that’s the primary concern.  Hopefully, if you’re at a point where you are planning a home birth and baby’s coming, your dog is very comfortable with people coming in and out of the house.  If not, we’re going to need to come up with a management plan for the birth and probably a pretty comprehensive behavior modification plan for your dog because when we see a dog who’s uncomfortable with people coming and going in the house, that tells me that the dog is pretty anxious.

Kristin:  Yes.  I have encountered that at some births I’ve attended.

Jenn:  Yeah.  So I think if you know that your dog is anxious around people coming and going, oftentimes I’ll recommend that if you have a parent or a friend who can keep your dog for the birth or maybe board your dog, even, so that you don’t have — you know, it’s stressful enough.  Our dogs are so in tune to our moods and how we’re doing.  It’s stressful enough for them to see us in discomfort.  Adding strangers coming and going is probably too much.  So if you have a dog who’s at all concerned about that, I think it’s probably best to board them for the birth or have, like I said, a parent take care of them.  I know I wasn’t lucky enough to have a home birth, but my mom came and took care of our dogs while we were in the hospital when my son was born.

Kristin:  And that’s a big planning factor for the majority of our clients who birth in the hospital and planning — you know, not knowing when you’ll go into labor, most of the time; who will take care of the dog; who do you call, what’s the best resource.  Having someone come in the home or boarding.

Jenn:  And I recommend whoever’s going to be that person, that they do — if it’s not somebody who’s already known to your dog, that you do several visits with the person prior to baby’s arrival so that your dog is comfortable with that person, you know, if they need to come in when you’re not home.  Sometimes dog can be very friendly when their owner is home, but when someone comes in the home and no one else is there, they get a little worried, justifiably.

Kristin:  Sure.  Protective.  Yes, of course.

Jenn:  So I think it’s good to have a good, established relationship with them.  If you’re going to board your dog, you may need to still have a trusted friend or family member take your dog to the boarding facility.  Not very many of them will pick them up for you.  I don’t know this for certain, but places like Nature of the Dog — our friends, Nature of the Dog, do dog walking, but they also have an in-home boarding facility.  Maybe an organization that does something like that might be able to help.

Kristin:  And so they would have the availability, potentially, for 24/7 call if someone is in labor at 2:00 a.m. and they need —

Jenn:  I don’t know about 24/7 call.  I think you’d be hard-pressed to find a dog care organization that could do 24/7, but certainly if dog is at home and you’re in the hospital, it’s not typically emergent for them to get out right away.  But, you know, you could say, hey, here’s my plan.  Can I send a text to your organization and see if the sitter can come and pick them up the next day early in the morning or what have you?

Kristin:  Sure.  That makes sense.

Jenn:  I can’t speak for other organizations, but I imagine that if you have a good relationship with your dog walker or dog sitter, or certainly with a friend or family member, you could probably arrange that.

Kristin:  What other tips do you have for new parents when it comes to planning with their existing dog versus getting a new puppy?

Jenn:  I think, you know, the biggest thing is really to — we want to keep things safe.  We want to set everybody up for success and not just expect everybody to get along.  So if you know that your dog’s got some anxiety, let’s start treating that anxiety right away.  It’s typically best to start with training with positive reinforcement, and sometimes if the anxiety is severe, we work with your vet, too, to kind of come at it from a collaborative approach.  And we want to keep things super, super safe.  So don’t count on your dog tolerating things because I think that that’s when we really run into trouble.  The vast majority of the time, kids and dogs do wonderfully together, but it always takes careful planning and supervision to make sure that everybody is okay and happy and not hurting each other on accident.

Kristin:  Great tips!  How can our listeners reach out to you?  I’d love to get your website info, as well as — I know you’re very active on social media.  Share away!

Jenn:  Thanks very much!  We have a website.  Our telephone number, because we have one of those, is 616-264-2532.  And we are on Instagram and Facebook at A Pleasant Dog.

Kristin:  Thank you so much, Jenn.  It was great to chat with you, and I appreciate all the tips.  We’ll chat later about my kids’ puppy preferences!

Baby monitors: Today Alyssa, a sleep consultant at Gold Coast Doulas, speaks with Lisa, a Building Biologist at Well Abode, and Brian, an engineer at Bebcare.  Bebcare has the lowest EMF baby monitors on the market.  The conversation gets a little technical but it’s really interesting, and you may learn a thing or two about creating a safer home for you and your family!  Listen until the end to get 10% off a Bebcare baby monitor for your home!  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa: Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Brian:  Hi there!

Alyssa:  Hi!  Hey, Lisa.

Lisa:  Hey, guys.

Alyssa:  So I learned about Bebcare – I think Juliana emailed me, and then as I read more about it, I was intrigued because of the sleep consultations that I do, and I already mentioned EMFs because of my relationship with Lisa, who’s a building biologist.  So Lisa, why don’t you introduce yourself, and then Brian, tell us what you do at Bebcare?

Lisa:  Yeah.  I am a building biologist, and a building biologist assesses the built space, so whether it’s a home or a school or an office building, for anything that directly impacts the health of the people who live or work or learn within those buildings.  And so the three kind of main categories that we look at are the electromagnetic – the manmade electromagnetic prevalence in that building, the air quality or the indoor air quality, as well as water quality, very just basically speaking.  And, yeah.  So I work with existing buildings to make them more health-enhancing, and then I also work on new construction projects on how to make them healthy from the beginning.

Alyssa:  Amazing!  Brian, tell us about you, since Lisa and I don’t know you at all.

Brian:  Yeah.  So my name is Brian.  I’m in charge of the product development at Bebcare.  So what this mean is I work with my team of engineers and developers to develop existing and new products, new exciting products, that we have.  What Bebcare is all about is really we are a baby monitor company that specializes in ultra-low emissions baby monitors.  And this is something that we are very passionate about because one of the things that we realize is, it’s kind of what Lisa mentioned, is the prevalence of devices in our homes that emit high doses of electromagnetic waves.  So, for example, your Wi-Fi routers, your cellular phones.  And what you don’t want around the baby is a baby monitor that emits really high doses of wireless radiation.  So this is a problem that we try to tackle with products, so we come up with a unique technology called DSR, digital safe radio technology, that aims to reduce wireless radiation coming from baby monitors.  So, in short, Bebcare baby monitors on average would emit anywhere that’s, you know, set up 2 to 5 percent of wireless EMF when you compare to traditional baby monitors that uses something called DECT technology.

Lisa:  What is the technology that you guys use?

Brian:  It’s called DSR, digital safe radio.  It’s just kind of a proprietary wireless protocol that we have designed ourselves.  So some of the research was originally done by our founders, actually, at MIT, but some of the research was more focused on the application of the radio signal for wireless communication.  So they were really looking at problems of how to increase wireless range while reducing the wireless power of the communication.  And then at some point, some of that research became the core technology of Bebcare because they realized some of that technology can actually be applied to baby monitors.

Alyssa:  Let’s assume most parents listening don’t understand EMFs or why a baby monitor would have EMFs and why EMFs are even troublesome for, you know, humans in general, but especially a little tiny baby or child that’s growing and developing at a rapid pace.  Do you want to, like, give a brief overview of why it’s disruptive?  And then I know you have a monitor there that we were actually going to test and see what kind of results you got.

Lisa:  In terms of kind of how it’s bioactive to the body, are you asking me that question, or are you asking Brian?

Alyssa:  Yeah.  Let’s just have you give a quick – you know, because Brian said they found – you know, this is a problem.  It’s why they created these, and I’m sure that’s kind of why you got into this as well.  Like, you know this is an issue.  But for somebody who’s never heard the term EMF, you know, like – even Bebcare mentions, I think, on their website that some baby monitors are emitting such a strong signal, it’s the same as a microwave.  But most people might go, well, okay, my microwave emits a signal?  Like, what?  I didn’t even know that.  And how bad is a microwave?  How bad could that be?

Lisa:  Right.  Well, from – I mean, in super quick laymen’s terms, essentially, the electrical pulses that happen according to the frequency, those are just very disruptive to the body, but especially children because they’re growing so quickly.  So the human systems or organs that are most affected by EMFs are the organs or systems that literally rely on electrical pulses to communicate with, you know, themselves or with other organs in the body.  And so those would be your brain, your heart, the nervous system, your immune system, and then intercellular communication.  All of those rely on literally the flow of electrons.  And so the human pulse, like when you look at just the brain, for example, that frequency is somewhere between 3 Hertz and then 30 Hertz, so at most it’s a double-digit frequency, so number of cycles per second.  But when we get into things that use DECT technology, whether it’s a wireless phone or a cordless phone or a baby monitor, those are in the gigahertz range.  So those are very disruptive, and the power density is just way higher than what the normal body is used to.  So it’s just very, very disruptive to, you know, the sleep cycles of babies.  But also they’re growing new cells, new tissue, new synapses every second of every day, and it’s just disruptive to the biological system of what a body is naturally trying to do.  And when you look at the DECT technology, that is in the gigahertz range, so that’s billions of cycles per second, versus the DSR, which is what Brian is talking about, in the megahertz range.  So that’s millions of cycles per second, which is, you know, in order of magnitude, less, versus, you know, the technology that other baby monitors are based on.  And what I typically find for baby monitors, and of course this varies by brand and by model, but typically speaking, an audio-only baby monitor measures somewhere between a half a million microwatts per meter squared or up to about three-quarters of a million.  And then when you get into the video baby monitors, which the majority of people have, that is anywhere from 1 million to 2 million microwatts per meter squared.  And if you look at the building biology guidelines in terms of what’s considered safe for a sleep space, you want to be less than 10.  So the slight concern starts in that 10 microwatts per meter squared or less.  And so when I measured your base unit, it’s about – it’s somewhere between 200 and 300.  So to get it down into that slight anomaly or less, we still need to distance the unit kind of probably about 10 feet away from a body or away from a crib, so there’s for sure a caveat that I would need to say, but this is orders of magnitude less of any other wireless baby monitor that I’ve measured.

Alyssa:  Which one do you have?  Because I know they have IQ, which is their most sophisticated model.

Lisa:  I have the Bebcare Hear.

Alyssa:  Is that the audio one?

Brian:  Yeah.

Lisa:  Yes.  It says ultra-low radiation on it.  Yeah.

Alyssa:  Brian, any comments about Lisa’s thoughts?

Brian:  Yeah.  I think Lisa gave a really comprehensive overview about why EMF waves could be bad for the body.  It’s a really interesting topic, and a lot of things that we see in the world is actually comprised of EMF waves.  So just to think, as an example, visible light is actually a form of electromagnetic waves.  It is how we can see light, is actually EMF waves interacting with our retina, which creates an electrical pulse that’s being sent to our brain, and the brain interprets that as light, as visible images.  So when we talk about electromagnetic waves, you know, not all electromagnetic waves are dangerous.  Some electromagnetic waves, we’re exposed to every single day since the beginning of the world.  But where electromagnetic waves can really start to get dangerous for the human body is sort of what Lisa mentioned.  It’s the frequency of the EMF wave.  So very high frequency waves tend to be correlated with a very high power output.  It’s not always an equal relationship, but it tends to be correlated, which is why people would say exposure to high frequency gigahertz or terahertz waves can have detrimental effects on the body.  And this is particularly prevalent for babies because babies, unlike an adult, a lot of their body structure is not formed.  And in particular, for a baby, the skull is not as well-formed as an adult skull.  So the amount of protection that they have around the baby’s brain is much less compared to an adult’s brain.  And there are some studies – it’s a bit of a controversial topic, but there are studies that have linked exposure to electromagnetic waves to baby, whether or not the baby is born or perhaps in fetus – there is link between that exposure and development learning disabilities that they develop down the road, and that may include ADHD.  So that’s why this, the idea of reducing EMF exposure for babies, especially at a young age, is a very important topic for parents.

Alyssa:  Before I even knew about this topic or met Lisa, the first realization I had of this was, I have a sound machine at home, and I remember in the morning, you know, putting my phone next to it one time, and all of a sudden the sound machine just made a crazy noise.  And I knew that I couldn’t put my cell phone near that, but I didn’t understand.  Like, oh, that’s weird.  My cell phone just can’t be next to this.  But then after meeting Lisa and doing some of these tests, it made perfect sense that the frequencies from this phone are so powerful that it’s actually screwing with this little device on my bedside table.  So what is that doing next to my head?  What is it doing when it’s in my pocket all day?  It just really makes you start to think about all the things that we have on us all day long.  And then you have a baby and create this nursery, and you put – you know, some nurseries have the Nest cameras.  We have the wireless monitors.  And then sometimes people are using their cell phones as a sound machine, so the cell phone is right next to the crib.  So there’s just all these devices that we’re putting in this little baby’s room who, like you said, their brain isn’t even – or their skull isn’t even formed enough to block some of those rays that we as adults are able to.

Brian:  You’re absolutely right.

Alyssa:  If somebody wanted to learn more about this – like, let’s say this is the first time a parent is hearing about EMFs, and they’re really skeptical.  Where would you send them to find, you know, scientific evidence-based information so that they know that this isn’t just some sort of weird conspiracy theory?  Do either one of you have a good resource list?

Lisa:  I mean, one of my two top go-tos are the BioInitiative Report, which is, I think, a 2500-page report, but they have a 19-page summary for the public.  It looks at both radiofrequencies as well as AC magnetic, so those – the biological impact of those two different types of waves and frequencies are kind of intertwined with that report.  But I think it looks at – you know, I think it looks at over 3800 peer reviewed studies that have been done, so it’s just a really good synthesis.  And the other thing that I point to is the World Health Organization’s classification of RF as a class 2B possible carcinogen, and there’s other things in that category like asbestos and stuff that we know that we should be staying away from.  And so especially when somebody is skeptical, I just try to find more – you know, the most plain, factual information that is not politically associated in any way, and those are my two go-tos.  Now, there’s a whole bunch of other researches and stuff that have done really good research, but sometimes I just find that to be too dense for the person who’s just getting introduced to this.  What do you use, Brian?

Brian:  Yeah.  I think you mentioned good sources, the Would Health Organization.  I think their classification as EMF as potentially carcinogenic – that was back in 2011 – really rang a lot of alarm bells for a lot of folks, not just parents, but really a lot of people who have wireless devices at home.  I think a simple Google search on the effect of EMF on the human body would yield a lot of scientific research on this topic.  In the past couple of years, a lot of really famous research institutions or universities have done really extensive and ongoing research on this topic.  For example, University of Chicago has done a really good study where they used exposure of EMF, different variety of EMF, different frequencies, different power, to a laboratory mouse and see what kind of effect that they observed on these animals.  And some of the results are pretty alarming.  So I think it’s definitely worth checking out the raw scientific paper if, let’s say, you are more technically inclined, just to see what conclusions these researchers have made.

Alyssa:  So, Lisa, you are overall – you would say that this base model from Bebcare is definitely one of the lowest that you’ve seen?

Lisa:  Yes.  It is.  But with, you know, the big caveat of, it still needs to be distanced from the crib itself.  And that’s a big caveat because parents, at least what I’ve seen in the homes that I’ve done EMF assessments on, they typically put the monitor, you know, as close as possible.

Alyssa:  It’s hooked right onto the crib.

Lisa:  You know, somewhere around a meter would be not close enough.  So, yeah.  But, I mean, if somebody – I mean, ideally, for me, and I don’t know if you guys have one of these coming or not, but I would love – there is a D link model, too, that you can – that is – you can plug an ethernet cable into, so obviously something that doesn’t emit any, you know, wireless frequency in the mega- or gigahertz range would be ideal.   You know, not everybody is open to pulling ethernet cables through the wall or having it strewn across their floors, but hardwiring your house is one of the top recommendations because then you can essentially turn off all the antennas that you have across your devices and electronics and stuff.  But if they aren’t willing to do this, then I would – this would be kind of the next-best option, assuming that they will distance it.

Brian:  Yeah, absolutely.  We do believe in the idea of creating a low EMF home for families, so that’s why actually on our website we put together a little short guide in helping parents.  You know, how can you create a low EMF home for yourself?  And there are just a couple of really simple tips.  For example, instead of using a Wi-Fi router at home, try to use a wired ethernet for your laptop or for your home computer.  Or at best, turn off the Wi-Fi router at night when you go to sleep.  And the same with cell phones.  A lot of our friends, when they go to sleep, they put the cell phone right next to the bed on the night stand, less than feet away from their head when they’re sleeping.  And it’s one of these little things that you can do: turn off your phone at night.  Or, if you have to keep it on in case of emergencies, put it ten feet away, away from where you’re sleeping.  Just the idea of sort of exposing – even for an adult – exposing your head to seven hours, eight hours of constant EMF exposure at night when you don’t really need to?  For us, these are the low-hanging fruits.  These are the things that you can do to really reduce the EMF level in your home.

Alyssa:  I did want to mention that the other two models that Bebcare has, they are wireless, but they completely turn off there’s no sound, correct?  So there’s zero emissions when it’s not in use?

Brian:  That’s right.  You brought up a really good point.  Actually, part of the DSR technology, it’s about voice activation.  And this is something that’s missing in a lot of other baby monitors.  So one aspect of EM exposure is, you don’t want to use a high frequency device for your baby.  The other part is about the power of the baby monitor.  What we have accomplished with Bebcare baby monitors is that – you know, most of the time, the baby is not crying.  So there’s no point for the baby monitor to be transmitting video or audio data and emitting a lot of wireless radiation.  So what the Bebcare baby monitor does is that, when there’s no sound inside the nursery, the baby monitor actually goes into a deep sleep state.  And in this sleep state, the emissions really does drop to zero.  So this is something that really makes a huge difference when you’re looking at the average EMF exposure for a device.

Lisa:  I have a question about that.  For the Bebcare Hear model, does it use that voice activation or not?

Brian:  It does.

Lisa:  And then when I was measuring this, the base unit, so the unit that would be closest to the parents, that is – I’ve never been able to measure where it is going into a passive state.  I am able to measure the portion that goes, you know, by the crib, that that goes into a passive state, but does the home unit also – is that also passive, or is it just the one in the nursery?

Brian:  It’s more the one in the nursery.  But that said, there’s a mode in the Bebcare Hear baby monitor that you have to enable.  It’s called the Green Mode.  And that – once you enable the mode, then the emissions level really does drop to zero when it’s in the sleep state.  And the reason why that’s the case is because even in, let’s say, the normal mode of operation, even if in the sleep state, that’s still a little bit of signal that’s being transmitted, and the reason why that’s the case is because that’s what we call the out of range and the low battery alert between the baby unit and the parent unit.  But if you turn those off, then it really goes to zero.  Does that make sense?

Lisa:  Are there instructions on how to turn the Green Mode on?

Brian:  Yep.  There’s this – we use an online user manual, and part of that is because we want to reduce the use of paper in a lot of commercial products and consumer products these days.

Lisa:  I’m just curious, why isn’t that set as the default?

Brian:  The reason is because a lot of parents do want the out of range and low battery alert in the baby monitor.  So they want to know, let’s say, if they kind of walk outside of the house, they walk to a neighbor’s house – they want to know if the two units are out of range, because once they’re out of range, then it kind of defeats the purpose of a baby monitor.

Alyssa:  So the part that’s in the nursery is always in that mode where it turns off if there’s no noise, but the parent, the base part that the parent holds, you have the ability to turn it that way if the parent wants to?

Brian:  That’s right.

Alyssa:  Got it.

Lisa:  And what type of sounds turn on the baby unit?  What if it was, like, a sound machine or a fan?  Or is it more intelligent knowing that it’s a voice or a cry?

Brian:  It is tuned to pick up human sounds, the frequency of human sounds, more easily.  But that said, it’s kind of a configuration issue.  So if there is a white noise machine inside the nursery, you may have to change the microphone sensitivity on the Bebcare Hear or kind of configure your white noise machine and the baby unit so that they do not interfere with each other.  But there are ways to do so.

Lisa:  Okay.  Great.

Alyssa:  Is there anything else we want to touch on?  No?  You, Brian?

Brian:  Yeah, I think that’s it.  Really, thank you so much for having me on this podcast.

Alyssa:  Yeah.  Thanks for joining us.  You too, Lisa.  I hope that we at least answered some questions for parents on what the heck are EMFs.  And I know that we – so Gold Coast is a partner with Bebcare now, and I know you offer a discount.  So if anyone wants to get a discount, they can go to Bebcare, and I think you just have to type in Gold Coast Doulas to get a 10 percent discount, or you can go to Bebcare.com/discount/goldcoastdoulas.  It’s kind of a long one, but I think either one will give listeners a 10 percent discount!  Well, thank you all!

Brian:  Thank you so much.

Lisa:  Thanks!

Read here for more of our past conversations with Lisa from Well Abode.

 

Kristin talks with Jennifer Hoekstra, one of the owners of Secure Quest, about car seat safety for our babies and toddlers.  You’ll be astonished at how many of us install our car seats incorrectly!  You can listen to this complete podcast episode on iTunes or SoundCloud. 

Kristin:  Welcome to Ask the Doulas with Gold Coast Doulas.  I’m Kristin, co-owner, and I’m here today with Jennifer Hoekstra.  She is co-owner of Secure Quest, LLC.  Welcome, Jennifer!

Jennifer:  Thanks for having me!

Kristin:  Thanks so much for hopping on.  And we would love to hear a bit about your own personal background, as well as about your new business.

Jennifer:  Perfect!  Well, I’m a mom of four kids.  I love being a mom.  They are extremely busy.  I now have two high schoolers, a middle schooler, and an elementary kiddo.  So we are in the mix of just about every stage of life except baby, which I’m not sad to be past that.  I’m not going to lie.

Kristin:  Right!

Jennifer:  But it was wonderful.  My first two kids are only 15 months apart, so that was a good challenge at the early onset of motherhood — figuring out how to do this mom thing with two little ones at the same time.  But we survived, and there’s hope out there.  For those of you who may have more than one little one at a time, it does get better, I promise, and it’s pretty awesome.

Kristin:  That’s great advice.  Yes.  It does get better and easier over the years, for sure.

Jennifer:  Yeah.  It sure does.  I started out my life as a teacher, and I loved teaching.  I loved presenting information to kids.  I loved watching them catch on.  And it was super powerful.  And then my husband and I moved to the mission field for a few years, and again, I loved teaching people and really helping them grasp information.  And then I transitioned into the world at the hospital, where I continued to teach.  I taught families all about safety, about making sure their children were protected from all different types of preventable injuries, from car seat safety to bike safety to water safety to lawn mower safety to poison prevention — a little bit of everything, and it was, again, very powerful to share information with parents.  And then, unfortunately, COVID hit, and the hospital had some hard decisions to make about programming and dollars and things that were just not able to be sustainable during a time of struggle.  And our position at the hospital, being the car seat safety team as people knew us, was eliminated.  And that was really hard, but it didn’t stop me from understanding the importance of providing information and education to parents.  Therefore, I joined forced with my previous hospital partner and now current co-owner with me at Secure Quest, Kim Hernden.  And together, the two of us have begun this amazing business called Secure Quest.  And our goal is to help families keep their kids safe, primarily focusing on child passenger safety or car seat safety.  We have so many years of experience between the two of us.  We’ve been in the field of car seat safety for over 25 years combined, and we’ve seen a lot of different things throughout that 25 years, from parents who truly had never touched a car seat before their first baby was born to parents who have researched and studied and made themselves self-experts by all of the research they’ve done.  But what we have noticed through all of our interactions with families, with all different backgrounds and pieces of information, is everyone loves to be reassured that they’re doing it right.  And that’s really one of the most powerful things we can offer to a family is the assurance that when you speak to one of us as an expert, that we can say to you, you are doing it great.  Or, we can say, hey, you gave it a great effort, but we have a few things that you could change to ultimately provide safer travel for your child.  And we thought it was important to really branch out and start this company because there are many misconceptions in our community that you can just turn anywhere and find help with your car seats, but unfortunately that is not the case.  I’m currently in West Michigan with you, and we are finding that there are very few places that are either, number 1, open for service for car seat safety help or, number 2, even have a certified person on staff.  I think when you ask questions of people, whether they’re doctors, nursing, working at the family fair, or somebody who works in your child’s school, if you ask them, where do I go for help with my car seat, many people’s first response is, oh, you can go to the fire department.  Or you can go to the police department.  And unfortunately, that is not a true statement.  What the statement should be is, oh, you can find someone certified and they can help you.  Locally in Grand Rapids proper, there is not one single person certified to check car seats anymore.  We have a few outlying people in different communities outside of Grand Rapids, so still in the greater Grand Rapids area.  We have a couple of firefighters scattered through different areas around Grand Rapids, but it’s hard because they don’t have necessarily the man power to do their primary job and still take families in.  So we knew that there was a deep need for experts in the field of car seats to be able to serve families who are looking for that information.  And hence, Secure Quest was born.

Kristin: I love it!  So fill us in a bit about some of the stats on families and their installation success with car seats.

Jennifer:  It’s always a little bit enlightening and a little bit frightening when you hear statistics.  So I’m going to put a little caveat.  Remember, statistics take a look at the broad picture.  Right?  They really take into effect nationwide and how many people we’re talking about.  So, statistically, across the nature, when you’re looking at the number of people who improperly or incorrectly install their car seat, that number hovers around 75% of people doing it wrong, and that number is taken from over 2 million car seats checked.  We’re talking about a huge number.  And that’s over 23 years of installation methods with an expert next to them.  So we’re talking about people who are gathering information from a specific event or time when they met with an expert.  They came; they did some tally marks and some informational gathering, and found out that that number was not very good.  It gets worse locally.  Over the past 12 years, I’ve been gathering data for all of the car seats that I’ve checked with my team, and we’ve checked over 8,000 car seats in the last 5 years, and over the last 12 years, we’re closer to 20,000 car seats.  And we are finding that in the local area, we’re at a 92% misuse rate.  And that’s really frightening, but there’s hope, because we can teach you.  One family at a time; small group settings; however you take information in is how we want to provide it to you.  And the reason that this number is so big is because there’s so many parts and pieces to a car seat safety installation.  You have the putting the car seat in the car part, but you also have the putting the baby in the car seat part.  And both of those pieces have to be done exactly right for that car seat to work the way it was designed and protect your child in the event of a crash.  I think for me, one of the most common statements that I hear from families when I’m working with them is, oh, well, I did it this way with my first baby, or I did it this way when my niece was over, or my dad did it this way, or my brother.  So people are learning from previous experiences or from other family members but not often are they having a reason to question the way they did things.  Most of us don’t crash on a weekly basis and hope that the outcome is good.  So when there’s not a factor, whether it’s a crash or an almost-avoidance of a crash or a just-miss, it doesn’t prompt us to think about, necessarily, how we have our child installed in the car or how our car seat’s installed in the vehicle.  It’s just, well, it’s probably good enough.  And we know that good enough usually isn’t good enough.  It does have to be correct.

Kristin:  Yes.  And if someone has a car seat that they want to transfer to multiple cars, A, they should have different bases for each vehicle and bring those to get checked individually?

Jennifer:  That’s a great idea because that is probably why car seats are so difficult, because you have so many combinations and factors that really change the way a car seat is installed in one car versus the other.  You may have a relatively simple base that you want to install in a car, but you open the door of Dad’s care, and you realize, wow, this is really not a very big back seat.  And then you open the back door of grandma’s car, and you say, well, don’t you have those hook things that I have?

Kristin:  Exactly.

Jennifer:  And then you open the door of Mom’s car, and you’re like, well, this is pretty easy!  But your questioning then is, why wasn’t it easy in the other car?  And it is a really good idea either, A, to get all the cars checked and all the bases checked, or B, spend time on one primary vehicle feeling super, super confident, getting that one on one education, and then taking it back to your other vehicle, taking what you have learned, giving it your best shot, but then always kind of doing a follow up.  And right now, we can do those virtually.  We can do those in person.  We are really wanting parents to have the confidence that they can do it.  We believe in our ability to teach families.  We believe that you will walk away confident and say, I think I could figure out the Camry, even though I didn’t bring it.  But we would encourage you to text us a picture.  How did you do?  Shoot us a quick video.  Show us, because we can give you that confidence then that it is correct.

Kristin:  That’s great!  So you mentioned virtual as an option.  Tell us what Secure Quest is doing during COVID.

Jennifer:  We are really trying to help families feel confident in not only knowing how to find us, being comfortable, being in the same space as us, or not being in the same space with us and learning virtually over the computer.  So if you visit our website, we have an appointment calendar that you can book under the Personal Assistance tab, and you can choose whether you want that to be virtually or in person.  We will come to you.  We can meet at an agreed-upon location, or you can come to us.  We don’t have a storefront, per se, but we have some meeting spaces where we have gathered permission to meet with families.  And we then will make sure that we are using all of the proper protocol during COVID.  We’ll wear mask.  We can sanitize before and after.  We will also wear gloves if a family is more comfortable that way.  We want to make sure that everyone is safe in the time of helping and learning, but we also want you to be comfortable.  So please know that we are very flexible, and we are willing to do what it takes to empower you to transport your children safely.

Kristin:  That’s wonderful.  And you did mention the website as far as how to contact and the online scheduling.  The question we always get from clients is payment.  What are the payment options, and is anything covered any, like, health savings or insurance?

Jennifer:  You know, we would love for anybody who might be listening who has a way to get it covered by a health savings to jump on our website and let us know.  We’ve been working really hard with some local insurance companies, trying to figure that out, but currently, there is not someone that feels that that’s an important service to pay for through insurances.  So we accept Venmo payment on our website.  We will take cash if that’s something that parents would prefer to do.  We’ll take a check when we get to the space there.  It is a pretty easy option right on our website to do Venmo, and there are instructions on how to set up a Venmo account if it’s not something that you’ve ever done before.  When we started our company, I was still in the world of PayPal, which is like old people payment, you know —

Kristin:  We still use PayPal!

Jennifer:  — and we had to make the switch to Venmo because it was more conducive to our constituents.  And working with our families, we want to make it as easy as possible.  We also really encourage families to think about this as a gift.  You as a pregnant mom may really value this experience for yourself and for your partner, but it is a great idea for a Christmas gift for your parents.  You know, grandmas and grandpas who are going to transport children also need to learn how to do it correctly, even though they’ve had some experiences, lots of things have changed.  Or a daycare provider.  Have a nice, you know, thank you for watching our child gift, and offer them an opportunity to come and meet with us or have us come to their home so that we can show them, and then you can be confident that your child’s riding safely with everyone who’s traveling with them.  A baby shower gift, too.  It’s a great gift.

Kristin:  Yeah, definitely.  A baby shower gift or — yeah, anything — Christmas gifts, you know, Christmas coming up, like you mentioned.

Jennifer:  And I think one of the things that — our goal is, obviously, like I mentioned, to help you to feel confident to transport your child.  But knowing that there are many, many different phases of car seat safety within your child’s life — you’re going to start with a rear-facing car seat, and then you’re going to, at some point, transition to a forward-facing car seat, and then you’re going to transition to the booster seat, and then you have to know when it’s okay to ride without something.  We do want to be part of your child’s growing-up experience when it comes to car seat safety.  We have no problem teaching families multiple times, particularly at those different stages, because some of the basic knowledge is very wonderful to carry from time to time, but there are some significant changes that take place at each stage, and without really having the grasping knowledge of all of those changes, some of them can be really tricky, and some of them can actually be a very significant difference between a good outcome in a crash and a not-so-good outcome.  So we’d love to be part of that entire experience of your child’s riding in a car seat time.

Kristin:  Love it.  Well, thank you for all of this wonderful information!  And I would love for you to let our listeners in other regions outside of West Michigan know how to find a licensed car seat safety technician.

Jennifer:  Absolutely.  Right now, it is awesome because we are really open to this virtual.  So whether you’re listening on the east coast or on the east side of the state or even in the Bahamas, you can always reach out to us, and we can help you over the computer.  But if you really are looking for that in-person service, you can always go to safekids.org, and there’s a tab at the top that says Find a Car Seat Technician.  There, you can enter your ZIP code, and anyone who has chosen to be listed publicly who meets the requirements of being a nationally certified car seat technician is available to find that way.  I can’t guarantee that everyone’s doing in-person stuff right now, but there is at least someone who will be within your area, hopefully, that can come and help you in-person if that’s what you’re looking for.

Kristin:  Thank you!  Any last words of advice for our listeners, Jennifer?

Jennifer:  Oh, man.  Car seats are a little bit scary, but really, once you take the time to learn them, they are an amazing tool to protect your baby.  I often will say to parents, it’s so difficult because you don’t often know what you don’t know until someone tells you.  And I would love to be that someone for any of you that are listening because this is a place where you can demonstrate your competence, your knowledge, and your commitment to your child’s safety.

Kristin:  That’s great.  And Jennifer, remind us again how to find you.

Jennifer:  Absolutely.  You can always call us.  We can take a text or a call at 616-485-0205.  Or you can find us at our website.  You can also send us an email at info@secure-quest.com, as well.

Kristin:  Thank you so much!  You’ve been listening to Ask the Doulas with Gold Coast Doulas.

 

Alyssa talks to Chris Emmer, a past sleep and postpartum doula client, about transitioning her daughter to a “big kid bed.”  Alyssa gives tips on shortening the bedtime routine and getting the child involved and excited about sleep!  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa:  Hi.  Thanks for joining us today on the Ask the Doulas Podcast.  I am Alyssa Veneklase, co-owner of Gold Coast Doulas.  I am a certified postpartum doula, newborn care specialist, and certified infant and child sleep consultant.  Today, we’ll be talking to Chris Emmer.  She is a past sleep client of mine and also a doula client of ours.

Chris:  Hi, Alyssa.

Alyssa:  Hi, Chris.  How are you?

Chris:  How’s it going?

Alyssa:  Good.

Chris:  Oh, my gosh.  I just got Sam down for her nap.  It’s such perfect timing that we’re going to talk about this right now.

Alyssa:  Well, let’s dive right in.  I know both of us, our time is limited.  She’s taking one nap a day, right?

Chris:  Oh, yeah.  She’s down to one.  She’s been a one-napper for a while.

Alyssa:  And she’s just two?

Chris:  Yeah.  She’ll be two and a half, actually, in, like, a matter of weeks here.

Alyssa:  Oh, my gosh.  Like, when did that happen?  That seems crazy.

Chris:  I know.  The shortest time.  It feels like a hundred years and one day, all at the same time.

Alyssa:  I bet!  So tell me what’s happening.  So since I’m recording, I’ll just update the listeners that you texted a while ago and were like, okay, you know, one of those asking for a friend — what do you do when your two-year-old is climbing out of bed or the crib?  So you had to transition her from crib to big bed recently?

Chris:  Yes, absolutely.

Alyssa:  And it hasn’t been going well?

Chris:  No.  It has not.  It’s been going fine, but it’s been a surprising transition that I was, like, wait, what?  I thought we figured out sleep.

Alyssa:  Well, it’s a different ballgame.  You have a toddler now with a little voice and an opinion, and yeah, it makes things a little more difficult.  I mean, typically, I like to keep a baby — or she’s not a baby anymore, but a toddler — in a crib until they’re three for, probably what we’re going to find out, is all the reasons that are driving you crazy, like they don’t have any impulse control, so they will just get out of bed, and then it turns into this really fun game for them to keep popping in and out of bed.  But then at that age, too, they might not understand the rules, and it might be hard to give them some rewards.  We’ll talk about some of the things that I suggest.  But, yeah, what do you find is your most difficult aspect of transitioning?

Chris:  The put-down has become a very long process.

Alyssa:  Like the whole bedtime routine?

Chris:  The whole bedtime routine.  It’s off the rails.  With the crib, it had gotten so deliciously easy where, I mean, read some books, put her in the crib, walk out, you’re all good.  Like, not even a peep comes out of her.  And since she’s transitioned to the big girl bed, she’s also — and I don’t know if it has anything to do with getting out of the crib and into the big girl bed, or if it’s just, you know, synchronistic timing, but she’s also developed, like, a little bit of fear of the dark, which is funny because when she was in the crib, the room was totally pitch black, and now that she’s in the big girl bed, I have got nightlights in every outlet in that room.  It’s much lighter in there.  So she just gets kind of nervous, I think, and that’s honestly the word that she uses.  She says, “I’m nervous.”

Alyssa:  Well, that crib is small and has walls and feels safe and secure, and now she’s in this big bed that maybe she’s afraid of falling out of or there’s all the — you know, it’s just a lot — it seems bigger, I’m sure.  The whole room seems bigger to her now.  But she was crawling out, right?  That’s why you —

Chris:  She sure was, and she just did it once, and I thought like, okay, well, she figured it out, but, you know, maybe we’ve got a few weeks where she won’t try it every time, and even that night, put her in the crib — two minutes later, boom, she’s out of the crib.  She’s running towards the door.  So, yeah.  It was not really an option.  It was like, okay.  Well, I can’t have her flying out of the crib.

Alyssa:  I wonder if — and you’ll know if this will work for her — a lot of times when kids aren’t ready to transition, we can put them back in one of those sleep sacks with the arms out, and then when they’re in a sleep sack, they can’t get their feet up high enough to actually climb over.  And if she’s smart enough to then unzip the sleep sack and get out of it, you can flip the sleep sack, like, backwards so the zipper is in the back and she can’t reach the zipper.

Chris:  Oh, my gosh.

Alyssa:  We’ve had to do that for some kids, but it helps.  Like, she might want to climb out of the crib, but she won’t physically be able to anymore.

Chris:  Right.

Alyssa:  I don’t know if you think that would work for her.

Chris:  She’s such a physical little lady that I think that she would go nuts if she was, like —

Alyssa:  If her legs were restricted?

Chris:  Yeah.  Yeah.  And then the other thing is that, you know, we’ve got our next kid coming in, like, end of May, beginning of June, so it kind of feels like it’s inevitable that we have to do this transition, and I’d almost rather get it done with without also having a newborn to try to wrangle, you know?  So it’s a little bit like, dang, this day — I knew it would come.  And also, like, well, it’s kind of good timing.

Alyssa:  Yeah.  Well, we don’t want to force it just because a baby’s coming.  Like, we could wait until — you know, baby’s not here until May or June.  You could wait until spring.  Maybe — you know, do you think Sam would understand if you asked her, okay, I know you’re nervous. Would it make you feel better to sleep in your crib again?  And even if you have it, like, completely torn apart and put away and the big bed up, like, you could put that crib in the nursery with the big bed temporarily again.  I just wonder how she would respond if you said, you know, it makes me sad that you’re nervous in the dark.  How do you feel about sleeping in your crib again, but you have to stay in the crib.

Chris:  Right.

Alyssa:  I don’t know.  It’s just so hard at this age.  Like, it totally depends on the kid.  Like, she might get that and be like, yes.  Yes.  I like that idea.  Put me back in the crib.  Or she might just look at you with a blank stare and be like, what are you trying to ask me here, lady?  You’re trying to reason with me?  Come on.  I’m two and a half!

Chris:  I think she’s a little bit of the, what are you trying to do here, lady.  But she is making progress with it.  It’s been, I don’t know, a month, maybe.  And it is getting easier.  Bedtime’s getting shorter.  She had a little bit where she — probably like a week or so where I would say three out of four nights of the week, she would wake up in the middle of the night and be awake and freaking out, and we would have to go get her, hang out with her for, like, an hour and then put her back down.  She’s gotten over that waking in the middle of the night part, and I think she’s — I can tell she’s proud of herself.  Things that have kind of worked are teaching her about, like, if you get nervous, take a deep breath.  That has worked, and then I have been toying with a reward chart, like a sticker chart, and she seems excited about it.  We have yet to put a single sticker on the chart.  So I don’t know, is she too young for something like that?

Alyssa:  Well, that’s a good segue into — okay, so I have the four Rs, and they’re kind of like your superpower for dealing with kids in big beds who want to pop out like Sam.  So the four Rs are rules, rewards, roleplay, and then returns.  So rules are just that.  Like, you can create a chart, but get her involved with it.  So if she likes stickers; if she wants a new doll — like, you could create a chart for a week, and once she gets a sticker on every day of that week, she gets to pick out something.  Or, you know, she really loves donuts, and she doesn’t get them that often.  You know, something that makes her super excited.  But then the rules have to be really simple.  Like, three of them.  Like, okay, Sam, let’s say the rules together.  One, stay in bed.  Two, be quiet.  Three, close your eyes.  But you can also make it fun.  Like, okay, what kind of animal is quiet, and what kind of animal is loud?  We don’t want to be the loud animal.  We want to be the quiet animal in bed.  You know, just think — and you know her best.  Like, you know what will trigger her little brain to be excited about this.  And like you said, we want her to wake up and be so proud that she did it.  And, again, the problem with doing this before three years old is she might need immediate gratification, and the reward chart just does not do it for her.  So she’s like, I did something good, but I have to wait all night for it, and then in the morning, I don’t even care anymore.

Chris:  Yeah.

Alyssa:  So that might be the tricky thing is, you know, just, you got to kind of work it to whatever works best for your own kid.  But if she lays in bed quiet and says the rules — you say the rules to her, and you leave, even if it takes her 20 minutes to fall asleep, if she’s lying there quiet and not getting out of bed and not being disruptive, let her.  Like, we want her to know her bed is not scary.  It’s a safe place.  So do whatever you have to do to figure out what’s making her nervous.  I also caution you about putting nightlights all over the room because we don’t want it bright in there.  That triggers her brain to stay awake instead of get sleepy.  So we don’t want it too bright in there.  So, yeah, maybe just come up with some rules and have her help you with them.  And then the rewards is kind of the second part of that, so it’s a positive consequence for following the rules, whatever those rules you made up are.  And if she hasn’t gotten a sticker yet, maybe the rules need to start a little easier.  Like, okay, the rules are, we brush our teeth.  We put on PJs.  We read one book.  And you need to kind of set a time limit because you don’t want to have to do this for an hour every night.  Make it very clear.  You get one book, one song, and five kisses or something.  Then I leave.  And if you say, then I leave, you really need to leave.

Chris:  Yes.  And don’t let her extend it.

Alyssa:  Right, because they’re so good at that!

Chris:  They’re geniuses!  For the sticker chart thing, you had said in your example, like, stay in bed, be quiet, and something else that was nighttime related…

Alyssa:  Yeah.  Close your eyes.

Chris:  Yeah.  Close your eyes.  So would you keep them all, like, in the same category?  Because what I’m doing right now — let me read to you my current reward chart.  Okay.  It’s a little all over the map.  One is picking up her toys.  Zero stickers.  One is staying in bed.  Again, zero stickers.  One is saying please and thank you.  Zero stickers.  And then another one is going potty.  So, I mean, it’s like everything that I want her to do.  I was just like, let’s put it on here.  So maybe I need to get more…

Alyssa:  Maybe focus it on just sleep right now.  Like, to be transitioning to a big girl bed and potty training and learning manners and all the things at once — I would just stick to sleep until she gets this figured out.  You don’t want to do rewards forever.  You want to give her a few weeks when she’s doing good, and then you get rid of the sleep rewards, and that would be helpful to then move on to, okay, now you get potty rewards.  You know what I mean?  And then once she’s going on the potty, now let’s work on your manners and cleaning up.  So we’re going to sing the clean-up song and you’re going to say please and thank you, and you’re going to help Mommy and whatever other manners you want.  But it might just be too overwhelming for her because it is kind of all over the place.

Chris:  Yeah.  Definitely.  I think she just is like, okay, whatever.  Sticker chart, I don’t get it.  Doesn’t mean anything to me.  Thanks, though.

Alyssa:  Well, and if the sticker chart doesn’t work, maybe — you know, what else could work for her?  What does she get super excited about?  Is it Skittles?  Like, you could give her two Skittles that day if she does something.  I don’t know.

Chris:  Right.  Like, she loves cookies.  Maybe she gets, like, to go pick out a big cookie from the bakery or something.

Alyssa:  Yeah.  Something that she can’t stop talking about, because you know they get something on their brain and then they tell everybody.  You want her to be like, I’m going to get a cookie if I stay in bed all night.  And you’re like, yes.  You will.

Chris:  Yeah.

Alyssa:  So if stickers don’t do it for her, then figure out what does.  And then when she does do it, like the first night she does it, make her feel like a rock star.  High fives, hugs, you’re so great, you did such a good job, I’m so proud of you.  You know, you’re going to be a big sister, and you’re going to be the greatest big sister because you’re going to be able to show this baby how we sleep like a big kid.  And that will be really helpful, too, when new baby does come and you’ll have to explain to her, you know, you’re going to hear your little brother or sister crying in the night.  They’re okay, but, you know, don’t go check on them.  Don’t mess around.  Don’t talk.  Just stay in your own bed and sleep, and then we need you to be the good big sister and show baby how we sleep through the night.  Just so that she doesn’t — because she’s going to feel left out no matter what.  She’s used to getting all your attention, and now baby’s going to get most of your attention for a while.  Bedtime routine at that point will be a big deal for her.  You and your husband will want to make sure you have a dedicated, like — while one of you is with the baby, someone has to have a dedicated time with Sam where it’s only focused on her because she’s going to feel like she doesn’t get that anymore for a while.  You know how hard it is in that newborn stage.  They just need you 100% of the time.

Chris:  Right.  I know.  Bedtime is one of the things I feel most nervous about.  Like, I can’t even wrap my brain around putting two kids down at the same time.  So it feels important to get her sleeping good, and I feel like this is — you know, we’ve got some time still.  So I feel like it’s kind of working out, slowly but surely.

Alyssa:  Yeah.  And it will.  You do have time.  I think, again, like, when we were doing sleep training when she was a baby, consistency is still key.  Like, you have to make the rules, and you can’t stray from those because especially now, they know how to push, and I know that if I ask for X, Y, and Z, and Mom’s going to get it every time, then of course I’m going to ask for these things every night.  And she might be a little mad at first, but she’ll get over it.

Chris:  Yeah.  Stick to your guns.  You don’t think she’s ready to drop that nap, do you?

Alyssa:  I don’t think so.  At two — most — I mean, if she’s not tired at night or waking super early in the morning, that’s kind of when you know they’re ready to drop the nap.  She needs — you know, let’s say she needs 14 hours of sleep in a 24-hour period.  So that’s 12 hours at night and a 2-hour nap.  Now, as we get older, we kind of need less and less sleep.  You know, I think most toddlers through teenagers, even, still need 10, 11 hours of sleep.  So school-aged kids are not getting enough sleep when parents just tell them they need 8.  They still need 11.  My almost 8-year-old daughter gets 11 hours of sleep at night.  She needs it.  But when you notice Sam is just either not tired for that nap or when you give her a nap, she refuses to go to sleep on time, or she goes to sleep on time but starts waking up at 5:00 in the morning, she’s just getting too much sleep.  So instead of eliminating the nap altogether, you could drop it down from 2 hours to 1 hour and see if that helps.  And then, you know, maybe in the next 6 to 12 months, you could try dropping it.  There’s going to be a period of transition where some days, she’ll need it, and some days, she won’t, and that’s totally fine.

Chris:  She goes to school two days a week, and there, she will take a nap like a champion.  Her teachers are like, oh, she laid right down and put herself to sleep.

Alyssa:  Of course she did!

Chris:  Like, what?  How did you do that?  Teach me your ways!  And one of the things that they do at school is they have a sticker chart.  That’s where I picked up that thought because I was like, what’s working for you?  Please tell me!  Tell me all your secrets!  So they do the sticker chart, and then when they get, like, five stickers, they get to pick out a reward.  So maybe that’s like — she came home with a pink sparkly bracelet one day, and she thought she was the coolest girl in the world.

Alyssa:  Oh, maybe you buy, like, a little treasure box for her that she knows she gets to look in and pick something.  You know, that way it’s, like, there in the house; she can see it, and she knows she gets to dive into that treasure box every Sunday.  So she has to, you know, Monday through Saturday, has to get a sticker on the chart, and then on Sunday morning, she gets to choose a little prize from the treasure box.  That’s a good idea.

Chris:  I feel like she would be so geeked about that, like if she could see it and know there was, like, treasures inside.

Alyssa:  Yeah.  I wonder if you could even find, like, a clear little locking — I’m almost picturing, like, what looks like a makeup case or something.

Chris:  Like a Caboodle?

Alyssa:  Yes!  A clear Caboodle filled with sparkly toys.  That’s a great idea.

Chris:  That would also just be so fun for me to put together!

Alyssa:  Right?  It would be, like, the cutest thing ever!

Chris:  No, I think that that would really work for her, though!  And, like, the reminder of being able to see it would be, I think, enough to keep it top of mind for her that, like, we’re going to work towards this.

Alyssa:  Yeah.  Be a good incentive for her.

Chris:  Interesting!

Alyssa:  Yeah.  So maybe try that!

Chris:  I will!

Alyssa:  So the third R is roleplay, and this could work well for her if she, you know, has, like, a favorite stuffed animal or doll.  Like, you would use roleplay with that little stuffed animal and put them to bed.  So you’d kind of do a little condensed version of your bedtime routine with the stuffed animal.  So you could say, let’s make rules for — you know, my daughter has a teddy bear named Fuzzy.  So let’s set some sleep rules for Fuzzy.  Let’s put him to sleep and then give him a kiss, sing him a song, and then you kind of just close the door and go out into the hallway and wait.  And then you just wait a couple seconds and say, okay, I think he’s sleeping.  Let’s go check on him now.  That, in her mind, triggers, oh, I think when I go to sleep, Mom and Dad might be waiting out in the hallway, like, checking on me, and that makes them feel comfortable, even if you’re not out there.  And then you go in and say, oh, good job.  You know, Fuzzy’s sleeping.  Let’s put a sticker.  You could even make a little chart for the stuffed animal and give the little stuffed animal a sticker on their chart.  And, again, you know Sam best.  Maybe that works for her; maybe it doesn’t.  But it’s worth a try.

Chris:  Yeah.  I love that!

Alyssa:  And if you don’t make a chart, you could put a little sticker right on the stuffed animal’s hand, like right then and there, and be like, oh, my gosh.  It’s so great!  And then in the morning when Sam wakes up, you can say, okay, let’s go check on the stuffed animal, too, and see how they did.  And you just make it silly and fun, whatever — and they also kind of feel like they’re in charge, then, of this little stuffed animal’s sleep schedule.  And most two-and-a-half-year-olds like to be bossy, so…

Chris:  I think she would love that.  I think she would be so into it.  That’s a really fun one.

Alyssa:  So maybe you could make, like, a little sleep corner for the doll or stuffed animal.

Chris:  Yeah.  She does have a little crib for her babies.

Alyssa:  Oh, perfect.

Chris:  I love that.  Good one!

Alyssa:  And then the fourth one is returns.  So when you say in the middle of the night she wakes up and needs your help and you’re in there for an hour, you know,  you kind of want to — we don’t want to be in there for an hour, but you also don’t want to do the bedtime routine for an hour, so everything needs to be super quick.  Like, remember when she was a baby and we would just kind of let her fuss it out, but we would always go check on her.  But the check-ins were, like, super quick.  They’re quiet.  No talking.  We’re not there to entertain her, and especially now toddlers love attention.  So if she knows, okay, I’m nervous.  I’m scared.  I woke up in the middle of the night.  We obviously want to go comfort her.  But we also want her to know that you’re not going to lay there with her for an hour at 4:00 in the morning because you’re exhausted, too.  So it would be more of, like, going — whether she got out of bed and came to you or was just crying in her bed, you could go — you know, you could go lay down with her for a second, or not even lay down; just, like, lean on — kneel on the floor and shush her or something.  Like, you don’t even need to talk.  Just shush, give her a kiss, rub her hair, and then say, okay, it’s time to sleep.   Remember your sleep rules.  And then leave.  So you want to be in and out really quick again.  And she’s old enough to understand, like — and you can tell her, like, Mommy and Daddy are tired, too.  I need to go to sleep.  So you definitely don’t want to do — and you said she’s kind of over that, but hopefully she’s done, but if she did that again — but then just kind of apply that same thing, too.  If you put her in bed and then she pops right back out and you’re watching TV and all of a sudden there’s a little pitter-patter of feet behind you, just do it really silently and quickly.  And you don’t want to say — you want to keep it positive, if you do say anything.  You don’t want to say, oh, you got out of bed.  You don’t get a sticker.  You don’t want to say anything negative or talk about consequences at all.  Don’t remind them that they won’t get a sticker.  They just won’t get one in the morning, but we don’t want them to get all upset in the middle of the night, which makes it harder for them to go to bed.

Chris:  Interesting.  Yeah.  So have it be just a positive reinforcement but don’t, like, rub it in?

Alyssa:  Yeah.

Chris:  Like, well, there goes your sticker for the week.

Alyssa:  Yeah.  And I find myself doing that.  You know, my daughter can take forever getting ready for school, and I’m like, you’re this close to losing your iPad.  And then all of a sudden she’s crying, and here I am, I’ve got five minutes to get her out the door, and I just messed everything up because now I have to say, oh, I’m sorry, and console her, and now she’s crying and all upset, and she has to go out the door crying, and then I feel awful all day.  And I’m like, why did I just do that?  You know, like, I can talk to her after school about listening better.  It’s the same thing in the middle of the night.  We’re tired.  We’re furstrated.  They’re not listening to us.  And we’re like, you just lost your sticker.  And kind of get upset, and then they’re crying because they can hear that we’re upset, and they just lost a sticker so they’re sad.  So it’s not that you won’t do it ever, but just try to keep it in your mind.  Just try to keep it positive.  Like, I know you can do this.  You’re a big girl.  You can go to sleep.  I don’t know if that helps.

Chris:  That does help a ton.  And yeah, I’m sure there will be times where I’ll slip up and accidentally bring it up.

Alyssa:  None of us are perfect.  That’s why I try not to be too hard on myself.  But, gosh, sometimes it’s hard.  Do you think a sleep training clock would work for her?  Would she, like, understand a light turning on at a certain time?

Chris:  Okay.  So we do have one of those, the Okay to Wake clock, and I set it so that — well, it was right before daylight savings time, and I set it so that it would turn green at 7:00 a.m.  And since daylight savings time, she’s been awake much earlier, so like 6:00-ish, and she wakes up just kind of like — I don’t know.  It feels like she wakes up and thinks, like, what the heck?  Like, where am I?  What’s going on?  Got to find Mom.  And so I am up anyways, and I’ll just open her door and let her come out, but I’ve been thinking about how I can get her to stay in her bed longer.

Alyssa:  So when the time changed, did you adjust her schedule?

Chris:  We did.

Alyssa:  And it just didn’t really click?

Chris:  We’ve just been in a little bit of a funky timing thing where bedtime started taking a lot longer, so even though we start it at the same time, it would take her longer to fall asleep.  And then you would think that that would make her sleep in later, but of course, it has worked the opposite and she’s been getting up earlier.

Alyssa:  Well, that could be a sign, too, then, of that maybe you just need to try shortening that nap.

Chris:  Yeah.

Alyssa:  And maybe that will push your morning out a little bit.  So she’s normally getting two, and you could even ask, you know, at school — how long does she nap at school?

Chris:  Like, an hour.  An hour and a half at the very most.

Alyssa:  Yeah.  Maybe ask them to —

Chris:  And same at home, too.

Alyssa:  — get her up after an hour and see if that helps.

Chris:  Yeah.

Alyssa:  Or 45 minutes, if she’s normally doing an hour.

Chris:  It’s just so terrifying to wake up a sleeping child.

Alyssa:  Do it slowly!  Go in gently.  I mean, even with a baby, you know, you would just kind of slowly maybe turn the lights on dim and sit on the bed and rub her back or something and slowly wake her up.  Doesn’t need to be loud and abrupt with glaring lights in her face.

Chris:  Interesting.  On one day of the week, she goes to Grandma and Grandpa’s house for the afternoon, and on those days, she generally doesn’t take a nap.

Alyssa:  Interesting.  How does she do at night those nights?

Chris:  Just a wreck.  She’s exhausted.  It’s super hard to keep her awake on the drive home, and it’s really hard to get her to bedtime.  And then bedtime just kind of falls apart because she’s so overtired.

Alyssa:  So why doesn’t she nap there?

Chris:  They just can’t get her down.  Because she’s a fighter, you know?  You got to be ready of the battle.

Alyssa:  It’s so funny.  She does it for everyone but those who are closest to her.  You know, like, she can do it at school.  Because it’s not their parents.  Like, they listen to everyone else other than parents and caregivers like relatives or whatever.  It’s just the hardest for us, and they know we love them the most, and they just push and push.  And usually we give in.

Chris:  Right.

Alyssa:  Which makes it so frustrating for us!  Yeah, so she can do it, but I get it.  If your parents don’t want to, like, even deal with that fight — but they too — I mean, if you’re going to try this, they could also have a sticker chart at their house where — you know, maybe it’s smaller things, that if she lays down and sleeps, she gets to pick out one thing from this jar when she wakes up.  So they could use their own version of that.  Because she obviously needs it.  That’s your first sign right there, when you answered, she’s a wreck.  So if she didn’t nap at all, then you would just be dealing with that every day.  I mean, she’s not ready.  Not ready to drop that yet.

Chris:  Well, that’s good for me!

Alyssa:  Even when she is ready, though, you can still make her have quiet time.  So let’s say in a year.  She’s three and a half or almost four, and she just doesn’t need to nap anymore.  When she’s at home, she just gets an hour of quiet time in her room.  So you still have that hour of reprieve, and she gets to play trucks or dolls or puzzles or color or whatever she likes to do, but she has to do that for an hour.

Chris:  And just be quiet in her room?

Alyssa:  Yep.  Just give her quiet time.  So I do have a section on a new sibling.  Expect some jealousy, like we talked about.  Well, you know, a lot of times, it’s — if the toddler’s in the crib still, they have this feeling of the new baby stealing their crib, but that shouldn’t be an issue since she’s already out of the crib.  I would just talk to her a lot about the new baby and how the baby is going to need you for a lot of things, but you’re still the big sister.  And then talk about them crying in the night.  They’re going to be hungry.  That’s why they’re crying.  They’re not sick or sad.  And that she just needs to stay in her own room in her own bed, and keep the expectations really clear.  And then, again, just keep using positive language.  Like, I know you can stay in bed because you’re such a good kid.  You’re such a big kid.  You’re a great big sister.  Just keep a lot of positive language.  And then really focus on her at bedtime.

Chris:  Yeah, and make sure to have one on one for that?

Alyssa:  Right.  That will be really important.  Do you think that they will ever — because I do have a section on siblings who share a room, and I did get asked by someone else who heard a different podcast to share some information about, like, if siblings ever share a room.  Do you think that the two of them would ever — I guess that might depend on if you have a girl or a boy?

Chris:  That’s true.  I mean, I think it’s cute, the idea of them sharing a room, but honestly, for that newborn phase, I can’t even — my brain can’t even comprehend how that would work.

Alyssa:  Well, yeah, newborn phase, usually the baby would be in your room in a pack and play or bassinet or something anyway.

Chris:  Right.

Alyssa:  But let’s hypothetically say you decide, you know, a few months in or something to move the crib into her room.  Ideally, you would put the baby to bed first and then Sam.  So, you know, by then, she — let’s say her bedtime is 7:30, but you’re going to put the baby down at 7:00.  That could be perfect.  So the baby goes down, and if you do any sort of sleep training, or let’s say you read through the plan I gave you originally, and you’re like, okay, at three months, we’re going to start doing some things.  Do that while baby’s still in your room, and then, you know, make sure that the new baby is — like, I know that after I put baby down, he or she is going to fuss for, like, 15 minutes and then fall asleep.  So that way you know, okay, once I transition — and even if — I mean, this could also work if the nursery is going to be right next to Sam’s room, like abutting walls.  It’s kind of the same as being in the same room, because she’s going to hear the baby all the time.  But you would know that I can put the baby down.  They’re going to fuss for, like, 15 minutes, but then I’m going to start at 7:30 putting Sam down, and then she’ll be asleep by 8:00.  Just keeping it really consistent and keeping her bedtime routine really consistent, but getting the baby’s out of the way.  And I think if you have to do them at the same time for some reason, you’re just going to have to divide and conquer so that she still feels like she’s got some, you know, one on one time with you.

Chris:  Yeah.

Alyssa:  I think letting her know that babies just wake up to feed, you know, especially at first, but let’s say baby’s three or four months old.  If the baby wakes up fussing, Sam will just have to know, like, it’s normal.  Leave the baby alone.  Don’t try to go do anything because then you’re going to wake the baby up more.  Just let the baby fuss back to sleep because that’s the last thing you want, to look at the monitor and Sam’s in there reading a book or singing a song or doing a whole dance routine!  Like, I know how to make the baby stop crying!  I’ll turn on some music and dance!

Chris:  I can picture it!  I can totally see it on the monitor playing out in front of my eyes!

Alyssa:  Disco ball going!

Chris:  That’s really helpful.

Alyssa:  Yeah.  Just talk to her a lot!

Chris:  I feel like we’ve got a kind of a phased plan where it’s like, okay, first, let’s get her — let’s do the rules, rewards.  And I think the roleplay thing would be really fun, too, to practice bedtime with her toys and get that going for a while until she gets really good at that.  And then we can start talking about what it’s going to be like when the baby’s here and how she can be a really good big sister and teach her sister or brother how to stay in bed and be quiet and those sorts of things.

Alyssa:  Yeah.  You could even use a baby doll and pretend.  You know, if you call your baby something right now, like pretend it’s little peanut or whatever.  And then say, let’s teach your baby brother or sister to go to sleep.  And then when baby actually arrives, you can make her a part of that process.  Like, remember how you do that?  We’re going to shush baby.  Let me swaddle the baby, and then I’m going to teach you how to help me, like, shush the baby.  And she can sit by the crib and go “shhhh” or something.  Have her be part of that, and then you slowly walk out together.  Then she’ll feel like she’s actually helping and part of this process as a big sister instead of just feeling left out.

Chris:  Yeah.  Totally.  I could see her feeling really cool being, like, a part of the mom squad.

Alyssa:  Heck, yeah!

Chris:  Awesome.  This is really helpful, Alyssa.

Alyssa:  Well, thank you for doing this!

Chris:  Thank you for all your wisdom!

Alyssa:  Yeah.  You know I’m always here!

Chris:  I know how you knew the asking for a friend thing…

Alyssa:  I’m like, wait.  Is Sam two?  Are you asking about your own child?  It literally kind of took me back a minute.  I’m like, no way she’s two!

Chris:  Let’s just say someone has a kid who isn’t sleeping.  What would one do?

Alyssa:  Hypothetically… Well, cool.  It was so good to talk to you, and congrats again.  I’m super excited for you.

Chris:  Thank you so much.  I’m going for that VBAC this time.

Alyssa:  Awesome.  Before you go, I can give you a little shoutout.  Are you still doing both Biz Babysitters and Sweaty Wisdom or neither or one or the other?

Chris:  I am actually doing both.  Sweaty Wisdom had a name change, and now we’re Mindful Social Co.  So we made a little switch, but still doing that, and then Biz Babysitters had been kind of on hold, but my fire has been reignited with this pregnancy, because I’m like, God, I’m in it right now.  I know exactly what this feels like.  So that’s back in biz, too.

Alyssa:  You learned from last time what you need this time.

Chris:  Yeah.  Exactly.  So it’s fun to strategize on that.

Alyssa:  Cool.  Awesome.

Chris:  Thanks so much!

If you have any sleep questions or would like to inquire about a sleep consultation with Alyssa Veneklase, these can be done via phone and text not only with local West Michigan families, but families all over the country.  Contact us here!

 

 

Today Kristin and Alyssa talk about some interesting, and funny, and gross things that happened to their bodies during pregnancy and birth that were a bit unexpected!  You can listen to this complete podcast episode on iTunes or SoundCloud.

 

Alyssa:  Hi and welcome to the Ask the Doulas podcast.  I am Alyssa Veneklase, co-owner of Gold Coast Doulas, and I am here with my business partner, Kristin, the other owner.

Kristin:  Hello!

Alyssa:  Hey.  So we had a podcast a while ago where we talked about things we wished we would have known postpartum.  And then we decided to talk about things we wish we would have known about pregnancy and just kind of talk about some of the weird experiences that we went through personally.  Maybe some funny things, maybe some gross things; who knows.  But yeah, what was your pregnancy like?  You had two.

Kristin:  Yes.  So with my daughter Abby, I had a pretty easy pregnancy up until 37 weeks.  My midwife used to call it the perfect pregnancy up until I got preeclampsia.  But yeah, I didn’t gain a whole lot of weight.  I wasn’t — I mean, I had a lot of nausea.

Alyssa:  Like, just in the beginning, or the whole time?

Kristin:  All of my pregnancy.  I was driving to Lansing every day for work, and I would pull over — I would plan out my day so I left really early because I would need to pee, so I would stop at the rest stop near Portland or, like, actually pull into a grocery store in Portland and use the bathroom because I could never make it the whole way to Lansing, and I also needed to walk around.  My legs just didn’t do that well driving and would get kind of tingly and needed to move.

Alyssa:  And that’s only an hour drive from here, right?

Kristin:  About an hour — depending on traffic, yeah.  An hour-ish.

Alyssa:  So in an hour to an hour and a half’s time, you couldn’t sit for that long or go that long without peeing?

Kristin:  And there were multiple times that I would have to pull over and throw up on the highway.  And that was part of it is I was so nauseous driving or being in a car, and there were times that I remember going to a friend’s party in the summer, and Patrick — I had him pull over and I threw up on the road.

Alyssa:  On the way to a party?

Kristin:  Yeah.  Yeah.

Alyssa:  So was that all day long, every hour to an hour and a half, you would have to get up and pee or you’d feel nauseous or you had to move your legs?

Kristin:  Mm-hmm.

Alyssa:  That’s tiring.

Kristin:  Yeah.

Alyssa:  But you still consider it a perfect pregnancy?  Like, it wasn’t…

Kristin:  I had nauseas.  Yeah.

Alyssa:  Yeah.  Wasn’t that bad.

Kristin:  And then toward the end of my pregnancy, I also had the restless leg syndrome, so I would get up in the middle of the night and have to, like, hop on one foot and wake Patrick up because my cramping in my leg was so intense.  But I’ve always had vein problems with the circulation in my legs, so…

Alyssa:  So that was probably a circulation issue?  While lying down, like that made it worse?

Kristin:  Yeah.  It was only — I only had the cramping when laying down.  And I didn’t know until later about using magnesium or Epsom salt baths and different things you can do when you are dealing with cramping.  It wasn’t anything — I don’t think I brought it up at an appointment.  I just was like, okay, I’ve read about it.  Whatever.  It’s weird, but yeah.  So what did you have that was —

Alyssa:  Well, what about with Seth?  How was your pregnancy?  Was it different with Seth’s?

Kristin:  Totally different.  Seth was so much easier.  He was also a much bigger baby by almost three pounds, so I was showing a lot earlier.  Like, I felt like I was instantly had, like, the little baby bump.  But yeah, he was a chill baby in the womb.  Abby moved around a lot.  I used to call her my little goldfish.  Like, she was in a fishbowl and I could feel her movements very early.  And with him, I was always like, is he all right?  He’s not kicking me.  He’s not, like, in my rib.  He’s not moving.  And so I would have to, like, are you in there?  He’s just sleeping and chill.

Alyssa:  Poke him a little bit to make him move around.  He’s like, leave me alone.

Kristin:  I’m just sleeping, Mom.  But I definitely was showing earlier and felt just — I didn’t have the nausea that I did with Abby, but with him, I just felt bigger and heavier.  But I didn’t gain more weight at all.  Same amount, like about 32 to 35 pounds.

Alyssa:  Yep, my pregnancy was — like, I always tell people if I could be a surrogate, like, I would just keep having — I don’t want more children, and we went into this knowing we were only having one, so I just cherished every moment.  But I didn’t have any nausea, like ever.  I slept great.  Everything was literally perfect.

Kristin:  Did you have heartburn or anything?

Alyssa:  One day.  Literally, one day.  I remember sitting in my office at — you know, I worked at a construction company, so it’s all these guys, and I’m like, does anyone have Tums?  Like, I don’t even know.  What do I need?  I’ve never had heartburn before.  Nobody did!  My boss was like, I think I have this old pack in this cupboard in this bathroom, and they had expired 15 years ago, but I was like, screw it.  I’m taking some.

Kristin:  Something!

Alyssa:  I remember mixing baking soda with water, and I drank that whole thing down, because I’m like remembering, you know, basic chemistry and acids and bases, and I’m like, I think I’ll just drink some baking soda and see if it helps.  And it didn’t.  But I literally only had it one day.  I didn’t gain a ton of weight, either, but since I was only having one, like, I wanted to look pregnant so bad.  So bad.  And I’m really, really tall with a really long torso, and it just took forever.  I felt like I looked pregnant at maybe 30 weeks.  So I bought — I remember finally seeing this tiny little bump.  I mean, literally, like I could have just eaten too many burgers and fries that day.  And I was like, yes!  There she is!  And I went out and bought maternity pants and all this stuff, and then the maternity pants would fall off because I just wasn’t ready for it.  But I really, really, really loved being pregnant; loved looking pregnant; loved how I felt when I was pregnant.  I worked out normally through the whole pregnancy, and then finally it was — I remember the day that I think she must have just dropped.  It was like my hips moved, and I was like, oh, what was that?  And I could no longer do the workouts I was used to doing.  I went from literally going to kickboxing and yoga and all these classes to, like, okay, I’m working out at home now.  I can’t run.  I can maybe walk.  And then I can no longer stand up — the whole — even 35 weeks pregnant, I was standing up to put pants on and doing everything normally.  I’m like, okay, now I have to sit down to get dressed.  Sit down to put my shoes on.  So that was the biggest change.  And my boobs got huge, which I didn’t expect to happen that soon.  I thought that it would — it got even worse after the baby was born, after she was born and my milk came in.

Kristin:  Like, what size bra do I buy?  Because they’re huge now.  Are they going to stay huge?  What do I buy?

Alyssa:  I was just busting out of my regular bras because I didn’t know.  Are they going to stay like this?  Are they going to get bigger?  Will they go back down?  What’s happening?  What will happen?

Kristin:  Yeah, and I was still nursing Abby during my pregnancy with Seth, so I didn’t have a big supply, but I had milk throughout my entire pregnancy.  So that was weird.  That’s how it was.  And then my milk came in after I had Seth, and it was like, whoa.  So much!  Didn’t know what to do with it.  Luckily, I had Abby, so she’s like, okay, I’ll have the milk.  Great!

Alyssa:  I’ll take it!

Kristin:  Yeah.

Alyssa:  So when you were pregnant, did you have really weird dreams?  I do remember hearing that you could, but that was one of the most noticeable strange things for me was that I had really wild dreams.

Kristin:  Yeah.  I felt like they were — some of them were so lifelike.  Like, I felt like I was living the dream.

Alyssa:  Like, very vivid?

Kristin:  Yes.  Very vivid.  Like, almost in full color, just — yeah, like a movie.  But I didn’t have night terrors like some women do.  I couldn’t remember all of my dreams.  Some people would keep a dream journal, I know, during pregnancy and try to record.  Did you keep a journal?

Alyssa:  Yeah.  I’ve always been a good journaler, and especially during pregnancy.  Again, knowing this was probably our only one, I wrote down a lot, and I did write down a lot of dreams.  One that I remember most vividly is I gave birth to a kitten, and the kitten was adorable, but I remember wrapping it, like swaddling it, and then telling Brad, this is a really cute kitten, but I hope next time we have a baby that’s a human.

Kristin:  That is awesome!

Alyssa:  Oh, and then another one is Finn came out, and she was a baby, but she could talk, and so she looked at me straight in the eye, and said, well, aren’t you lucky?  You have a baby that can tell you what she needs.  And I was like, this is amazing!  This is great!  Yeah, just really, really strange.  Really strange ones.

Kristin:  I can’t remember anything specifically, but I do remember that they were very vivid and colorful.

Alyssa:  What about hair and skin changes?  Like, I know I had friends who their nails grew long and their hair was so beautiful.  And I had the opposite.  It’s like she drained all the nutrients from me.  My hair got super stringy.  My nails were really thin and would break a lot.  And then it finally went back to normal after I had her.  But those people who get the beautiful hair during pregnancy, those are the ones who it starts falling out.

Kristin:  They lose it in clumps.

Alyssa:  So I didn’t have the hair loss, but it’s because I didn’t have gorgeous hair during pregnancy.

Kristin:  Yeah.  And I felt like I did have — I grew more hair with Abby, but with Seth I was nursing, so I was depleted, anyway.  So yeah.  But I didn’t get a lot of weird hair growth.  My belly button popped out, like when my belly popped.  My belly button was probably four inches or so out.  You could see —

Alyssa:  Four inches out?

Kristin:  You could see it in photos.  Like, with the belly, the belly button was like, boom.

Alyssa:  With both pregnancies?

Kristin:  Yeah.  And I always had an outie belly button, but it never was, like, protruding all the way out.

Alyssa:  So do you think pregnancies with that belly button that pops out is people who already have an outie belly button?

Kristin:  I don’t know.

Alyssa:  I wonder what the stats are on that because I don’t have an outie, and I never got — I mean, obviously, because the baby’s pushing on it, it got closer to the — you know, there was less of a hole there.  But it never popped out.

Kristin:  Maybe someone with a medical background could explain that.

Alyssa:  Yeah.  Someone, please answer this question!  Or I could Google it, I suppose.

Kristin:  But it does make sense that if you had an outie and — I mean, I really popped.  Because of my frame, I was all belly with both of my kids, and Seth was bigger, so it was even more pronounced in the photos.  But I had friends that asked me, and they’re like, so is my belly button going to look like yours?  I don’t know!  And theirs never popped out, so it’s definitely not for everyone.  People can have hair growth in different places in their body, and the nails, like you mentioned.

Alyssa:  You know what, I feel like I did get hairier on my body, which was not a good thing.  You know, I would have rather had the luscious hair on my head.  I do remember, like, my belly looked fuzzy.  I mean, I kind of have peach fuzz anyway, but I feel like it was dark.

Kristin:  Yeah.  Some people get the line around going up their stomach.

Alyssa:  I didn’t get that, either.

Kristin:  I didn’t either.  But, yeah, there’s some definite weird changes in pregnancy.

Alyssa:  Finn was born covered in, like, black hair.  Like, not all.  I shouldn’t say covered.  She wasn’t like a monkey, but she had —

Kristin:  And she’s so blonde!

Alyssa:  Yeah.  She had dark hair on her head, which she lost it all, but all — her shoulders and her back had this, like, black peach fuzz, and I remember Brad looking at me and going, oh, my God, will that go away?  I was like, yes.  It will.  We had a fur baby!  What is going on?

Kristin:  That’s awesome.

Alyssa:  But yeah, it all fell off, but unfortunately so did the hair on her head, and she was bald for about a year.

Kristin:  Right?  Yeah.  That happens and people don’t expect it.  Or the hair can be really dark and then be light.  There’s so many weird changes with babies, as well.  My kids were covered in vernix.  I don’t know if Finn was?

Alyssa:  Yeah.  I mean, quite a bit, when I look at pictures.  Not like the — not, like, super thick, where it looks like you could peel it.

Kristin:  Like, that cheesy kind of it.  Yeah.

Alyssa:  You had a lot, huh?  You had excessive?

Kristin:  I didn’t know as much about the benefits of it.  I would have, like, rubbed it in.  But I definitely — I mean, we kept it on them a bit until they sponge bathed it off.

Alyssa:  I remember my boobs getting really veiny.  Like, in producing milk.

Kristin:  Oh, 100%, yes.  You could see the veins all over.

Alyssa:  And I didn’t even really notice it until Brad one time was like, why are you so veiny?  And I’m like, what do you mean, veiny?  And then I had a tank top on.  I think it was in summer, and I was like, oh, my God, I am veiny!  It’s like they just kind of — it was like they were going to pop right through.  My skin became transparent or something.

Kristin:  Yes.  That is definitely…

Alyssa:  And then it got even worse when I was actually nursing.

Kristin:  Yeah.  I was going to say, that continues through nursing, and then after, things go — a lot, most everything, with pregnancy goes back to normal after either nursing or delivery, so depending.  But yeah, I don’t think I have any strange after-effects, like things that listed beyond pregnancy, that I didn’t have before, other than getting varicose veins, which is genetic for me.  They were more pronounced and worse with Seth, and so — and I’m still off and on getting treatment for it because my legs ache, and as I mentioned, like I had the restless leg syndrome.  So that is — I would say that’s my biggest lingering thing is problems with circulation in my legs.

Alyssa:  Yeah.  I don’t think I have anything either.  I mean, the basic, you know.  Your bladder’s not as strong, but if only every — I mean, probably every woman in general, but even during pregnancy, if you go see a physical therapist — you know, I saw a wonderful woman named Joellen at Hulst Jepsen, and she literally changed everything.  I don’t think people understand.  Like, there is — you can do physical therapy, and it’s not just Kegels, and you can go Kegels the wrong way, and you can actually do Kegels too many times and then it has the opposite effect.  I just really learned a lot, and it helped tremendously.  Like, even now, seven and a half years after giving birth, I still had to get up once, sometimes twice a night, to pee.  And when I remember to do these exercises, I sleep all night long.  I wake up and I go pee.  But I can tell if, for like, a week, I just kind of forget about it, two or three nights into it, I’m waking up at 4:00 in the morning every day to go pee.  I’m like, oh, shoot, I haven’t been doing my exercises.  And there’s a very specific way to do them, and it’s so easy.  I could literally be doing them right now, and it helps instantly.  But people just — you know, your mom tells you it just is what it is.

Kristin:  You’re never going to be able to jump on the trampoline.

Alyssa:  Yep.  You’ll never be able to do jumping jacks.  You’ll never be able to run.  Now, granted, when I sneeze, I still do have to cross my legs and sometimes go change my underwear because I peed a little bit.  So I probably should do the exercises more, that means.

Kristin:  Yeah.  I noticed it.  I was doing a virtual 5K with some friends, and I was like, my bladder just — I feel like I need to, yeah, empty my bladder right now.  It just doesn’t — I should probably go see a physical therapist, I think, because the concrete running was not ideal for me.  I couldn’t imagine being a marathoner.  That was just a 5K.

Alyssa:  Nope.  Not for me.

Kristin:  For me, the books you read and classes you take, it’s like, yeah, you’re going to be potentially gassy in pregnancy and not know it, and I was working at the house in the later part of my pregnancy in Lansing in communications, and I remember huddling around with some male coworkers, and I passed gas in front of them, but it was silent, but it was very smelly.  And they were all like — and they knew it was me, and they didn’t want to —

Alyssa:  They didn’t blame it on each other?  They knew it was you?

Kristin:  Yeah.  They knew it was me.  I knew it had to me, and it was like, this is a real problem.  So I apologized and walked away.

Alyssa:  I didn’t know farting was a pregnancy issue.  I don’t even remember reading that.

Kristin:  Yeah.  It is.

Alyssa:  I guess I didn’t have it.  Or if I did, I was just farting my whole pregnancy without knowing it.  I don’t remember it at all.

Kristin:  I remember in childbirth classes, like, people would pass gas.  Yeah.  That’s just how it is.

Alyssa:  I mean, I was nervous about the whole pooping on the table.  I mean, that was my biggest fear.  Oh, my God, am I going to poop in front of my husband?  And I don’t think it ever happened.

Kristin:  But that is one of the most common fears that my clients have is pooping during labor and having people see it.  But it’s not a big deal.

Alyssa:  The nurses just kind of sweep it away, right?

Kristin:  Yeah.  You don’t even know.

Alyssa:  Yeah.  I remember asking Brad.  I was like — a friend was like, yeah, I think I pooped on the table, and I was like, Brad, did I — he was like, no.  I mean, not that I know of.  I don’t think so.  I’m like, okay, good.  Even if I did, he’s —

Kristin:  Not everyone does.  I mean, not all of my clients do.

Alyssa:  I remember going, like, specifically going to the bathroom that morning, and thinking, good.  I went.  Not that I can’t go again, but I had that thought in my mind.  I hope that the day I give birth, I poop in the morning so that I don’t do it in front of my husband on the table.  That was a legitimate fear.

Kristin:  Yeah.  It makes sense.  I mean, it’s weird.  Bodies do so many weird things in pregnancy, and we can talk about some more of the birth experiences later in a future podcast.

Alyssa:  Did your water break?

Kristin:  In my labor?  With my first, while I was pushing, my water broke.  And then with Seth, it was — I’d gotten to the hospital.  I was in pretty active labor, and I remember, he was so low.  I felt a ton of pressure the second I got to the hospital.  It just felt like I needed to empty my bladder constantly.  So I was toilet-sitting, which is great for labor.  I always tell my clients to do it.  And then I remember doing hands and knees on the floor of my room.  Patrick was out in the hallway calling our friends who were going to take Abby from the babysitter — actually, my parents had Abby.  Never mind.  But he was in the hall, and he could hear the pop of my water breaking from the hall on the phone with our friends.  And so it was that loud, and I had a long skirt on, and the water went — it was like a huge pool, and everything was soaked, so that I was naked after that.

Alyssa:  So you were in active labor in regular clothes?  You still had —

Kristin:  I had planned to be in a long skirt and a nursing tank, was my choice for labor.  And I had a pad and underwear, but it was like, boom.  So then my doulas took off my skirt, and then I was naked for the rest of the time.

Alyssa:  My water broke, but it was totally — like, that’s what you expect to happen.  Like, from the movies, like, it just is the huge explosion and water everywhere.  When realistically — I think in our other podcast, I said, like, 30%, but I think it’s half that.  I think it’s 10 to 15% of women.  So it’s very, very low.  It’s highly unlikely your water will actually break.  But mine did lying in bed.  And I was laying there, and it woke me up.  I felt like a — I don’t know.  Like, when your period first starts and, like, you can feel some blood coming out.  It was almost like that kind of feeling.  So I got up, and I was like, well, I’m awake now.  I better go pee.  And I climbed out of bed, and went, oh.  And I remember, like, grabbing myself and then kind of waddling to the toilet, and I sat down, and I’m like, okay, wait.  Okay, wait.  My pants are wet.  My underwear is wet.  Like, what is this?  Did I pee myself?  I’m going through all these thoughts.  Did my water break?  But it’s not, like, gushing.  I don’t remember a smell.  I pictured, like, this big gush of water, and it wasn’t.  It was like a slow trickle.

Kristin:  Yeah.  You had a slow leak.   Yeah.

Alyssa:  Yeah.  So I’m sitting on the toilet, and I go pee, but then I put a pad on, and I realize that it’s just a constant trickle, so I better call my midwife, and I did.  And when you go into triage, they always check that, because they’re like, oh, yeah, you think your water broke, but…

Kristin:  I’ve had clients think their water broke and it was a trickle, and then it was pee.  Like, the baby’s so low that —

Alyssa:  And I’ve heard that.  So then they check, and she’s like, no, sure enough, that’s amniotic fluid.  You’re good.  So that was — I mean, I think I slow leaked from — if my water broke at maybe 4:00 in the morning, and I ended up in the hospital — I went in at noon.  So it was a long time of it just kind of slowly leaking out.  I just felt like I was peeing myself a little bit every time I took a step.

Kristin:  And did it continuously leak throughout your labor in the hospital, or did you feel —

Alyssa:  That, I don’t even remember.  I mean, by the time I was in the hospital bed, contractions were, like, pretty…

Kristin:  You were focused, doing your work.

Alyssa:  Yeah.  Yeah, I don’t remember.  But I think we have this notion in our heads of what your water breaking will be like, and probably it won’t even break, and if it does, it could be any number of ways.

Kristin:  And we also expect pregnancy to either be really life-changing where you can’t do any of your normal things and don’t have the energy to work out and all of that or birth to just be like in the movies where you’re screaming and in pain.  But the reality can be so different from child to child, pregnancy to pregnancy.  Your energy levels can be different based on nutrition and exercise and age, of course.   I had my kids at an older age, so it’s much different than my clients who are 22.  Like, being 39 with my second pregnancy.  There’s some of that.  But what else was different to you than what you imagined either in pregnancy or in your labor?  I know you mentioned, like, after delivery, the pushing down on the stomach and all of that at one point.

Alyssa:  Yeah.  So one of our listeners actually had that question or that comment of, after listening to our postpartum one, she was like, I didn’t realize that after I gave birth, they were going to palpating my uterus through the top of my stomach.  And I do remember that.  They would come in and push on it to make sure it was shrinking.  And then one of the — you know, you know that you have a baby hooked to an umbilical cord, which is hooked to a placenta, but I don’t think most women — and men, like Brad was really thrown off — you have to birth a placenta after the baby.  It comes out, and he’s like, oh, my God, it’s huge!  It is a giant organ.  I don’t remember that happening.  I remember she came out, and I was just relieved, and then she’s on my chest, and I remember them saying, you still have to push out your placenta, and I was kind of like, what?  And I have no recollection of how it came out, if it was hard or easy.

Kristin:  Yeah, because then you’re so focused on baby.  It’s like that isn’t even a big deal, and it’s a pound or so.  For most people, it’s not as dramatic as birthing a baby.  It’s pretty easy.  Sometimes there can be issues.  It can get stuck.

Alyssa:  I think she was probably getting weighed and stuff at that time, so I probably was just like, oh, okay, I need to push a couple more times?  Because I do remember her being on the scale and stuff over there.  So it was probably after I birthed the placenta that they put her on my chest.  But yeah, I don’t remember it being hard.  It was just kind of weird.  I was like, oh, my God, that was in there?  Like, that’s as big as the baby!  No wonder!

Kristin:  It’s amazing.  I didn’t want to see it.  I remember my midwife asking me if I wanted to see the placenta after I had given birth to Abby, and I was like, no.  Gross.  I didn’t like blood at that time.  No thanks!

Alyssa:  And now have many placentas have you seen?

Kristin:  I love placentas, and I wanted to see with Seth, but with Seth’s pregnancy, I wanted to do — like, he was my last, and I wanted to do all the things.  So, of course.  And I saw, like, the front and the back and wanted to, like, examine it after Seth, and I wasn’t a doula at that time, so it was much different.  But I think the placenta’s beautiful.  It’s amazing.  But not everyone digs seeing the placenta.

Alyssa:  Yeah.  It’s like a big organ flinging out of your body.

Kristin:  Yeah.  Women are amazing, and bodies are amazing.  But yeah, birth can be weird.  Pregnancy is certainly different.

Alyssa:  Yeah.  I remember — and maybe it is because I’m very tall and slender with a long torso, but it was like all of a sudden, this — like, this whole area, it was just gone.  I mean, my stomach wasn’t back to normal immediately, but it was just gone.  And that’s really weird.  You don’t think about — like, you’ve held this, grown this baby inside for so long, and then all of a sudden, she’s not there anymore.  And as happy as you are to have her in your arms and meet this baby, it’s like, oh, but you’re not protected in here anymore, and I can’t feel those movements anymore, which are really cool, but I think probably that’s because I loved being pregnant so much.  If I had had a really hard pregnancy, it’d probably be like, great.  I’m happy you’re out.  You’re not jabbing my ribs and kicking my bladder all day long.

Kristin:  And you weren’t on bedrest for three weeks, and I was.  Yeah.  Things like that.  But I did love that, touching the belly and connecting and playing music and talking to my babies in the womb.  And I remember being at a political training for women who wanted to run for office, and I was pregnant with Abby at the time, and I stood up and gave my pitch, my stomp speech, and I was holding my belly.  And I remember we got feedback after, and they’re like, you really shouldn’t be touching your belly and connecting in that way.  And I’m like, it’s just what I do.  It’s natural for me to touch my belly when I stand.  But I was getting feedback that it was not a good thing, and I needed to keep my hands down and be strong.  So I remember after giving birth, not having that belly, and being so used to —

Alyssa:  Like, what do I do with my hands?

Kristin:  Right.  Having the baby in the womb to connect with, and even my first shower in the hospital after Abby.  It’s like your stomach isn’t how it used to be, but you don’t — you can see everything, your feet, you knees again.  It’s like, whoa.  This is weird.  It’s a big change for women.  So yeah, to get used to that adjustment, that first shower can be a big thing.  And, like, being able to fit into your normal clothes.  Like, when I got into my old jeans, I was, like, yes.  So that took a bit, but yeah.  But everything can be so different, and my friends had completely different pregnancies than I did.  Some were really easy.  Others were — you know, had to be induced or had physical issues.  So, yeah.  But it’s fun.  I was pregnant with two of my best friends at the same time.  I was pregnant with Seth, and our kids have grown up together, and we had completely different experiences in birth and pregnancy.

Alyssa:  Yeah.  Had I started younger, I would have had more, and knowing how much I loved it, I would love to keep having them.  But…

Kristin:  But we’re curious to hear what you found to be different than what you expected it to be or weird things about pregnancy and birth that you didn’t fully understand until you experienced it yourself.  It’s one thing to hear a story from a friend or to read something in a book, but to actually go through it yourself, like, the heartburn or acid reflux —

Alyssa:  Farting!

Kristin:  Or the farting!  Like, whatever it might be, or having milk come out of your breasts when your pregnant or getting some of that crust on your nipple and looking at it like, whoa, is this normal?

Alyssa:  Yeah.  So maybe leave us some comments about your stories or give us some story ideas for the future!  Thanks for listening.  This has been the Ask the Doulas Podcast.