Monday, December 31, 2012

Joseph, Dads, and Random Thoughts to Round Out 2012

I wanted to share this picture one of my best friends got for me for Christmas to hang in my famous bathroom.   Maybe you've seen it before, but it was new to me.  I loved it. 

"Nativity" by Brian Kershisnik

The focus on nearly all nativities is baby Jesus - rightfully so - followed up with Mary.  My animal-loving 7-year-old would say the sheep and cows are the second most important feature of the nativity.  Rarely do we focus on Joseph.  This depiction was one of the most interesting I've ever seen for 3 reasons.

Reason 1:  Mary can't see Joseph's face and he doesn't know all those angels are surrounding him.  He must have felt tremendous pressure all those months leading up to the birth, about to father the Son of God on Earth.  And then the strenuous journey with his laboring wife, not able to find someplace for her to give birth.  While he didn't have the media to provide him with scary birth images, I imagine there was some anxiety about the actual birth.  After the Savior was born, the relief must have been overwhelming.  I'm sure also on his mind was what was to come.

I just want to put this out there that I think many dads feel the way Joseph might have felt.  I'm sure he loved Mary very much and wanted her to be safe and happy.  I have lots of moms in class that want to birth out of the hospital, but the dads are scared.  I've seen a lot of emotions on both sides, but I just want moms to remember that he has likely been exposed to fear in our modern culture surrounding birth.  He loves you and may still have some fear of his own to work through.  It's a lot of pressure to become a dad, supporting and caring for his wife and new baby.  Help him through education, but have some empathy along the way.

My famous bathroom
Reason 2:  Mary is breastfeeding!  This is why the picture will find it's way to my bathroom walls.  I've commented before that of course she breastfed baby Jesus, and I'm sure she co-slept too.  "Away in a Manger" always cracks me up when we sing about "no crib for a bed" - surely it was written by an American, for I don't know that other cultures would worry about not having a crib!

Reason 3:  I love the angels surrounding the scene.  I'm sure the heavens rejoiced when the day finally came when Christ was born, come to Earth to save us all.  On a much more personal level, I believe angels surround each one of us.  I believe they are actually relatives that have already passed on, sent to help us by our loving Heavenly Father, to help answer our daily prayers on our earthly journey. 

As we round out 2012, it's been a wonderful and exciting year.  Launching Birth Boot Camp was intense, but I am so proud of what my team and I have put together.  2013 promises to be another great year.  I love the goal-setting aspect of starting a new year.  We have many exciting goals to accomplish, and I truly believe that getting there is half the fun!  May there be many babies born this next year by parents who have wonderful and empowering births.  Set a goal to breastfeed your baby.  It will be one of the greatest and sweetest experiences of your life.

A quote to end with by Theodore Roosevelt:  "Be practical as well as generous in your ideals.  Keep your eyes on the stars, but remember to keep your feet on the ground."  Thank you for allowing me to be a small part of your life this past year.  Here's to 2013 and another great year!

Monday, December 24, 2012

The Importance of the Natural Birth and Breastfeeding Requirements to be a Birth Boot Camp Instructor

As most of you probably know, I wrote a childbirth education curriculum in the last year and launched it as Birth Boot Camp®.  The classes can be taken online or you can take a live class in your area taught by a certified Birth Boot Camp Instructor.

In addition to an intense training program, an instructor-in-training must have given birth without the use of any pain medication.  She also must have breastfed at least one of her babies for at least one year.  Believe me when I tell you that this policy is in place for the benefit of the students in her class. It has very little to do with the instructor.  Let me explain.

Recently, I had a brief conversation with one of my daughter's teachers.  She saw the "Birth Boot Camp" vinyl on the back of my car and asked what that was all about.  I briefly told her and she said, "Wow!  You did that without drugs?!" in her sweet Southern drawl.  She went on to say, "I don't think I've ever known anyone who's done that!"  Imagine that she wanted to be in my class and I'm teaching her how to have a natural, unmedicated birth, but I've had an epidural.  Or a shot of Demerol , right at the end.  Now she still doesn't know anyone that's ever "done it" without the drugs.  How is she ever going to do it with everyone around her NOT doing it, even her instructor? It must be impossible to have a natural childbirth, right?

While the education is invaluable, I have often felt that the most important thing people walk away from class with is confidence.  They know they can give birth without medication.  Their instructor did it, and so can they! 

I've had so many women over the years tell me that they thought of me during their labor.  "If Donna could do it, so can I!"  Husbands cheer their wives on right at the end when she wants to give up, saying, "Donna said it would be like this at the end.  You are almost there.  We're going to meet our baby soon!"  If their instructor was teaching it, but didn't -- for whatever reason -- do it, that would break their confidence. 

The graphic designer for Birth Boot Camp's (awesome) materials was in my class last year.  Because of the shape of her uterus, her baby could not turn. He was stuck in a transverse (side-lying) position, despite her trying every single thing she could to get him to turn.  She was devastated to have a c-section, but she really didn't have a choice.  Thank goodness for modern medicine that could give her a healthy baby.  She is a total advocate for natural birth.  She knows the material.  She was completely ready for labor and I'm certain she would have "done it."  Unfortunately, she never got to experience a single "real" contraction.  She asked at one point about the possibility of teaching Birth Boot Camp and I had to tell her no.  I've had to tell a few people no.  It's not personal.  I love this girl, but it's not about her!

If a woman went all the way through labor without drugs and was even pushing and then had a c-section right at the end, how are the students going to truly trust birth in her class?  The same might happen to them.   And it might anyway.  The point is, learning how to give birth naturally is as much about what's going on in the head as with the body.  A woman can teach "prepared" childbirth education without having had an unmedicated birth, but in order to teach how to have a natural birth, we feel strongly that she should have done that herself.   There are other courses a couple can take if they want an epidural or c-section, but that is not what we do at Birth Boot Camp.

The role of the educator is unique.  It's not clinical, like a midwife or an OB.  It is not just supportive of "whatever choice they would like" - like a doula.  Birth Boot Camp is all about natural birth and we deliver a really good road map to get there.  A good teacher - no matter the setting or subject - teaches on a topic that she is not only passionate about but knowledgeable as well.

Sarah Clark, aka Mama Birth, helped write the Birth Boot Camp curriculum, and she tells of having 3 doctors in one of her classes.  She was quite intimidated - or so she says! - and they all said they knew the mechanics of birth (one had caught 200 babies), but they were coming to her class because she had DONE IT.  Boom.

The fact remains, unless you have done it, you can't know what it's like.  You cannot grasp the loss of modesty, the time warp, the inability to make a decision, or the fact that, in the thick of labor, you won't even remember this is all for a baby!  Talking about these things but not having had experienced them does not carry the same weight.  This carries over into so many areas of our lives:  Would you learn to play piano from someone who loved music but didn't play?  Would you go to a marriage counselor who had never been married?

I know things happen in labor.  I've had my fair share of epidurals and c-sections from class. They are usually necessary, sometimes even life-saving.  Couples that sat through my class were able to make informed decisions in their labor.  My heart goes out to those women who wanted a natural birth and didn't have one.  I know there are women who have not been able to have children, but if they did, they'd want a natural birth.

As for the breastfeeding requirement, we have actually accepted a few trainees who have not been able to breastfeed for the required one-year minimum.  We have a fabulous lactation consultant, Mellanie Sheppard, on our Advisory Board that we took these special cases to in order to help us understand what was possibly going on.   Again, my heart goes out to these women who tried and tried to breastfeed, but had true physical reasons that they were not able to.  With this requirement, we are trying to avoid are the "I had to go back to work" or "He just wasn't interested at 6 months anymore and we quit."  Sometimes breastfeeding, like birth, is hard.  It is so worth it to push through those challenges.  We want our instructors to be a support and example to the couples in their classes.  The recommended amount of time to breastfeed, according to the AAP, is at least one year, and according to the World Health Organization, 2 years and beyond is recommended.  We want to be the childbirth education program that is encouraging these standards not only on paper, but in practice and example.

Birth Boot Camp Advisory Board

Ultimately, Birth Boot Camp is about teaching couples to have a natural birth.  That is the Instructor's responsibility, and she goes through a thorough training process to be sure she is ready to do that.  Each couple that takes a Birth Boot Camp class - online or in-person - receives the Breastfeeding Class, The Ultimate MRE, on DVD.  They get a complete course taught by Mellanie, our lactation consultant, and the instructor will lead some discussion on breastfeeding in class, but they are not responsible for teaching the full breastfeeding course.  Thus, there is some leniency with this requirement.

We are not the "judge and jury" on a woman's birth or breastfeeding experience.  That is entirely up to her. We are not passing judgement or saying there is a right way or a wrong way.  These are simply our guidelines for our instructors and we feel they are important in order to help a couple achieve their desire for a natural birth.

Dani Long, BBCI
If you are interested in how the instructors feel about the requirements to become a Birth Boot Camp Instructor, you might enjoy this post from Dani Long, who recently completed her training all the way from Spokane, WA.  There is pride in completing an intense program and our instructors are ready to teach!

P.S.  I didn't write this post to start a fight.  I've had a couple of people sincerely ask for explanation and I thought others would probably like to hear it as well.  I'm a nice person.  This isn't personal. I love you guys. Peace out.

Monday, December 17, 2012

Combating Gestational Diabetes

Jenni Rongey, a co-Chapter Leader for the Tarrant County Birth Network, wrote this post for the Banned From Baby Showers readers.  I've known Jenni for a few years - she was Jillian in the BOLD Fort Worth production of  "Birth" two years in a row.  She had a VBA2C almost 2 years ago and you can read her birth stories here. She also works as a birth assistant at a local birth center.  She is a wealth of knowledge and I hope you walk away with a new perspective on dealing with gestational diabetes after reading Jenni's comments.  Thank you, Jenni, for sharing your expertise and story with us here.

"Diabetes has affected every part of my life but none quite so deeply as pregnancy. I have personally experienced many of the complications and risks associated with Type II diabetes in pregnant mothers. Multiple miscarriages, strict diets full of counting carbohydrate to protein ratio, insulin injections, pre-eclampsia , c-section, induction leading to an emergency c-section, babies with under-developed lungs that were separated from me for hours or days after birth.

Funny thing is I’ve also seen a diabetic pregnancy where none of those complications reared their ugly head. That was my pregnancy too. So what changed you might ask? I stopped listening to my doctors list off all the reasons why I was high risk and I couldn’t have a normal, uncomplicated birth. I realized that the only thing that separated me from my friends that had normal, low risk, out of hospital births was that I had blood sugar
levels that fluctuated from high to low and they did not. I just needed to figure out how to control my blood sugar levels without medication. Figure it out I did and like so many of our modern day diseases it was all about diet and lifestyle.

What I want to discuss are the measures a woman that has been diagnosed with gestational diabetes mellitus (GDM for short) can take to help boost her chances of having the birth she wants. Merely getting a birth without all the interventions is an uphill battle for someone with gestational diabetes. It’s even harder if you desire a natural birth or one out of the hospital. The best thing you can do is to educate yourself and keep your blood sugar tightly controlled and educate yourself. Did I mention that you need to educate yourself?

First you should know that gestational diabetes can be readily controlled without medication. It takes some planning and determination to stick with your plan but aren’t the things that are most important in life worth a little work? Let’s get to work.

10 Things You Need to Know to Keep GDM under Control

1. Understand Gestational Diabetes – 
Gestational diabetes is a condition where a woman that has never been diagnosed with diabetes suddenly has high glucose levels in the third trimester of pregnancy. Insulin is an important hormone in the body. Its two main jobs are storing fat for future use and escorting glucose (sugar) into the body’s cells where it can be used for energy. When a woman becomes pregnant her body naturally becomes insulin resistant to a degree. This means that some of her cells start refusing to let insulin do its job. Extra glucose is left circulating in her bloodstream where it ends up being metabolized by the fetus. This is the body’s way to secure a steady stream of energy for the fetus as it grows. By the third trimester the mother’s insulin resistance is higher so that extra glucose can be secured for baby’s fat stores before birth. In most women, the insulin resistance isn’t noticed because their pancreas puts out ever increasing amounts of insulin to keep blood sugar levels normal. However in some women, the pancreas just can’t keep up and despite high levels of insulin in the blood stream, blood sugar levels remain elevated. Being diagnosed with GDM does not mean you are diabetic. It can mean however, that you have a greater chance of developing type II diabetes in the future. Learn to take care of it now and you greatly reduce that risk.

2. Understand the Actual Risks of GDM
Big Baby Syndrome - Insulin works in the body by taking glucose out of the blood and putting it in cells for energy. It drives glucose first to muscles, then to the liver, and finally to store in fat. If your blood sugar
remains elevated the baby’s pancreas is left to deal with the excess. It will produce extra insulin which will help store glucose as excess body fat. That is how an uncontrolled diabetic mother can have a baby that is
too large. If your blood sugar is tightly controlled this is not an issue. By the way, if you do have a large baby there are several squatting style birth positions that open the pelvis by an extra 30%. This is a lot of wiggle
room. A large baby alone is not a reason for an automatic c-section.

Low blood sugar in the newborn – If your blood sugar has been chronically high or is high during labor then your baby may be born with low blood sugar. Remember that your baby’s pancreas puts out extra insulin to help get rid of the excess glucose in its blood. When the supply of excess glucose is shut off by birth, the pancreas still takes a while to slow down production of insulin. This can result in low blood sugars. Symptoms of low blood sugar in the newborn can be hard to see but they include irritability, lethargy, excessive hunger, and rapid pulse. For a baby exhibiting signs of low blood sugar the best cure is to put the baby to the breast early and often. Usually no other treatment is needed to help stabilize blood sugar as long as it is not dangerously low.

Significant increase in interventions – The most dangerous risk of being diagnosed with GDM is merely being labeled as a gestational diabetic.  A woman diagnosed with GDM has up to a 50% increased chance
of induction or c-section just by being diagnosed. She may also be subjected to frequent sonograms, non-stress tests, and other invasive and unnecessary procedures. Many doctors want to induce around 38 weeks to “make sure the baby isn’t too big.” If you keep your blood sugars tightly controlled and within normal range your risk of having an overly large baby is no greater than a woman without GDM. Educate yourself so you can defend your choices if it comes to that. If a natural or low intervention birth is what you are wanting, you will need to be ready to fight for it. The best thing you can do is keep your blood sugar in the normal range. Ready for the how-to?

3. Eat a Diet That Does Not Raise Your Blood Sugar and Insulin Levels.

If a food raises your blood sugar it will also raise your insulin. The pancreas will fight hard to put out extra insulin to take care of any extra glucose in the bloodstream. The damage inflicted by excess insulin circulating in the body is enormous but for the purpose of GDM I will distill it down to one important complication, pregnancy induced hypertension. Insulin raises blood pressure and this is part of the reason that women with uncontrolled blood sugar in pregnancy are at a higher risk of developing pre-eclampsia. So exactly what foods will raise your blood sugar and insulin levels? Glad you asked!

4. Go Grain Free
Grains are the number one culprit in high blood sugar with sugar close behind. Are you surprised that sugar isn’t in first place? Unless you are drinking gallons of corn syrup laden soda and eating Snickers for snack
everyday (and if you are, quit that!) most people consume more wheat, corn, rice, and oats than sweets in any given day. This makes them the number one food to control. Do you really need to cut out all grains, even whole grains?  The answer I’m afraid is yes, at least until you have had a week or two of absolutely normal blood sugar readings. Then add in whole grains, if you must, one serving at a time. Pay careful attention to how you respond to any particular grain. I personally can’t even look at rice without my blood sugar hitting the ceiling but small amounts of corn or corn tortillas can usually be tolerated. If you monitor your blood sugar carefully you will know when you have reached the upper limit of your grain intake whether that is one serving a day or four. Along with grains you have to watch your intake of starchy vegetables, mainly potatoes and peas. White potatoes are the vegetable world equivalent of white bread. Sweet potatoes offer great nutrition with a much lower impact on blood sugar. What about sugar? Obviously sugar needs to be severely limited in your diet (even if you aren’t dealing with GDM.) Have you noticed that most of our favorite desserts and treats pair grains with sugar? Talk about a double whammy. So what’s a pregnant girl to do? Eat fruit…..just kidding! Check out recipes for grain free treats that are sweetened with honey, maple syrup, or other unrefined sugars. There are thousands of tasty recipes on the web waiting for you. If you are the experimental type in the kitchen you can start trying out wheat flour alternatives like almond or coconut flour.

5.
Eat Whole, Real Food from Good Sources
Grass-fed meats, wild caught fish and seafood, and pastured chickens and eggs should make up the bulk of your protein. Local, seasonal, and hopefully organic vegetables will give you your best source of vitamins and minerals.  Organic fruit should be eaten in small quantities. I can hear the rumble of, “Sheesh! I’m not made of money,” out there. I know. I’m not either. Figure out your priorities. If you eat a lot of eggs but rarely touch red meat then spend your money on pastured eggs, and go ahead and buy standard grocery store meat. That small amount won’t be your undoing. You get the idea.  Dairy is questionable for some people struggling with blood sugar issues.  Usually cheese has very little impact on blood sugar but milk is actually quite high in sugar (lactose.) It will just take a little experimentation to decide whether or not milk will be an option for you. For those of you that are Weston A. Price devotees, and you know who you are, raw milk generally has less of an impact on blood sugar than pasteurized. Always eat dairy in the full fat form. It will slow the impact on your blood sugar plus the vitamins and calcium in dairy foods require fat for your body to absorb them.

6. Don’t Worry About Fat in Your Diet

If it’s good fat that is. Fats are necessary to human health. Fats feed our brain,  give our cells structure, and keep our skin glowing and wrinkle free. Fats help us metabolize vitamins A, K, and D. Good quality fats are necessary to  properly nourish mom and baby. The problem is figuring out which fats are  good and which are not.  Saturated animal fats from pastured and grass fed  animals are great! Grass fed beef is high in omega 3 fatty acids. Pastured lard  is full of heart healthy monounsaturated fats. If you eat pastured bacon save the grease and cook your eggs in it just like Grandma used to. Butter, cold pressed coconut and olive oil are all good choices that are easy to find as well.  Steer clear of processed vegetable oils, even canola oil. These oils become oxidized and rancid during processing. To hide the awful smell they are chemically bleached and deodorized. Sounds yummy right?

7. Check Your Blood Sugar Often
How can you know if you are successfully keeping your blood sugars level if you don’t check? Get a glucometer and check your blood sugar several times a day. Yes I know it’s tedious but trust me, it’s better than having to inject insulin twice a day. Your care provider should go over the values that you are looking for but just in case, your fasting blood sugar should be below 100mg/dl and under 140mg/dl two hours after a meal. Consider your glucometer your most important tool to helping you stay on track.

8. Exercise! For Real, Do It!
Consistent exercise is a major key to blood sugar control. When you do any exercise you move large muscle groups. To fuel those large muscle groups your body will direct glucose out of your bloodstream and into the cells of the muscles. Exercise can have a large and immediate blood sugar lowering effect.  If you exercise consistently it will boost your metabolism and make you more sensitive to insulin. Over time regular exercise will help to keep your blood sugars lower. I’m not talking about hours every week at the gym. Moderate walking several times a week for as little as 30 minutes has a huge impact on your insulin sensitivity.  Consistency is what’s important here. The more consistent you are the more benefit you will see. If you find that following all of these recommendations isn’t quite getting the job done there are a few more tricks up my sleeve.

9. Great Supplements
Choose quality whole food supplements that support metabolism and lower blood sugar levels. A whole food prenatal may be in your best interest. It is generally believed that people with metabolic disorders, and GDM is one, have a harder time absorbing nutrients. A whole food prenatal vitamin is more readily available to your body. A whole food chromium supplement is a must.  Chromium is a necessary mineral that helps regulate blood sugar. With depleted soils it is impossible to get all you need from food. Cinnamon is another valuable supplement for lowering blood sugar. While you can buy cinnamon capsules, just sprinkling some on your food everyday is a tastier way to get it. Certain brands carry Chromium blends specifically for blood sugar control that contain cinnamon as well.

10. Coconut Oil 
I know I went over fats earlier but coconut oil is a special one. Coconut oil when taken as a supplement supports your adrenal system, boosts metabolism, and lowers blood sugar. You can take up to 3 tablespoons a day if needed. If you have been on a low fat diet then start small. Begin with 1 teaspoon before each meal and work your way up. You may find benefits at a low dosage or you may need to go all the way up to 1 tablespoon before each meal. You can stir the oil into herbal tea or take it straight from the spoon.

As with anything regarding your birth, the better educated you are the better chances you have of getting the birth you desire. Gestational diabetes is not a one-way ticket to a c-section or induction. With some planning and dedication you can have the birth you envision. Happy healthy birthing to you!

*I am not a doctor or licensed medical professional. I have done my research and these are the steps I took to control my blood sugar during pregnancy. If you have been diagnosed with GDM and are currently controlling it with medication you need to start this diet under supervision of your care provider. You will need to very carefully monitor your blood sugars as you wean off of medication."


For more information, I wrote a post about testing for gestational  diabetes earlier this year, including the criteria set by the American Diabetes Association.

Monday, December 3, 2012

How to Have a Natural Birth

Recently, I had a conversation with someone about wanting a natural birth and how hard it is to get that without a fight on your hands.  She asked the question, "Why can't you just say 'I don't want the drugs.'?"  It was an interesting question, really.  Why is it so difficult in American obstetrics to have a natural birth?

I think there are many factors here.  Fear is at the top of the list.  Fear of pain, fear of lawsuits, fear of the time commitment.  I think loss of control is also a factor.  We like to control everything.

And as much as we glorify the "superhero," we hate her when it comes to birth.  We want her to fail.  Her natural birth makes me feel bad about my medicated birth.  It's easier to believe that no one can do it than it is to believe I couldn't do it. 

The media is at fault here too, but it's largely because they feed the fear.  I have a mom right now doing Birth Boot Camp online classes that was thinking about transferring to a natural-birth-friendly hospital but it's an hour away.  We get this idea from all the sitcoms that the minute labor begins - or water breaks - the baby is going to fall out.  Women and men are fearful of a birth place that is more than a few minutes away. In reality, they could probably cross state lines with plenty of time to kill!

And then there's the noise factor that I've been talking about for years - the majority of the people at the hospital want you to have the drugs because of the noises you might be making, be it moaning, grunting, or even screaming.  Those noises make people uncomfortable when they are not used to hearing them. Personally, I like to hear the noises a woman is making in labor because you can tell how well she is handling things. Those noises let her support team know what she needs. Who needs a vaginal exam?!  Just listen to her!

In addition to making the laboring woman be quiet, the control is now shifted to the medical staff.  They do not have to wait for your labor to progress.  Like magic, they can force your uterus to contract whenever they want it to with pitocin.  What power!  The laboring woman is powerless at this point.

Frankly, people just don't understand why someone would want an unmedicated birth.  I was that way with my first baby.  I couldn't believe it when people would ask me if I was having the drugs.  Of course I'm having the drugs!  I get it.  I've heard a million different reasons for wanting a drug-free birth over the years, but in the end, a couple has to be willing to do what it takes.


HOW TO INCREASE YOUR CHANCES OF GETTING A NATURAL BIRTH

1.  Believe that your body and baby will work together.

2.  Choose a care provider very carefully.  They may make or break this experience.  If you have chosen wisely and you do have a cesarean or are encouraged to induce, you will not second guess them EVER.

3.  Take a thorough childbirth class.  As the founder of Birth Boot Camp®, I believe our 10-week curriculum is the best program out there, preparing both partners for an empowering birth experience. If there is not an instructor in your area, take the online course. After you have an amazing birth, become an instructor!

4.  Communicate with your partner.  This is an opportunity to grow closer together.  It's not every day you bring a baby into this world.

5.  Hire a doula.  She will help you achieve a drug-free birth.

6.  Know your options.  If your chosen birth place is not natural-birth-friendly, RUN.  If you take the attitude of  "I'll stay with my OB this time and switch to a midwife next time," they may set you on a path of cesareans that will make it harder next time around.

7.  Practice relaxation on a regular basis.  Eat well.  Stay fit.  If you become high-risk because you eat junk food and have a sedentary lifestyle, your plans for an intervention-free birth may go out the window.

8.  Surround yourself with people that believe in YOU!

9.  Don't be afraid to ask the hard questions and read between the lines with your care provider.  If you feel like you are jumping over red flags, you probably are.  As long as the baby is still inside of you, you have options.  Regardless of what you may have heard, it's never too late to switch care providers.

10. Read positive birth stories.  Read - and believe - affirmations that you can do this.  You are strong and capable.  Embrace this experience.  It is yours and yours alone.