Birth Support
for families during the Childbearing Year
Giraffe Watch 2019
I don’t usually jump on the viral bandwagon, but here I am about to write an absurd blog post about April the Giraffe and what we can learn from the livestream of her birth. [Disclaimer: this is going to mostly be a comical post that is 90% opinion and maybe 10% facts about mammalian birth. Don’t take it all seriously, but do take it a little seriously…]
Once again, several hundred thousand of us found ourselves checking in on a livestream of a pregnant giraffe doing absolutely nothing, hoping that she might suddenly pop out a calf while we were watching (I’m going to leave aside the ethics of putting a webcam on a pregnant animal who can’t consent to it, but don’t shy away from thinking about how that might make you feel near your due date). Luckily for me, I have friends who are much more obsessed with this YouTube channel and whom I could trust to quickly alert me when hooves appeared. I certainly would not get sucked into checking the livestream at 2am and watching for labor signs again(lets imagine this is the equivalent of texting your friend every single day after her due date to ask if she’s had a baby yet). I tried to take my own advice concerning due dates by having patience and trusting that someone would let me know if something important was happening. Let someone else text April the giraffe at 4am to ask if she’s feeling any contractions.
This morning while loosely monitoring a group chat, it happened. I saw the word “HOOVES” and I knew one of the craziest displays of mammalian birth was about to happen live on Youtube. So I put the livestream on our tablet in the living room and subjected my family to the agony of waiting for a baby giraffe to emerge. Giraffes are queens of slow birth. To begin with, they gestate for somewhere between 400 and 460 days ending with a 6ft tall, 150lb infant. Even though the pelvis of a giraffe is quite ample for the task, it can still take hours from when the first hooves emerge until the birth of the entire calf. Earlier today, an absurd amount of us humans watched a giraffe freely roam about her labor room with actual hooves protruding from her vagina for hours. I couldn’t help but think, if we’re fine with a giraffe walking about with a significant portion of her baby sticking out of her, when will we finally all be on the same page regarding the freedom of movement for humans during their labor and delivery? We watched as April walked, paused, licked her infant’s hooves, and continued walking again to help move her baby out. My three year old said things like “wow, her neck is so long that she can lick her own butt” as we assembled a new Harry Potter lego set, occasionally glancing up to examine April’s progress. Though she is somewhat domesticated, I have no doubt that April gave no fucks about our preconceived notions of how her labor was supposed to go. Like most animals she did what came naturally to her and got her baby out just fine by herself. I only lament that she was confined to such a small area and did not have the company of other female giraffes. It’s purely conjecture here but since giraffe groups are mostly segregated by sex and familial ties, I imagine that they naturally give birth supported by a herd of other female giraffes.
The moment of birth for a baby giraffe is something fairly shocking if you’ve never seen it before. Giraffes give birth standing up, and when you consider that they are the world’s tallest land mammal…Well you can certainly imagine that a baby giraffe’s entrance into the world is something of a fall; its a big, wet, ungraceful flop earthside. Yet, we did not see her care-providers jumping in to catch this baby and suction it immediately. In fact her care givers were completely hands off during this whole experience, simply on hand to help out in an emergency. To add to that, there was no panic when it took baby more than an hour to nurse, as it takes many human newborns when given appropriate time to acclimate and self-attach to the nipple. Alright, by now I’m sure your sick of me touting the lessons we should learn from April the giraffe, but I’ve got one more. Her caretakers announced that in light of the birth of a healthy baby, they have left her area to give her privacy and would be performing a newborn examination tomorrow. I’m over here self aware of the satirical nature of my blog post today, and also very serious when I say that in the case of a normal labor and delivery no matter what species #handsoff the #slowbirth and when it comes to examinations of the well newborn #itcanwait. Lets try to give our human parents and babies time to bond with their newborn in the immediate postpartum, and afford them the same courtesy that we are giving to a giraffe in New York today.
If you didn’t see the fantastic birth of April’s new baby, you can check it out at Animal Adventure Park’s Facebook page and YouTube channel.
The Low Down on Due Dates
So, what is your due date anyway? It’s an estimate of when your baby will be born based on the first day of your last menstrual cycle calculated by adding 280 days to that date. This number would bring you approximately to 40 weeks of gestation. It assumes a 28 day menstrual cycle and a normal time of ovulation.
Some providers might calculate a more accurate date based on other details that you provide, particularly if you have an irregular cycle or know the day that you most likely conceived. Providers may further adjust the estimated due date with information gathered from early ultrasounds. A word of caution to parents about this: early ultrasound measurements (in the first trimester) are the most accurate for this. The margin of error for these measurements is often cited as approximately 2 weeks, however as gestation progresses the margin of error increases. One study states that for measurements taken from ultrasounds at 17-36 weeks, errors in estimation of gestational age could be as much as ten weeks. To put that in perspective, a trimester of pregnancy is between 12 and 14 weeks.
The 40 week estimate of birth falls roughly halfway within a range of normal. Babies are considered “term” at 37 weeks of gestation, however they are not considered “post dates” aka ‘overdue’ until 42 weeks gestation. Yup, you read that right. You aren’t out of the range of normal gestation until after 42 weeks. Even then, we must allow for the fact that some healthy individuals may still fall outside this range and have a normal birth and a well baby. This considered, some pregnancies carried past 42 weeks are not healthy, and most providers using evidence based practices will increase surveillance around 41 or 42 weeks depending on other factors in the pregnancy.
So, when will you give birth? There isn’t any way to know when your body will naturally go into the process of labor. Some recent study suggests that there are more factors than healthcare professionals first assumed that contribute to when labor begins. These factors include (but are not limited to) variable time of implantation, early hormone levels, age, weight, genetic factors, and events in the first two weeks of pregnancy. It has also been stated that factors traditionally thought to influence length of gestation such as BMI, alcohol intake, parity (how many prior pregnancies), and sex of the baby do not show any association to the time of birth. The conclusion of the particular study is:
“Human gestational length varies considerably even when measured exactly (from ovulation). An individual woman’s deliveries tend to occur at similar gestational ages. Events in the first 2 weeks after conception are predictive of subsequent pregnancy length, and may suggest pathways underlying the timing of delivery.” View it here
If this leaves you feeling confused, here’s my take-away. The length of a healthy, normal pregnancy is extremely variable. Your due date may be a useful piece of information for you, but it may lead to some stressful interactions with friends and family toward the end of your pregnancy. My advice is to pick a less specific estimation of when your baby will come, maybe cite your most likely birth month when asked about your due date. You can even go less specific than that and tell folks the season that your baby is due. For example, my son was due August 18th, but I often told people that he was due in August or late summer.
My hope is that this can help folks avoid the stress of a barrage of phone calls, texts, and Facebook messages that I see starting to pile up for my clients after 40 weeks. Pregnancy and birth can be stressful, so lets do our best to avoid unnecessary anxiety. If someone you love is pregnant, trust that they will announce their birth when they are ready and resist the temptation to call/text/message unless you’re offering support as the pregnancy continues. If you are pregnant, consider going offline after 40 weeks. Take some time to yourself and your close family to enjoy the last portion of your pregnancy and the ability of your body to grow an entirely new human.
Taking Off the Rose-Colored Glasses, Breastfeeding in Appalachia
On Friday I attended the second annual Appalachian Breastfeeding Network Conference. The theme was “Taking off the Rose-Colored Glasses”, and the presentations focused on the barriers to breastfeeding in our region.
The conference was held at the surprisingly lovely Burr Oak Lodge, in Glouster OH. Thankfully it was close enough to attend while on-call. It doesn’t look like I’ll be able to go next year in Tennessee if I have any births lined up. I enjoyed taking short walks down to the lake between speakers, and am definitely keeping this locale in mind for future close-to-home vacations!
Anyway, I digress from the topic here. I loved the theme of this year’s conference, but it was challenging to sit through a day of presentations on opioid addiction, sexual assault, racism, and birth trauma. I am really grateful to the awesome friends and co-workers who attended with me, who added some levity to an otherwise very heavy day. We have a lot of challenges ahead of us as Breastfeeding support professionals! I learned so much about navigating the subtlety and variety of breastfeeding problems that can accompany the aforementioned topics.
I am also extremely grateful to have listened to a speaker like Linda Smith! She was honestly so amazing. If you didn’t know, Linda is one of the Breastfeeding goddesses, and author of books such as Impact of Birthing Practices on Breastfeeding, Comprehensive Lactation Consultant Exam Review, and Sweet Sleep. I found her presentation on how Birth practice and trauma effect breastfeeding to be really informative. It reinforced suspicions that I’ve had on this topic for a while, but didn’t have evidence based guidelines to back it up, until now. One of the things I found fascinating was how different delivery methods can present particular barriers to successful breastfeeding for baby. For example, the way in which a baby is typically extracted from the womb during a cesarean birth can put pressure on nerves that connect to the tongue, which in turn can lead to an ineffective suck. Thankfully Linda mentioned some strategies for helping in the postpartum. Pretty amazing info to keep in my CLC bag!
The other speakers were great too, but none stick out in my mind quite like Linda! I might update again with a bit more on the other speakers and presentations, but that’s all for now.
On-Call
I’ve had a lot of folks ask me, ‘What does it mean when you’re on-call?’ Usually clients are curious what they’re paying for, or prospective Doulas are curious what it entails. Since I’m finally off call for the summer, I thought it would be a nice time to reflect on the experience!
Whether I’m on-call for a doula or Midwifery client, the call period begins when the client is at 37 weeks gestation and ends at birth.
When I am on-call, I am committing to make sure that I am not without phone service for any unreasonable about of time. In West Virginia this isn’t always easy. I can’t spend too much time at my favorite places in the forest or in Thomas without checking in with 
WiFi each hour. If I want to go for a hike in the woods this means leaving my cell phone with my husband where he can answer for me if a client calls, and assure them that I’ll be able to leave when I return.
When I am on-call, I am committing not to travel further than a few hours from my clients (typically not much further than I already). I need to stay close enough not to miss their birth. This means no trips to Pittsburgh to go to the zoo with my son (unless my client is in Morgantown) and abstaining from many other small adventures that we enjoy. I’m constantly googling the distance from where I am going to my client’s chosen birth place.
When I am on-call, I am committing to always having a back-up plan. Maybe my family takes two cars to a destination instead of one, maybe I’ve had to call around to make a plan for getting my husband and son home in case I need to leave for a birth, maybe I’ve made plans to get dropped at the hospital and get a taxi to a friend’s house whenever I’m done at the birth. I always tote around my birth bag, and maybe extra (more birth appropriate) shoes. I always have a few babysitters to call if my husband won’t be available, and I try to check in with them so they know the period in which I might need them.
When I’m on-call, I’m committing to check my phone before bed. I make sure it’s charged or plugged in, I make sure the ringer is on and turned up! I am desperately hoping I won’t sleep through a call and hoping that I can relax and sleep despite the worry. I turn it on vibrate during a movie and set it in my lap. I always have it in my pocket or within reach.
Here’s a special one for me: when I’m on-call, I’m committing to say no when my friends ask if I’d like to raft down the Cheat Canyon, or the Narrows, or the Dry Fork. Sometimes if a client’s birth place is close to the river I’m planning to paddle, and the run is short, and I’ve checked in with the client about it, and I take my phone in a waterproof case….then maybe I can go. I love rafting, particularly with my partner and son. It’s one of our favorite activities, but I’m willing to wait until my client has had their baby if necessary.
When I’m on-call, I’m committing to my clients above all other commitments. I tell everyone that I will leave when I am called: my family, my friends, my students, my co-workers. I am asking my family to adapt and change their plans at a moment’s notice.
To a lesser extent, this is even true for my encapsulation clients. I need to get to them within a few hours of birth to pick up the placenta so that it can be processed quickly.
So there it is: working births is amazing, but being on-call can be trying. I’m adapting my plans and habits to work around being available for clients, I’m spending extra money to bring two cars somewhere just in case, and I’m always thinking about how this might affect my plans. Maybe after reading this you’re thinking, ‘wow, this sounds really difficult’. It certainly can be, and that’s why I have a built in fee compensating me for being on-call. I guess the end message here is: appreciate what your doula or midwife is doing for you, even when you aren’t in labor yet!
What’s in your Doula Bag?
After two births in a week, its time to re-stock my birth bag! So of course, I thought it was blog worthy.
What is a birth bag, you may ask. This is the bag I have with me at all times when I am on call for a birth (refresher, I am on call from 37 wks gestation until the birth). It goes from car to car, and I’m constantly asking my partner “did you grab my birth bag when you packed the car?”
Some Doulas and birth workers lug around giant tote bags filled with massage rollers, balls, blankets, candles, twinkle lights, heating pads, and all kinds of goodies! Me? I’m more of a minimalist. I have a small shoulder bag which I mostly use to sustain myself during a long labor. Here’s the run down:
Two changes of clothes (typically yoga pants and a birth-y tee shirt): who wants to show up at a birth in a party dress? or get meconium on your favorite pants? This last week I was called out to a birth when I was leading a plant walk in the middle of a rain storm with soaking wet clothes on, thank goodness I had something to change into! I keep two changes in case I am on call for more than one family or in case I get coated in blood, amniotic fluid, or meconium before my work is done.
Toiletries: I keep a travel toothbrush, tiny tube of tooth paste, tiny deodorant, chapstick, and a small bottle of my favorite moisturizer. Sometimes I’m at a labor for a very long time, or need to run right from a labor to somewhere else; my little refresher bag is essential!
Rebozo: technically I carry this traditional Mexican wrap to help mother’s during labor, but more often than not I end up using it to keep myself warm in a chilly hospital or home.
Unscented Oil: I keep a very small bottle of very unscented oil, usually almond oil or jojoba oil, for doing massage during labor.
Hair ties: I have very short hair, so these are for my mom’s! I have a tiny pouch with a bunch of these just in case mom gets a sudden notion to get her hair out of her face or her own hair tie breaks.
Snacks: these are for me! I keep a number of non-perishable bars and fruit chews that are high in calories and pretty healthy. Again, sometimes labors are very long and I need to make sure I keep my energy up!
Double-shot Espresso: do I need to explain this one? More likely for the ride home than during labor.
Watch: when I’m attending births as a midwifery assistant I need to be able to take vitals.
LED candles: I finally used these at a labor for the first time! Laboring mothers typically prefer low-lighting during childbirth, and sometimes they didn’t anticipate that or a hospital will not allow candles. LED candles are cheap and provide remarkably pleasant lighting.
Pen Light: In case I need to search for something and mom doesn’t want to lights on, or if I’m working as a midwifery assistant its good to be able to provide direct light sometimes.
Tea, Cough Drops, and Instant Coffee: Strictly for me, to keep me perky and lubricate my vocal cords. My voice is my most valuable tool during labor!
Lactation Pocket Guide: my small lactation pocket guide is nice to have in the immediate postpartum. I am a CLC and often provide some counseling for parents choosing to breastfeed.
Change and a few bucks: just in case I need to pay a parking meter, or snag something from a vending machine.
Honey pouches: This is for the laboring mama! Its an easy energy-boosting food to ingest during labor, and to be honest honey is easy to sneak at a hospital which has a (non-evidence based) nothing-by-mouth policy during labor.
Cellphone Charger: just in case!
With all this in my bag, I’ll say the things I use most at a birth are my voice and hands. They are my most valuable tools for support and healing; if my birth bag flew out of the bed of my truck while I was driving to a birth, I would likely barely notice once I started supporting the laboring mother. I have things like birth balls, but I don’t bring them unless my client specifically requests it. I sometimes bring the deflated balls and pump in my care just in case it becomes apparent mid-labor that it would be useful. I also tend to keep a sleeping bag in my car, I can easily fold down the back seats and take a comfy snooze if I simply can’t drive any longer on the way home.
Week 13 - Beyond the Boob
