Upright Physiologic Vaginal Breech Birth

So grateful to Dr. David Hayes OBGYN @breechwithoutborders for their amazing continuing education workshop to thoroughly review the data and teach skills of attending vaginal physiologic breech birth globally. Some key take aways are: 📣Modern US clinicians and hospitals, and other countries that follow US, where only cesarean is taught and practiced for breech - please get back your skills and follow ongoing current impressive research and guidelines of other western countries where upright vaginal breech birth is being heavily studied and practiced as the norm, as it has been among community out-of -hospital midwives around the world through history.

More & more mamas don’t want c-section and all the risks associated with major abdominal surgery for them, their babies, and future fertility as the only option, and are seeking safe alternatives. Breech presentation occurs at term ~ 4% of the time ,vast majority are called frank with hips flexed, legs extended upward. Sometimes they can be turned head down to vertex presentation, sometimes they can’t and are breech for a reason. It’s very rare for a term baby to stand in the uterus, presenting one or two feet first - which is usually NOT footling (a common misdiagnosis) but complete or incomplete breech - hips flexed, buttocks in pelvis like a frank breech but one or two legs flexed, with one or two feet dropped down. These presentations in healthy pregnancy are fine candidates for term vaginal breech birth. It’s crucial for providers to know when to keep hands off, support mamas own movement and pushing efforts, upright positioning, how to resolve uncommon stuck arms, shoulders and head behind the pelvic bones, monitor baby’s condition, expedite birth and effectively resuscitate baby if needed.

Significantly less invasive maneuvers are required in physiological breech birth in upright positions with improved outcomes for mamas and babies. For mamas, breech birth is often claimed to be easier than birthing babies in head down position, with less injury to pelvic floor muscles and reduced tearing. Those I’ve attended all went well. The trouble and poor reputation associated with vaginal breech birth are mostly caused by unskilled providers, keeping mama on her back, impatience & pulling - which skewed the data of the older term breech trial they still quote. If you have a persistent breech baby know you have options. Get true informed consent!

If you’ve been told that your baby is breech at your mid pregnancy anatomy scan, know that baby is still swimming and it is likely they will be head down by term. If baby is breech later in the third trimester, don’t freak out. There are many ways to gently and lovingly ease your baby into vertex. Since there is slightly greater risk to breech babies born vaginally and by cesarean, and many people do not have providers near them who are skilled to attend them for a vaginal breech birth, it is ideal to try to encourage baby to turn head down.

Towards the end of pregnancy, the baby settles into its favorite position. Ideally, this position is vertex, meaning that its head is down towards your pelvis and its bottom is high up in your abdomen.

Less commonly, the baby is breech (with its head up and its bottom down towards your pelvis).

It’s not always known why a baby is breech at term. Sometimes it has to do with:

• Relationship between the shape of the baby and the shape of mom’s uterus or pelvic bones

• Location of the placenta

• Issues with the umbilical cord

• Excessive amniotic fluid

• Lax abdominal or uterine muscle tone

Labor and birth does carry more risk of complications when the baby’s head is not down towards the pelvis, even though breech is a variation of normal. So, when a baby is breech by the 30th week of pregnancy they should be encouraged to convert to the ideal vertex position. That said, the majority do turn by themselves at the beginning of the ninth month.

What to do When Baby is Breech

If your baby is breech at 30 weeks, consider doing a couple of the following exercises 10-15 minutes 2-3 times each day until your baby turns.

1. Belly massage. Massage your abdomen GENTLY in the natural direction the baby will turn. But stop if you meet any resistance, and never attempt to forcefully turn the baby yourself.

2. Visualization. Close your eyes and imagine your baby with his or her head moving down in your pelvis.

3. Coaxing. Play classical or relaxing instrumental music by your pelvis, so that the baby will turn towards the soothing sound. Or shine a flashlight by your pelvis, so that the baby may move towards the light.

4. Go for a swim. Swim laps and do some handstands in the pool.

5. Pelvic rocking. Shift your pelvis up and down and side to side while on your hands and knees.

6. Act like an elephant. Walk around the house on your hands and feet.

7. Bridges and inversions. If you have an established yoga practice, go upside down with any of the inversions, using props for supportive modifications. Headstands and downward-facing dogs work wonders.

Beginners should start with bridges. To do this, simply lie on your back with your feet flat on the floor approximately 1 ½ - 2 feet apart and your knees bent. Elevate your hips 9-12 inches higher than your shoulders. You can support yourself in bridge with a yoga block under your sacrum.

Alternatively, lie on your front in the same “upside down” position, keeping your weight on your forearms and knees wide, with your bottom in the air. Lying on three pillows or a beanbag chair can help further elevate your hips.

Or, lie bent over the edge of a sofa or top of a staircase with your legs on the floor and your body lying down the sofa or stairs. Support your body with your hands or forearms so that your torso is inclined upside down.

Gently roll your hips side to side while in any of these positions.

Taking homeopathic Pulsatilla 30C will help the above exercises be more successful. Allow 4-5 pellets to dissolve under your tongue 3 times daily for 3-5 days. As with any homeopathic remedy, avoid eating or drinking for 15-20 minutes before and after.

Natural Remedies for Breech Babies

In addition to exercises that help your baby move into the best birth position, there are a few techniques that can be administered by care providers. If you’ve tried the above suggestions without success, look for a practitioner that practices one of the following.

MOXIBUSTION

Find an Acupuncturist or Doctor of Traditional Chinese Medicine who has had success turning  breech babies to vertex with moxibustion. The technique involves burning certain herbs close to the skin at specific acupuncture points.

WEBSTER TECHNIQUE

A chiropractor trained in the Webster Technique can use this sacral adjustment to help facilitate the pelvic alignment needed for your baby to get into birth position.

MANUAL TURNING (External Cephalic Version)

If all else fails, you can opt for having your baby turned manually if the right conditions are met (such as no cord around the baby’s neck or short cord, adequate amniotic fluid, and healthy baby as detected on ultrasound with a normal fetal heart beat). Sometimes this is can be easily done in your birth practitioner’s office at 34 -36 weeks, especially in a woman who has delivered vaginally before, while carefully assessing the baby’s heartbeat. It has a high rate of success in skilled hands and supportive conditions.

Experienced midwives can turn breech babies. Most obstetricians prefer to do it in the hospital, often with medication to relax your uterus, ultrasound guidance, and continuous fetal heart monitoring. But it can safely be done out in of hospital settings while monitoring baby.

Ask for a wedge pillow to support you in a tilted pelvic lift position, or a bed that can be placed at an angle, with your legs higher than your head to help baby out of pelvis. Also, having it down while in deep meditation being supported in a pool of water has been effective and a wonderful experience.

Once the baby is turned to the head down position, stop inverting yourself, wear an abdominal binder at all times to prevent the baby from turning back to breech.

If your baby insists on being breech as you approach your due date, discuss your options with your provider. If they are not supportive of your choices for a vaginal breech birth, find a different practitioner, optimally one who has the essential skills and philosophy of birthing breech babies vaginally when appropriate and safe to do so. You can ask for recommendations at Breech Without Borders.

A baby lying in the transverse position, however, can only be delivered safely by cesarean section.

For more information on having the birth of your dreams, check out my Guide to Pregnancy, Birth and Postpartum

If you desire personal guidance, schedule an online or in person coaching call with me.

Gestational Diabetes Screen & Alternatives

Gestational diabetes is rare in the healthy population. Occurring in about 6% of pregnancies, it’s incidence is increasing largely due to the growing obesity, insulin resistance and adult onset diabetes, poor diet and lifestyle habits in the United States. There is much controversy around gestational diabetes, how it is screened for and diagnosed, and whether universal screening improves outcomes as opposed to testing when there are risk factors. If you do have it, however, treatment that includes appropriate actions like maintaining ideal weight, enhancing nutrition and exercise habits does make a significant difference in reducing the serious health consequences for both you and your baby.

In the US, it is standard of care that all women are screened for gestational diabetes at 24-28 weeks of pregnancy, although in some other European countries, only women with risk factors are screened. Screening that is most common involves giving pregnant women a “Glucola” drink that has 50 grams of sugar in the form of dextrose, and then testing blood sugar an hour later. Many holistic providers and the families they serve are concerned about this potentially toxic drink laden with chemicals that may make them feel sick, harm them and their babies, and can be associated with false positives that label them unnecessarily as high risk. This increases stress and angst, leads to more testing, monitoring and potentially other risky interventions. They want alternatives.

While it is within your right to refuse the test, you may want to consider screening for gestational diabetes in another way and discuss your concerns and options with your provider. If your provider is unwilling to work with you on this, consider switching providers to one who will. Although we do not have enough evidence that alternative screens are as accurate as using the more extensively studied Glucola drink to screen for diabetes of pregnancy, alternatives are not to be easily discounted, and may be a viable option in the low-risk healthy population. 

It is recommended according to evidence based care, but you have the right to make an informed decision to decline. The evidence does support screening for diabetes of pregnancy (GDM), as the benefits of accurate diagnosis and treatment outweigh any potential risks of the screening blood test.  Treatment does impove health and birth outcomes, whereas untreated abnormally high blood sugar levels in pregnancy carries substantial risks to mamas and babies. In the early 2000s, the US  only screened those with risk factors, but since the rates of GDM are increasing, and rarely found in those without risk factors, it has become standard to screen everyone. In the UK, only those with risk factors are advised to get the one 3 hour glucose tolerance diagnostic test. There is disagreement on the best screen to use, and what numbers are diagnostic. In the US, standard of care is to use a two step process in which the pregnant mama drinks 50 grams of a Glucola drink made of dextrose and blood is drawn 1 hour later.  Some practitioners and labs use 140 as the cutoff blood sugar level indicating a positive screen others use 135, and some use 130. The lower the cutoff number, the increased number of false positives along with a slight increased ability to diagnose true GDM, whereas the higher the cutoff number the opposite effect can result.  So it depends on the cutoff number your provider and lab uses, each showing different degrees of sensitivity and specificity. Levels of 135-140 are considered normal according to the Mayo Clinic, ADA, ACOG and other highly medical sources.

There is an option for screening for gestational diabetes by home testing. This involves checking your fasting blood sugar at home when you wake up in the morning, and then again 1 hour after eating your usual breakfast, lunch and dinner. While approved for monitoring blood sugar once diagnosed with diabetes, this method of screening is less studied and without clear standards. It is also more cumbersome and costly, as you need to get the supplies to do it, then take the time to get it right and keep records to discuss with your provider at your next prenatal visit. 

I discuss natural alternatives to the chemically laden Glucola drink in my Natural Birth Secrets book 2nd edition….but here are some basic tips if you want a more natural approach.

Alternative Gestational Diabetes Screening Options to Glucola

Starting three days before your appointment, increase complex carbohydrates such as whole grains, sweet potatoes and winter squash.

The meal before the test should only contain protein, vegetables, and unsweetened dairy. A veggie cheese omelet is a great choice! Avoid sweetened foods, fruit, and carbs. If this last meal before the test is lunch or dinner, you can eat a normal breakfast, but avoid carbs or sweets for the rest of the day.

Fresh Test is a new organic alternative that is also said to taste good, with only three ingredients. It has exactly 50-grams of glucose yet is void of unnecessary artificial additives, and is laboratory tested to be virtually equivalent to the Glucola without the unhealthy ingredients. To make your own drink that is most equivalent to Glucola without the chemical additives, dissolve 50 grams of organic dextrose in 8 ounces of water. You will need to do some math. If there are 20 grams of dextrose in 2 Tbsp for example, then you need 5 Tbsp of the powder. You ideally want dextrose, as it is the sugar made from corn that makes up the Glucola drink, and it is most bioidentical to the sugar in your blood called glucose. Therefore, it is the best alternative to screen for gestational diabetes as the standard Glucola drink does, according to the laboratory parameters designed and tested for this purpose.

Another alternative is to drink an equivalent amount of pure corn syrup dissolved in your tea, since the sugar in corn syrup is dextrose. You can find organic non GMO varieties in the health food store, but you still need to do some math, to get 50 grams of sugar total. 

Reputable research indicates that you can instead, eat 28 all natural organic jelly beans or enough that equals 50 grams of sugar, which is studied to be a reliable alternative to the 50 gram glucose beverage. It is not standardized as is the Glucola drink, amounts and types of sugars vary with each product, so you need to do the math and make sure you are eating 50 grams of sugar. The study was relatively small but results can certainly be considered.

Other less ideal options are iced tea, organic Gatorade or a cola drink that has 50 grams of sugar added in the form of added table sugar or dehydrated cane juice (sucrose) - similar to the kind of sugar in jelly beans. They are not a first choice because they are not as extensively researched, the form of sugar is different than dextrose, and thus may have a different effect on your blood sugar levels and test results, designed to screen for diabetes based on your response to dextrose. 

The blood test to screen for gestational diabetes was studied and formulated to test your reaction to ingesting 50 grams of dextrose. Sucrose is made up of 50 % glucose and 50 % fructose. You will need to read ingredients and nutrition labels to use an alternative, an important skill to develop anyway. And you still need to do some math, as the nutrition label might say something like 23 grams of sugar per 8 ounce serving. 

When going for sugars that are not dextrose extracted from corn, you can choose any sugar sweetened drink without added fruit juice. Fruit contains a different type of sugar called fructose that makes the test less accurate as it has a different effect on your blood glucose levels than does dextrose and sucrose. If you can not find or have no time to figure it out and have low risk of gestational diabetes, Snapple 16 oz raspberry peach drink is second choice. Although it is mainly sweetened with sugar (sucrose), it does have a little fruit juice, which again is mostly fructose.

Coconut water is another, but less than ideal option, as it contains sugar in the form of mostly sucrose and glucose, and it does have some fructose as in fruit. ZICO coconut water 16.9 ounces has 20 grams of sugar, so you would need to drink 2 ½ bottles. Honey is another alternative, but it is also not made up of an equivalent sugar - it is sucrose and fructose. Again, you need to read the label. Different honeys have different amounts of sugar per serving size. 

Hopefully there will be more studies on these alternatives, but for now, are listed here to consider with your provider, if for some reason you can not take the dextrose or corn syrup equivalent and you are healthy, with healthy weight and lifestyle, with low risk for diabetes. 

45 minutes before your appointment, eat the jelly beans or drink an amount that equals 50 grams total of sugar, then nothing until the blood test, which will be drawn 1 hour after you consumed the drink or candy.

If you have time, do some form of exercise like taking a brisk walk for 20-30 minutes after drinking, but before the test.

Bring a high protein, whole carbohydrate and healthy fat snack to eat after the test if needed, to keep blood sugar stable. This will help you avoid unpleasant symptoms once your blood sugar drops, like shakiness, lightheadedness, fatigue, anxiety and irritability.

Rest assured, most healthy pregnant women (about 94%) do not have gestational diabetes. A positive screen simply means you need more testing to confirm it or rule it out. And if you do have it, you can learn how to keep your blood sugar normal throughout the rest of your pregnancy and life. 

If you need more guidance,  schedule a coaching call with me.

Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.

INITIAL POSTPARTUM CARE AT HOME: YOUR COMPREHENSIVE GUIDE - PART TWO

POSTPARTUM CARE AT HOME: YOUR COMPREHENSIVE GUIDE TO THE FIRST FEW WEEKS - PART TWO

Do see last month’s blog for Postpartum Care at Home: Your Comprehensive Guide to the First Few Weeks - Part One.

Dealing With Postpartum Exhaustion

Welcome to motherhood!  Caring for a newborn and recovering from childbirth is no small task.  Fatigue can easily lead to exhaustion, infection, irritability and depression if you do not listen to your body’s signals for increased rest during this time. 

The best way to minimize fatigue is to spend the first two to four weeks after birth (longer after cesarean) caring only for yourself and your baby, while someone else (like your partner, a close relative or friend) tends to the other needs of the household. No need to feel guilty for doing nothing other than resting, taking care of you and your baby during this time. This is your sole job right now, with nothing else on your plate. 

Many of the suggestions for fatigue in pregnancy still apply, but other suggestions specific for postpartum to prevent exhaustion include:

• Eat well, at least three whole food varied healthy meals and snacks, without skipping meals

• Drink at least 8-10 glasses (64 ounces) of water daily

• Take recommended supplements, to ensure you are getting all the nourishment not you need for yourself and your baby while you breastfeed and recover, that is not supplied by diet alone. 

• If you are anemic or had excessive blood loss after birth, be sure to take herbal iron at least for the first 6-8 weeks postpartum, until you feel back to yourself and your labs including iron stores are normal. 

• Try to plan so that for the next 2, ideally 4 weeks, someone other than you is doing errands, cleaning, preparing meals for you and your family, and tending to the older siblings.

• Consider hired help (such as a mother’s helper or postpartum doula, a cleaning lady and even a personal chef or healthy meal delivery) if you do not feel you have enough support, or after your support leaves. This can be put on your online baby gift registry and is much more essential than stuffed animals, toys and an oversupply of newborn clothes Baby will soon grow out of.

• Be honest and direct about communicating your needs. Don’t be afraid to delegate responsibilities to others.

• Gratefully accept offers to help. Remember this is not just a much needed time to heal from the birth, but it is also a sacred time to get to know your baby and learn to breastfeed. As long as you are well supported, allow yourself to enjoy this special time and bask in the loving support of others.

• Rest, sleep and lounge as much as possible during at least the first month postpartum. Nap when Baby naps and ask a friend or relative to take the older kids for even an hour or two each day so you can do this. When you have a choice between folding the laundry or doing the dishes and napping, choose napping. Do not give into the temptation to do any housework, errands, childcare or cooking, as these tasks can be delegated to others during this time while you are recuperating. This is not a time to be supermom. Allowing yourself this extra time to rest now, will help you stay well physically and emotionally for you and your family, and will help you feel back to yourself sooner.

• Be strict with visitors. Don’t be shy about suggesting when it’s best for them to visit or excusing yourself if you feel tired. Ideally, put a sign on your front door saying something like,

“New moms and babies need lots of rest and help. We are resting now, please do not disturb. But, we would love a short quiet visit between {insert baby’s most awake hours}. If you would like to stay longer, please bring or cook a meal, play with our older children, or do some housework like the dishes or laundry.”

• Ask your partner to tend to the baby at night after you breastfeed for burping, diaper changing, settling, or holding skin to skin. Once breastfeeding is well established, your partner can also give the baby a bottle of expressed breast milk for one of the night feedings.

• Keep night feedings dark, quiet and boring so that baby will eventually learn to sleep longer periods of time during the night.

• If you can’t fall asleep at night, try these suggestions for insomnia, and make sure to take 1-2 daily naps or rest periods when the baby sleeps. Remember to silence your phone. Better yet, keep it out of the bedroom.

• Limit caffeine and avoid it after 4:00 P.M.

• Limit time on computer and iphone, and avoid it after dark.

• Get daily fresh air and sun exposure during the non-peak hours. 

• Treat yourself to a nice deep tissue massage focused especially on areas of aching muscles, or ask your partner to do it. A soothing simple combination for massage oil includes 3½ ounces Almond oil, ½ ounce Arnica oil, 15-30 drops of your favorite uplifting essential oils like Rosemary, Evergreen (Pine), Peppermint, Spearmint, Rose, Geranium, Ylang Ylang, Orange, Lemon, Citrus blend, Lavender or Jasmine. Shake well before each use, and store in a cool dark place in a glass bottle (this Almond oil comes with an extra 4 ounce travel bottle). A few drops of Vitamin E oil can be added to preserve it.

• After the first few weeks, an occasional weekend in a nice hotel with your partner and baby can be a really nice restorative rest and treat. And so worth the expense, as the hotel staff will clean your room and cook your meals!

• Practice regular yoga and light stretching any time. There are many ways to do it with your baby, or you may benefit more from having some space to do it alone, leaving Baby with pumped breast milk and a trusted sitter. Gradually get back into exercise in the morning or early afternoon after the first several weeks, and increase as tolerated after your bleeding stops and you feel up to it. 

• Do daily 10-20 minutes of conscious connected breathwork that provides you with natural energy and increases vitality. 

• Heed to signs of not getting enough rest, which include:

  • Ongoing exhaustion

  • Feeling run down and achy

  • Excess or prolonged bleeding

  • Inflamed clogged milk ducts

  • Frequent infections and colds

  • Excess emotional irritability 

Report to your practitioner if you cannot sleep, are too exhausted to cope, or your fatigue worsens or does not ease up by six weeks after Baby is born.

Excessive Sweating, Peeing and Shaking

A normal increase in perspiration and trips to the bathroom are common as your body rids itself of additional fluids that developed during pregnancy, and IV fluids if given during labor. Intense shaking right after birth is also common due to the hormonal fluctuations, temperature and body changes after the huge work your body just did to give birth. This is a normal stress response to release the intense energy that was involved.

Suggestions are:

• Ask your partner to hold you when shaking, but do encourage and embrace the shakes, without trying to stop your body from doing what it needs to do in order to reset.

• Take Rescue Remedy to support your normal stress response, if you feel you need it.

• If you are cold, wear absorbent all-cotton clothing and warm socks, dress in layers and cover yourself with warm blankets.

• For sweating and chills not related to infection:

  • Sleep on a large towel or terry cloth sheets.

  • Drink Ginger tea alternating with Cinnamon tea. It is best homemade, by adding a pinch of freshly ground ginger or a stick of Cinnamon to 1 cup boiling water and brewing covered for 15-20 minutes. Or a steep a stick of cinnamon in the water for a few minutes. Strain into a glass mason jar, add honey and or pure nut milk to taste.

  • For severe sweating, get an acupuncture treatment to balance your Qi and promote healing. 

Report to your practitioner persistent sweating that lasts several weeks, chills, muscle aches, and temperature over 100.4 after the first few days.

Dealing with Feeling Fat

This is one of the most common postpartum complaints. Women often struggle with body image issues postpartum, and feel fat. Typically, only about 12 pounds are lost with delivery, another 5 pounds are lost during the first week, and an additional few pounds are lost by the 6 week check-up. It can take several months for the fat stored around your hips and buttocks for breastfeeding and nourishing you during the pregnancy and postpartum, to be used up. So, it is good to remember that the calories used for breastfeeding will help you lose this extra pregnancy weight.  

The rest of the weight gained during pregnancy will have to be lost through a healthful diet and exercise program. Also, it takes at least 6 weeks for the uterus to return to a non-pregnant size, and it takes time and abdominal exercises to tone up the muscles and overlying skin that was stretched. It takes at least several months to return to your pre-pregnant size. 

Remember, breast milk production requires even greater caloric intake than pregnancy, as you are the primary provider of nourishment to your rapidly growing baby. So, this is definitely not an appropriate time to diet, as it deprives you and your baby of essential nutrients. If you gained excessive weight in pregnancy or were overweight before pregnancy, eating varied, whole food of high quality, and avoiding processed foods high in unhealthy fats, refined carbohydrates and sugars, and regular exercise when ready, is usually sufficient.

To summarize:

• Drink 64 ounces filtered, spring or well water daily between meals, at least 20-30 minutes before or 2 hours after eating.

• Eat a balanced, nourishing and varied diet high in:

  • Fresh organic fruit and vegetables

  • Organic tofu and tempeh

  • Beans 

  • Nuts, nut butters, and seeds

  • Organic pastured whole eggs

  • Organic free range, grass fed chicken and turkey, beef, lamb, and wild game

  • Wild Alaskan salmon and other fresh water fish from non polluted waters

  • Organic whole raw dairy-goat or sheep is best

  • Limited whole grains (sprouted is ideal)

  • Organic cold expeller pressed extra virgin olive oil, coconut oil, ghee or goat butter 

• Avoid foods that are heavily processed and loaded with unhealthy refined vegetable oils and partially hydrogenated fat, sugars, refined flours and starches.

• Begin regular exercise like brisk walking or dancing as soon as you are able and the bleeding stops. Aim for 30 minutes 4-5 times per week. Pilates is a great way to strengthen your muscles, and especially tone up your core. Yoga will tone your core as well, in addition to increasing total body flexibility and strength, and helping you calm and grounding feelings. Ideally, take a local class like mommy and me yoga or postpartum yoga and Pilates. There are also plenty of online classes until you can manage to get out to an actual class. Light walking, gentle yoga stretching, side lying leg lifts, pelvic floor muscle strengthening, and gentle abdominal toning exercises can be done after the first few weeks. Gradually increase time and intensity as you are able. Listen to your body, though. There is no need to rush or push yourself during this time of needed rest, healing and recovery.

• Historically and in plenty of cultures around the world, a fuller figure is more glorified, respected and honored, and being too thin is not considered healthy or attractive. While obesity is unhealthy and it is important to have a healthy weight and body image, there are many variations in normal weight and body characteristics. Ditch the pervasive media pictures of thin models. They are not realistic, they wreck havoc with body image and often result in you feeling unnecessarily bad about yourself. If you need to, look at the #BodyPositive images of mothers on social media. Be mindful of unhealthy thoughts from modern, western cultural stereotypes that imply “thin is most beautiful” and “looking fat is ugly.” Try to replace them with more true affirmations of pride and gratitude for your body having just grown and birthed your baby. Maintain acceptance and love for your unique body type which is forever changing. Know that you are more than just a body, but a beautiful eternal soul with your own special gifts, attributes and purpose far bigger than that of your body. Even though you are a postpartum woman who has just birthed her baby, you are also physically radiant, lovely, magnificent and have a deeper sort of beauty and wisdom.

Postpartum Depression and Anxiety

Intense emotions, mild depression, anxiety and mood swings are common in the first few weeks after having a baby, as are postpartum struggles. This is especially true if you are overtired and exhausted, without help or support from others, and/or have other stresses, personal issues or other problems. You may find that you are at times down, irritable, easily upset, extremely sensitive, cry without apparent reason, overwhelmed, tense, anxious, and unable to concentrate or remember things.  

Natural remedies to lessen the emotional ups and downs, and help you cope include many that are mentioned in my posts for managing stress and emotions in pregnancy. 

Suggestions specific for postpartum include:

• Minimize fatigue with the tips from the exhaustion section above. A - adequate sleep is crucial.

• Eat a healthy well-balanced diet as described above, but many feel best completely off gluten, dairy, soy and all forms of cane sugar. Consider eating an organic Paleo diet, an ancestral whole or real food way of eating high in pastured organic animal protein and healthy fat, plenty of fruits, veggies, nuts and seeds, with free use of herbs, spices and healthier sugars like raw honey. Try it for a month. You will be amazed how much better you feel physically and emotionally.

• For general health and physical and emotional well-being, make sure to take the supplements here that include a whole food multivitamin, omega threes, probiotics, Vitamin D, plus those specific for symptoms of anxiety and depression:

  • Calcium, 250-500mg 2-3 times daily

  • Magnesium, 200-400mg 2-3 times daily

  • Vitamin B complex, 20-50 mg once daily with methylated folate and 

  • Vitamin B12 sublingual (under the tongue) in the form of methyl, hydroxo or adenosyl cobalamin), 1000-5000 mcg daily to 2-3 times weekly depending on symptom severity and blood levels

  • Curumin (Tumeric), 500 1-3 times daily to reduce inflammation linked to depression, anxiety and other mental health challenges

  • Evening Primrose oil, 500-1300 mg daily

  • Continue your iron supplement if prescribed during pregnancy until you stop bleeding

• Take your encapsulated placenta pills as directed (see supplement section).

• Spend extra time breastfeeding and cuddling with your baby, skin to skin.

• Share your feelings with a close friend, relative, transformational life coach or integrative health professional. An occasional good cry does wonders, as does a good hug, and a good laugh. 

• Write and feel free to share your birth story. Include the details, the lessons you learned about yourself and others, your strengths you have discovered, how you and your partner have grown, and qualities you found that exceeded your expectations.

• Commiserate with other mothers by taking a postpartum yoga or exercise class, or joining a mothering, breastfeeding or parenting class or support group.

• Every day, remember to protect your emotional well-being by doing things that cheer you up and avoiding things that upset you.

• Each morning, shower, brush your hair, put on your usual make-up, and get dressed, even if it is just changing PJs or sweat pants and shirt. After the first two weeks, get dressed in clothes. 

• As soon as you are able and the bleeding stops, begin a regular exercise program such as brisk walking, hiking, low-impact aerobics, more active yoga, dancing or swimming for 30 minutes 4-5 times per week.

• Get out of the house and get some fresh air at least once daily, even for just a little walk in the park, a trip to the farmer’s market, or enjoying a cup of tea with a friend.

• Plan some leisure time away from the baby at least twice a week in the early weeks and more frequently later postpartum, even if just an hour each day.

• Avoid drugs, alcohol and caffeine. 

• Before attempting medication, try the recommended lifestyle changes, natural remedies and herbs for stress and emotions first, as they are non- toxic, effective and address the root causes, unless symptoms are too severe.  If you are already on medication, the natural modalities and suggestions here can be used in adjunct, and can ultimately support you when you one day taper down to lower doses and choose to stop taking them.

• For persistent symptoms, make sure to have your provider check a comprehensive thyroid panel with thyroid antibodies, your vitamin D and B 12 levels, fasting glucose and hemoglobin A1C and address issues accordingly. Do what you can to prevent postpartum depression and anxiety and minimize underlying possible causes.

• In Chinese medicine and many other ancient traditions, the dried placenta powder is recommended postpartum for its powerful healing properties, especially helpful for balancing emotions, prevent or lessen postpartum depression if there is a risk or history. Many doulas and birth professionals encapsulate placentas. If you encapsulated your placenta, take as directed by the provider who encapsulated it. 

Report to a healthcare professional if your symptoms of depression or anxiety worsen or last more than the first few weeks, if they interfere with your ability to carry out your daily tasks, if you notice significant changes in your eating and sleeping habits, if you feel desperate, hopeless, afraid, unable to cope, or have thoughts of harming yourself or your baby. 

Siblings

Postpartum is always a time of adjustment for siblings. It’s healthy and normal, and they each handle it differently. The youngest tends to have the hardest time, but not always. Some temporarily regress a bit. Some show upset towards mom, dad, or the new baby. Others become more needy and try to get negative attention and act out, if they can not get enough attention in a positive way. 

Although your heart doubles with each new baby, meeting the needs of the older children and balancing that with your own healing and newborn care can be challenging. Having a strong network of family, friends, mothers with similar aged children, or hired help is essential in the early weeks. This support system can help with the siblings’ care, give you time to heal, rest, and focus on the baby and mastering breastfeeding. Extra support is especially important if the sibling is a toddler or young child, as they usually need the most tending to. 

Take a deep breath and let compassion run through you, and imagine how you would feel if your partner just brought home a new girlfriend everyone's all excited about and loving towards, and encouraged you to love her too. Reassure them they are loved, give them a lot of approval, and include them in age appropriate ways if they are interested in helping to encourage them to feel involved and important. Try to spend some quality time with each of them alone regularly, so your attention can be focused on them completely without interruption, ideally after Bbaby has been fed and can be held by someone else. 

It is important to avoid expressing criticism or anger towards them when they are seeming to be acting out or trying to help, and do not suppress the expression of their feelings. A great book written in easy to read comic strip form, with great suggestions on helping older children adjust healthfully is Siblings Without Rivalry by Adele Faber and Elaine Mazlish.

If you haven’t already done so, get the wonderful book written by herbalist, midwife, and doctor Aviva Romm, Natural Health after Birth, for a more complete holistic and heartfelt guide to postpartum healing and wellness.

Need more help from me?

Check out my insider’s Guide to the joys and challenges of recovering from birth in these modern times created by a seasoned holistic nurse midwife who has seen everything! Learn simple tricks of the trade to make the journey to motherhood more holistically healthy and fulfilling.
You will have direct access to me through the Guides and I can help you:

• Help yourself recover postpartum healthfully and with easeful joy

• Get the support and guidance you need to answer all of your questions to create a postpartum experience you love and treasure forever

• Understand holistic modalities on common postpartum issues

• Get the support and tools you need for stress reduction

• Answer questions and make informed decisions

BUY NOW!

Give yourself this gift a lifetime to have the experience of your dreams, you will treasure forever.
As always, if you need more personalized support and guidance, schedule a chat with me so I can advise you about the best supplements, remedies and dosages specific to your situation.

My Natural Birth Secrets book 2nd edition is a great adjunct to the online Guide for postpartum and holistic modalities to common issues and discomforts.

For general postpartum healing:

INITIAL POSTPARTUM CARE AT HOME: YOUR COMPREHENSIVE GUIDE: PART ONE

POSTPARTUM CARE AT HOME: YOUR COMPREHENSIVE GUIDE TO THE FIRST FEW WEEKS - PART ONE

Welcome to the postpartum period, the fourth trimester, a period of healing and adjustment, of getting to know and comfort your baby, and mastering breastfeeding. All your baby needs now is love and breast milk. If you are unable or choose not to breastfeed, consider feeding baby pumped breast milk, or donor breast milk from registered milk banks. Breast milk is the ideal food for your baby, although organic goat milk formula is most similar to human milk and you can discuss best alternative options with your pediatrician. And do see the Postpartum Guide to Breastfeeding Postpartum, for initial issues specific to that.

The rest will follow naturally, as you learn on the job, take guidance from wise experienced others, and let Baby be your teacher. As in pregnancy and birth, trust your instincts and your heart. But, do not hesitate to ask for help and support as needed. Hopefully you prepared in your pregnancy so that you are well supported during this sensitive time, as it has always taken a village to raise a baby as well as new parents. A postpartum doula is a must if you do not have family and friends to help you. 

After the first week or so, but before your memory of details fades, it is a wonderful experience to reflect on your pregnancy and birth with heartfelt honesty, and write your pregnancy memories and childbirth story down in a bump to birthday journal. This is something special to share with your child one day, and it is also a wonderful gift to yourself. It can be especially helpful for healing if things were difficult, or your labor and birth did not go as planned or as you hoped. Journaling will help you express, later process, understand, come to terms and make peace with any painful feelings that come up more deeply. 

Below are some helpful hints to make the next few weeks easier and more comfortable, so you are more able to heal, enjoy and reflect upon your extraordinary new miracle. The most important advice is to slow down, stay in the moment, try to resist the temptation to do, do, do...and just be, be, be. Trust that you will heal, as you are perfectly designed to do, given the proper care and support. 

Nutrition for Postpartum Care

Maintain at least the same healthy nutrition as you did in pregnancy, especially now for recovery after birth, and during breastfeeding. This will help you to make good quality milk, and nourish your baby as well as yourself. Make sure to eat at least three whole food varied healthy meals and snacks, and even a little bit more than you would normally consume. And keep well hydrated with at least 64 ounces of water daily. 

Traditional foods for the early postpartum weeks across cultures typically include soups and stews with a lot of vegetables, including the starchy ones like sweet potatoes and winter squash, stew meat or chicken, and whole grains like barley and oats. Also, do eat plenty of eggs, seasonal fruits and vegetables. Much nourishment can be added to fruit/veggie smoothies, soufflés, whole grain hot cereals, and breads/muffins like zucchini-apple, banana-date or carrot-raisin, enhanced with almond flour or chopped nuts and seeds, nut milk, and eggs. 

Herbs and Supplements

Make sure to supplement your diet as in pregnancy, with herbs, vitamins, minerals, omega threes and probiotics to complete nourishment not supplied by diet alone. This will aid in your recovery and help supply all of your and your baby’s nutritional needs. Do increase iron foods and take an herbal iron, especially if you were anemic in pregnancy, have low iron stores, lost a lot of blood at birth, gave birth by cesarean, and/or are still anemic. 

Do continue your nourishing pregnancy herbal infusion to your diet but add alfalfa and red clover. You can have a support person make this by:

1. Blending a handful of dried Nettle leaf, a handful of dried Red Raspberry leaf, a pinch of Alfalfa, large pinch of Red Clover, and several Rose Hips. 

2. Add a pinch of Comfrey to help with healing. (optional) 

3. Brew in a mason quart glass canning jar of boiling water 1-4 hours. The longer the brew, the stronger the taste and effect.

4. Strain, and drink plain or lightly sweetened with Rose Hip infused honey and/or a splash of fresh squeezed lemon or lime juice.

5. Enjoy hot or cold, up to 4 cups per day.

 You can make it in larger quantities and store in the fridge.

Other herbal tonics for new moms to promote general physical and emotional postpartum recovery and healing include Ashwagandha and Gotu Kola (½ -1 tsp each twice daily), and Milky Oats (1/1-1 tsp 1-3 times daily), in addition to herbs mentioned below as appropriate for each specific issue.

To promote healing after birth, take 3-4 pellets of homeopathic Arnica 30 c under your tongue every few hours for the first 3 days, then three times daily for a week. You can also dissolve the pellets in a clean unused bottle of water, shake vigorously a few times, then gargle a mouthful before swallowing, which increases the strength of the remedy.

Treatment for Afterpains

Periodic cramping, known as afterpains, commonly occur as your uterus muscle fibers contract around the blood vessels that supplied the placenta. This is your body’s natural defense in order to minimize excessive bleeding and return to its non-pregnant size. They can be quite painful, and can occur with increasing intensity after each subsequent baby.  

Breastfeeding can temporarily increase the severity of these pains, which is actually helping your body heal and prevent excess blood loss. Afterpains should gradually subside over the next week and lessen significantly over the first 3 days after birth. 

Below are some suggestions to lessen the discomfort.

• Frequently empty your bladder, even though you don’t feel like you need to pee, as is common from the swelling after childbirth.

• Especially during the first 24 hours, check the top of your uterus several times per hour to make sure it is nice and firm like a hard nectarine or knuckle. Massage the top of your uterus gently when it begins to soften or feels boggy.

• Lie on your stomach with a pillow under your lower abdomen.

• Apply warm moist towel compresses, hot water bottles, hot herbal packs or rice packs heated with a few drops of essential oil of Lavender, or a heating pad to your lower abdomen. 

• Practice your breathwork, deep breathing and conscious relaxation exercises during the afterpains, dropping your focus right down into them, relaxing with surrendering to the intense sensations as you did in labor.

• Try soaking in a well-cleaned, warm bath with drops of Lavender or Chamomile.

• For an effective herbal infusion: 

  • Mix a large pinch of Chamomile blossoms and/or Catnip in 1 cup boiling water.

  • Brew covered for 10-20 minutes.

  • Strain in a glass canning jar.

  • Add honey to taste (optional).

  • Drink very warm, 1-4 cups daily.

• Take a dropperful of Motherwort herbal tincture up to 4 times daily. If without relief, try Cramp Bark herbal tincture, 1 dropperful every 30 minutes to 2 hours, then 2-3 times daily. You can add a dropperful of Black Haw tincture 3 times per day. You can make your own cramp bark infusion by steeping a handful of Cramp Bark and Black Haw with a pinch of Hops and generous pinch of Blue Cohosh root in a quart mason jar overnight.

• Take Wish Garden AfterEase herbal tincture as directed

• Take 3-4 pellets homeopathic Chamomilla, Arnica, or Caulophyllum 200 c. Try one remedy under your tongue. If no relief try the other. If the remedy works, repeat daily as needed.

• Try Moxibustion treatments by an acupuncturist.

• Try additional suggestions and remedies mentioned here for aches and pains in pregnancy. They work!

• If the pain is too much for you and interfering with your ability to breastfeed, rest and sleep, you can take ibuprofen (up to 800 mg every six hours) OR acetaminophen (up to 650 mg every four hours) ½ hour before nursing for the first several days only, as needed. But before reaching for these medications, try 1-2 grams of Curcumin (Turmeric), a natural herb studied to be as effective for pain relief than most over the counter synthetic analgesics without their associated potential risk of toxicity. 

Consult your practitioner for severe cramping or cramping that lasts longer than 1-2 weeks, or if accompanied by uterine tenderness, fever or foul smelling discharge.

Home Remedies for Bleeding

During the first two to five days, bleeding is no more than a heavy period with an occasional clot the size of a 50 cent piece or egg, dark red in color with a fleshy smell. It tends to be less after cesarean birth. Clots are simply congealed blood mostly that pools in the vagina when you are reclining, and can occasionally be as long as the vaginal canal. Sometimes bleeding increases with nursing, strenuous activity, heavy lifting and pushing motions, full bladder, and as you rise from a lying down position. 

During the next week or so, the bleeding becomes paler pink or brownish, and it lessens in amount so that you only need to change sanitary pads several times per day. Over the following two to four weeks, discharge becomes creamy white or yellow and even less in amount, but usually returns to red bleeding or spotting for a day or two around the second postpartum week.  

Some women occasionally spot on and off for longer periods of time or throughout breastfeeding. Suggestions for keeping clean and comfortable are:

• Take a daily bath in a well-cleaned tub (add Calendula tincture and Lavender oil to water if desired) or shower.

• Change disposable organic sanitary pads or herbal infused natural pads every four to six hours, and after going to the bathroom. Do not use tampons, menstrual sponges, or menstrual cups. The first day or two, especially at night, consider wearing adult diaper type pads simply because it is just easier, as bleeding can be heavier than common postpartum maxi pads can accommodate, and can leak onto your clothes and sheets. Use them with a smile.

• Wash hands before and after changing pads.

• Remove pad from front to back, squeeze a peri-bottle of warm water over perineum. If you had tearing with or without repair, you can also add 1 tsp Calendula tincture and Lavender oil to the water. Pat dry.

• Do not douche.

• Check the top of your uterus for firmness several times per hour when awake for the first 24 hours, then several times per day for three days. It should feel as firm as a hard nectarine. If it feels soft, massage it firmly so it re-contracts.

• To prevent excessive bleeding, take homeopathic Arnica 30 c as described in the supplement section.

• Take herbal Shepherd’s Purse, 1 dropperful of the tincture three times daily for the first 3-5 days.

• Wear an abdominal binder or Bellefit’s postpartum support girdle. You get a $20 off with code: ANNE20 at checkout.

• Continue your herbal iron dose until your bleeding stops in 4-6 weeks, which may need to be increased per your practitioner if there was hemorrhage. Eat foods high in iron, like red meat, dark turkey meat, eggs, dark leafy green veggies, and dried fruits.

• If bleeding becomes heavy (you are saturating more than a large maxi pad every half hour):

  • Try herbal Shepherd’s Purse tincture (1 dropperful under your tongue), repeat every few minutes as needed)

  • Add 3 dropperfuls tincture of Cotton root, 2 dropperfuls each of Lady’s Mantle, Witch Hazel and Blue Cohosh, and 1 dropperful Yarrow. Take them every 10 minutes under your tongue until the heavy bleeding resolves, but only up to an hour. 

  • If heavy bleeding persists, take 2 dropperfuls of HerbPharm Erigeron/Cinnamon tincture of Erigeron and Cinnamon  under your tongue every 20 minutes for no more than 2 hours, and add 1 dropperful of Angelica if without relief.

Report to your practitioner if you’re saturating more than one pad an hour for more than a few hours not relieved by the other suggestions above, especially if you are starting to feel lightheaded, weak, disoriented, cold and clammy with rapid shallow breathing and heart pounding. Contact them also if you’re experiencing large clots, foul-smelling vaginal discharge, severe lower abdominal pain, temperature over 100.4 after the first few days, and deviation from the described pattern of bleeding.

Perineal and Vaginal Discomfort

After delivery, your perineum and vaginal area may feel sore, swollen and uncomfortable. Any pain or tenderness should gradually lessen over the next several weeks, or longer if you had a large tear. 

Suggestions are:

• Practice good perineal hygiene as previously described in the section on bleeding.

• Don’t forget to take the homeopathic remedy Arnica 30c as directed above, in the first few weeks to support healing after giving birth, which definitely helps your perineal and vaginal areas.

• For a small tear that did not need stitches, using a peri-bottle, squeeze warm water with several drops of Calendula tincture and Lavender oil over the area as you urinate to reduce stinging. Squirt Vitamin E oil a few times daily on the tear to promote healing. Motherlove and Earth Mama make wonderfully soothing and healing herbal combination perineal sprays.

• Apply a perineal ice pack or frozen maxi pads saturated with Witch Hazel for the first 24 hours (with 30 minute respite each hour) or as long as you feel it is soothing.

• Periodically sit in a cool sitz bath during the first 24 hours or as long as you feel it is comforting.

• After the first 24 hours, take a warm sitz bath, or warm shallow bath 2-3 times per day. You can also add tea tree oil, tincture of calendula, garlic, ginger and/or lavender, or try herbal sitz bath combinations with Uva Ursi, Comfrey and Sage or Calendula and Oatmeal (both combos have Witch Hazel, Yarrow and Plantain). You can also try herbs with Epsom and Dead Sea salt or herbal salt soaks and see which feels best for you. You can use any leftover unused liquid for compresses or your peri bottle rinse.

• Use a pillow or cushion when you need to sit.

• Contract your pelvic muscles (Kegels) or even better, engage your mula bandha (all of your pelvic floor muscles) when changing positions.

• Take the homeopathic Arnica 30 c as directed above for general recovery.

Report pain that worsens or does not improve over time, an increased area of redness, swelling or pus-like discharge.

If You Have Difficulty Urinating

During the first four hours after birth, many women have trouble urinating such that they feel no urge, feel the urge but cannot urinate, or feel burning after the urine comes out. It is essential that you urinate within eight hours after birth as difficult as it may be, to prevent infection and excess uterine bleeding.  

Suggestions to help you urinate are:

• Listen to running sink water.

• Squeeze warm water over your perineum with your peri-bottle, infused with a few drops of oil of Peppermint.

• Dabble your fingers in water.

• Apply light pressure to the area above your pubic bone.

• Put oil of Peppermint in the toilet.

• Sit in a sitz bath with several drops of the oil of peppermint.. 

• Take a bath or shower.

• Blow your thumb.

• Concentrate on relaxing and opening your pelvic floor muscles while imagining the urine flowing out.

• Drink eight glasses of water per day.

• Try homeopathic Arsenicum or Causticum both at the 30 c dose.

Report inability to urinate more than eight hours after the birth, burning pain before or as the urine is coming out, feeling the urge to urinate frequently but little urine comes out, fever, or back flank pain.

Cesarean Birth 

If you birthed your baby by c-section, it will take more time to heal physically, and psychologically - especially if unexpected and unplanned, or traumatic. Trust that you will get back to your new mama self. The scar will be there but will eventually fade. Allow for at least 3 months recovery for your body from major abdominal surgery, possibly longer to heal the mind and heart. Homeopathic remedies help tremendously and definitely speed and enhance your recovery safely and naturally.  If your cesarean is planned, start Arnica 200 c three times daily the day before and continue through 3-4 days postpartum. 

Other remedies helpful to have on hand are Aconite 30 c for intense fear and panic before surgery, Bellis Perennis 200 c post cesarean to boost healing after you finish the Arnica, Staphysagria 200 c for incisional pain and healing, and Hypericum 200 c for shooting nerve type pain from the spinal anesthesia (only if needed). Use one remedy at a time and take it three times daily until you feel improvement. Consult your classical homeopath for more personal guidance.

The first week is the hardest in terms of postoperative pain, so take ibuprofen or acetaminophen if absolutely needed, then switch to more natural pain relief remedies like ginger or turmeric that are safe for you and your breastfeeding baby, but still effective. 

Use the skills from breathwork and mindfulness to center and ground yourself, stay present one breath at a time, surrender, lean into and embrace the temporary painful sensations you feel, without the story, with love and compassion towards yourself. Whenever you feel overwhelmed or stressed, take a few minutes to simply breathe, keeping your focus softly on a distant nonmoving object (drishti) or close your eyes and internally gaze between your eyebrows, relaxing deeper with each exhale. Send your love and breath (divine life force) and imagined light to areas of pain. Use visualization to support you as you desire. This is powerfully healing.

While in the hospital, it is important to take deep abdominal breaths also to keep your lungs fully expanding (use the incentive spirometer many hospitals give you), and to get up and walk within 12-24 hours after birth for 10 minutes each waking hour, especially to prevent serious blood clots and painful abdominal gas buildup. The more you walk, the sooner you pass gas and get your bowels moving, and you keep your blood flowing rather than stagnating from immobility.

Ask to be progressed from a clear to regular diet within this time, and choose healthy foods and bottled spring water from the hospital menu (if that even exists!) or have your family and friends bring you more wholesome real food meals and snacks. For gas and bloating, limit:

• Gluten containing foods found in wheat, spelt, rye, barley and some oats

• Some fresh fruits and veggies

• Cow dairy if lactose intolerant

• Carbonated liquids

• Chewing gum. 

Eat slowly, chewing thoroughly and mindfully. Natural remedies for gas and bloating include chewing Fennel seeds, drinking Fennel tea, or taking 2-4 ml of the tincture three times per day, taking Slippery Elm lozenges 3-4 three times daily, and a high quality multi species probiotic twice daily on an empty stomach. Eat and drink more fermented foods like kefir. For bad gas and abdominal pain, take 1 dropperful each of Chamomile and Passionflower, ½ dropperful each of  Hops and Lemon Balm, and ¼ dropperful of Lavender tinctures every four hours.  

The dressing over your incision should be removed within 12-24 hours, so your incision is kept clean and dry to prevent infection. You can apply a clean maxi pad over the incision if your belly is folding over it, so it does not stay warm and moist, inviting bacterial growth. You have been sewn back together in many layers, and the skin is brought together by a glue like substance, absorbable stitches or staples, or removable metal staples. While it takes time to heal, when all is proceeding normally, it is unlikely to open as commonly feared. 

Sometimes they use steri-strips over the incision which will come off eventually or you can remove them in a few days. You can definitely shower, but do not use soap initially on the incision. Dry the area gently. A little oozing of blood is common to see on the dressing, as is a tiny amount of clear, white, or yellowish fluid, as long as it is not pus- like discharge. Look at your incision so you can monitor its healing as well as work on acceptance and appreciation for the journey you and your baby needed, made especially for you both. Once you go home, you can apply herbs for perineal and vaginal tears mentioned above to soothe and enhance healing. Earth Mama makes a lovely herbal balm specific to healing a cesarean scar and there are other organic balms that also help the scar fade. 

Make sure to keep Baby skin to skin in dim quiet as much as you can, bonding and soothing baby with your love, telling Baby all is well, Baby is safe and acknowledge that was a tough journey for both of you. Get help with breastfeeding as soon as possible. Baby may be sleepy from the medications, and it takes longer for the full breast milk to come in, but you will get the breastfeeding going with excellent support and patient perseverance. 

I encourage you to love, be proud and grateful for your cesarean scar. This may take time to cultivate, but is a worthwhile goal. Do not be shy to ask for extra needed help, and get support processing and healing emotionally. For online and local group support and advocacy, there are many wonderful resources like ICAN, but you may want to consider breathwork to release the strong stuck emotions and trauma energy in your body if it is interfering with your well-being. If you are suffering from birth trauma or you suspect your baby has it as well - as is common after cesarean birth - there are resources for healing for you and for your baby.

Consult your practitioner with:

• For fever over 100.6 with general muscle aches and chills

• Persistent or worsening pain

• Area of tenderness/foul smell/pus/redness/swelling by your incision

• Area of leg swelling, redness, warmth and pain worse when you flex your foot

• Unusually frequent, urgent or painful urination

• Heavy or foul smelling vaginal bleeding

• Vision changes, nausea, vomiting, chest pain and/or headache, especially if you had high blood pressure

• Anything unusual you are concerned about. 

Obviously, if you have problems breathing, feel weak, disoriented and faint, call 911.

Constipation and Your First Bowel Movement

It is normal to go a few days after delivery without having a bowel movement. Many have loose stools before labor and pooped during pushing, and those who birthed in hospitals who don’t allow eating in active labor probably did not eat much, if at all, in labor, unless they (hopefully!) respectfully challenged that outdated policy, or simply sneaked it. So you have a few days leeway. Some mothers are afraid that a bowel movement will be painful or open their tear more or stitches if they had them. Other women are too busy and preoccupied with all that is involved postpartum to even think about taking the time. Do rest assured that although the first few bowel movements may be uncomfortable, they will not open your tear or effect the stitches. Even if you had a large tear, it’s extremely rare for them to be torn by a BM.

Suggestions to limit your discomfort and prevent constipation are similar to remedies in pregnancy with some additions:

• Replace refined highly processed foods with whole grains, lots of fresh fruits with the skin, and vegetables (especially green leafy salads).

• Drink at least 64 ounces of fluid each day, preferably filtered, spring or well water, or herbal tea. Consume between meals, at least 20-30 minutes before or 2 hours after eating.

• Do Kegels and abdominal muscle toning exercises.

• Drink warm prune juice or a cup of tea or coffee on an empty stomach.

• Drink Smooth Move Tea, which tastes yummy and works like a charm.

• Mix 2-3 Tbsp oat or wheat bran, or ground flax seed, in your hot cereal or apple sauce. Or, mix with stewed prunes or dried figs. 

• Try raisin bran muffins with black strap molasses (ask someone to make you a batch, with whole grains, or Paleo - gluten, sugar and dairy free).

• You can take these remedies in these doses for preventing and treating constipation which include Magnesium or the powdered liquid equivalent in Natural Calm, herbal Floradix liquid Magnesium, Triphala, Psyllium seed husks, or homemade Dandelion and Yellow Dock root infusion. 

• Use Colace (stool softener) as directed if your bowel movements are getting hard despite these above suggestions, and you are on opioid pain medication after a cesarean birth.

• If you are taking iron, use alternative sources of iron other than ferrous sulfate, such as ferrous fumarate, ferrous gluconate, or herbal iron.

• Do not ignore the urge to have a bowel movement, which usually occurs ½ hour after breakfast.

• Take an interesting book or magazine into the bathroom with you to enjoy some relaxing time on the toilet.

• While on the toilet, rest your feet on a low stool and avoid straining. Support your perineum by applying counter pressure with a folded tissue if needed.

• If it hurts while having the first few bowel movements, do some relaxation and deep breathing exercises, relax into the discomfort instead of fighting it and tensing up, or try splinting the perineum with your hands to provide extra give to the area.

• Avoid relying on enemas and laxatives on a regular basis.

• Ask your classical homeopath, or refer to books like Homeopathy For Pregnancy, Birth and Your Baby’s First Year by Miranda Castro, for a homeopathic remedy specific to your unique symptoms.

Consult your practitioner if there is no bowel movement by the end of the fourth postpartum day, or you experience unusual pain or bleeding.

Treating Hemorrhoids

Hemorrhoids are varicose veins of the rectum, and are a common postpartum occurrence. They resemble a pile of red grapes or marbles just outside the anal area, but they can be internal as well. They can itch, bleed and be quite painful during the first 2-3 days, before gradually becoming smaller. Refer to the suggestions for natural remedies for hemorrhoids in pregnancy as many still apply now.

Suggestions for relief are:

• Herbal sitz baths as mentioned above for your perineum, with Epsom salts, Witch Hazel, and/or Comfrey.

• Use a pillow or cushion when you need to sit on a chair.

• Sleep on your side.

• Lie down several times each day with your hips and legs elevated with pillows.

• Try gently placing the hemorrhoids back inside your rectum with a lubricated finger, and then tightening your rectal muscles around them for 2 minutes.

• Natural remedies with dosing are here for internal and topical use, and include applications of already made Witch Hazel compresses (known as Tucks in the pharmacy) or make your own by pouring Witch Hazel onto round cotton pads, plantain, pure Aloe Vera gel, clove of garlic insert, and homeopathic Hamamelis and herbal combinations in a salve or ointment.

• Shine a red heat lamp on the affected area.

• Avoid constipation and straining.  See above.

Report if pain, swelling or bleeding worsens or becomes severe.

Postpartum Dizziness or Faintness

It is very common to feel dizzy, light-headed or faint the first few times that you get up from a lying or sitting position, especially after a long, hard exhausting labor with a large amount of blood loss.  

Suggestions are:

• Make sure you are eating well and drinking enough water as described in nutrition and constipation sections. 

• Have someone assist you the first couple of times that you have to rise.

• Rise from lying down gradually. First sit, then stand slowly.

• If feeling lightheaded or woozy while standing, lie down with your feet elevated or sit down with your head between your knees. Ask for someone to bring you a few large glasses of juice, as well as a high quality whole carbohydrate, fat and protein meal. For example, a nut butter and jelly sandwich on sprouted multigrain bread, or yogurt with fruit and granola.

• If you feel faint or do faint, sniff ammonia or smelling salts. This is an important first aid item to have, especially if birthing at home.

• Open windows to get fresh air.

• Splash water on your face.

Contact your practitioner with dizziness that lasts longer than the first few days or any actual fainting.

CONTINUED NEXT MONTH….STAY TUNED!

Need more help from me?

Check out my insider’s Guide to the joys and challenges of recovering from birth in these modern times created by a seasoned holistic nurse midwife who has seen everything! Learn simple tricks of the trade to make the journey to motherhood more holistically healthy and fulfilling.
You will have direct access to me through the Guides and I can help you:

• Help yourself recover postpartum healthfully and with easeful joy

• Get the support and guidance you need to answer all of your questions to create a postpartum experience you love and treasure forever

• Understand holistic modalities on common postpartum issues

• Get the support and tools you need for stress reduction

• Answer questions and make informed decisions

BUY NOW!

Give yourself this gift a lifetime to have the experience of your dreams, you will treasure forever.
As always, if you need more personalized support and guidance, schedule a chat with me so I can advise you about the best supplements, remedies and dosages specific to your situation.

My Natural Birth Secrets book 2nd edition is a great adjunct to the online Guide for postpartum and holistic modalities to common issues and discomforts.

Routine Labor Interventions Needing to be Abolished

Routine interventions in healthy labor and birth that need to be abolished when all is well include not allowing food and drink, IV, laboring and pushing in bed on back, artificially breaking your bag of water, continuous electronic fetal monitoring - including the admission and periodic strip, using the outdated Friedman curve to asses progress, forced coached pushing during the resting phase before the fetal ejection reflex - during the resting phase once diagnosed as fully dilated, episiotomy, immediate and premature cord clamping.

Many labor in hospitals that don’t allow food and drink, and need IV to prevent dehydration which can cause complications needing more interventions….unless you are sneaking food and drinking plenty orally. If you’re pregnancy and labor are healthy and proceeding naturally, IV fluids aren’t at all necessary and may cause harm. Even the American College of Obstetricians & Gynecologists (ACOG), the American Society of Anesthesiologists (ASA) & of course the World Health Organization (WHO) all recommend encouraging oral fluids instead of IV fluids.

Why is this not happening? Routine intravenous fluids can over hydrate and decrease newborn weight & blood sugar & cause maternal swelling - even in the breasts which impairs breastfeeding, can be uncomfortable, get inflamed, infiltrated or cause infection; IV restricts needed movement in labor, undermines mama’s confidence and sense of feeling empowered and healthy. It’s harmful practice to restrict needed nourishment and hydration during labor and birth. As long as you are keeping well hydrated by drinking, you can absolutely feel no qualms about declining that routine IV. There is also no evidence to support the IV access called saline lock for low risk laboring mamas because in case of postpartum hemorrhage. The risk of that in this population is low, and needing treatment beyond natural remedies and medications without IV even lower. An excellent practitioner can start an IV in that rare emergency.

Artificially breaking your water is another routine intervention that has no place in normal birth. The bag of amniotic fluid is intact for a reason. Let it break on its own. Most often that is late labor or during pushing. Occasionally it breaks before labor or rarely doesn't break at all, leading to an en caul birth with baby born in the amniotic sac.

If you’re told there is little to no risk - it's just nothing - you are not getting informed consent or evidence based care. Breaking it artificially without medical reason has drawbacks like causing more intense painful contractions and use of pain medication to cope, increased risk of infection and fetal distress from cord compression without the protective barrier around baby. It can also lead to malposition of baby which can lengthen labor. All this leads to a cascade of other interventions from IV Pitocon, continuous external or internal fetal monitoring using an electrode screwed into baby’s scalp, and c - section. If your cervix is not soft, thinned out or dilated much, the risks of all the above significantly increase. If baby is presenting other than head first, or not yet engaged in your pelvis, breaking the water can cause the cord to prolapse needing emergency cesarean to save your baby’s life. It's proposed benefit of speeding up labor is possible, but no guarantee. Is that worth the risks? Sometimes a provider tells you they want to do it to check for meconium - not uncommon, which baby at some time of stress in pregnancy or labor had its first bowel movement that mixes with amniotic fluid. If there are no signs of fetal distress and heart rate is reassuring, why create more stress? Knowing there is meconium stresses the team, then you, as they now treat you as having a complication that requires more intensive surveillance. There is no need for this when all is well. When there’s a problem, such as prolonged or stuck labor and you’re exhausted or not coping well, after trying all other more natural remedies, breaking the bag can help. But make sure you are well informed by preparing in advance with my Guide to Pregnancy Birth & Postpartum.

Continuous electronic fetal monitoring (EFM) is still routine despite the overwhelming amount of evidence against its use. Non reassuring fetal heart tones is the second most common reason for first time cesarean in the States, after “Failure to progress”’, many unnecessary as babies are born vigorous without any signs of it. Per the research there is no benefit for the admission and periodic 20 min continuous electronic fetal monitoring strip either, in healthy low risk pregnancies. It isn’t just ineffective, it’s uncomfortable, harmful, leads to increased continuous fetal monitoring, other risky interventions and cesarean without making any difference in baby outcomes. There is no evidence to show that this kind of fetal monitoring is safe or effective, and has contributed to huge increase in cesarean rate without improving Apgar scores, cord blood gases, admission to neonatal intensive care unit, low oxygen brain damage and cerebral palsy, stillbirth and newborn death. Even Obstetric professional organizations like ACOG acknowledges this and endorses intermittent fetal heart rate monitoring with a hand held doppler in low risk pregnancies and those laboring without complications. Furthermore, they encourage training of staff to its use to facilitate freedom of movement and increased comfort. NICE in the UK as well as SOGC in Canada agree there is no evidence to justify routine use of continuous EFM & that intermittent hands on listening to fetal heart rate is the preferred method of monitoring. NICE goes as far as opining that providers NOT even offer continuous EFM to laboring women low risk for complications. The ACNM says intermittent listening of baby’s heart rate with a hand held device should be the preferred method of fetal monitoring in those low risk for complications. Research is not clear & guidelines differ even regarding who does benefit from continuous fetal monitoring, when it comes to certain higher risk complications. This is not what is happening in reality of US hospitals due to a variety of factors from big business of EFM, understaffing, lack of training and equipment to outdated policies, providers not keeping current or practicing evidence based care.

I don’t like to disturb a laboring mama when all is well, just periodically need to check on baby. Some mamas prefer the fetoscope but it can best be assessed with mama on her back, & most in labor don’t want to get out of tub and be on their back. I love using it in pregnancy, but in labor, find most prefer the doppler so mamas can stay in the tub, shower or any position they want to, & everyone can hear that most often reassuring heartbeat. Distressed babies usually tell us whether we use hands on doppler or intermittent monitoring - which also allows for freedom of movement and the enormous benefits of upward mobile positioning plus more contact with and support from your provider. Research also documents the benefits of continuous labor support (which can involve plenty of privacy if that’s what you need!). Being a midwife fly on the wall is often the best intervention in normal labor, who can be there if needed, otherwise keep the fly on the wall role- with a huge heart.

Assessing progress by outdated rigid parameters needs to go. According to evidence based birth, the definition of a “normal” length of labor that has been used since the 1950s based on the biased, flawed Friedman curve is obsolete. The new, evidence-based definitions of normal labor should be used, and the vague term “Failure to Progress” should be abandoned. Yet still used in many hospitals.
If the laboring mama and baby are both healthy, and as long as the length of labor does not qualify as an arrested labor, laboring mamas should be treated as if they are progressing normally, even if what seems to be slow and prolonged for the mama. Pregnant mamas - especially first time vaginal birthers should be given more time in the early phase of labor, making sure they keep well nourished and hydrated, mobile and active but also rested, and also well supported with a doula or doula like care. I have many more suggestions in my online course Guide to Pregnancy, Childbirth & Postpartum, as this can be a challenge to mamas and their partners.

If you are wanting or needing an internal exam, six centimeters—not four centimeters—should be considered the start of the active phase for most people and caregivers should keep in mind that normal early labor (before six cm) sometimes includes a period in which there may be no change in dilation for hours. People may decide, together with their caregivers, to delay birth center/hospital admission until active labor. Similar with homebirth, but there is a more intimate relationship there between midwife and mama, with periodic contact in early labor being the norm.

Still, people are still being told to labor in bed, and give birth on their back. I can’t believe this is still happening despite not just common sense but loads of research about the harmfulness and risks to this practice.

Laboring and pushing your baby out on your back goes against gravity and trying to do so is more work and stress on your body and baby. Laboring and pushing with the force of gravity is less painful and all the more easier. Lying on your back also causes your heavy uterus to exert some compression on major blood vessels that go to the baby which can cause fetal distress, let alone to your upper body and head - why people don’t feel well on their back late pregnancy. It’s a position that was created by doctors not birthing mamas, who would be more comfortable in any other position when given the choice. As it’s a position best for the provider not the mama and baby. And that’s the best birthing positions - what feels best at the time to work your baby down and out. I go over these best positions to labor and help your baby come through your birth canal and into the world with demos in my Online Guide to Pregnancy, Birth and Postpartum - sold separately or bundled.

Mamas need to be moving asymmetrically as they need to move working with their body and baby as well as using the force of gravity to help them guide baby down and out. The pelvis is three bones connected by ligaments and it can stretch to accommodate baby. It’s at is smallest capacity on your back. Pushing on your back is much harder as you have to work against gravity. Occasionally some mamas need to rest and can lay on their side, and some do want to birth on their back and it works for them. But the routine practice of insisting all mamas labor and birth on their back is harmful.

Good bye to forced coached pushing when fully dilated. If and when you are told you are fully dilated, rest, eat and drink if you need, get up and dance…but wait for the fetal ejection reflex (FER). When you wait for the FER, and naturally feel the urge to push, instinctively push, working with your body. It is a bit similar to pooping - think of what it feels like and what happens when you try to push it out for a prolonged period of time when you don’t feel the urge. Then think of how easy it is when you just go after feeling the urge. Some may need or want a little gentle guidance to get started but avoid forced coached pushing. It’s not evidence based because it’s harmful, associated with such problems as more swelling, tearing, fatigue, fetal distress etc. Honor the FER!

It happens. The sensations of pushing and FER, fetal ejection reflex can be so intense that mamas initially may want to fight it, which makes it all the more harder. What we resist persists. When we dive in and lean into the sensations we birth.
Being in the water helps. Movement in asymmetrical positions & roaring like a lion helps, as does channeling your inner monkey, letting your primal take over. Relaxation & coping techniques to practice in pregnancy so you can just tap right in to them in labor are a huge help, as is bringing fun, joy, the primal & sensual, & enhancing pleasure using all your senses into the birth experience . But a complete change in mindset and perspective is key, as is my preparation. You can learn to use different language for the sensations of labor, instead of pain which implies illness and something that needs to be remedied, and to see them for what they are. You can learn to use other words for contractions, which imply tension and negativity, and the word contraction is not empowering, and does not fully explain what is happening. Yes, the top of the uterus contracts so the birth canal can open and expand, as well as push out your baby. So expansions are also happening in labor – that is really the goal of what you are doing – expanding so your baby can emerge from your womb to the outside world, and you can both be birthed as a new mother and baby.

Suffering is a choice. And you can chose to embrace your intense sensations for what they are, as healthy signs, what is needed to birth, what your baby needs to transition earth side - not that anything is wrong. I go cover this in much greater depth in my online Guide to Pregnancy, Labor & Childbirth.

Routine episiotomy in a normal birth is of the most harmful unnecessary procedures. It’s so not evidenced based care. And if you do tear despite prevention efforts (it can still happen), little tears heal fine on their own; if we have to do a repair we do try to put everything exactly or almost exactly how we found it. The perineal and vaginal area of a mom who has given birth vaginally before never looks exactly like it did prebirth. But we do our best! Sometimes there is some scar tissue that forms and definite changes from muscle stretching. These are our beauty marks and badges of honor.

Immediate and premature cord clamping is another harmful routine intervention that needs to be stopped. Just think about it. We did not cut cords right away for most of history. No mammal cuts the cord after birth. They just allow the normal natural physiological process to proceed instinctively…or they would have not survived as species.

The number one best recipient for cord blood is baby. 1/3 of baby’s own blood backs up into the placenta during birth. Baby needs to get it back - it is loaded with blood volume oxygen, nutrients, stem cells, antibodies and ingredients essential for transitioning from womb to world and long term health. If you want to donate or bank the cord blood, if baby is doing well at least wait 10 - 15 minutes so your baby gets most of it and there is still enough to bank.

Don’t let them convince you to have it cut ever after a minute because they are in a rush or tell you some misinformation that it’s not good. Clamping right away was probably invented for the doctor but now we know it’s harmful. Delayed optimal clamping can even be done after cesarean until placenta is birthed if there is no other problem.

I have way more info on this in my Natural Birth Secrets book 2nd edition but make sure this is clearly communicated to your providers and written in your birth plan. Ideal is to wait until it stops pulsing completely, flat and white, and you can even feel and see that yourself. When all is well I don’t cut it until after the placenta unless they want a lotus birth.

The best intervention in normal labor and birth is no intervention. Beloved obstetrician Dr. Michel Odent goes further and says best intervention in healthy childbirth is to knit. Knitting keeps our hands occupied instead of trying to meddle and fix something that isn’t broken. Part of Hippocrates oath doctors have to take after training is “First Do No Harm.”

But knitting goes deeper. It is the calm presence of an experienced attendant who has seen it all, communicating to you with their body language to relax, all is well. Their calm is contagious and will make you feel more calm. Their heart, ears, eyes and mouth are open to listen, watch, support, encourage and help you as needed; and of course they can put the knitting down as appropriate, but the point is brilliant.

The ideal is birth attendants are there, so there with the laboring mama, especially towards later labor when sensations can get intense, but know that mama needs to feel private, safe and undisturbed to labor best, to not feel watched; so we try to leave her alone, on her own, until she needs us. Even then, we try to be in background so mama doesn’t feel watched, after doing needed assessments without causing much disruption, as a lifeguard just in case and there of course if more support is needed.

Prepare yourself to be empowered, have an advocate and birth YOUR way!