Tips for Postpartum Healing

Those of you who have given birth to a baby know that many physical and emotional changes occur, many of which catch you by surprise. As a new mom, postpartum care is essential to both your physical and mental health and well-being. Working with your midwife and doula can help guide you through the healing process and provide you with resources to make your recovery as smooth as possible.

I cover this in depth along with holistic modalities for all the common discomforts along the journey to having a baby in my Natural Birth Secrets book 2nd edition, and how to prepare for postpartum healing and support during pregnancy, in my Guide to Postpartum e-course.

The First Few Weeks

The first few weeks of postpartum can be a difficult time for new moms, with many physical and emotional changes happening, while the days seems to be a blur of feeding, diapers and a complete lack of sleep. Here are a few of the struggles new moms can face in those first few days and weeks after baby. 

Pain/Tenderness

Pain and tenderness are one of the most common issues experienced by new mothers. This is due to the stretching of muscles and tissues during labor, as well as from any tearing that may have occurred. The area can be quite sore and tender, making it uncomfortable to sit down or even go to the bathroom.

Fluid Leakage

Lochia, or vaginal discharge, is common following childbirth, and even after cesarean birth. While seeing such a large amount of blood is naturally alarming- this is completely normal. Wear whatever you need to be comfortable, and know that it gets better with time and completely stops at some point after four to six weeks. I love these postpartum panties from Mommy Matters which absorb leaking fluids while also having a pocket to hold an ice pack which helps provide some much needed relief. 

Emotional Roller-Coaster

As a new mother, it is completely normal to feel overwhelmed and exhausted during this time- don't be too hard on yourself. 

While some mood changes are common after giving birth, postpartum depression and/or anxiety can be serious and should not be ignored. If you're feeling too overwhelmed to function, having frightening thoughts and are unable to care for yourself or your baby, it's important to seek help right away. Organizations like Postpartum Support International are available 24 hours a day to provide mental health support.

When you find yourself getting frustrated with caring for your baby, it's ok to step away and take a few deep breaths. Remember, you did something amazing by bringing life into this world and you deserve to be easy on yourself. Be honest with your midwife or doctor about what's going on so they can help you come up with a plan that's healthy for everyone.

How does a vaginal birth affect your body?

After more than twenty-eight years as a midwife, I know that some moms will experience some degree of tearing during vaginal childbirth despite all preventative measures. The vagina must stretch to allow the baby's head to come through, which can result in various types of tears ranging from first to fourth degree. Small tears can occur that do not need repair but still need to heal. The discomfort with a first or second-degree tear can last for a week or more, making simple everyday activities like going to the bathroom, coughing, sneezing, and even having a bowel movement painful and sensitive. 

Third and fourth-degree tears are more common after episiotomies, can take longer to heal, and the pain and tenderness associated with these injuries may be felt for several months. If you have recently had a baby and are experiencing this type of discomfort, it is important to take things slow and understand that this is normal. Your body is healing, and you will eventually be able to regain your strength and pelvic floor. 

What happens to your pelvic floor as a result of childbirth

Childbirth can have a significant effect on your pelvic floor, which is made up of the muscles and ligaments that hold the uterus and other organs in place. Pregnancy hormones cause these muscles to relax, making them more likely to tear or stretch during labor. During birth, you may experience pain, tenderness, and tearing in the area due to the strain of childbirth although there is much you can do to prevent tearing - there are no guarantees.

No matter what type of birth you had, it's important to take care of your pelvic floor afterward. Doing regular pelvic floor exercises can help prevent stress incontinence and support your bladder and rectum, improving your overall health and strength. A pelvic floor physical therapist, in addition to your provider, can help guide you through the postpartum period and advise you on ways to rehabilitate your pelvic floor after childbirth.

How can new moms expedite healing?

Giving birth is a beautiful, life-altering experience that can cause immense physical and emotional changes. As a midwife, I understand the importance of allowing your body the time it needs to heal, while also recognizing the value in doing everything possible to ease and expedite the process. 

One of the most important things new moms can do to accelerate and support postpartum recovery is to practice good self-care. This means getting adequate sleep, nourishment, and rest. The days after birth can be incredibly draining, so it's essential to take time for yourself to rest whenever you have the opportunity. Additionally, wearing comfortable clothing and using cooling packs to alleviate swelling can help keep your body feeling comfortable as it heals. 

If you experienced tearing or an episiotomy during childbirth, Mommy Matters has created an amazing product called NeoHeat. Finally, we have a real mechanism to heal the perineum after birth! NeoHeat’s red and infrared LED light provides fast, effective and lasting relief from possible injury caused during childbirth, while reducing the long-term risk of infection, accidental bladder leakage, and even pain during sex. I am so happy to have something to help women heal, in the comfort of home. 

I often recommend a perineal spray to help with instant relief. The SOOTHE Perineal Spray is a great way to help relieve any pain or discomfort. This natural spray is specifically formulated with herbal extracts and organic oils known for their anti-inflammatory and calming properties. Dr Tara, who created this product, recommends keeping it in the fridge for extra cooling relief. 

By taking the time to care for yourself and utilizing products that are specifically designed to soothe and support postpartum healing, you can make this time a bit smoother.

I know how difficult it can be for moms to recover from vaginal birth. I love red light due to its healing properties, while being extremely safe. In this case, high-powered red & infrared LED light therapy is designed to activate internal and external healing of the perineal/vaginal tissue. It helps accelerate wound healing, increase circulation, reduce inflammation, and provide rapid pain relief.

Red LED light energy and thermal energy work together to help speed up the recovery process. The red LED light energy helps reduce pain, while the thermal energy increases circulation which accelerates the healing process. In fact, this type of therapy can reduce healing time by up to six times compared to traditional methods. It not only reduces pain and heals 6x faster than traditional methods, but it also reduces the long-term risks of infections, incontinence, and painful sex. Most importantly, it is a natural and effective method with no need for medication. If you're looking for an easy and natural way to help speed up your postpartum recovery, I recommend trying out high-powered red & infrared LED light therapy. 

By having NeoHeat and NeoBrief in your toolbox, you are giving your body a chance to heal so you can return to you again- but faster. 

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We took the JetKids by Stokke BedBox on a long-haul trip from New York to Milan, Italy and we were nothing short of impressed. The BedBox offers ease of use that similar products just don’t provide. Why? Because traveling with children is a strenuous experience for parents, Stokke’s aim is to make it easier and more pleasurable for them, have more positive memories, and spend quality time together.

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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!

Routine Newborn Procedures

Many mamas who want a natural birth may not be as familiar with the the number of choices they need to make regarding interventions to baby postpartum. These are routine in many hospitals, with more freedom of decision making out of hospital at a freestanding birthing center or home with a midwife. Healthy babies are suctioned, all exams and procedures are done in the nursery, not by bedside, they are bathed, given Vitamin K injection and antibiotics in their eyes, and Hepatitis vaccine, and babies with a penis are told they need medical circumcision. Other procedures are pulse oximetry to screen for critical congenital heart disease not picked up on the mid pregnancy anatomy scan if baby had one, audiology screening, and the newborn screening blood test.

Healthy vigorous babies born vaginally can clear their own lungs and don't need suctioning - even with bulb syringe. That's not a gentle welcoming for them, but invasive and traumatic. Suctioning can be harmful to baby’s transition from womb to world, and isn't evidence based care. It's more effective and less harmful to do percussion and postural drainage or use ambu bag if needed. Most of the lung filled fluid is cleared with the big squeeze through the birth canal. The rest is absorbed into the body, and for ~ first 24 hours, baby spits it up, coughs or sneezes it out.

All routine baby exams and decided upon procedures can be done in room with parents. It’s an important part of bonding, nursing and sensitivity to baby’s nervous system. Baby needs to be skin to skin for warmth and comfort after birth, close to mama for nursing. There’s no medical reason for healthy newborn nurseries, with babies separated from parents in bright rooms in isolettes filled with strangers. Nurseries serve hospitals, not babies. If mama needs a rest, it can be done with baby in room cared for by another support person.

Babies born in hospitals are still be given unnecessary baths with chemically laden soaps and kept dry with toxic talc and artificially fragranced baby powder. The birth juice and meconium can be wiped with your own natural products by you or your partner, but there is no rush to wash off the skin disrupting the flora of good bacteria that protects baby’s health, and remove the vernix (the white waxy, cheesy protective material that covers baby’s skin) so most of it can absorb into baby’s skin and allow baby to receive its protective benefits. It is not only a skin moisturizer and softener, it’s also an antioxidant and skin cleanser with anti-infective properties. It regulates baby’s skin pH needed for health, helps control baby’s temperature and insulate the baby, so crucial after birth from womb to world. It might help babies latch, as the scent of vernix may trigger neural connections in babies’ brains needed for breastfeeding, and bonding with that delicious new baby smell. It also smells of mama, which can provide comfort to baby and enhance bonding after birth. The The World Health Organization (WHO) recommends waiting at least six hours — and if you can go a full 24 hours, even better to give the first bath. Since it doesn’t fully absorb until day 5-6, I’m not sure why the first bath can’t wait until then. Leave it on and even rub it in like body butter. Don’t let anyone wash it off.

Hepatitis B vaccine is given to prevent baby from blood born infection spread by contact with blood and body fluids like unsafe sex, IV drug use, accidental professional needle stick, and high risk communal settings. If baby has not had these sources of exposure, it can be delayed until prior to entering school, if you choose infant and childhood vaccinations. Refer to my blog on immunization for more info.

Vitamin K injection and Antibiotic eye ointment are given routinely to all babies born in US hospitals without considering individual situations. In some states you can refuse, in others it’s the law and they can report you to Child Protective Services - but these organizations have bigger problems to deal with and often the case is dropped after some unnecessary stress and aggravation. We don’t have these laws in most homebirth settings.

The antibiotic eye ointment is to prevent sexually transmitted infections gonorrhea and chlamydia that could cause blindness in newborns after exposure in birth. It is given within the first hour of life during the most alert time of baby after birth, interfering with vision at such a sacred crucial time when initial bonding and breastfeeding take place. It is irritating to baby and disrupts the delicate balance of flora in their eyes which can lead to other infections. Needing to give antibiotics is not relevant to babies born to mutually monogamous parents who do not have these infections. Taking into consideration that one may not know for sure there is another secret partner, these infections can be tested for in a pregnant mama at term, and if negative, the antibiotics can be refused in good faith. If you do test positive for one of these sexually transmitted infections, you and partner can be treated and retested to see if cured, but it may be wise to consider the antibiotics for baby’s eyes, since exposure can happen again. Then you can delay the medication until after you and baby look into each other’s eyes, have some time for bonding and breastfeeding.

To give vitamin K to the newborn within the first hour of birth is to prevent a rare but serious blood clotting disorder called vitamin K deficiency bleeding (VKDB). There is an early onset VKDB that happens within the first 24 hours, classical expression in 2-7 days, and late onset that usually occurs in 3-8 weeks of life. Our bodies need vitamin K to help the blood to clot when needed. Giving it to babies at the recommended dose via injection is currently evidenced based care, but still not a simple matter.

The American Academy of Pediatrics opines strongly in favor of it. The current evidence does support the injection, saying there is little risk other than rare potential allergic reaction, and that the benefits far outweigh the potential risks. The injection is mega dosed, with 20,000 times the amount new baby has at birth, 5000 times the recommended daily allowance. It is injected into the muscle, which is a more rapid route than oral. In its synthetic form, it is considered a class C drug which means its safety is unknown in pregnancy, risk cannot be ruled out, there are no satisfactory studies in pregnant women, but animal studies demonstrated a risk to the fetus or potential benefits of the drug may outweigh the risks. The package insert itself warns that it can cause sometimes fatal allergic reactions when injected into a muscle or vein, and is ideally take by mouth or injected under the skin. The synthetic medication contains concerning chemical preservatives. It is available, but not accessible in most hospitals without the preservatives, but the preservative free vitamin K still does have some chemicals to increase absorption. It is also concerning to ponder the impact of overdosing on a fat soluble vitamin that stays in the system, as opposed to water soluble vitamins in which excess is excreted out in the urine.

In formula fed babies, the risk of VKDB is negligible as the formula contains synthetic vitamin K. For babies who breastfeed, an alternative is the oral form of vitamin K, in which some protocols have not been as effective as the injection in preventing VKDB - although some of the increased risk was related to parents not administrating of all the doses. Vitamin K using the Danish protocol is just as effective at preventing VKDB, though not accepted by modern medicine and hospital practice in the USA. Several European countries have a licensed oral vitamin K available with varied protocols, for those who wish to decline the injection, which is most effective according to the research to prevent vitamin K deficiency bleeding in babies. Except the Danish protocol. The Danish protocol is preferred as it seems to be just as effective as the injection according to the studies. It is vitamin K1 - phytonadione: 2 mg orally at birth, the 1 mg once weekly for 6 months as long as breastfeeding is greater than 50% of the baby’s diet. As it is a supplement in the USA, it is not regulated, FDA approved or certified like the injection made from pharmaceutical companies, for preventing VKDB in new babies. That does not mean it is not effective or unsafe. Still many who decline the injection prefer it as a viable alternative. Finding it in the states can be a challenge, but some homebirth supply companies and midwives carry it. If doing this protocol, best to do with a feeding as vitamin K is fat soluble, to increase absorption.

Little research is available on the alternatives, such as breastfeeding mamas eating more vitamin K or supplementing (like with 5 mg daily) to boost levels in breastmilk and prevent the rare vitamin K deficiency in newborns.

But as with all other routine interventions in the entire healthy normal physiological process of having a baby, the more we study, the more we find their lack of benefit and increased risk, and that mother nature or the Divine intelligence that created it all did not get it wrong. Maybe there is a reason we do not know yet why newborns are born with low vitamin K that does not reach optimal levels until the eighth day of life, from the gut flora. Is it a deficiency if they are all born that way? I defer to Dr. Sara Wickham who has analyzed the research for over 20 years and even wrote a book on this subject alone. “Several thousand babies need to be given vitamin K in order to prevent each case of vitamin K deficiency bleeding (VKDB), a disorder formally known as hemorrhagic disease of the newborn. Unfortunately there is little research interest (as is so often the case) in questions such as 1- how we might be able to pick out the babies who are truly at risk rather than giving the universal prophylaxis and 2- whether and why it might benefit babies to have a relatively low level of vitamin K compared to adults.”

Newborn screening checks a baby for serious but rare and mostly treatable health conditions at birth. It includes blood, hearing and heart screening. The newborn screening blood test may screen for up to 50 diseases, including phenylketonuria (PKU), sickle cell disease, and hypothyroidism but know it is only a screen that leads to more testing to confirm or more likely rule out the rare diagnosis. It has a high false positive rate, as there are more than 50 false-positive results for every true-positive result identified through newborn screening in the United States. This means baby tests positive on the screen but do not actually have the disease. Screening is mandatory in and funded by nearly all states - despite the varied diseases for which each state screens; although most will reluctantly allow parental refusals on religious and other grounds, and such refusal does not usually engender civil or criminal penalty. The American Academy of Pediatrics opines strongly about the importance of the screening, but it does not control the different conditions screened for by each state. You or your partner can certainly hold and comfort baby during the blood test which hurts for a few moments.

The American Academy of Audiology supports early identification, assessment, and intervention for all types of hearing loss in infants and young children to minimize deleterious effects on speech, language, education, and social/psychological development. The screening should take place by an audiologist at 1 month of age and does not need to be done after birth. It is not an invasive screening and can be done in your room by your side, so if you gave birth at the hospital it can be more convenient doing it there. Or you can take baby to an audiologist by one months of age if you choose the hearing screen.

Pulse oximetry screening is a simple and non-invasive procedure used to measure how much oxygen is in the blood and has been found effective in screening for critical congenital heart disease (CCHD) in newborns, if done within 24 hours after birth. Current evidence supports consistent accuracy for detection of CCHDs in newborns by pulse oximetry screening in addition to prenatal ultrasound and clinical examination. Overall, early diagnosis of CCHD with pulse oximetry is judged to be beneficial, identifying disease that may be treated and lifesaving, and potential harms associated with false-positive tests are not serious, but stressful, while missing CCHDs and other serious diseases detected by hypoxemia without pulse oximetry screening can lead to serious consequences. It is interesting that this is not the position of other institutions such as the United Kingdom National Screening Committee and the Royal College of Pediatrics and Child Health. Further research is required to understand and improve the effectiveness and efficiency of the screening and its algorithm. Some mamas do not want this philosophical standard medical approach of looking for diseases, prefer to address the issue if baby shows signs, and have Divine faith that whatever happens is meant to be.

Medical (non-religious) circumcision is the most controversial routine surgical procedure done mostly in the US on babies with a penis, prior to discharge. The vast majority of boys in world aren't circumcised. There's no evidence to justify this routine procedure on medical grounds & its risks are downplayed. The American Medical Association classifies it as a non-therapeutic procedure, as it has no proven benefits and risks outweigh them. The American Academy of Pediatrics has never, in its over 75 years of operation, recommended routine newborn circumcision. The foreskin is a normal, sensitive, functional part of the body, protecting the head of the penis from urine, feces, and irritation; it also has an important role in sexual pleasure, as it has specialized, erogenous nerve endings, gliding and lubricating functions. For a thorough analysis of the literature, science & research, potential risks & alleged benefits, cultural/religious roots & human rights bioethical issues see here.
THIS ISN’T ABOUT PAST, HOW WE WERE ADVISED MEDICALLY OR CULTURED TO DO. IT’S ABOUT DECISIONS MOVING FORWARD.

I like to promote informed choice, question routine status quo, and help those interested in studying the data and what factors create opinion and dogmatic policies, as well as encourage those who wish to ponder this topic with a more critical eye and make their own decisions about their baby’s health care.

Educate yourself & make an informed decision about what you want or don't want for YOUR baby, with my online Guide to Pregnancy, Birth and Postpartum. And in adjunct, my Natural Birth Secrets book 2nd edition, as in many cases, it is totally safe and appropriate to investigate natural alternatives.

Premature Rupture of Membranes at Term

How do you know your main bag of water breaks? You feel a pop & fluid bursts out of your vagina like a river, making a large ~ 2 1/2 - 3 cup puddle on the floor, or it totally saturates your clothes or where you were sitting/lying. You keep leaking fluid throughout the day that’s not pee, saturating your maxi pad like the first morning baby diaper, or your poured at least a few cups in it. It looks clear, blood tinged with white specs of vernix, or it’s brown/green color of baby’s first poop meconium (let your provider know). It does not look or smell like pee or semen (no history of recent sex). Your provider sees it flowing out of your vagina, pooling in your vagina on sterile speculum exam or on microscope, or simply + Amnisure test.

And it’s not the few tablespoons of fluid between the two membranes that can release before labor making ~ pancake size stain on your underwear, seat, sheets. It is important to know that as main membranous bag is intact. When in doubt discuss with your provider. They can confirm or rule it out. The test strip that turns blue with amniotic fluid is not diagnostic by itself as it can also turn blue with other things, like blood and even the fluid in between the membranes. It is important to be certain of the diagnosis of PROM. You do not want to be falsely diagnosed as “ruptured membranes” with all the possible unnecessary potentially treatment that entails.

PROM - premature rupture of membranes means when the main amnion bag of amniotic fluid breaks at term, before labor. It happens 8-10% of the time. It’s important to know for sure it’s not just a crack in the inner chorion membranous bag, leaving the main bag intact, so you’re not on the “clock” unnecessarily. Babies are double wrapped with a few tablespoons of fluid in between the two membranes - enough to make a pancake sized stain on your underwear or whatever you’re sitting on if outer bag tears, but then no further leakage. If in doubt, I advise wearing a maxi pad & walking around a few hrs. If it becomes saturated like an overnight diaper that’s the main inner bag with lots more fluid just > 1/2 liter; if it remains dry PROM is unlikely.
But is this “clock” evidence based? No. Recommending to induce to avoid risk of infection & stillbirth is based on outdated low quality studies from 1959s-1960s. According to newer quality research, as long as mom & baby are doing well & meet certain criteria, induction is just as much an evidenced based option as waiting for mama to go into labor on her own up to 48-72 hours later, without increased risk newborn health problems or death. 77-95% will go into labor anyway by 24 hours.

Many leading professional organizations like ACNM, RCOG, NICE, AOM, & RANZCOG recommend offering both options as acceptable as long as certain criteria are met - like single term uncomplicated pregnancy, clear fluid, no fever, no GBS, & normal fetal heart rate. ACOG says induce immediately but that if mom declines, waiting for labor to start on its own (expectant management) is acceptable. Waiting for labor to start on its own has very good outcomes for moms & babies. Induction of labor has strong consequences like the cascade of interventions, cesarean & birth trauma, & many opine it can not be justified as standard of care for a normal physiological occurrence in healthy term pregnancy.
It’s important to know your rights to autonomy, & be educated to make an informed decision if this happens. Do avoid or minimize internal exams or anything internal as it increases risk of infection.

If you are interested in more gentle ways of bringing on labor naturally refer to my Natural Birth Secrets book second edition.
Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.