The positive impact of prenatal exercise

The following is a re-post of my August 2008 post Wanna Improve Your Odds?:

I mentioned back in April that I had been skimming the book Exercising Through Your Pregnancy, by James F. Clapp M.D. I was really impressed at that time with the amazing benefits of exercising through pregnancy. But I didn't read the book in-depth. I decided earlier this week that I wanted to take a closer look. Now that I've read several of the chapters and examined the data thoroughly, I am telling you... it absolutely blows me away.

There are risks inherent in pregnancy and childbirth, but we can do things to minimize those risks. We all know that good nutrition is essential for pregnant women. Poor nutrition often leads to pre-term and low-birthweight infants as well as pre-eclampsia in mothers. Eating well is one of the absolute best things you can do for your unborn child's physical and neurological growth. But now I'm convinced that exercise may be just as important.

I won't go into all the benefits of prenatal exercise here. I'd just like to focus on one set of benefits in particular--the effects of exercise on the course of labor. You might remember my very early post about the benefits of doulas. Having a doula assist your labor and delivery reduces many chidbirth risks significantly. Prenatal exercise has even more pronounced benefits.

Women who continue exercising regularly through the end of their pregnancies (three times a week for at least 20 minutes at a moderately hard to hard level of exertion) demonstrated the following reduced risks during the birth process...

* 35% decrease in the need for pain relief
* 75% decrease in the incidence of maternal exhaustion
* 50% decrease in the need to artificially rupture membranes
* 50% decrease in the need to induce or augment labor with pitocin
* 50% decrease in the need to intervene because of abnormalities in the fetal heart rate
* 55% decrease in the need for episiotomy
* 75% decrease in the need for operative intervention (forceps or cesarean section)

In addition, check these out...

* More than 65% of the exercising women delivered in less than four hours.
* 72% delivered before their due date (but fewer of them delivered before 37 weeks--preterm--than the control group). The exercising women delivered, on average, 5-7 days earlier than active women who did not exercise regularly.
* Significant reduction in the incidence of umbilical cord entanglement.
* Much lower incidence of fetus passing meconium from distress.
* Umbilical cord blood samples indicated that babies of exercising moms remained relatively stress-free with plenty of oxygen. They seemed to tolerate the stresses of labor and delivery better than the control group.
* The exercising mothers' infants were, on average, 14 oz lighter but overall growth was not compromised.
* Placentas of exercising mothers are larger, more efficient, and healthier-looking.
* Infants born to exercising mothers were more alert postpartum and needed less consolation from others.

(All of these results are taken from Dr. Clapp's studies as reported in Exercising Through Your Pregnancy. See this fabulous book for even more amazing benefits.)

It blows my mind.

Imagine how huge the risk reductions would be if you exercised through pregnancy AND had a doula. Whoah. We can do so much to avoid the pitfalls of pregnancy and birth. It gives me so much joy and hope to know that I am not at the mercy of chance. I have a great deal of power over my circumstances when it comes to pregnancy and birth. It is a wonderful thing to be able to choose to pro-actively reduce risks and bring so much benefit to myself and my babies. I love it!

Rejoicing with a friend

We must not, in trying to think about how we can make a big difference, ignore the small daily differences we can make which, over time, add up to big differences that we often cannot foresee.  -Marian Wright Edelman

Back in January, I got a surprising email from a local friend.  I discovered:

1) She was pregnant with her first baby. 
2) She had been following my birth blog.
3) She had chosen a practice of fantastic nurse-midwives. 

She also said, "I've loved reading about your home birth... I just am not 'courageous' enough to go that route on a first (maybe our next?)." 

All of these discoveries made me giddy with excitement.

Then at the end of April, she and her husband attended my "Birth Coach Boot Camp" where I shared what I believed were the best ways husbands can help their wives in childbirth.  Her due date was right around the corner, so I sent her home with my birth ball and my copy of The Birth Partner, by Penny Simkin.  And then we waited. 

Nine days after her due date, she sent me an email announcing that her daughter "was born last night at 10:44 p.m.  She is 7lbs 14 oz and 20 inches long.  We're both doing well."  I couldn't wait to hear all about the birth, but I didn't want to pester her about it, so I waited.

A couple of weeks later, I got a knock at my door.  There was my friend.  She said, "I have a bunch of things for you," returned to her car, and came back with my birth ball, my book, an envelope, a typed document (multiple pages of birth details!), and a sweet treat.  We chatted for a few minutes while she told me about her birth.  With the exception of having her water broken, everything had gone as she had hoped--intervention-free and unmedicated.  She was full of thanks for my help.  I was full of giddiness with joy for her.  It made my day.

After she left, I opened the envelope.  It was a thank you card.  She said, "I feel like I owe you a big thanks for so many things.  I've appreciated your passion and encouragement during this pregnancy."  More warm fuzzies.

Then I read the document with all the wonderful birth details.  Oh what a joy to read.  Because her midwives had three clients in labor that night, it was a little chaotic for them.  In the end, my friend's baby was caught by the nurse.  Her thoughts afterward:  "I felt empowered, like we could really do this on our own--we practically had!"  When the midwives came back in, they began talking about her needing to be stitched-up and delivering the placenta, but my friend remembers "not caring what anybody was saying and just happy to have the baby on my stomach."  The very last thing she wrote in that document was that she remembers:

Feeling grateful for the birth coach class our friend had offered.  It helped me feel empowered to say what I needed without fear. . . . It also helped me to put special emphasis on making sure I provided positive feedback by telling them the things that helped.  Finally, it introduced us to techniques of providing counter-pressure.  That turned out to be the only pain relief we needed!

 There are days when I throw mini birth-tantrums, and say, "Forget it!  I'm wasting my time trying to make a difference!  Nobody even cares!"  And then there are days when I know that I can never stop sharing what I know and love about childbirth.  The day my friend said, "Thank you," was one of those days.  A magical day.  

Never stop sharing, my friends!  Never give up.  We are making a difference.  Maybe only for one woman here and another woman there, but those women are worth it.  And so are their babies.  And there is nothing in the world like rejoicing with them as they bathe in the joy and empowerment they feel from their positive birth experiences.  Nothing in the world.

Re-post: Tips for avoiding tearing and episiotomies

Things have been quiet in my corner of the blogosphere despite my having one or two posts in the works in my head.  I just haven't had a block of time to get them on "paper."  In the meantime, I thought I'd re-post and oldie but goodie from the early days of my blog since some of my newer readers might not have seen it and might find it helpful.  (Stay tuned for a post about waterbirth next.)

Giving birth for the first time was one of the most empowering experiences of my life. My water broke, my contractions started, everything progressed smoothly, and, less than six hours later, my baby girl was born. It was an ideal birth experience, except for one thing. That one thing made my next few weeks of recovery extremely painful. I tore. I really tore....

Read the rest of this post over at my new website!

Ask Busca: Arizona Birth Activism?

Diane said:

I am getting ready to deliver baby number 3 and this will be my first delivered at home with a midwife. I have been learning and trying to digest everything I can get my hands on regarding midwifery care and home birthing, and I have been absolutely stunned and appalled at what the women in this country have not been told about giving birth. I myself had no idea how things should/can be, and had always assumed that the doctors know best. 

So on to why I am writing to you. My husband and I have been moved by our desire to get the word out to other women, and to also encourage an overhaul of our maternity care in the US. I believe you are in AZ too, and I was wondering if there are activism groups here? Or am I riled up about nothing? I just feel like we should DO something.

Thanks in advance for your time.

 Busca's Babble:

Diane actually sent me this email back in March, so first I'm going to apologize that it has taken me two months to respond.  But I am thrilled that you have had a fire lit under you and want to do something to help other women discover the truth, Diane.  You're definitely not riled up about nothing.

I think the first place I'll direct you is the Arizona Birth Network.  They hold monthly Birth Circle meetings at locations throughout AZ where you can meet with other like-minded women to discuss a variety of topics and brainstorm.  I haven't gone to any of the Birth Circles yet, but I am definitely planning on doing so.  Hopefully soon.

You also might consider attending your local La Leche League meetings.  I have friends who attend the meetings and have formed friendships and support networks through them.  The other women attending those meetings are also likely to either share your desire to share truth and knowledge or be open to further truth and knowledge that you are excited to share.

Another thing you might consider is starting your own group.  One of the fellow doulas-in-training at my doula workshop decided to create West Valley Birth Advocates.  I have attended and hosted meetings for that group.  You might consider hosting viewings of birth films or discussions of birth books in your own home for your friends and other women in your area to learn more.

You can also get involved on a more national level with groups such as Lamaze, Citizens for Midwifery, Childbirth Connection, and others.

I hope that helps, Diane!  Any of my Arizona birth junkie readers, please comment if you have any other ideas or tips.

Parturient Relations: PR for Dads

Remember these "Five PR's"--the most helpful things you can provide for your partner while she labors...

1. Presence

• Sometimes all she needs is your loving physical presence.
• Be “Rock Steady”—the familiar, strong, soothing rock she can hold on to.
• Be “present” in every way—don’t let your fatigue or fear take your attention away from her emotional and physical needs.
• Do NOT fall asleep (unless she’s asleep).
• Do NOT leave her alone unless she demands it. 
• Some women prefer to be alone while they labor. (But don't go too far!)

2. Protection

• Be a buffer between your wife and the rest of the world. 
• You can’t protect her from the intensity of childbirth or from unexpected complications, but you can protect her personal space and surround her with peace and calm.
• Close doors.
• Turn off/down the lights.
• Take over answering questions so she can keep her energy focused on her hard work.  If someone tries to talk to her mid-contraction, gently ask for them to wait or stand between them and your wife until her contraction is over signaling with your hands for them to wait a moment.
• No matter what happens or how much stress may arise, ensure that she always feels safe and secure.  Remember Jesus Christ’s calm in the storm that frightened his disciples:  “Peace, be still.”

3. Pressure

• One of the most helpful hands-on ways to help with the most difficult contractions is counter-pressure.
• Use your hands to provide firm, strong, steady pressure.  
• Lower back/pelvis
• Double hip squeeze
• Knees while sitting with something against her back
• Hip while side-lying
• Do not let up until the contraction ends!  (You will probably get tired.)

4. Prompts

• Your wife will likely not be in a position to remember all of the ways to increase her comfort, so your job is to prompt her.
• Remember PURRR
• P Position: Is she changing position every half hour?
• U Urination: Is she using the bathroom every hour?  (And drinking lots of fluids?)
• R Relaxation: Is she as relaxed as possible?
• R Respiration: Is she breathing evenly and as calmly as possible?
• R Rest: Is she resting between contractions?

5. Praise

• All of your words must instill her with hope, confidence, peace, comfort, pride, and power.
• Think of it as your job to help her get to the “finish line” without giving up.
• "You are so amazing right now!"
• "I am so proud of you!"
• “You are doing so well!”
• Kissing counts! (Some women find kissing very helpful.)
• When she says, "I can't do it!" reply with, "You are doing it."
• When she’s reached the point when she thinks she can’t do it anymore, that usually means she’s almost finished, so shower her with praise, encouragement, and lots of statements like: “You are so close!”  “You’re almost there!”  “The baby is almost here!”
See also:  Emotional Signposts of Labor

Seeking your input

I'm doing a daddy-doula "boot camp" for two couples soon to embark on their first drug-free hospital births. If you had less than two hours to teach dads how to help their wives through labor, what would you say are the best things I could teach them?

More Magnesium Mumblings

Some stuff that has been rolling around in my brain thanks to my recent magnesium obsession...

Prenatal Vitamins and Leg Cramps

So... this morning, out of curiosity, I looked at the bottle of prenatal vitamins I took on occasion while pregnant. Lots of folic acid and calcium, for sure. Magnesium... nope. What the?!

Then I remembered something about my sister.  A year or two ago, she told me that she always got bad leg cramps with her pregnancies (I did too). Then she switched to the prenatal vitamins from NuSkin where her husband works, and her leg cramps disappeared. She thought maybe the NuSkin vitamins just absorbed into her body better, and she may be right. After I saw that my bottle of vitamins didn't contain magnesium this morning, I got wondering about NuSkin's prenatals.  So I googled it. And... Yepperdoodle. 39% of the DV of magnesium.  More magnesium, fewer leg cramps.  Just like you'd expect.

Hard Water for Contractions?

My sister also used to get a lot of contractions in the last trimester of her pregnancies (I do too), but she noticed (or her doctor suggested) that if she drank a bunch of water, they would go away. It may have been partly dehydration, but I can't help wondering whether drinking a large amount of the hard, mineral-rich Utah mountain water gave her magnesium stores a boost and helped relax her uterus?  Maybe. Who knows for sure, but I thought it was an interesting connection. 

Hard Water for Cramps and Fetal Hiccups?

Not long before I got married, I was visiting my future-in-laws with my future husband.  While there, my period arrived, and I was hit with some horrendous menstrual cramps.  I literally passed-out in their basement bathroom from the pain, and then spent the next several hours moaning, embarassingly in the arms of my fiance while his mother and sister offered their sweet sympathy.  I remember my mother-in-law saying that she always had excruciating cramps until after her first pregnancy.  So I've been wondering over the past week whether low magnesium was to blame for both of us.

Then a friend recently mentioned that her doula trainer, a midwife, had taught her having that a fetus who hiccups a lot can be a sign of magnesium deficiency.  I told my husband about that, and he remembered his mother talking about how her first baby hiccuped all the time while in utero.  Then the cogs and wheels started going in my brain.

Something changed between her first pregnancy and the rest. She only remembers the first baby hiccuping, and she no longer had bad cramps afterward.  Interestingly enough, she had been living in California for a while before getting married and pregnant.  At some point after her baby was born, the family moved to Utah.  That baby was the only one born in California.

So I found a map showing the relative hardness of the drinking water in the U.S.  on a water science website. I'll throw in a screen shot of it here:  

They were measuring calcium in the water, but I'd venture a guess that water high in calcium would also be high in magnesium.  So if you look at the map, most of California has relatively soft water while Utah's water is completely hard.  I can't guarantee that water hardness was what changed to get rid of my mother-in-law's cramps and baby hiccups, but it's an interesting possibility.

*Edited to add*:  My mother-in-law also grew up in New Zealand which has primarily soft water.  She moved to Porterville, California (a soft water area) as an adult just a few years before marrying.  She was probably already low on magnesium when she arrived in the U.S.  (Fortunately, New Zealand is also surrounded by ocean water, so God provided a simple way for those soft water islanders to get their mg.)

Fluoride + Soft water + Lousy diet = Scoliosis?

The other day I had an epiphany... maybe magnesium will help my scoliosis pain?  So that led me on a google search that turned up some really promising stuff.  There definitely seems to be some connection between scoliosis and low magnesium.  Also, most women who have osteoporosis also have scoliosis and seem to exhibit a cluster of similar symptoms related with magnesium deficiency.  I was thrilled to make this discovery. So I am full of hope that magnesium will tremendously reduce or eliminate my back pain and save me from a future of other possible health problems.  Yay.

But that also led me on a search for other answers.  I was diagnosed with scoliosis around age 14.  At the time, I was living in Massachusetts, in area with fluoridated water.  So yesterday I turned to Google to see if it might be related.  And it turns out that when fluoride meets magnesium in the bloodstream, they bond into magnesium fluoride.  Magnesium fluoride is insoluble, so it "cannot be assimilated by the pituitary, with the consequent failure of the pituitary to function properly that leads to the symptoms of magnesium deficiency" (source). Yikes.

I can also tell you that I had a fairly lousy diet as a teenager.  Most days I skipped multiple meals out of sheer busy-ness or laziness.  Many days all I had for lunch was french fries and a carbonated beverage.  (Oh the things I wish I could go do-over!)  Dinner was the only somewhat nutritious meal I had every day, but we still ate a lot of refined carbs. So... what little magnesium I may have been getting in my diet was probably getting trapped by the fluoride in our water.  Dang.

It gets worse.

If you look on the map, you'll see that MA is an area with very soft water relative to hard water areas. That's three strikes against me: fluoride, poor diet, and soft water.  Ouch.

But I also carried all my heavy text books around in my monstrous backpack, always on my right shoulder... every school day.  I never used my locker in middle school or high school. Strike four!

It's really no surprise that I was diagnosed with scoliosis two years after I moved to MA.  And it's really no surprise that two years later I started having absolutely horrendous menstrual cramps.  Can we say magnesium deficiency?! 

All of this makes me feel like a detective.  It's kind of fun finding possible answers to all these questions after all these years.

*****

The more I learn, the more amazed I am how much impact little things can have.  It's makes me both afraid and hopeful.  Afraid of what little things are impacting my own children right now that will come back to bite them down the road.  But hopeful because I can see that there is almost always a simple solution to our health problems if we can just find all the puzzle pieces and fit them together. 

How's the water where you live? Hard or soft? Is it fluoridated? Is there magnesium in your prenatal vitamins?  I'm totally curious.

Hold your horses (er... scissors)

Cord cutting on the brain because of this and this...


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Magnesium Manifesto

"There is no life without magnesium." -Mark A. Sircus

I feel so overwhelmed. There is simply so much to say, and I have no idea how to say it all coherently because my mind has been spinning with all this new, amazing information for almost a week. I'll do my best. (And I'll pepper as many of my research sources as I can fit in throughout the post, so I'd recommend clicking around and checking them out.)

Magnesium is incredibly important.  (Especially for pregnant women, but I'll get to that later.) Magnesium is probably most well-known for its partnership with calcium in muscle function--calcium contracts muscles, magnesium relaxes them.  But magnesium is actually involved in far more than that.  From what I gather, every time a nerve cell fires, magnesium is required to control the entry of calcium into the body's cells.

Dr. Christianne Northrup sums it up nicely when she says, "Magnesium is essential for the functioning of more than 300 different enzymes in the body, particularly those that produce, transport, store, and utilize energy. . . . In short, living without adequate levels of magnesium is like trying to operate a machine with the power off" (source).  And Mark A. Sircus, a magnesium proponent, describes magnesium as "the source of life" and "the lamp of life" because of its essential role in plant photosynthesis and human bodily functions (source).

As I've immersed myself in studying this amazing mineral over the past week, I have come more and more to see it with deep awe and reverence. Magnesium is at the core of all life and life-giving.  I'm in love with magnesium.

And, unfortunately, most of us are low on magnesium. Magnesium and calcium must be maintained in their proper balance in order to function correctly, but the average modern American consumes far more calcium than necessary and not nearly enough magnesium. That excess calcium can disrupt many important functions. Instead we should take in more magnesium than calcium or at least a 1:1 ratio.

There are myriad ways that magnesium deficiency can manifest itself in your body. Some of those are:

• Anxiety and panic attacks
• Asthma
• Nausea and vomiting
• Headaches and migraines
• Abnormal bowel function, constipation, etc.
• Heart disease
• High blood pressure 
• Muscle pain, cramps, and spasms
• Depression
• Hypoglycemia
• Kidney disease and kidney stones

And low magnesium can lead to several problems of particular interest to women, both pregnant and not pregnant:

• Recurrent miscarriages and premature labor
• Premenstrual syndrome
• Menstrual cramping and bloating
• Infertility caused by spasms in fallopian tubes
• Pregnancy leg cramps
• Pre-ecplampsia
(Source)  

So how do we ensure that we get enough magnesium?

Our ancient ancestors would have obtained more than enough magnesium through plants, nuts, and seeds from the earth's rich non-depleted soil and through soaking in the pristine ocean's limitless supply of magnesium chloride. With soils depleted of nutrients and oceans often too far away and/or full of toxins and pollutants, we aren't quite so lucky. But we can do our best with what we've got.

What are the best food sources of magnesium?

You pretty much can't go wrong with dark leafy greens, nuts, seeds, legumes, salmon, and whole grains.  Some of the best among those sources, according to The World's Healthiest Foods:

• Pumpkin seeds
• Spinach 
• Swiss chard
• Sunflower seeds
• Sesame seeds

Magnesium is also found in hard water.  One site I visited explained:

In a survey of 25 cities in the US, the lowest death rates from heart disease were found in areas where the drinking water supplied above average levels of magnesium. Part of Texas has the highest levels of magnesium in drinking water, and also the lowest cardiovascular mortality rates in the US Australia has some of the lowest drinking water magnesium levels, and also the highest cardiovascular death rate in the world.

How can we improve the body's ability to absorb dietary magnesium?

Avoiding or limiting certain magnesium-depleting foods and beverages will protect your body's magnesium stores, including:

• Soft drinks
• Sugar and refined carbs
• Excess unhealthy fats
• Alcohol 
• Caffeine
• Excess animal protein
• Certain medications, such as diuretics and steroids/corticoids

Increasing consumption of probiotics and prebiotics has also been shown to increase the absorption of essential minerals, in part because of their ability to break down the mineral-binding phytic acid in foods, releasing those formerly bound minerals for absorption. (See here)

Getting vitamin d through regular sunlight exposure will also improve your body's ability to retain magnesium and calcium.  Sunlight seems to do this more efficiently than vitamin d supplements. (See here) 

How else can we get magnesium?

Ocean water is a limitless source of magnesium chloride.  And, based on my internet research, magnesium is better absorbed through the skin than the gut.  If you live near a beach with clean water, regular soaks should benefit your magnesium levels.  For the rest of us, taking baths with epsom salts (magnesium sulfate) or magnesium chloride flakes will raise levels of magnesium in the body.

Magnesium is also available, of course, in oral supplements, but these can cause diarrhea in some people.

Pregnant Women, Listen up!

Clearly magnesium is essential for all of us, but I'm becoming convinced that maintaining adequate magnesium levels could reduce or eliminate a large portion of the pregnancy complications women encounter.  And, as I listed earlier, magnesium can also remedy many of the other complaints associated with our womanly cycles.

Dr. Christianne Northrup shared a story that illustrates what I'm talking about:

I was first introduced to magnesium during my obstetrical training, where I saw how effective magnesium sulfate was in preventing seizures and restoring normal blood pressure in pregnant women suffering from toxemia. Magnesium is also frequently given to women having preterm labor to stop contractions. It works! 

A good friend of mine, Alexa, had her third baby in 1994. About seven weeks before the baby was due, she started to have contractions that would only stop when she lay down. Because she was 2.5 centimeters dilated and almost fully effaced (conditions often present when a woman goes into labor with a full-term third child), she was put on bed rest. Luckily this helped, and she was able to avoid a lengthy stay at the hospital. After having her baby, Alexa was extremely run down, had frequent migraines, and severe muscle cramps. She decided to go to a Naturopath for help. He immediately diagnosed severe magnesium deficiency, and she was given weekly magnesium IVs to correct the imbalance. . . .
 
Alexa's OB/GYN was insistent that she get 1500 mgs of calcium every day to protect her baby's and her bones. He told her to take a couple of Tums, an antacid, any day she didn't get enough calcium from the food she ate. Tums contains calcium, and it was the calcium "supplement" he recommended to all his patients. (This was his strategy for keeping her calories from dairy fat down, too.) He never recommended that she increase her magnesium, just her calcium. It's not surprising that she had a magnesium deficiency after following his advice during three pregnancies.  (Source)

This story is frustrating for so many reasons.  But I want to focus on what Dr. Northrup says in the first paragraph.  Doctors know that magnesium helps women with toxemia and preterm labor.  So my question is... if they know it, why do they wait until a woman comes to the E.R. to pump her full of magnesium?  Why are they putting women on bed rest when they have preterm labor instead of teaching them about optimizing their magnesium levels?  Why aren't women with recurrent miscarriages or infertility or PMS or excruciating menstrual cramps being tested for low magnesium?!

Why aren't we all being told how crucial it is to keep our magnesium levels optimal?


I couldn't know this information and not share it.  So here I am.

Magnesium is crucial. 

Please spread the word.

Dolphins and Birth Plans

While I was in California a few weeks ago, we hit the beach. Almost as soon as we got there, we saw something swimming several yards out in the water. At first I didn't know what it was and sort of screamed (thinking shark), "There's an animal!" Once it became clear it was a pod of dolphins, I had to smile to myself, reminiscing.

I used to be mildly (or... very) obsessed with dolphins as an adolescent. I had dolphin figurines, dolphin stuffed animals, dolphin posters, dolphin videos, dolphin stationary, dolphin everything. I did book reports about them, dreamed of swimming with them, toyed with becoming a marine biologist because of them, etc.

I was reminded of that adolescent dolphin fascination again this morning.

Years ago, my sister saw Marsden Wagner's Creating Your Birth Plan at Overstock.com for cheap and, knowing my passion for all things birth-related, she told me about it. I had never heard of the book itself, but I knew simply because it had Marsden Wagner's name on it that it was a book worth having. So I ordered it, and it has basically been collecting dust on my bookshelf ever since.

About 2 weeks ago we got word that my sister-in-law is pregnant after years of infertility. I'm ecstatic for them. And, naturally, I'm feeling protective of her and wanting to do all I can to ensure that she has the best birth experience possible. So I was perusing the birth books on my shelves about a week ago, contemplating which one(s) I should lend to her first, and I pulled out Creating Your Birth Plan, thinking it might be a good one to start with (especially since it has an M.D. in the by-line). As I flipped through the book, however, I realized that I'd probably better read it before I lend it out to anyone, just so I know what I'm sharing with people.

(I lent her Penny Simkin's Pregnancy, Childbirth, and the Newborn and The Birth Partner instead. Her husband's currently in physical therapy school, so it seemed fitting to start them off with the words of a fellow PT.)

So I've been skimming through Creating Your Birth Plan off and on over the past week or so. This morning I lingered on p. 176 where Dr. Wagner shares some fascinating details about dolphin birthing. Here's an excerpt:

At its physical and emotional best, support for women in labor has always reminded me of dolphin birth. When a dolphin gives birth to a calf, several female dolphins swim in a circle close to the laboring mother. Slightly farther away, another larger group of all the remaining females in the pod circle around the laboring dolphin. Then, even farther away, all the male dolphins in the pod circle around her. The entire collective comes together to protect the laboring dolphin and her emerging calf from intrusion and harm. A woman giving birth to a baby thrives when she's at the center of a circle of love.

This prompted me to do a google search and discovered that there are actually places where women give birth in the water "assisted" by dolphins.

A Russian male midwife, Igor Charkovsky, says this about the practice: "Dolphins have an affinity with the baby in the womb and are automatically attracted to pregnant women. They sense when a woman is about to give birth and gather round. They give both the mother and child a sense of protection and safety" (source).

I've been mulling over the topic of birth partners in preparation for writing something for the book, so this dolphin stuff feels relevant. And it has reminded me, yet again, how crucial it is for women to have supportive people around them as they give birth. The people we invite or allow to be with us can make or break our birth experiences. I recently encountered a 2005 study indicating that there is a strong correlation between patient satisfaction with care provider and lower cesarean rates. And Penny Simkin's research has demonstrated that the women with the highest long-term levels of satisfaction with their birth experiences were the women who had positive memories of the way they were treated by their care providers. Which brings me back to birth plans.

I think writing a birth plan is a helpful exercise. But I think most women do it too late in the game. A birth plan will do little to help you if the care provider and place of birth you have chosen have a practice style totally incompatible with it. In my opinion, the time to write your birth plan is before you ever choose a doctor or midwife (which is why I toyed with giving my sister-in-law Marsden Wagner's book now). I can't stress enough how important it is to choose the right provider--someone who will support and respect your birth preferences and shares your personal philosophy of birthing. You'll know you've found the right provider when you know you don't need to give them a copy of your birth plan when they arrive to catch your baby. Birth plans, at their best, aren't for labor day, they're for doctor/midwife interviews. Unfortunately, most women don't approach the doctor/midwife selection process this way. Hence, there are far too many battles in the labor room where peace and joy should prevail and far too many cruel jokes among doctors and nurses about "those women" with birth plans. Alas.

Given how protective I feel of my pregnant and laboring loved ones, I suppose it's no surprise I grew up with such an affinity for dolphins. I wish I could circle protectively around them throughout their pregnancies and births as the dolphins do. Maybe if I ever start an official doula business, I'll have a dolphin logo? That would be cool.

Ask Busca: Iron and Vitamin D suppplementation for infants?

Ali, a nursing student, asked:

[The teacher of my nutrition class said] that babies who are breast fed will likely need an iron and vitamin d supplement. This makes absolutely no sense to me, because breast is supposed to be best, so why would anything need to be supplemented. The teacher said because the baby stops living off of it mothers iron stores at four months, and so that is why, but do they not get enough from the breast milk. I would just think that if the mother was eating healthy that the baby would not need to be supplemented on anything.

Busca's (excessive) babble:

Thanks for your question, Ali. So sorry it has taken me nearly 6 months to finally give you a response! I'm not a doctor, nurse, dietician, or nutrition expert, but I do love to dig around and see what I can find to help my readers out. So here's what I dug up in regard to iron and vitamin D supplementation...

Iron Supplementation

I knew kellymom.com would probably have something to say about it. And, indeed, she does. In fact, she has so much great info over there, that I'm just going to direct you to her site where you will find just about everything you could possibly want to know on the subject of iron supplementation. Here's a brief excerpt:

Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one of these studies, done by Pisacane in 1995, the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia.

The original recommendations for iron-fortified foods were based on a formula-fed baby's need for them and the fact that breastmilk contains less iron than formula (doctors didn't know then that the iron in breastmilk is absorbed much better). Also, a few babies do have lower iron stores and will need extra iron at some point. . . .

La Leche League recommends that babies be offered foods that are naturally rich in iron, rather than iron-fortified foods. . . .

Note: Additional iron intake by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Iron supplements taken by mom may produce constipation in baby. Anemia in the nursing mother has been associated with poor milk supply, however.

Learning about baby-led weaning really changed the way I saw iron supplementation. My first two daughters had iron-fortified rice cereal before 6 months of age, but my son was exclusively breastfed without any supplementation for 6 months. Afterward, he simply ate whatever offered foods he managed to get into his mouth. But I never worried about his iron levels.

Vitamin D Supplementation

As for Vitamin D, there was a recent news article on the subject that caught my eye and prompted me to finally tackle your question. USA Today reported on a couple of studies published in the journal Pediatrics related to infants and vitamin D. Nicolas Stettler, a pediatrician interviewed in the article, acknowledges, "Because humans originated in equatorial areas with year-round sunshine, babies in the distant past wouldn't have needed to get vitamin D from breast milk," but, according to the second study from Pediatrics, 58% of infants today have deficient vitamin D blood levels. It also reported that "Getting lots of sunlight helped raise vitamin D levels in moms, but not in their newborns." (It was unclear to me whether they meant that the mother and baby were both exposed to sunlight or whether they meant that sunlight didn't improve the vitamin d levels of breast milk.)

I have to wonder when I hear that breast milk is "low in Vitamin D," whether that really just means that mothers themselves have been low in Vitamin D for decades leading researchers to conclude that breast milk is always low. I've read elsewhere that Vitamin D supplementation will increase the Vitamin D content of breastmilk, so I think that's worth exploring. Maybe breast milk isn't inherently low after all?

I am partial to Vitamin D expert, Michael F. Holick, who has been researching Vitamin D for more than three decades. The home page of his website has some great info on Vitamin D:

Vitamin D is not a vitamin but a hormone. It is unique in that it is made in the skin as a result of exposure to sunlight. Photosynthesis of vitamin D has been occurring on earth for more than 750 million years. Some of the earliest life forms that were exposed to sunlight for their energy requirement were also photosynthesizing vitamin D. Both children and adults have in the past depended on adequate sun exposure to satisfy their vitamin D requirement. It is well documented that at the turn of the last century upwards of 80% of children in the industrialized, polluted cities of northern Europe and northeastern United States suffered from the devastating consequences of vitamin D deficiency rickets. The skin has a large capacity to make vitamin D. Exposure of a person in a bathing suit to a minimal erythemal dose of sunlight, which is typically no more than 15-20 minutes on Cape Cod in June or July at noon time, is the equivalent to taking 20,000 IU of vitamin D orally. It is now well documented that in the absence of any sun exposure 1,000 IU of vitamin D3 a day is necessary to maintain healthy levels of 25-hydroxyvitamin D in the circulation. An analysis of the NHANES III data has demonstrated that neither children nor adults are receiving an adequate amount of vitamin D from their diet or from supplements.

Holick is a strong proponent of sensible sun exposure. And so am I. I feel fortunate that I live in the Valley of the Sun where my children and I can go outdoors at any time of year most days and receive more than enough Vitamin D in ten minutes to keep our levels adequate. Even so, during times of the year when the weather keeps us indoors more often, I have mixed safe amounts of liquid vitamin D into my kids' yogurt or juice to keep their immune systems functioning and prevent illness.

(Getting a few minutes of backyard Vitamin D at lunchtime in February)

The American Academy of Pediatrics is opposed to exposing infants to direct sunlight. Personally, I think their recommendation is counter-intuitive. Human beings have been living with the sun for thousands of years (and without chemical sunscreens). We even took my newborn son outside for a few minutes every day (at my midwives' recommendation) because of his slight jaundice. Even after his slight yellow tinge had disappeared, I still took him with me outside in the early April morning sunshine while I watered my vegetable garden. He absolutely loved it. As soon as the sun's warm rays would fall on his face, his facial muscles would relax and take on a look of total peace and serenity. He always turned to face the sun no matter where I put him. And my instincts told me it was good for him. My gut tells me newborns need a few minutes of sunlight every day, just like the rest of us.I love the sun. I really think that human beings need regular sunlight exposure to survive. I don't generally use much sunblock on myself or my children unless we are in the sun for an extended period of time. I remember asking our pediatrician about the safety of sunscreens for infants when my first daughter was about 6 months old. He encouraged us to use hats, clothing, and shade rather than chemical suscreens. At the time, I was slow to take his advice and continued to use sunscreen. As I learned more about Vitamin D and safe sun exposure, my sunscreen use has decreased dramatically. Now we rely on hats, clothing, and shade to prevent sunburn (as our pediatrician recommended all those years ago). We all try to wear shirt-style swimming suits to keep our backs and shoulders protected. When we do use sunscreen, I focus on the areas most likely to sunburn--the nose, cheeks, ears, tops of feet, etc.While I wouldn't advocate spending large stretches of time in direct sunlight, I do advocate spending a few minutes every day (sunscreen-free) with some of your skin exposed to the sun, even babies. In places where sunlight is minimal in winter months, I also advocate taking Vitamin D supplements. I'm convinced that widespread Vitamin D deficiency is largely responsible for the "cold and flu season" phenomenon.

So what am I trying to say with all this Vitamin D babble? Yes, babies need vitamin D. How they get it is a personal decision mothers should discuss with their pediatricians. Personally, I'll echo what the Vitamin D council has to say:

Infants and children under the age of one should obtain a total of 1,000 IU (25 mcg) per day from their formula, sun exposure, or supplements. As most breast milk contains little or no vitamin D, breast-fed babies should take 1,000 IU per day as a supplement unless they are exposed to sunlight. The only exception to this are lactating mothers who either get enough sun exposure or take enough vitamin D (usually 4,000–6,000 IU per day) to produce breast milk that is rich in vitamin D. Formula fed babies should take an extra 600 IU per day until they are weaned and then take 1,000 IU a day, as advised below.

Children over the age of 1 year should take 1,000 IU per every 25 pounds of body weight per day, depending on latitude of residence, skin pigmentation, and sun exposure. On the days they are outside in the summer sun, they do not need to take any; in the winter they will need to supplement accordingly.

I hope that helps!

Speaking of loving the sun, this is one of my new favorite songs. I was introduced to it over our Spring break trip to CA when I attended a prenatal yoga class taught by my book collaborator, Felice. Love it! It's definitely going on my next birthing c.d.

Pain, pain, go away

So... I've had chronic back pain since my first daughter was born. I attribute it to my scoliosis (which has worsened over time through pregnancy and motherhood). I've also spent my life fighting chronic headaches. I used to pop ibuprofen like candy multiple times a day to keep my headaches at bay (now I only take pain killers maybe a couple of times a year).

Reducing processed (MSG-laden) foods in our diet has alleviated my headaches immensely, but I'm finding I can minimize my body pain even more by eating more anti-inflammatory foods and avoiding foods in the nightshade family--tomatoes and potatoes. Apparently they can exacerbate pain for some people. Not sure if I'm one of those people yet, but I'm experimenting to see. (No easy task since I love tomatoes and cook with them all the time.)

I love anti-inflammatory foods. They're my new best friends. Here are a few of my favorites...

1) Turmeric
I had never used this deep yellow spice until this past year when I started hearing about how health-promoting it is. It's a main ingredient in curries and it's what makes mustard yellow. Now I put a bit of turmeric in our meals several times a week. I won't go into all of the health-benefits associated with turmeric, but studies have shown that its natural anti-inflammatory effects are as powerful as painkillers like ibuprofen. The smell and flavor of turmeric remind me a lot of celery which I'm not a huge fan of, but I'm getting used to it.

2) Sweet potatoes
Did you know they're in a different family than regular potatoes? And super healthy too. Since I'm avoiding nightshade vegetables, sweet potatoes will be my substitute in potato recipes. Growing up I really didn't care for sweet potatoes, but they've grown on me a lot over the years, especially since I discovered they can be cooked without marshmallows.

3) Olive oil and fish oil
I was already cooking with olive oil everyday and taking fish oil fairly often, but now I do it with more gusto and purpose. Instead of popping ibuprofen when I've got a headache or my back is particularly painful, I pop fish oil capsules instead. Studies verify that fish oil is an effective and safe alternative for pain relief (olive oil too).

Other anti-inflammatory foods: blueberries (and other berries), papaya, pineapple, broccoli, cauliflower, cherries, garlic, ginger, almonds, apples, cinnamon, dark chocolate, rosemary, chili peppers, meats from grass-fed animals, and more.

Last night we had ground bison and cut-up sweet potatoes sauteed in olive oil with fresh onion and garlic, sprinkled with chili powder and turmeric, steamed broccoli on the side. Yum.

DIY cardboard play kitchen, anyone?

As I was posting the pictures in my last post, I realized that I never shared our January 2008 home-made play kitchen adventure on this blog, and since I figure I have lots of readers who might be interested in making their own play kitchen from recycled moving boxes... here it is!

Years ago, my brother and his wife gave us the play kitchen their kids had outgrown. It was fantastic. Our girls got a lot of use out of that thing. You can see part of it in this picture here...Then we made plans to move to AZ, and (being naive and inexperienced in the world of play kitchens) we thought we'd sell it at a yard sale and just get a new one on Craigslist after we moved. We figured it would be easier than trying to move the thing 'cause it was pretty big. I think we sold it for like $11 or something ridiculous like that. Fast forward to post-move when I find out that some people actually expect you to pay $100 for a used play kitchen!? Obviously we were crazy to part with our FREE one. Yikes!

Seeing that there was no way we were going to pay that much for something so non-essential, I did a google search to see if anyone had a site with do-it-yourself play kitchen ideas. That's when I found forty-two roads. She made a play kitchen with cardboard and contact paper. Not a bad idea. What do you have coming out your ears after a move? BOXES! Stacks and stacks of flattened boxes were residing in our garage.

So, two years ago, my husband and I (with a little help from our girls) created a play kitchen using recycled cardboard boxes, contact paper, packing tape, glue, and a few knick knacks, screws, and gadgets thrown in. Voila! A pretty stinkin cool hand/home-made play kitchen for my little girls to go nuts with.

We were quite proud of our little creation, particularly the special features not included in the forty-two roads' original. We sort of took her idea and modified it to our liking. The special features include: a window in the oven door (with a sheet protector acting as "glass"), two functional cardboard drawers, a "granite" countertop, a faucet (bike hook), and colorful contact paper. Here are some pics of the work in progress and the final product:The folks who sold us our house left a couple of things in the storage closet, one of them being an old Sony stereo cabinet. We didn't have a stereo fit for it, and it had just been sitting in that closet for months... So... we covered the glass door with cardboard, contact paper and tape to make it safer, and it was instantly transformed into... you guessed it... a refrigerator! Check it out!They were a lot of work, but it was fun work. We've decided they're definitely better than anything we could have bought at the store.

Curvy

About two years ago I went to a chiropractor, hoping he could help me figure out why I had chronic pain in my right shoulder blade region. (It still plagues me to this day.)

Wow. That's what I thought when I saw the x-rays of my spine. Wow. Holy cow. Good grief!

Back when I was a teenager I was diagnosed with scoliosis, but they watched it for a while and it never became more than "mild" scoliosis, so they sent us on our way and I sort of stopped thinking about it. Until the pain started several years later. When I was lying "flat" on my back, things just didn't seem to be where they were supposed to be. I was definitely right! As we stood there looking at the x-rays, I thought to myself, hmmm... that doesn't look like "mild" scoliosis to me! The chiropractor concurred. Mommyhood had taken its toll and made my curvy spine even curvier.

What does this have to do with birth, you're asking?

A recent post by Rixa alerted me to something fascinating. It's totally logical... one of those things you learn and wonder how you never thought of it before. Scoliosis and epidurals aren't always compatible. Makes sense, huh? I really don't know how it never occurred to me before.

So I just googled "epidural scoliosis," and found quite a few stories from women with scoliosis on forums and Q&A sites. It seems to be hit or miss. Some women with scoliosis had no trouble, but they seem to be in the minority. Most of the women with scoliosis fell into one (or more) of these categories:

1) They forgot about their scoliosis until the anesthesiologist pointed it out. It took some time to place the epidural, but it worked fine.

2) Placing the epidural was extremely difficult. The anesthesiologist had to poke them multiple times, sometimes excessively, and they suffered back pain for days, weeks, or months after the birth.

3) The epidural only worked on one half of their body or only worked when they positioned their body a certain way. Most of these women went on to choose natural deliveries for subsequent children and raved about how much better they were compared to their complicated epidural experiences.

4) Their OB recommended meeting with the anesthesiologist in advance and bringing along x-rays to ensure everything would be smooth.

5) They were told an epidural would not be possible because of the severity of their scoliosis. They opted instead for a spinal, a c-section under general anesthesia (Seriously... one lady's doctor let her have an elective scheduled cesarean because her scoliosis was incompatible with an epidural. Seriously.), or a natural delivery.

I feel so fortunate that I didn't have to learn these things the hard way. What if I had gone into my first birth expecting the epidural to save me from the agony? I think an unmedicated birth is so much more painful and difficult when it is unwanted and the mother is completely unprepared for it. It never occurred to me to mention my scoliosis to my OB or hospital nurse. I wonder how many women with scoliosis have miserable births because, like me, they didn't realize it could impact their experiences.

I also discovered through my internet digging that scoliosis can affect fundal height measurements. One women was told she would give birth to a 10+ pound baby because she was measuring so "big." Her child came out a 7 pounder. If you have scoliosis and your doc starts pressing for an induction or cesarean for a suspected "big baby," keep this in mind. Spinal curvature just might be misrepresenting the size of your baby. When I imagine hours of bone-crunching pit-contractions followed by an epidural that only works on half of my body followed by months of back pain from the multiple insertion attempts... all for an unnecessary induction... Ugh. NO thanks.

Fascinating stuff.

DIY Natural Hand Sanitizer

I've always been one to chuckle to myself at "those people" who carry hand sanitizer around. I don't keep my house clean by any means, but I have always assuaged my guilt with the rationale that it's good for my kids' immune systems (and it is). The only reason I have any antibacterial hand soap in my house is because I got a bunch for free with coupons last year. I'm not a germaphobe because I know that there are germs, bacteria, and viruses lurking everywhere. Everywhere. And I think our attempts to avoid them are somewhat delusional, and sometimes only succeed in turning the bugs into supers.

So my approach has always been... rather than trying to kill/avoid the bugs, make it possible for us to live in peace with them by strengthening our immune systems so they're no longer a threat. So far my approach has worked well. We rarely get sick, but when we do it's usually because we've let our immune systems get weak by staying up too late (repeatedly) or eating too much sugar.

The problem is... your immune system can't protect you from everything. Sometimes a healthy immune system malfunctions. Sometimes those malfunctions manifest themselves in frightening ways. As some of you are aware, my baby was admitted to the hospital last week with what they eventually diagnosed as Henoch-Schonlein Purpura (HSP). HSP usually occurs when the body is exposed to a bug and sort of overreacts to it and causes the capillaries in the skin to become inflamed and bleed creating a rash, aches, and swelling. It's not fun. Here's a pic of my Bubby from Sunday...So although he never got "sick" with the bug, the bug did make him "sick" by provoking his immune system to overreact.

The good news is that he's doing much, much better. The swelling has disappeared and the rash is slowly fading. He is almost back to his happy self again. The bad news is that a good portion of those who experience HSP will have another bout of it, usually within a month through exposure to another virus. One bout of HSP was more than enough for us! And I no longer have the illusion that I can live in complete peace with the germs around us. Any one of those bugs could bring another HSP nightmare upon us. (This experience only fueled my distaste for hospitals and the "bad eggs" of the medical establishment... ugh!)

So I've turned into a germaphobe. At least temporarily. I will not be taking my baby to the store, to the school, to the church, or any public place for at least a few weeks (or months?). I will be slathering my daughters' hands in sanitizer before they get into the car after kindergarten and preschool. And we will be washing our hands thoroughly first thing when we walk in the door.

As I was talking to my brother about my new-found-inner-germaphobe, he mentioned that there are natural hand sanitizers out there if I want to avoid the harsh commercial ones. Did you know that the alcohol-based versions say they're not suitable for infants? So that got me thinking... maybe I could make my own natural sanitizer? I turned to google and found quite a few recipes. They all had roughly the same ingredients, but with quite an array of proportions. So I took a couple of them and sort of morphed them to make my own version using the ingredients I had.

Disclaimer: I'm no chemist. I have no idea if this will actually kill germs. It's my understanding that a sanitizer has to be at least 60% alcohol to do the job, but I don't know what proportions are necessary when you're using other antibacterial agents. Here's what I do know: vinegar and lavender essential oil can be used as antibacterials. So I figure that whether or not my natural hand sanitizer kills everything, it's bound to be better than nothing. I chose lavender because I had a bottle in the cupboard and it's safer for children than the more potent tea tree oil most of the sanitizer recipes called-for.

So here's what we used... Natural Hand Sanitizer

1/2 cup distilled white vinegar
1/2 cup distilled water
approximately 1 3/4 cup 100% aloe vera gel (12 oz bottle)
14 drops lavender essential oil

We mixed the ingredients in a glass bowl with a whisk and then poured the mixture into an empty soap dispenser. The remainder we poured back into the aloe vera bottle to use for refills. My husband and I tested it out last night. I was initially worried that it would either smell too strongly of vinegar or too strongly of lavender. Neither of those smells is really noticeable. In fact, mostly it smells like the aloe gel with just a hint of vinegar and lavender. Not bad at all. A bonus to using these ingredients--alcohol-based versions will dry out the skin, but aloe vera and lavender will benefit the skin.

Will it work? I don't know. But here's my plan... I will use our "natural" sanitizer when I know we will soon be able to wash our hands (after-school, etc.). But I will also keep commercial sanitizer in the car for times when we are in exceptionally germy situations or not likely to have access to a sink or soap within a short period of time. So it'll be good enough for our purposes.

Anybody else make their own sanitizer? Does it seem to work for you?

Stand by me

A statement out of a recent Midwifery Today E-Newsletter reminded me of something I've been wanting to blog about ever since my doula training almost a year ago. Dutch midwife, Gre Keijzer, explained:

In my view, starting the second stage in a standing position can be seen as a preventive measure against the occurrence of shoulder dystocia. If it does occur, it can be easily corrected without having to perform all sorts of heroic manoeuvres.

I've become somewhat obsessed in the last year with giving birth in standing positions. My fascination began when my doula trainer, Mary, shared a handout adapted from an article by Jean Sutton called, "Physiological Second Stage or Birth Without Active Pushing."

Jean Sutton, my doula trainer explained, was an engineer before becoming a nurse/midwife. So she applied her understanding of engineering to the human pelvis and determined the optimal maternal stance for the baby's smooth journey through the birth canal. She argues, "Human birth is an engineering situation . . . . We have tended to ignore the way the maternal pelvis and [fetal] head are designed to interact. Parents should be given the facts about how the process works." She also says, "In a normal physiological birth, the mother has no need to deliberately push her baby into the world." Here are the particulars of achieving this apparently effortless process:

1) Optimum fetal positioning. In order for this smooth "fetal ejection reflex" to occur, the baby should be in the anterior position (facing the mother's back) before the pushing stage begins. The website Spinning Babies has excellent resources for encouraging babies to rotate into this optimal position before and during labor.

2) Supportive environment. The laboring mother needs to have freedom of movement. Jean Sutton recommends having "strongly fixed rails or bars at or above normal waist height." A sturdy support person to hold onto may also be sufficient.

3) Optimum maternal positioning. The laboring mother should be in an upright position--standing or kneeling. The mother's weight should ideally be "in front of her ischial tuberosities" (the bones in your bum)--so the upperbody leaning slightly forward. The mother's hands should be grasped onto something above waist height to release tension in the lower body. Her back arched, head thrown back. If ideally supported, her body will sag and her knees will rotate outwards, and the lower part of the woman's spine which includes the tailbone (the Rhombus of Michaelis) will move backward causing her pelvis to destabilize. Midwifery Today describes this fluid physiological process this way:

The following spontaneous actions then occur: the mother reaches upward for something stable to grasp; her body sags forward and knees roll out; her back arches and she begins to wriggle her lower body; the uterus contracts and forces the baby downward (a series of actions very similar to those during orgasm).

Jean Sutton argues that any position raising the knees above the seat, reclining, or squatting will cause the pelvis to be "splinted" and fixed. It is also important that a woman's tailbone be free to flex and move out of the way of the baby's head as it travels down.

A woman reclined in a bed cannot experience this spontaneous, fluid process. She also can't experience it with an epidural. Jean says:

I think we need to get women to understand that, although epidurals are great for pain relief, they actually get in the way of a spontaneous second stage and vaginal birth. In many cases, the reason they've got an epidural is that the baby wasn't in the best position when it started, and the baby in the less suitable positions needs all the space he can get to turn around in.(Source)

Jean Sutton also emphasizes that it is crucial to resist the temptation to "help" a woman through this process: "Women may be left with permanent damage if the legs or pelvis are moved at the wrong time or at the wrong angle. It must be understood that the spine has no support once the Rhombus moves."

I've given birth three times. Every time I have been squarely on my tailbone with my knees up... like so...And pushing took a great deal of effort every time. It's my dream to someday experience this spontaneous physiological process as God and nature intended--standing upright!

You may also enjoy this article about the Rhombus of Michaelis and physiological birth by Sara Wickham and Jean Sutton.

PMS Tips

Diana J. asked if I would explain more about my PMS game plan choices, so here goes.

I started suspecting that my PMS was caused by a hormonal imbalance awhile ago. Progesterone came up on my radar screen mainly because progesterone levels are high during pregnancy, and pregnancy is when I feel most "myself," happy, and emotionally-stable. I've also gathered that abnormally high estrogen levels can cause the anxiety, aggression, and irritability some PMS-sufferers experience (PMS type A). So I'm thinking it's likely I have elevated estrogen levels when they shouldn't be high and not enough progesterone. Maybe.

Based on what I found digging on the internet, I created my own game plan to attempt to regulate my hormones as follows:

1) Early to bed. I'm a night owl. (And I have a baby who nurses off-and-on in the night.) So I'm basically in a state of constant and chronic sleep-deprivation. In fact, I think I could say I've been sleep-deprived since I was in high school when I started frequently staying up late. So that's over a decade of lost sleep. Based on what I've been reading, sleep loss can wreak havoc on your hormone levels. Ooooops. It's also my understanding that our bodies are designed to sleep from about 10:00 p.m. to 6:00 a.m. Varying from that can cause big problems. Interestingly enough, there was one week-ish when I was consistently going to bed by 10:00 and getting up around 6:00, and I was amazed how great I felt. I'm doing better, but still working on this one.

2) Down with the xenoestrogens. You know... those chemicals in our environment that act like estrogen. They're everywhere! It's virtually impossible to eliminate them from our life, but we can try to minimize our exposure through using more natural and organic products and avoiding foods and drinks heated in plastic, etc. This is one of the reasons why I started drinking organic milk, buying more organic meat/produce, using natural products for lotion, shampoo, conditioner, and drinking from a less-toxic water bottle when I'm out of the house.

3) Mushrooms. In my research, I discovered that mushrooms may reduce estrogen levels and decrease breast cancer risk. If I do have elevated estrogen levels prompting my PMS symptoms, I figure more mushrooms are in order, especially on days 26 and 27 of my cycle (when I usually experience the anxiety, aggression, and irritability). Plus I think they're yummy. So far I've been eating them somewhat randomly, but I think I will start reserving them (they're kind of expensive) specifically for the "luteal phase" (last week-ish) of my cycle. I've never seen or heard of using mushrooms to treat PMS, but I figure it makes logical sense... worth a shot.

4) Other PMS prevention measures.

* Exercise
* Omega-3s
* Avoid junk food
* Get extra calcium (more yogurt), magnesium and vitamin E (almonds), vitamin D, and B vitamins

These are all natural PMS remedies I found popping-up all over the web. I am still trying to work regular exercise into my routine. This site has some excellent tips on what to eat to beat PMS.

I hope this helps! It seems to be helping me so far, and that's a HUGE relief!