Breastfeeding

Breastfeeding in Public Info Cards

I've always wanted a stash of breastfeeding info cards I can whip out and give to nay sayers or those in need of a little education when I'm out and about breastfeeding. I couldn't find any cards online that were specifically for NZ, so I've made ones that are possibly usable across many countries.

Please feel free to print and use at your own discretion. Just right click and save. You can make single or double sided cards. They are approximately 9cm x 5.2cm with 300 resolution - the standard size and resolution of a business card before it is printed and cut. You can simply save the images and send them to your chosen print company. Enjoy and pass along!




Birth

My Birth Plan

For my last three pregnancy's I didn't write a birth plan. They went well, but they could have been better. So in the event I'm ever pregnant again, I'm now prepared!

Birth Preferences

Relaxed environment.
Provided baby is not in distress, only myself, my partner, and midwife are to be in the room.
Closed door.
Dimmed lights.
Warm room temperature.
Classical music available (brought by me along with CD player).
Electrolyte drink available throughout labor (brought by me).
I'll wear a birth gown of my own.
My partner will be taking photo's throughout the labor.
If it's medically necessary to have other medical staff present at the birth, there is to be no students, interns, residents or non-essential personnel present at any time.

Provided the baby is not in distress, maintain a high level of privacy throughout birth.
At times, especially towards the end of the labor, I may:
Want only my partner in the room.
Want no one else in the room.
Want to be alone in the toilet.
In these situations please respect my privacy and only enter the room if I ask you to, or if there is an emergency.

Avoid pain medication.
Do not offer me pain medication.
Do not ask me to rate my pain.

Employ natural pain relief measures.
If I am in distress, please remind me to focus on relaxing with my contractions.
Otherwise, please do not talk to me or ask me questions during contractions.
My partner will apply heat packs, massage and acupressure where needed.

Provided the baby is not in distress, avoid any other interventions.
No vaginal exams.
No continuous fetal monitoring.
Check baby's heartbeat using a handheld Doppler every 30 minutes in the latent phase, every 15 minutes in the active phase, and every 5 minutes in the descent phase.
No syntocinon (also called pitocin). My partner will employ nipple stimulation to induce contractions if needed.
Allow placenta to deliver on its own, wait 30 minutes.
Do not inform me of my progress or lack of progress in dilation. I do not want to know.
No stretching of the cervix.
No artificial rupturing of amniotic membrane. Allow amniotic membrane to break on it's own.
No directed pushing. Leave me to push at my own discretion.
No stretching of the perineum.
No episiotomy. My partner will apply perineal caster oil massage and heat pack.
If any medical procedure is necessary, you will first get my informed consent, which includes discussing with me the reasons for it, and all possible side effects of it.

I will remain upright whenever possible throughout birth.
Please encourage me to:
Walk, dance, rock or sway between contractions.
Sit on birth ball and beanbag when needed.
Try to squat during contractions, and hold onto partner or a firm structure for support.

If baby is posterior please try these measures.
Apply diaphragmatic release.
Use lift and turn technique.
Change position - get on hands and knees, head down, bottom raised, and sway hips side to side or rock pelvis back and forth.
Partner will apply counter pressure on my back, apply back massage, or heat pack.

If baby is breech please try these measures.
External cephalic version.
Change position - get on hands and knees, head down, bottom raised, and sway hips side to side or rock pelvis back and forth.

Newborn care.
Baby's head is not to be pulled as it is crowning. Myself or my partner will cradle the head gently.
Myself or my partner will catch the baby.
My partner will announce the sex of the baby.
Immediately after birth, place nappy on baby, then place baby on my bare abdomen. Cover with a warm blanket. Leave there indefinitely. There is to be no separation of myself and baby unless expressly permitted.
My partner and I will clean baby and rub the vernix into baby's skin.
Evaluation of baby will be done on my abdomen.
Delay cord clamping until cord has stopped pulsating. My partner will cut and tie the cord.
Placenta will be saved and given to my partner to take home for encapsulation.
After the birth my partner will be staying with baby and I in the hospital for as long as we need.

Avoid any unnecessary newborn procedures.
Baby will not be receiving eye drops.
Baby will not be receiving a vitamin K injection.
Baby will not be supplemented with formula.
Baby will not be using a pacifier.
Baby will not be given a bath.
*Vaccinations are not routinely administered to newborns in NZ, though if they were I would be choosing not vaccinate my newborn either.

If you're wondering why I chose the above preferences, here's some links with useful information about a number of birth preferences mentioned above:

Why choose not to have coached pushing?
Pushing During Labor: Coached Pushing vs Physiologic Pushing
by ANDREA CROSSMAN, RN, BS, BA

Why choose to keep upright during labor instead of lying down?
Get off your back: references
by Stand and Deliver Blog

Why choose not to be induced with pitocin?
The Truth About Pitocin
by Elaine Stillerman, LMT

Why choose not to have an epidural?
Epidural Labor Side Effects
by Kim James
Side Effects of Epidurals: Research Data
by Janelle Durham
Protecting the mother-child bond
by Cherie Raymond

Why choose not to have interventions?
Labor and Birth Interventions
by Natural Birth and Baby Care Website
Cascade of Intervention in Childbirth
by Childbirth Connection Website

Here's some other birth plans to give you more ideas:
These are naturally focused, minimal intervention hospital birth plans.
Birth Plan 1
Birth Plan 2
Birth Plan 3

Birth

Natural Pain Relief During Childbirth

The key players in pain relief and even pleasure during birth are oxytocin and opioids. They diminish pain, trigger pleasurable sensations and increase feelings of empathy. As the level of pain increases, as do these hormones, allowing the body to experience both intense pain and intense pleasure at the same time. However, these hormones are primarily released when a woman feels relaxed and safe. They are secreted in spurts and not continuously, and levels decrease over time unless you retrigger their release with stimulation. Anything that causes tenseness, anxiety, stress or fear can easily inhibit their release – turning a potentially pleasurable experience, into a horrifically painful one. 

The below flow chart helps explain how our perceptions can influence pain:


Pain relief is centered around getting these hormones flowing - creating a safe, relaxed, comfortable and stress free birth experience. Below is a list of factors that can greatly contribute to creating a pain free birth experience:

Confident, Supportive Midwife and Companions
Remember this is YOUR birth. It's an instinctive inclination to be in a private, secluded, safe location. A calm relaxed atmosphere is integral to birth pain management. Whether it be your partner, mother, sister, or best friend, choose companions who will create a relaxed and supportive atmosphere. For instance a woman who has naturally given birth herself may provide much needed empathy and wisdom, while your partner may bring a sense of familiarity, security and safety.


For professional support, a doula is a trained birth support person, providing practical support and ensuring your birth choices are respected. The benefits of having a professional doula attend your birth are well documented:

  • 50% reduction in the cesarean rate
  • 25% shorter childbirth
  • 60% reduction in epidural requests
  • 40% reduction in oxytocin use
  • 30% reduction in analgesia use
  • 40% reduction in forceps delivery
- Excerpted from Mothering the Mother: How a Doula Can Help You Have a Shorter Easier and Healthier Birth,  Klaus, Kennell, and Klaus (1993).

For more information about the role and benefits of a doula click here.

Abdominal Breathing
Abdominal breathing focuses your mind and increases oxygen and energy flow to muscles. It involves slow, repetitive, deep breathing using the full extent of your lung capacity. Completely forget the "hee hee hee" breathing you see in movies, it's not relaxing. Anytime you feel your breath shortening, return your focus to deep, slow, long breaths.


Vocalisation
Completely allow yourself to vocalise when you feel the urge. Let out deep, low moans, with your mouth gently open, like the deep growl of a tigress. Ina May Gaskin calls it the "sphincter law" - if your jaw and mouth are relaxed so is your bottom. Grit your teeth and tighten your mouth and your bottom gets tense. Try it.

Movement
Repetitive movement helps you relax, helps prevent you from tensing your muscles too intensely, improves blood flow, and helps baby descend deeper into your pelvis.

Rhythmic Movement
Helps you focus and relax. You could try slow dancing, belly dancing, or simply swaying back and forth. Even if you prefer to sit you could still rock back and forth if you crave movement.

Walking
If you feel the urge to walk, then walk, around the room, through the house, or even outside. When a contraction comes brace yourself on something like a tree, a low table, or hold onto somebody - put your arms around their neck and let them support your weight.

Birth Balls
Provide excellent support to your pregnant body while allowing you to move relatively freely while sitting on them. You can also drape across them while you're on your knees or squatting.

Positions

Do not lie on your back
Lying on your back causes more painful contractions, less effective contractions, longer labour, reduced blood flow to your baby, and narrower passage through the pelvis for baby to pass through.

Below is a very informative and eye-opening clip about the risks of lying on your back in relation to newborn birth injuries. A must watch...


Squatting
Squatting opens the passage through the pelvis for baby to pass through, uses gravity to help baby descend deeper into the pelvis, helps prevent perineal tears, allows you to be more in control of pushing, and helps you focus on pushing with the right muscles. A squat bar on a hospital bed, a birth stool, or a handle or counter can be used to hold onto for support while squatting. Try doing 100 squats per day during pregnancy to help build strength and flexibility.


Hands and Knees
For mothers who are experiencing back pain during childbirth, a hands and knees position can help to relieve some of the back pressure. It also uses gravity to help encourage the baby to turn to an easier position.


There are many other great positions to try during childbirth, for a more comprehensive list of positions have a look at any of these three charts available to download:
http://www.mediafire.com/view/kv17ai69ag34yy8/Birthing_Positions_Chart.png
http://www.mediafire.com/view/x633da4kcgl7l06/Birthing_Positions.pdf
http://www.mediafire.com/view/exm355gyrey5u1e/birth_positions_-_good.jpg

Water birth
A warm bath improves blood flow, reduces pulse rate, helps you relax, and improves the effectiveness of contractions. It also reduces the effect of gravity on the back and buttocks, minimizing pain. Do not worry if baby is delivered in the water - baby can quickly be lifted out, and will still be drawing oxygen from the umbilical cord (it's spent the last nine months immersed in fluid anyway).

Photo Credit: www.mygoodbirth.com
Visualization
Visualization is an excellent tool to help focus and gain control over your body. I found myself doing this automatically when giving birth and it worked very well. It involves imagining a particular scene in vivid detail. A few examples would be...
Imagine the walls of the cervix opening with ease and comfort, with no limit to their ability to open to whatever size needed. 
Imagine the space inside your cervix getting larger and larger, opening to unimaginable proportions!
With every contraction imagine baby edging further and further down the wide open birth canal. 
Imagine baby sliding down and out of the birth canal like a slippery, fun waterslide. 

Positive Birth Affirmation
Positive birth affirmations are the basis of the popular HypnoBirthing technique. By repeating positive birth affirmations we're able to turn negative perceptions about birth into positive ones - which has a profound affect when it comes to your ability to relax and manage pain. Here are some great examples from The Baby Dust Diaries...
"Birth is an easy and natural occurrence for which my body has been perfectly designed."
"My pelvis releases and opens as have those of countless women before me."
"My body knows how to have this baby just as my body knew how to grow this baby"
"I surrender my birthing over to my body."
"The strength of my uterine contractions is a sign of my feminine strength." 
"Good strong contractions help my baby come into the world."
"I greet each contraction with openness and expansion."
"I allow my body's natural anesthesia to flow through my body."
"The power of birth strengthens me." 
"I am now willing to experience all my feelings."
"This day, hour, and minute is sacred and blessed."
A wonderful downloadable PDF packed choc with affirmations can be found here.

Affirmations are most effective when practiced in a meditative state, regularly throughout pregnancy, so they're well entrenched by the time the big day comes.

Massage
Massage during childbirth reduces pain, alleviates tension and anxiety, stimulates contractions, improves the flexibility of muscles, facilitates blood flow, circulation and fluid drainage, helps revitalize the mind and body, and offers a sense of emotional support. The areas of the body likely to need massage during childbirth include the back, buttocks, inner thighs, legs, feet, stomach and hands.

A laboring woman's back in particular can get extremely sore, and a good rub can make a world of difference. The back pain can be more intense than the contractions - this has been named 'back labor', and occurs in 25% of births. Usually the back pain is caused by baby being in the 'occput posterior position', in which baby's back is pushing against mum's spine. If your back is sore during childbirth, make sure you speak up, don't grin and bear it! It may mean you're experiencing 'back labor' and you need to change position onto your hands and knees to ease pressure on your spine, and receive a good back rub.

Aside from using hands for massage, a rolling pin, or other massage tool can be useful, and of course a little massage oil or lotion. Below is a list of essential oils recommended for birth that when blended with a carrier oil make an excellent massage oil:
Geranium - Great for the circulation and helps breathing.
Jasmine - Warm and fragrant and has anti-spasmodic and analgesic properties. It is also very beneficial in a compress on the lower abdomen to help expel the placenta.
Lavender - Antiseptic and excellent for aching backs and limbs. It is recommended in a bath during the early stages and is wonderful for the healing of vaginal tears or episiotomy scars.
Neroli - Helps combat any fear or apprehension.
Rose - A very feminine oil and is a uterine tonic which helps to regulate labour.
Ylang Ylang - Very calming and helps lower the blood pressure.
Clary sage - Can be used as it is a sedative, with analgesic properties.

Reflexology and Acupressure
Reflexology and accupressure both involve the application of pressure, to points on the feet or hands (reflexology) and the rest of the body (accupressure), which effectively correspond to various organs and systems in the body. Massaging and applying pressure to the following pressure points during childbirth effectively lessens pain:
Between the puffy pads under the big toe and next toe
Just below the centre of the ball of the foot
All along the inner ball of the foot
Upper buttocks between dimples
Side buttocks 
Center shoulder
Between thumb and forefinger
Along the middle crease of the palm
Either side of the archilles





Graphics by Debra Betts

An excellent site referenceing these points in more detail, along with pictures and video is available here.You should also be careful not to apply too much pressure, or you'll cause more pain than good.

Arnica
Arnica reduces fatigue, bruising, and trauma; it controls bleeding, prevents hemorrhaging, and minimizes the strain on soft tissues. After childbirth, it eases afterpains, assists in the contraction of the uterus and relieves retention of urine after long childbirth.
During childbirth it's recommended to take 200c potency Arnica every 3 hours, and continue this dosage throughout the day after delivery. From the second day onwards you can use the 30c potency every 3 hours.
A Wet Dose can be made by mixing the arnica with spring water.

Vitamin E
Vitamin E prepares the cervix and perenium for stretching, encourages skin healing and reduces scarring after injury. It is recommended to take 800 units of Vitamin E every 3 hours during childbirth.

Hot or Cold Application
Face cloths or cloth nappies, and a bucket of steaming hot or icey cold water
Wheat or rice packs frozen or heated
Hotwater bottles
Hot showers
It can be useful to focus the hot or cold on your back (especially when experiencing 'back labor') or lower abdomen. It can also be useful to have a washable pouch to place a hot or cold pack in, which has an elastic belt with velcro fastenings to wrap it around your abdomen and hold it in place.

Perineal Castor Oil Pack
Caster oil helps relieve prenatal pain, makes perineal tissues supple, helps prevent perineal tearing, and has healing and restorative properties. A heat pack increases blood flow to the area, relieves pain, and improves circulation. To make a caster oil pack...
Use only cold pressed castor oil.
Soak a soft cloth in the oil, wring it out, and put it on your perineum.
Place a heat pack on the cloth – make sure the heat pack has a waterproof cover or the caster oil will soak in and stain it.
Leave it as long as needed.
A mini hot water bottle makes a
great water proof hot pack
Perineal Massage
Perineal massage lubricates the tissue making it softer, more supple, and more flexibile. It also familiarizes you with the stretching sensations of birth, helping you learn to keep your perineal area relaxed, thus preventing tears.

Here are some excellent step-by-step instructions by Birthing Naturally
Perineal massage is usually done by the mother herself, or her partner. It can be done for up to 10 minutes a day during the last four weeks of pregnancy.
Wash hands thoroughly. Ensure there are no sharp or long nails that may scratch the mother.
Locate the perineum, directly below the vagina. It is the skin between the vagina and the anus. Apply some cold pressed and pure oil (such as olive oil) to this skin.
Place the thumbs at the base of the vagina, allowing them the slide inside the vagina (to about the first joint) moving some oil with them.
Using gentle but firm pressure, move the thumbs from the base of the vagina up the side walls as if you were making a "U".
Return the thumbs to the base of the vagina, and repeat procedure.
As the mother becomes more comfortable with the stretch, you may increase the amount you stretch the skin.

Pelvic & Abdominal Muscle Exercise
The ability to relax the pelvic muscles during birth is immensely helpful. Think of the pelvic muscles like a door that needs to relax and open in order to let baby through. Tensing these muscles prolongs birth, increases pain, and increases the risk of perineal tearing.
The abdominal muscles, in particular the deep transverse abdominal muscles, aid in pushing baby out during the descent stage of birth. The combination of relaxed pelvic muscles and toned transverse abdominal muscles ensures you are using your body most effectively, instead of fighting against the surges (contractions). See this article for an excellent list of pregnancy exercises to help prepare the pelvic and abdominal muscles for birth.




Sources:
Avoiding Tears and Episiotomies by Rachel Silber
Labor Massage by NativeRemedies.com
Point location Videos by Debra Betts
Positive Birth Affirmations by Baby Dust Diaries
Arnica after birth by ABCHomeopathy.com
Unassisted Birth Tips by Pregnancy-and-giving-birth.com