Lamaze Healthy Birth Practice #5: Get Upright and Follow the Urge to Push

Lamaze Healthy Birth Practice #5: Get Upright and Follow the Urge to Push

Born to birth. Trust your team. One at a time. 

That’s the mantra that slipped onto the page while emailing with a client recently. And it applies to every part of labor. Labor is not meant to be a medical event. It’s not meant to be a solo event. And, unlike the marathons that labor is often compared to, you get natural breaks in labor – which you don’t get when running continuously for 26.21 miles – so you only have to do one contraction at a time.

What comes to mind when you think of a woman giving birth? For many parents-to-be who have yet to experience labor, their minds go straight to the Hollywood version of birth. A mom in pain, a partner unsure of what to do, water breaking in the elevator, a 5 minute labor, a bossy nurse, lots of hook ups, and last but not least, a mom pushing flat on her back while holding her breath. Aside from the 5 minute labor part (and maybe the bossy nurse), there are some births that look like this. So the question is, “Is that what you want your labor to look like?”

As educators and doulas, we often quote the famous line, “If you don’t know your options, you don’t have any.” This is very true. The other half of that important concept, however, is “Do you have access to those options?” 

Let’s look at this mantra a little closer, and then I’ll get where I’m going with the Lamaze Healthy Birth Practice #5…

  1. Born to birth. Your body, as a woman, was designed to give birth. If you are feeling unsure about that, take some time to read Ina May’s Guide to Childbirth, by Ina May Gaskin or spend some time learning about Gail Tully’s concepts for birth and baby positions at Amazing. You were born to birth.
  2. Trust your team. Find yourself a reputable, normal birth oriented childbirth class, preferably not taught in a hospital or doctor’s office. A class where you will learn about birth, not just about labor. If you wonder where to find a class like this, check out the Lamaze website for an instructor near you, at Lamaze instructors teach about normal, natural birth. Not as opposed to un-normal or unnatural, but within the context of what your body was designed to do first. In this kind of class, they will also share with you about all of your options for birth, using class time to walk through the evidence based research on primary interventions and procedures. Use this experience to help you figure out what you are open to and hope for during your birth, and then surround yourself with a provider, place of birth, doula, and a primary support team that understands and encourages you in these areas. Talk with your team – know that you can trust them to support you in the kind of birth that you hope for.
  3. One at a time. Birth can be long, like a marathon. It can be quick, like a rain storm. It can be so many things. But here’s what you don’t have to focus on – how much time is ahead of you. Your job, Moms, is to do one wave, one surge, one contraction at a time. That’s all you have to focus on. Just one.

So, how does this apply to the Lamaze Healthy Birth Practice #5: Get Upright and Follow the Urge to Push? When you get these first ducks in a row,  you’ll find in that last stage of labor you’re closer to being supported with these healthy steps to birthing your baby with confidence:

  • Follow your body’s natural urge to push. Gail Tully of Spinning Babies says, “10 is just a number. If the baby’s head isn’t there, it doesn’t mean anything.” When your baby moves down and you feel an incontrollable urge to bear down and push, you will know. I promise, you won’t miss it! Getting to this point in labor for a mom sometimes takes time though. It’s key that you’re supported by a provider who understands this and wants to support you in this manner. Just because you’re 10 cm, doesn’t always mean you’re ready to start pushing. Follow your body’s natural urge to push.
  • Being upright during the pushing stage of labor not only utilizes gravity to help you, but it’s also often less stressful for baby. When you’re upright, you tend to get into positions like squatting, that can open your pelvis by as much as 30% more, creating lots of space for baby. Here are some positions to try:
    • Standing
    • Squatting
    • Kneeling
    • Hands and Knees
    • Side Lying ( If you are tired or your legs feel shaky and you feel the need to lie down, try a side lying position with help from your support team to hold your leg.
  • Breathing your baby down (making guttural noises while you push as opposed to long lengths of holding your breath), short breath holding, and spontaneous pushing are also known to reduce the risk of episiotomies and tears to the perineum. When you first feel the urge to push, typically just at the peak of a contraction, try using the words, ‘Pop-pop-pop-pop’ over and over again in a loud voice. Sing it if you need to! Ease your way over those pushy peeks until you feel a strong urge to push. Then, when you do, bear down in a way that feels positive to you. At the end of each contraction, blow ‘horse lips’ to loosen the tension in your jaw and neck. This will also allow you to be more relaxed during the break between pushes, in order to save your energy.
  • Vary your positions. You don’t have to stay in one position for pushing. Although it’s hard to transition to a new position, sometimes the difference in how it feels for you makes it totally worth while. If one pushing position isn’t working for you, try another one. Switching it up is good for your muscles, conserving strength, and encouraging baby to move on down the canal.

You can do this! Born to birth. Trust your team. One at a time.

Info generated from

Written by Julia Sittig, MSW, AdvCD(DONA), BDT(DONA), LCCE

Lamaze Healthy Birth Practice #4: Avoid Routine Interventions for Non-Medical Reasons

The topic of interventions–during labor and at birth–can be controversial. Everyone has an opinion to share, and as an expecting mom those opinions can be overwhelming. It can often be the case that questions rather than answers arise when hearing the past stories of laboring women. The neighbor down the street just had a drug-free, intervention-free birth and tells everyone how it is the only way to do it. The coworker in the next cubicle swears that her epidural was a lifesaver and there is no way she could have labored without it. The manager of the local grocery store talks about her induction before the holidays to avoid giving birth on Christmas and what a blessing that option was for her family. Each story touches your heart in a different way but causes you to wonder what choices you will make as your time to give birth draws near.

Will you need an intervention? What about routine interventions? Are those helpful?

Birth is a natural process. We want to limit interfering with the vital hormones that regulate pregnancy, labor, birth, breastfeeding and attachment. While it can be critical to use the available interventions to improve an outcome during labor, how do routine interventions play a role?

Lamaze’s 4th Healthy Birth Practice is to Avoid Routine Interventions for Non-Medical Reasons.

Our bodies are amazing, and we are gifted with several hormones that help the birthing process move along to eventually give us a baby. Oxytocin is one of these phenomenal hormones. Oxytocin (sometimes called the love hormone) increases both the strength and efficiency of contractions. When Oxytocin levels are high, endorphins start pumping out. The way you view and handle contractions becomes easier. Oxytocin is your friend.

Catecholamine is another beneficial hormone during labor. At the end of labor it can produce the ejection reflex that quickly allows mom to birth baby. If you have a high level of both oxytocin and catecholamines at birth, you will find that you are more alert and your baby is ready and eager to start breastfeeding. The goal is to not interfere with or disrupt the normal process that is occurring. Unfortunately routine interventions–done for non-medical reasons–can do just that. As a result, these interventions increase the risk of complications.

Pitocin (the synthetic form of oxytocin) comes into play as an intervention when it is used to replace or augment these hormones that our bodies rely on for labor. Pitocin does not cross the blood-brain barrier and as a result endorphins will often fail to release. Pain without endorphins can often become difficult. Due to this, management for the discomfort is often requested. In some cases pitocin is critical in revving up a stalled labor or even in starting one, however in unwarranted situations it can brew up a cascade of interventions.

The same can be said for epidurals, also an intervention in the natural course of labor, which do provide excellent pain relief, but come with the risk of causing natural levels of oxytocin to drop. Its relaxation of the pelvic muscles can make rotation and descent of baby more difficult. The use of epidurals very often leads to more aggressive interventions to assist with birth and to a possible longer second stage (pushing baby out). There is also a decrease in the likelihood of spontaneous vaginal birth and early use increases the risk of persistent fetal malposition. Epidurals can also readily increase the risk of maternal fever and increase risk of breastfeeding issues.

It is important to have a healthy understanding of these interventions, and to use them only when medically necessary. Below is a list of other common interventions that–like pitocin and epidurals–should be discussed with your provider before using them as a routine part of you labor:

Intravenous Fluids

  1. Can cause symptomatic fluid overload, which can decrease uterine contractility.
  2. Can cause hypoglycemia in mom and baby due to glucose in the fluid.
  3. Can cause Breast Edema which can negatively affect breastfeeding.

Electronic Fetal Monitoring

  1. Introduced in the 1970s to decrease Cerebral Palsy and perinatal mortality
  2. Quickly became a standard of practice even without evidence
  3. Studies have found no difference in infant outcomes
  4. Causes women to more likely have a C-Section or instrumental birth when not needed
  5. Restricts movement
  6. Limits access to comfort measures


  1. Amniotomy
    1. Artificial Rupture of Membranes (AROM)
    2. Risk with umbilical cord
    3. Risk with fetal heart rate and Routine amniotomy is not recommended.
  2. Pitocin – 30 percent of women have their labors augmented with pitocin.
  3. Stronger, harder contractions are difficult for moms to manage and put additional stress on the uterine muscle
  4. Epidurals are often required to handle the contractions


  1. 17% of women have episiotomies
  2. No evidence to support routine episiotomy
  3. Causes more pain than spontaneous tears
  4. Causes more healing complications than with spontaneous tears
  5. No effect on neonatal outcomes
  6. Does not preserve pelvic floor functioning
  7. May contribute to urinary and anal incontinence

With any decision you make, there can be risks and benefits. The benefit of having access to these interventions during a medical emergency is monumental. We are blessed that we live in a day and age when interventions like these exist. However with all good things there must come a balance; knowing how to keep that balance is important. Discuss these different interventions with your provider and find out whether they perform them routinely or only when medically necessary.

Hire a doula to help you navigate through the birthing process and take a childbirth class to help you become more informed on what will be occurring at your birth so that you can feel like you are the driver and not the passenger during your most memorable event.

By Nella Goho

(All information used in this blog post was gathered from the Healthy Birth Practices #4 Essay written by Judith A. Lothian, Phd, RN, LCCE, FACCE)

Lamaze Healthy Birth Practice #3: Continuous Labor Support

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So imagine this… Today’s the day you give birth. You have spent the last 9 months planning for today and it’s finally here. Yay! Except then you remember you haven’t done this before, or it has been a while since your last child was born. And lots of thoughts and questions start going through your head…

  • What is it going to be like? (like it is on tv? I watched this one birth on Grey’s Anatomy last week, Yikes!)
  • When do I call my care provider or go to the hospital? (I don’t want to get sent home for going to early, so embarrassing)
  • I have to remember to stay hydrated (where is my water bottle anyways? Ugh, here comes another contraction)
  • My back hurts every time I have a contractions (Is that normal!?)
  • Which midwife or doctor is on call? (I hope it’s not that one I don’t like, just my luck right?)
  • How am I going to get through these contractions? (I don’t know if I can do this)
  • I’m not having my mother-in-law in the room! (I would totally freak out!)
  • What will my partner do if I start freaking out? (They are gonna think I’m crazy!)
  • Labor can take 24 hours!? (do I just sit in bed the whole time?)
  • What if something doesn’t go as planned? (do I even have a plan?)…

You get the picture. And the more you think about it, the more you realize birth is a whole lot of unknowns. Then the thought hits you, I wish I had someone who is familiar with all this birth stuff to come with me. DING DING… let’s talk about continuous support!

Lamaze’s 3rd Healthy Birth Practice is Bring a Loved One, Friend or Doula for Continuous Support.

As humans, we are social beings. We like to be surrounded by people we know and trust, who care for us and encourage us. As women, we don’t even like to go to the bathroom alone. So why wouldn’t you want to have someone with you for one of the biggest days of your life. Especially when studies have shown that women vividly remember their births and that those memories can have a lifelong impact. Birth is NOT just another day in a woman’s life. Don’t treat it like one.

One of the best ways to get quality continuous support is by hiring a doula. A doula is a woman who provides support during labor. They provide informational, physical, and emotional support. What does that even mean? I like to explain it like this… A doula is like a best friend who knows everything about birth.

The most recent reviews of research continue to show that doulas are beneficial. Not only are they beneficial, there are no known risks. In general, women who have doulas have shorter labors (you heard me right!) and healthier babies (higher apgar scores). Doula support can reduce the need for a cesarean section, Pitocin augmentation, use of pharmaceutical pain relief, and the need for assisted delivery. Here are some numbers for you number people out there…

  • 31% decrease  in the use of Pitocin
  • 28% decrease in the risk of Cesarean
  • 12% increase in the likelihood of spontaneous vaginal birth
  • 9% decrease in the use of any medications for pain relief
  • 14% decrease in the risk of newborn admission to the special care nursery

These birth improvements are all great benefits when comparing numbers and statistics. (find out more at But, I think the greatest benefit of a doula is also the hardest to measure. Well-supported women are more satisfied with their birth experience. This may seem like just another tally in the “pros” column, but this is the purpose of a doula’s work and what makes doula support invaluable. One of the founders of DONA International (an organization who trains and certifies doulas ), John Kennel said…

 “If a doula were a drug, it would be unethical not to use it.”

– Laura Schwartz

Lamaze Health Birth Practice #2: Freedom of Movement Throughout Labor

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When you stub your toe – what do you do?  Stare at it and think (insert deadpan voice) “Ouch, I stubbed by toe.”?  Or what if you slam your finger in a door? Or have some other type of  acute pain…imagine it….  What do you do?  Usual reactions are to potentially let out some choices words like “Dag nabit” or “Sugar peas” or whatever else might come to the tip of your tongue.  But very quickly following or even perhaps simultaneously – is MOVEMENT.  Shaking your foot or hand. Pacing back and forth. Walking it off (as I tell my kiddies when they get a bump). We typically want to move in response to discomfort. It is common to address the pained area with physical touch.  We rub the toe. We suck that finger in our mouth.  These again are physiologically soothing acts that we don’t think about, we just know it feels better when we do them.

So how does this apply to childbirth?  Well, let’s talk about that!  Ask anyone in 2016 what they think about when contemplating their upcoming labor and #1 answer will be…..pain.  As defined by Mirriam-Webster: Pain – the physical feeling caused by disease, injury, or something that hurts/harms the body. With that definition, there is no pain in labor!  AWESOME!!! I just removed all pain from your labor!!!  Whoo Hoo!!!  This is a big point – it is NOT disease, injury or harm.  It is normal.  That being said, it has been known to hurt a little bit.  The PAIN we talk about in our childbirth classes are intense physical feelings (contractions) that are:

P – Purposeful – they are doing something – like dilating your cervix and moving your baby down

A – Anticipated – I just told you that it is going to happen – so no surprises! J

I – Intermittent – HUGE!!  They come and go!  Average first time labor is 15 hours.  About 3.5 hours of which is contracting (“coming”). Thus the “going” part equals approximately 11.5 of NOT feeling contractions/intensity/waves of powerful awesomeness.  11 and a half hours!!!

N – Normal – it’s ok, the human race has been doing this song and dance for a while. It is normal and necessary to bring the baby out.

Luckily, movement is a super big helper with the perception of discomfort.  I say perception, because technically the muscles are still contracting – the nerve endings are still sending signals to the brain that are recognizing discomfort and a baby is still moving down and out.  These things do not change; however, a woman in labor has the ability to feel the intensity differently – less – with the introduction of comfort measures and movement is a good one.

How does movement change perception of “pain”?  Our body helps us out a lot in labor.  From the release of endogenous opioids (a.k.a. endorphins) to the presences of mechanoreceptors, we have a loaded tool box of physiological assistance in moving the perceived pain farther away from our point of focus.  When you are free to move in labor, you stimulate your mechanoreceptors.  These are sense organs or cells that respond to the mechanical stimuli of touch.  There are Pacinian corpuscles, Meissner’s corpuscles & Merkel’s discs and are activated with different pressures as they are located at different depths within your skin.  These are stimulated by light and deep pressure/touch.  They are located in your joints (as you walk and move), palms of your hands (rubbing, making a fist or better yet a nice hand massage) and soles of your feet (walking or nice foot massage), lips (remember sucking on that hurt finger…) and in the genital regions (sitting on a birth ball works great) as well as hair follicles (having your head stroked or hair brushed).  When these receptors are activated or stimulated, they send signals to the brain faster than the “pain” and create a more dense perception making it less intense by closing the “pain gate”.

Why does movement help in labor?  According to Teri Shilling, Amy Romano & Joyce DiFranco in their article for The Journal of Perinatal Education, “Freedom of movement is important in making the birth of your baby easier.  It is the best way for you to use gravity to help your baby come down and to increase the size and shape of your pelvis. It allows you to respond to pain in an active way, and it may speed up your labor process (Simkin & Ancheta, 2005)”.

What does the evidence show?  In all of the research studies published on freedom of movement in labor, none showed that walking in labor was harmful to healthy women with normal labors. In addition, it found that women in the study who did walk in labor, 99% stated satisfaction and in fact would walk again during future labors.  No study showed women stating she was more comfortable on her back. Care providers and facilities that had policies encouraging women to walk or change positions in labor found higher findings of:

  • Shorter labors
  • More efficient contractions
  • Greater comfort
  • Less need for pain medicine in labor (Simkin & Bolding, 2004; Simkin & O’Hara, 2002)

What’s in a name? Just the name Freedom of Movement gives a sense of power.  Freedom. Choices. It expresses the innate desire to move in response to the “pain”. To work together with your baby to find the most efficient way down and out.  A study by Storton in 2007 found that restricting women’s movement may result in worse birth outcomes and may decrease women’s satisfaction with their birth experience. In all of our births we have witnessed as BBC doulas, every woman has their own path.  They each move in different ways to different rhythms at different times with different breaths. It is fascinating and amazing to watch as they open up to their own power and birth their child.

Here are some ideas on positions to try in labor and having experienced labor support like a doula will help facilitate movement and position changes during your labor in person.


Lamaze Healthy Birth Practice #1: Let Labor Begin on Its Own

It’s not your Ma’s Lamaze! For years (mostly around the time when many of our mothers were giving birth), Lamaze childbirth education became widely known as a ‘method’ for birth, teaching a breathing and coping style that came to be known by its name. Lamaze today is a ‘philosophy’ of birth, founded on 6 Healthy Birth Practices that are designed to encourage women to trust their bodies, reduce fear, and have a healthy and safe birth for mother and baby.

We’re excited to walk through these 6 Healthy Birth Practices with you over the next several weeks, in order to bring greater understanding to not only the benefits of Lamaze, but to the amazing way that women’s bodies are designed to work!

Healthy Birth Practice #1: Let Labor Begin on Its Own

Want to increase your chances of a smooth labor and birth, as well as a good beginning to life with baby after birth? Lamaze’s Healthy Birth Practice #1 encourages women to let labor begin in its own time, knowing that mom and baby have built in hormones designed to signal each other when they are ready for birth.

As a woman nears the end of her pregnancy, her hormones are likely to be the ‘fall guy’ (or ‘fall girl’ in this case) for every teary moment or emotional outburst. It is often a roller coaster, as she walks through those last days and weeks feeling uncomfortable, facing some unknowns, and sometimes doubting her own ability to do the big job of labor and parenting that lay ahead.

All in all, it’s the hormones that get a bad rap. How often do we hear, “Thank goodness for those hormones! Don’t know what I’d do without them!” In reality, you are much more likely to hear, “Oh, it’s just your hormones, sweety, it’ll get better…” Or, “Those hormones are acting up again – stay out of her way!”

Let us tell you, we LOVE those hormones! While hormone levels rise and fall with frequency, and yes, they do sometimes result in extra tears and waves of emotion, they have a singular, focused purpose. And it’s all about the health and well being of mom and baby.

Here are the top five reasons we should celebrate the hormones at work in a woman’s body at the end of pregnancy and throughout labor (Hormones and Healthy Birth, Giving Birth with Confidence,

  1. Baby speaks up. At the beginning of this beautiful dance of labor hormones, it is believed that the baby initiates by releasing cortisol (steroid hormone) simultaneously to mom experiencing an increase in the production of estrogen (female sex hormone) (Sarah Buckley, Executive Summary of Hormonal Physiology of Childbearing, The Journal of Perinatal Education). This signals the start of early labor!
  1. Prep work. As the levels of estrogen, oxytocin, and prostaglandins rise, they are preparing a woman’s body for labor by helping the uterus to practice and be more efficient, loosening the joints to make way for baby, and softening, effacing, and opening the cervix for labor.
  1. Labor land. Beta-endorphin receptors are increased before labor, which means that the more oxytocin works throughout labor to bring on contractions, the more endorphins a woman’s body receives to counteract and diminish pain in labor. These endorphins not only act as an analgesic, reducing stress in labor, but also help to create a sometimes euphoric state of mind for the mother, often known as ‘labor land.’
  1. Healthy stress. Catecholamines (often referred to as stress hormones) actually have an important role at the right time in labor. A healthy dose of these hormones not only help the mother to push a baby out, known as the ‘fetal ejection reflex,’ but they also play a role in ensuring that baby has enough oxygen during labor and enough blood supply to baby’s heart and brain.
  1. After birth. Hormones pave the way not only for the delivery of the placenta (often known as the afterbirth), but for mother and baby post birth. Oxytocin in particular, paves the way for strong contractions to continue after the baby’s birth by encouraging the uterus to work back down to size and reduce risk of hemorrhage, as well as setting the stage for bonding and breastfeeding. And those catecholamines? Still helping out by giving baby energy, helping with breathing, and regulating baby’s body temperature (Hormones and Healthy Birth, Giving Birth with Confidence).

Healthy Birth Practice #1

Because we have learned that, ‘Maternal and fetal readiness for labor is precisely aligned at the physiologic onset of term labor to optimize labor efficiency and maternal and newborn transitions,” (Sarah Buckley, Executive Summary of Hormonal Physiology of Childbearing, The Journal of Perinatal Education) we then know that interrupting this cascade of hormones with labor induction or a scheduled cesarean has a dramatic impact on both the mother and the baby. In these cases, we can pause, delay, or even create an absence of these valuable hormones in the dance of birth and early postpartum.

Knowing this, we also have to be aware that there are medical considerations and times when induction may be safer than waiting for labor. It’s important to talk about this with your provider should any medical needs arise.

Important questions to ask your provider, should you be advised to induce labor or schedule a cesarean:

  1. Why are you recommending an induction or cesarean?
  2. What type of induction is recommended?
  3. How does it impact mom?
  4. How does it impact baby?
  5. How long can we wait and what are the risks if we choose to wait for labor to begin naturally?
  6. Can we try more natural methods of induction first?
  7. Is induction likely to be successful for me (what is my Bishop’s Score?)?
  8. Do research studies confirm that induction or cesarean are the best course of action?

As long as we have a healthy mom and healthy baby, we want to encourage all moms and babies towards a natural start to labor, because the benefits are so clear. Even when it’s a challenge to wait, when the hormones are flying high, and when this beautiful but vulnerable ‘in between’ time of waiting seems to stretch on to infinity, know that mom and baby are perfectly designed to work together.

For more information on reasons for induction, the impact of induction before labor begins, and on evidenced based research related to reasons for induction, please check out the following:

This information in this blog  is not to be construed as medical advice, but will hopefully encourage healthy conversations with your health care provider.

Celebrating Doulas

I was reminded yesterday of two very important things related to my work as a doula: community and passion. Core elements to why we do what we do, and what I find to be the foundation of what keeps me going. As we close  out World Doula Week for 2016, I’m inviting you to celebrate these two beautiful gifts with me.

Rochester is blessed with an incredible doula community. We connect. We bond over birth stories. We back each other up and support each other in countless ways. We keep each other going when it’s really tough to be on call one more night, during one more important family day, or when we’re feeling undervalued and worn out. Doula sisters have brought me coffee,  arrived with food, watched my children, and covered for me when I needed to go home and nurse my baby. They are a constant reminder that it always works out. They have committed to births that weren’t theirs so that I could go out of town with my family or attend my daughter’s graduation. Sent me endless texts and checked on me in the middle of the night. As a whole I can say that we’ve stopped by the hospital to visit doula sisters during births – to pow wow in the hall and share some energy and positive thoughts. Checked in on other doulas’ clients across the hall when they haven’t been able to make it there to support a mom just yet. We’ve cried over the phone with our fella doulas in the parking lot, sometimes over beauty and sometimes over grief, and taking 5:00 am selfies together outside the hospital doors in the middle of January just to wake ourselves up. We have been a listening ear for frustrations and grievances that we can’t voice to our clients and we don’t want to take back home with us. We’ve been present with each other, soaking in the beautiful silence surrounding the miracles we bear witness to over and over. Countless rallies, picnics, and round table meetings with providers to help get hospital policies changed. Birth movies, Red Tents, community gatherings, pregnancy expos, literature reviews, classes, and conference travels together. Doulas believe in support, full circle. We live it.

Why birth work? “I do it, because nothing else… nothing else, compares to watching a woman move mountains with her own self, to watching her rise to a challenge and meet the moment with all she has, and that experience is only enhanced when she is supported by those who care for her, respect her, and want her to be empowered by the journey.” (The Yarn Harlot) Countless times we may ask ourselves this question, “Why birth work?” Listen quietly and you’ll hear the answer echoed above. Because nothing else compares.  It’s because birth work has been planted deep inside of each of us, and the vines that have grown from our labors and the labors of those whom we serve have stretched out and wrapped themselves around our hearts. Nothing else compares.

So today I celebrate the community of women who are fueled by this unique gift, and I celebrate the passion that breeds awe, happiness, mystery, and joy.  I celebrate doulas. “We are made to do this work, and it’s not easy… I would say that pain is part of the glory, and of the tremendous mystery of life. And that, if anything, it’s a kind of privilege to stand so close to such an incredible miracle.” (Quoted by Simone in Klasson, 2001)

Here is just a small glimpse of a few area birth workers, creating space and witnessing incredible miracles.

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Sometimes birth is just being present. Bearing witness.


As labor moves forward, this doula offers comforting touch and words of encouragement.


Doulas observe as  a mother is born, and share in her joy.

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This doula and mom have worked together before. There’s a quiet understanding as labor builds and the mother surrenders.

The role of a doula takes many forms. Labor support, one who helps bring understanding, and sometimes a photographer, capturing moments.


Immediate postpartum, this doula helps a family claim their golden hour.


Working together: creating  rhythm, relaxation, and ritual. The doula’s actions echo the writing on the wall.


All doulas learn, all the time. Here, two doulas train together.


A doula is the quiet whisper in a mother’s ear, reminding her to call on the inner strength that lies deeper and stronger still.

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Holding the mother’s space with her, calling out the birth warrior.


Doulas strive to work as a team with other birth workers, each with their own incredibly important role, in order to benefit the family as a whole.


Wisdom and peace from within this doula is being imparted to the mother, creating a circle of support.


Transition is never easy, in life or in birth, so this doula helps to steady and center this mother as she reaches out.


Doulas advocate and strive to provide evidence based information.


The circle around a mother that a doula helps to create provides a sounding space for a laboring woman – where she can call out, be heard, and keep moving forward.


Mothers need a resting place. A place where they can stay in the in-between, the vulnerable moments, and be.


And sometimes, no words are needed, just touch.

“Speak tenderly to them. Let there be kindness in your face, in your eyes, in your smile, in the warmth of your greeting. Always have a cheerful smile. Don’t only give your care, but give your heart as well.”  Mother Teresa

– Julia M. Sittig, MSW, AdvCD(DONA), BDT(DONA), LCCE

– Thank you to Kaela Ann Photography for many of these lovely birth images.

Know Your Options

“If you don’t know your options, you don’t have any.”


“If you don’t know your options, you don’t have any.” (Korte) One of our favorite quotes at BBC, and exactly where our name came from.  Knowing your choices is key.  Key to support, key to using your voice, key to walking towards the kind of birth you hope for, key.

In our childbirth classes, we review what we call the ‘Key Questions Card.’ It’s this little golden nugget that you can carry around in your back pocket, birthed out of trainings from Penny Simkin and DONA International, carried through Lamaze, Passion for Birth, and Birth Matters, and now it’s a BBC must have. Here’s what it says:

  • What is it?
  • How does it impact mom?
  • How does it impact baby?
  • Are there any natural things we can do first?
  • How long can we wait?

Now, first I want to say that this key questions card is not meant to question your doctor’s knowledge, experience, or training.  Of course their input is incredibly valuable, but sometimes their road and yours look different. The primary goal here is to be informed, and to make choices that put you on a mutual path.  So often, the leap of, ‘You don’t trust me’ is made before the bridge of, ‘Let’s talk about options’ is ever crossed. Find the bridge, walk it together early on in your pregnancy, and make sure you’re on the same path.

Think about it this way.  If you were talking with a well known car manufacturer and could ask any question you wanted about the vehicle that you were about to spend your life savings on, what would you ask?

  • How does it run?
  • What happens if I do this?
  • How was it made?
  • What’s the best way to keep it running well?
  • What kind of information can you give me about this?

Or, would you just drive it off the lot and never question at all?

You are seeking knowledge in order to make good, informed decisions about your investment.  You are the consumer.  You have choices.

So, when options about pregnancy and labor come along, and they will, ask. And ask early on – start this process now.  Be informed.  Get wise counsel, seek your care provider’s thoughts, weigh your options, and make your beautiful birth choices.


On a trip recently to the National Women’s Hall of Fame in Seneca Falls, I came across something surprising to me and maybe to some of you! Most of you have heard of the term “Apgar Score”, but what is it and where did it come from?

The APGAR score was developed in 1952 to help assess an infant at 1 minute and 5 minutes of age. The babe is given a score of 0, 1 or 2 on the 5 categories: Appearance (Skin Color/Complexion), Pulse rate, Grimace (Reflex Irritability), Activity (Muscle Tone) and Respiration (Breathing). Technically, a baby can get a perfect 10 (although sometimes there is a tendency of giving a 9 instead for superstition says a perfect 10 is asking for trouble).

Apgar scores are usually said out loud during those first vital minutes of life but usually the parents are, for some reason, distracted by their new beautiful baby or something, and the score goes unheard. When I am present as a doula, I always make sure I get those scores to later give to the parents because they are good to know. Be sure and ask what your babies scores are! I would assume (although not always best practice to assume things) that the babies care provider is given that information and I believe I have seen it charted in the computer at all the births so might be on the labor and delivery records from your care giver. Either way, just ask.

What I found interesting at the National Women’s Hall of Fame was that the APGAR score is not only a backronym (a backward acronym) to help remember what the 5 criteria, but was also the name of the women who created it.  Dr. Virginia Apgar was interested in birth defects and preventing them.  Because gestational age is directly related to an infant’s Apgar score, Apgar was one of the first at the March of Dimes to bring attention to the problem of premature birth, now one of the March of Dimes top priorities.

Apgar scores are being used now as a potential predictor in future learning disabilities.  That is one reason it is good to know what your child’s Apgar scores were, if situations arise later in life.

So shout out to you, Dr. Apgar, for helping us understand the immediate and future health of our children a bit better!


I love birth!

I Love Birth!  Sometimes I just have to shout it out for the world to hear (or – just our limited circle of bloggers, but hey…) – I Love Birth!

Last week I had the privilege of attending a wonderful, natural, normal birth.  This was the birth of a beautiful baby girl, whose mama happens to be a friend.  But I wasn’t the only support person – oh, no.  This mama was supported by a terrific husband who never left her side.  But it wasn’t just the two of us laboring with mama.  This mama was supported by a very close friend, who had also been present at her first birth.  But, no, that isn’t the end either.  This mama was also supported by another good friend who offered to be present for encouragement and help.  And do you know?  This mama kept all of us busy, all of the time.

At one point, I do believe that I had tears of joy in my eyes at the sight we made.  One of those surreal moments when you look down on the scene from somewhere outside of yourself.  Mama was in the tub, gently rocking and sounding through each surge as her body made way for this new little one.  Dad sat at the end of the tub, offering his support through gentle words of encouragement and his near presence.  I was next in line, scooping up warm water with a basin and gently pouring it back and forth across mama’s belly with a rhythmic motion.  One friend held her hand and kept cool cloths on mama’s head, and another began a soothing reading about gentle birth choices in a dreamy, sing-song voice.  It was inspiring.

No matter what else took place during the course of that mama’s labor, that moment was normal, natural birth and it was unforgettable.

I love my job.

Birthdays…A Rite of Transition

What is a Birthday, anyway?  Wikipedia tells us that, “Birthday is the name given to the date of the anniversary of the day of a person’s birth… Birthdays are traditionally marked by celebrations including a birthday party or, in some particular cases, a rite of transition.”

When our children are born, they are not the only ones to experience a Birth Day.  We, as adults, enter our own rite of transition on this special day… we become parents.  Somehow our hearts grow bigger, our days grow more full, our minds grow busy with the anticipation of what lies ahead, and our lives are forever touched by something so small and precious.  Time seems to stop for one amazing moment.

Someone once said that birth is like having your heart step outside your body and walk around in the world on its’ own two feet.  Happy Birthday, Heart.

Our own Christy Muscato celebrates her Birth Day this weekend… Happy Birthday, Friend – I’m so glad you were born!