Did you know that perinatal mood and anxiety disorders are more common than gestational diabetes—yet we screen for them less often?

When you become a parent, you want to feel calm and confident, but that’s often harder than you expect. Obstacles can get in the way, and unprepared parents may feel overwhelmed. While your moods may fluctuate, your overall happiness level is like a muscle: it gets weaker or stronger over time. If you ignore symptoms of depression or anxiety and hope that the problem will go away, you are likely to find yourself feeling more depressed and anxious.

The Gottman Bringing Baby Home workshop prepares expectant and new parents for the excitements and challenges they’ll likely face. If you get the support you need, while building habits that feel good and are not too easy and not too hard, you are likely to get happier over time. And when you do things that you enjoy the pleasure pathways in your brain grow stronger!

Check out this article that I wrote for the Gottman blog. In it, I (a Gottman Bringing Baby Home educator and trainer) share mood enhancing strategies that parents learn in the Bringing Baby Home workshop.

Nesting Parties - The Coolest New Trend in Parenting Preparation

Nesting Parties - The Coolest New Trend in Parenting Preparation

What’s the difference between a baby shower and a nesting party?

A baby shower focuses on the baby. It focuses on STUFF. Some stuff is good and useful — a baby needs a place to sleep, a car seat, some clothes, a few bottles or boppies or burp cloths. But if you end up with too much stuff, you just have to sort it out and manage it and find a way to give it away later. If you're a first time mom, you may really want —or need — to have a baby shower. Just be aware that you might not need twenty adorable onesies or a dozen stuffed animals, and the money spent on those items might be better spent elsewhere (see ideas in the downloadable PDF below).

"I wish I would have ‘said no thank you’ to so many given clothes, and put less on my registry... I got sucked up into needing all the things... I only use about 20% of what we got. It was a lot of work to donate, and return things after the baby arrived." E.B.

"I wish they'd put all the money they wasted on toys and fancy baby clothes into a cleaning service once a week. And food we actually wanted to eat (instead of what they cooked)."

On the other hand, a nesting party is focused on preparing the home and the family. Close friends can come to help deep clean the house or prepare meals. Co-workers or distant relatives can contribute gift certificates or money towards house cleaning or pet-care services, restaurants or meal- delivery, or doulas or mother’s helpers. A nesting party focuses on providing you with the support you need to have more snuggle time with your baby and more "me" time to take a long hot shower or get in a nap after your baby is born.

"Planning a nesting party opens the conversation of what a family's needs will be after birth and how people can help out. You need that support whether it's your first baby or your fifth!... It allows the guests to feel like they really made a difference." (Instead of Baby Showers, Expecting Moms are Throwing Nesting Parties)

Remember that the goal of a Nesting Party is to set up a family for success after their baby is born. This can be a new concept for both expectant parents and guests. So take the time to think about how you want to reframe the traditional baby shower into its modern-day version.

“I wish I had thought more about the support I would need after baby was born. I hardly knew what I needed, but I just knew I needed SOMETHING...” says Laura Baker, pregnancy/newborn photographer.

Now go have fun planning for your amazing postpartum time, and the Nesting Party that will help you achieve it! And if your friends can’t help themselves and still give you a cute onesie, oh well...

3 Steps to Nesting Party Success

1. Download my free PDF by entering your name and email address below. Within the next few minutes, you will receive an email containing the link to download your free PDF to get started having your own nesting party today!

2. For personalized support to plan your nesting party, schedule a free 30 minute nesting party planning call.

3. Plan a party that sets your family up for success, with more support, less stuff, and less stress!

*This PDF contains affiliate links. That means that if you make a purchase after clicking on a link I may earn a small commission at no extra cost to you.

Related Content

Posts Related to Pregnancy

Boosting Immunity for Babies and Parents (especially useful for exclusively breastfeeding mothers!)

Boosting Immunity for Babies and Parents (especially useful for exclusively breastfeeding mothers!)

Recently several people have asked for strategies that can boost the immune system for an exclusively breastfeeding mothers. Moms who are breastfeeding have to be so careful of what they put into their bodies and what they pass on to their babies.

So what's my answer? Interestingly, the research (as shown here: https://www.youtube.com/watch?v=625t8Rr9o6o) shows that contempt and criticism erode the immune system. So one of the best things that any new parent can do to boost their immune system and protect their baby is to WORK ON THEIR MARRIAGE! Strange, isn't it?

One of the best ways to work on our marriages as a new parent is to take the Gottman Bringing Baby Home program. It's research based and research tested to:

• increase relationship satisfaction;

• increase language and cognitive scores in babies;

• help babies to cry less and smile more;

• and to reduce the incidence and severity of perinatal mood and anxiety disorders.

It has NO negative side effects! It leaves you feeling empowered, knowing how to handle conflict and to strengthen your friendship so that your relationship can weather the storms of life. And it boosts your immune system by reducing criticism, contempt, and hostility.

Interested in a class? Let’s talk about it!

It makes a great gift for the expecting and new parents in your life! Gift certificates are available here or put the class on your registry at Be Her Village.

Why have a birth doula?

Why have a birth doula? An interview with Rebeca Martin, birth photography & doula services

What impact do you think that having a birth doula had on you as a mother?

My labor was really hard, and my doula was the thing that got me through.  I tried to escape. I didn't want to do it and the moment it got real, I was like, I'm just going to go over here. And I just didn't... I tried to literally climb out of my body. I didn't want to participate. And so she just helped keep me present enough to get the work done, but not be super traumatized. So I mean, birth can be traumatizing even if it's an ideal birth. And with her, she just kept it present, she let me know that everything was okay, she helped get maneuvers for my body so that my baby could reposition himself. And it was really, really good and then, she gave me the tough love when I really needed it the most, when I was just refusing to cooperate with everyone. And then she just let me know "You're getting in the shower now or". No, she didn't say "Or else you're going to transfer", of course she didn't say that at the time, but that was what was happening. So I did, and then he was born, it's what needed to happen. And so it was really, really valuable. I can't even... She was just the best, I can't even put a price on it. She was so good.

Why do you think a new parent would want to have a birth doula at their birth? 

Someone who is trained in repositioning your body to help the baby reposition inside is really, really valuable because sometimes all you need is to get in a different position. And when you're going from moment to moment, breath to breath, and you're in labor land, it's really hard to think about that stuff. And especially if your partner is so overwhelmed with the experience that they can't... It's almost like they're in labor land as well. And so, to have someone who's emotionally detached enough and has a skillset and awareness enough to be able to understand which position to go to next, is really, really important. And, then it just... Having that second or that third other brain there, allows you to really just get into the zone and not have to think as much. It's like you release, you're allowed, at least for me, I'm allowed to surrender without worrying.  And when the worrying is gone, it really makes a big difference in how I’m able to relax and just allow the process to happen.  Because it's so hard to explain to someone who hasn't been through labor, what labor is like. And so you might have an idea, but until you get there, you have no clue. And then for each person it's different too, so you actually really don't know what to expect. You don't know if it's going to be something that you don't feel until you're eight centimeters or something that you feel very strongly at one. And so, it can be really helpful to have those extra pair of hands to help give you some comfort while you're going through the whole thing.

How would new parents find a birth doula who is a good fit for them?

Interviewing, interviewing. You go to the main birth... there are some websites that have a lot of different people listed, birth resources. And you go, and you just... One after the other call and interview, you can meet in person. Whatever resonates with you, really, it's just what feels right for you in that situation.

What other reasons would someone use a birth doula?

Anxiety. If you have high anxiety, if you feel the need to have to have a lot of control, having that extra person there can help you just relax and just let go, and surrender. Guidance, especially for your partner, if you want your partner to be involved, but they don't know what to do, the doula can really help bring you guys together and can show things that the partner can, you guys make that connection. Because sometimes I've heard, where there's a bit of dissatisfaction because they didn't feel like... the laboring woman didn't feel like she was as supported as she had in her mind during the labor from her partner. And so having that extra help to show the partner what to do can really, really help a lot.

Do you have thoughts on how a birth doula can be supportive of the partner?

Instead of doing the movements and the comfort measures that you know in your mind as a doula, instead of doing them yourself, you can show the partner how to do them themselves, to their birthing partner so that they can do it every time and feel like they're making a huge difference. And then also, you can bring them around and be near the face. It just really depends on what the situation calls for, but you can recommend things, especially beforehand, having prenatals helps to talk about that stuff before the birth. But even if you're jumping in right in the moment, it helps to just not have them feel kind of like a deer in the headlights sometimes, it can happen.

What do you think the impact is on a partner when there's a doula present?

I think it calms them, they don't feel so much like a fish out of water. And they feel it helps to give them things to do, a task, a job, feeling like they're useful, they're helpful. I remember my dad, still today, says that when my mom was in labor, he wanted to be able to help her by giving birth himself so that she didn't have to do it, but there just wasn't many things for him to do.

Why would someone want a birth photographer at their birth?

For my first birth, I needed it to be very, very private and I didn't want pictures, I didn't want video. I didn't even think of video, but I didn't want pictures and it just had to be very private. So I have a very few, very fuzzy pictures from someone's phone, which I cherish so much. And even with my second, I wanted it to be private, but it was less of a concern, but still no pictures. And the few pictures I have I'm like, oh gosh, I totally could have done so many more. Like I just wish now that my kids are older, I want to show them what it was like for them to be born. And so I wish I had a video and photos. I would love to share with them their birth, and I [inaudible 00:13:28] see my birth if that... well, when my mom was giving birth, oh it would just be so special. And so I really, really like being able to provide that for others because later on just having that, because you can't ever go back and get it. So having that is just so, so special to be able to share it. You don't ever have to share it, but just having the option is really nice.

When you are at a birth, are you both the doula and the photographer? Or one or the other?

I do both. But during our prenatal appointments we have discussions on which is more important if certain situations arise. Do I put down the camera and give doula support or do I take a step back and pick up the camera? So it just depends on the birthing mom which part takes priority in those situations?

How do people find you?

https://www.placerbirthconnection.com/members 

https://www.nbbirth.com 

https://www.facebook.com/NBbirth/ 

Creating a warm, caring environment for a new baby

Creating a warm, caring environment for a new baby

The dream:

As new parents, you hope that life with your baby will be exciting - a fun, new adventure and a chance to get to know a new member of your family.  You want to create a warm, nurturing home for your children. You want time and space and support to bond with your baby. You want a peaceful postpartum. You want to instill positive values in your children. And if you have a partner, you want your relationship to be happy and connected.  Ultimately, you want to raise a kind, positive human being that contributes to society when they are older.  

The challenge:

Bringing a new member into the family is exciting and wonderful.  It’s also challenging, stressful and can increase hostility between partners and even with extended family and friends. The dynamics of the new addition changes everyone’s lives and everyone is affected. Your identity changes. You shift from being a couple to being a family. You take on the identity of “mother” or “father” or “parent”, and you even deal with your parents as they take on the title of “grandparent” (whether for the first time or not). And if you have other children, they have to adjust to sharing their parents’ attention, affection, and time.   

It is critical that new parents feel nurtured and supported, so that they can nurture and support their babies. Knowing that they are loved and safe is a crucial foundation for babies’ learning and development.  

The solution:  

There are 3 types of support that new families need to thrive:  physical support, relationship tools, and financial support. 

1. Physical support 

In a perfect world, every birthing family would receive three kinds of physical support: a birth doula, a postpartum doula, and a pelvic floor physical therapist. Here’s why.

BIRTH DOULAS

A birth doula provides physical, informational, and emotional support during labor. They help birthing parents with comfort, suggestions, reassurance, and advocacy. Doulas may provide massage, relaxation techniques, and other types of emotional and physical support their clients need. And birth doulas can help partners to know what to expect during labor, as well as how they can best support the birthing parent.  

According to Evidence Based Birth, “Overall, people who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans. In addition, their labors were shorter… and their babies were less likely to have low Apgar scores at birth. There is a smaller amount of evidence that doula support in labor can lower postpartum depression in mothers. There is no evidence for negative consequences to continuous labor support.”  

During COVID, some birth doulas have worked completely virtually. Other birth doulas have supported families in person in their homes until it was time to go to the hospital and then switch to a virtual model if needed after that. Gemma Mrizo, at Doula Gemma says, “For me, …I think that the virtual model completely works. … I think every woman should still have a doula… The doula and the remote model almost feels like that's your expert to call when it's hitting the fan and you're panicking. And I think a lot of people like that, that they have somebody to back them up if they need it. And then if they don't, they're cool.”.

POSTPARTUM DOULAS

A postpartum doula’s role is to support you to get your needs met as a new parent, whether that is taking care of the baby so that you can get a nap or snuggle with your partner for a few minutes, getting you a warm bath to soak your feet as you feed your baby, pulling up a good breastfeeding meditation on YouTube, or making sure that your water bottle stays full.  Postpartum doulas also provide a listening ear as you process your birth experience and learn to be a parent.  A postpartum doula will encourage and support you in gaining confidence as a parent.  DONA, one of the agencies that certifies doulas, says that a postpartum doula’s job is to be NEAR: nurturing, educating, assessing, and referring to additional resources.

PELVIC FLOOR PHYSICAL THERAPY

Pelvic floor physical therapy can decrease your chance of injury and help new birthing parents to heal after birth. “I recommend a visit with a pelvic physical therapist before or during pregnancy week 30. [Parents] need to start doing the exercises I prescribe daily 6-8 weeks before delivery for them to get maximum benefit.” Dr. Romy Havard of Peregrine Physical Therapy.

Julie Kwong of LadyBits PT puts it this way, “"Why wouldn't you (see a pelvic floor physical therapist)?" You've been through so much. This is the least you deserve--to heal after birth, be put back together. It's the very least you deserve.” 

2. Relationship tools 

During pregnancy, most couples don’t know what to expect and don’t know what important conversations to have. As a result, they often feel resentful when their expectations don’t match with reality after the baby arrives. That’s why I love to teach the Gottman Bringing Baby Home program to expectant and new parents.

Bringing Baby Home educators give parents the tools that they need to express their needs clearly and respectfully, using research-based tools included in the Gottman Bringing Baby Home program.

 Not only is the Gottman Bringing Baby Home program research-based, it’s also research-tested to increase relationship satisfaction. Babies of parents who have taken the class have been shown to cry less, smile more, and develop higher language and cognitive scores at one year of age than babies of parents who did not take the class. And that’s what new parents want!

3. Financial support

You probably noticed that the support options above are expensive. There are a few insurance companies that will cover a birth doula but most insurance companies don’t.  What if we can get the support that we need anyway?  

Some hospitals have volunteer doula programs for doulas who are in the process of getting their certification, or want to donate their time. Ask the hospital where you are birthing if they have a doula program, and encourage them to develop one if they don’t.  

Your friends and family can help support you.  Let’s change the way that we do baby showers! Instead of receiving a zillion newborn onesies that will never be used, you can ask for a nesting party, where your close family and friends come over to help you to cook and clean and prepare your home for your baby.

You can also use a registry such as behervillage.com to ask for the specific support that you need to thrive.  Be Her Village is a gift registry for services, not stuff.  Expectant and new parents can register for either physical support, such as a birth doula, postpartum doula, or pelvic floor physical therapist, or relationship support such as a Gottman Bringing Baby Home class.

So now what?

You want to create a family that is safe, healthy, calm, and strong. Don’t be under-prepared for the amount of support that you will need.  Start your journey to parenting with the knowledge, skills, and confidence to do just that.  

Let’s chat about how things are going so far and how I can support you!

Support for c-section scars

Support for c-section scars

This week I spoke with Dr. Hannah Flammang about C-section scars.  We talked about self care and things that we can do to help with recovery and healing after a c-section.

Dr. Hannah is a local chiropractor.  She is opening her practice in Rocklin, but she does a lot more than just chiropractic.  She really likes to work with women’s health patients, specifically in the prenatal and postpartum periods.  C-sections are one of her favorites because she thinks it’s a very underserved population.  You get sent home with pretty much no instructions other than: “don’t lift 20 pounds; watch your scar; make sure that it doesn’t have an infection; come back and see me in 6 weeks.”  Then they clear you and say you’re good to go.  

What are some of the challenges that people have with C-section scars?

Dr. Hannah: A lot of times people want to work on them because they’re experiencing symptoms.  They may have numbness in the area of the c-section scar.  They may have hypersensitivity where you feel like you can’t put on underwear or wear jeans on that area because it’s just so sensitive to touch.  Basically, you’ll have trouble connecting to those lower abdominals because things have been cut and moved around.  Someone may come in to work on core work because they may have what we call shelfing: where the scar starts to develop a shelf and above the scar starts to fold over.  That can definitely be helped by doing some scar mobilization and working on the area.  So when patients come in to me for c-section scar work, it’s normally numbness; hypersensitivity and not being able to wear clothes, or things that are too tight or rub on that area, and having trouble with the abdominal region. That goes hand in hand with diastasis recti, which is the separation that can occur during pregnancy and postpartum.  That can be heightened with a c-section because those muscles have actually been cut through and then stitched back together.  

What are some of the first things we think about healing after a c-section?

Dr. Hannah:  Other than the baby and breastfeeding, this is a major abdominal surgery that unfortunately the medical system doesn’t really treat like a major surgery.  I do a lot of sports rehab work as well, so I see people that have had ACL tears or they’re having rotator cuff repair on the shoulder, and they are given pre-hab (pre-rehab) to their surgery, and then they’re set up immediately with a physical therapist afterwards.  I wish that c-sections were dealt with in the same manner, because it is a massive surgery.  

So I’d say that the initial period should really just be around healing.  I won’t work on anyone’s c-section scar, and I don’t recommend that anyone does any scar mobilization, if they are prior to six weeks postpartum.  So if you’re in that zero to six weeks and you haven’t gone back for your six-week checkup, if your sutures haven’t healed or if you’re having any infection, then we definitely don’t recommend any scar mobilization at that point.  

Once you’ve been cleared and there are no more stitches, then we can start to work on the tissues.  First I have to start with, I am not your doctor and this is not medical advice.  I highly recommend that you reach out to someone in your area, whether that’s me, or I can help you to find someone.  But some of these things you can do at home.  

So if you’re at least six weeks postpartum and you’ve got a nice scar, this is something to be proud of, not something to be embarrassed or hold a lot of fear around.  I find that c-section scars become very emotional because sometimes it was an emergency c-section or things didn’t go the way that you wanted.  You were planning for a natural birth, and it didn’t happen.  And when you end up with a c-section, it’s something to be proud of. You birthed your baby.  

Practical tips

Scar desensitization:

We’re going to start with something I call scar desensitization.  You’re going to use some things that you can find at home. I have an old makeup brush. It’s soft, not rough at all.  And I have a little hand towel.  C-sections cut through the superficial nerves that supply the sensation to the area, and it can give you all sorts of issues like numbness, tingling, and make that area hypersensitive to where you feel like you can’t put on leggings or jeans, and underwear rubs you.  It can be irritating all day long.  So with a healed scar and a clean makeup brush and a towel, we’re going to brush along the scar.  We’re just trying to get that area used to a new stimulus.  You can do it different ways.  You can do it side to side.  We can use the towel which is a bit rougher.  We’re not pushing super hard.  We’re not digging in with the towel.  We’re just getting the area used to different sensations.  If you have a pair of jeans that you can’t wear because of your scar, you can use that jean material just to get used to it.  This is something you an do for like 5 minutes a day before you go to bed, just getting it used to different sensations.  

Pulling

Another thing that I love to get patients to work on is scar pulling. We’re not yanking. All of this is super gentle.  We’re just going to pull in different directions. We’re just trying to get that scar to have mobility.  Scar tissue gets a bad rap. Everyone likes to blame all their issues on scar tissue. But scar tissue is super useful because it heals things, and brings you back together.  As we pull, we are working on getting all those layers mobilized that were cut through.  In a c-section they cut through about seven layers: 1. Skin 2. Fat 3. Rectus sheath (fascia) 4. Separation of the rectus abdominis muscles 5. Parietal peritoneum 6. Loose peritoneum 7. Uterus.  You may feel that one side feels tighter than the other, and that’s okay.  That’s really normal.  

Rolling

Another thing we can do is called skin rolling. That looks like grabbing your skin.  And we just want to remind you that everyone has belly fat.  That’s normal.  We’re going to grab the skin around the c-section scar.  If it’s too tender to do over the top of it, we can go either above it or below it.  We grab some of the skin and gently pull it and roll it.  You can roll slowly over the scar.  Most people will find that the edges of the scar have what feels like little knots in them.  That is scar tissue from the healing, which is important.  But you can use skin rolling to move those around and mobilize them.  It may be a little uncomfortable, but it shouldn’t be super painful.  If we’re pushing 6 out of 10 pain level then we’re either doing it wrong or there’s something else going on.  You can even grab it and go sideways.  

Massage

The next step would be to go even a little bit deeper, so I normally recommend that people do this while on their back.  It’s great to do at night before you go to bed.  We’re going to massage with gentle circles, trying to get things to move a little bit better.  You’ll notice again that once side is typically more tender than the other. You may have more of those feelings of scar tissue on one side more than the other side.  I’d suggest just 5-10 minutes every day.  

Belly Breathing

Belly breathing is something you can do starting in the first few weeks postpartum.  It has nothing to do with the incision itself, and we’re not doing any scar work, so you can do this in the first weeks postpartum whether you have a vaginal delivery or a c-section delivery.

There’s no right or wrong way to breathe, but one I like to work on with postpartum moms is working on getting our breath lower into the abdomen.  This is easiest to lie on your back on a hard surface like the ground.  When we take a deep breath in, I want everyone to see where their breath goes.  You can have a hand on the chest and a hand on the belly if that’s helpful.  We are going to take a deep breath in, and then let it all the way out.  A lot of us are chest breathers, which is not a bad thing, but ideally we’re going to work on getting our breath lower in the abdomen so that we would consider ourselves more belly breathers than chest breathers.  If you’re going to start to work on core strengthening, having your breath down low into your abdomen and using that to your advantage is huge.  

To practice belly breathing, it’s easiest to be on your back.  Put both hands on either side of your abdomen with your fingers on the side so that you can feel both sides of your abdomen.  We’re going to take a big breath in, and we’re going to expand all the way around rather than just pushing the belly out.  We’re trying to breathe into the outsides and into the back as well, trying to get that breath a little bit lower, helping to expand the area and bring awareness to it after a c-section or abdominal surgery.  

Core exercise example

A really good core exercise to work on postpartum is just bringing the legs up into a 90 degree position.  We’re going to make sure that the back is flat on the floor, and we want our hips to be as bent as they need to be to help flatten the back so that we aren’t arching.  We’re keeping our ribs down and ducked. And as we work on breathing into the abdomen, it’s a bit more challenging but it’s helpful to have the legs out because now you have something to push against.  We’re going to breathe nice and low into the abdomen.  Then we will slowly bring our feet down one at a time into a heel tap.  

Lara’s note: this is good to teach our kids too!  Common and Colbie Collait and Elmo have a cute song about belly breathing that you can check out on YouTube.

Hannah’s response:  If you have a baby under the age of 2, watch them breathe. They are expert breathers.  As life goes on and we get to school, we sit more often, we have more stress, and our breathing patterns start to change.  If you watch babies, they are amazing belly breathers.  

Cupping

In the clinic I also use a lot of cupping.  I use the little silicone cups.  It is similar to scar rolling, where we are pulling up on the tissue. The cup is just a way to do that without having to use your hands, and it can get into smaller areas where it’s really hard to pull on the skin.  You can use the cups to get the fascia moving better underneath the scar.  

How to find Dr. Hannah:

The website may not be up and running yet, but it will eventually be craftedhealthco.com.  You can find Dr. Hannah on Instagram at @craftedhealthco.  You can email me at Hannah@craftedhealthco.com.  If you have a c-section scar or postpartum rehab that you would like help with, please reach out to Dr. Hannah.  

Fear of childbirth

Fear of childbirth

An interview with Karen Rothstein of Sacramento Hypnobirthing

This video is available on Instagram here.

Fear

Sometimes moms will think they have fear, and what they really have is just a little bit of worry and a little bit of anxiety. This (technology changes going Live on Instagram) was fear for me. My heart started racing; I started getting a little sweaty. I was getting ready to go into that fight or flight. And when you said, "Do you want to go later?" I was almost gonna go, "Yeah, that sounds like a really good idea." Oh, boy, that is just a perfect, perfect example of what real fear is for me--just having that visceral reaction.

A lot of women come to hypnobirthing because they are referred by their doula or their physician because they have fear. I don't get a lot of what they call primary fear people--people with tokophobia--that's really a fear of childbirth--because usually those people don't get pregnant. 

Distinguishing between worry, anxiety, and real fear

But what I do get is a lot of secondary fear people, and those are people that they may have had a birth trauma, or maybe they lost a pregnancy, and they have high anxiety, and they have real worries that this time it's going to be just a replay of what happened last time, so they get referred to us. We don't diagnose because we're not therapists or educators, but we need to do an assessment and see if they have worry, if they have anxiety, or if possibly they have real fear. When it comes down to real fear, I would say about 70-75% of women have real worry and anxiety. 

Worry

It's important to make a distinction, because a worry is something you can do something about. So here's an example of a worry. Your sister-in-law gives you her used car seat, and she paid a lot of money for it, but you're just not quite sure it is safe for your baby. You end up doing a lot of worrying about it, and you have double worry right? 

If you get a new car seat. You might risk offending.

If you don't get a new car seat, then every time you put your baby in that car seat, you're gonna have a little bit of angst.

A worry is something that you can do something about. You can bite the bullet. Tell her "thank you very much", and get the car seat that makes you feel comfortable. In the long run, that is going to be far healthier than worrying every time you have to put that baby in the car seat. 

Anxieties

The next thing we get are anxieties. Anxieties usually come up somewhere in pregnancy and it's most likely when you go in for one of those checkups and your doctor, or maybe the physician's assistant, or the nurse says something that you just really don't understand, but you're already a little anxious, or you have that white coat anxiety. You don't have a lot of resources in that moment to make decisions in the executive brain, so you don't ask for clarification. You go away from the room, and what happens to you? You just keep running the conversation over and over and over in your head. So by the time you get to me and you've been running that conversation for a while, it takes a little bit of practice to calm that nervous system down. So that's why we think, no matter how you're going to birth, one of the best things you can do is give yourself hypnobirthing education. Together, we start from the beginning, with little mini exercises that help you to calm your nervous system. I mean just breathing alone—that's what I was forgetting to do when I was trying to get on here. If I only stopped to calm my breath, I would have been able to change my whole physiology. But, you know, I didn't do that. Because all of that blood was going away from my brain. And it was getting ready to help me take flight.

Scary birth stories and what Lara calls “mood spread”

So Lara, have you ever sat in a scary movie and been really afraid?  That’s what we call a movie trance.  Even though you knew that wasn’t real, you still had that reaction, right? Where you started breathing a little heavier, perhaps your heart started beating faster.  The subconscious mind doesn't know the difference between what's real and imagined. Anxiety is really worrying on steroids.  So one of the things that happens when you have anxiety is that you keep replaying it in your mind, over and over and over gain.  And pretty soon your subconscious mind takes it as the truth. So you can have little fear or little worries stacking up, and then what it turns into is what I call scary fear. So even if you're not particularly fearful of birthing itself. You can start running your fear trance. That  takes the whole joy out of pregnancy. And well meaning friends, when you say that you’re going to do hypnobirthing or that you’re going to have a natural birth, they have to give you their advice. They go on to share their scary story, and that causes fear in you.  Or you attend a reveal party and you’re obviously pregnant. And so somebody strikes up a conversation with you, and then before you know it everybody is sharing their scary birth stories.  The people who are saying “I had the best birth experience…” those people usually remain silent.  

What can we do?

Breathing

So what we can do first thing is to harness our breath.  Any time you take a deep breath in and you take a longer breath out, you’re going to be calming your Vegas nerve.  We ask women to take a deep breath in to the count of four, have a pause, and then slowly let it out to the count of eight. Just a few breaths like that—as short as 30 seconds, 45 seconds—and you can change your whole physiology, calm your nervous system down. And you can go about your business. Sometimes you can come up with something brilliant to say.  Blood has not drained from you head, and you’ve stayed off the fight or flight treadmill.  

Counting breaths

Lara:  It gets me thinking about what works.  One of the things that worked well for me in labor was that my husband would hold up a certain number of fingers and I had to take that number of breaths.  

That's just really excellent because what that's doing is it's asking you to focus. You're changing your thought pattern as you focus on that and then you have to execute a task, which highlights a different part of the brain. And although women like to think that we can hold two thoughts at once, we really can’t. So that helps you to get down off that platform of fear and have your own focus, which is really important. 

Stroking & touch

And another thing that we teach that's really easy for people to do is to just stroke yourself softly, allowing yourself to feel this type of movement. It's really nice when your birthing companion does it but if they haven't gone into the appointment with you or if they're not standing there when somebody is telling you a scary birth story. Research shows that stroking your skin will do the same thing as taking those calm breaths. It soothes the nervous system. So just when I'm doing that I just kind of go into a light trance.

Yawning

The other thing that works is yawning and stretching out, because those are things that you do when you’re relaxed.  We are changing the physiology of the body. So if you force them, then you’re going to go into that relaxation response.

Breath breaks

We are so stressed as women. We have busy careers. At the time that we're getting pregnant, it's usually the time that many of us are trying to climb up that corporate ladder. Are we going to say no? No. So we have the stress of the looming deadlines, the stress of all of the hormones changing in our body, and we just don't take time to think "I deserve some self love, I deserve some relaxation." So that's one of the things that we stress in hypnobirthing is that every day you need to take breath breaks--five breath breaks a day where you are mindfully breathing. And then when you come home, you want to practice your self hypnosis, because that's gonna put you in that relaxation, what we call the healing room. Just allow yourself to be in that bliss state. And the more you practice going into that state, the easier it will be to get in that state, and the more natural it will feel. Right now our stress state feels natural. In fact, many of us don't know who we are without stress.  

Get started

Check out Sacramento Hypnobirthing and learn more.

A postpartum doula for dads

Recently I had the exciting opportunity to interview Juan Irby II. Juan is a postpartum doula for dads. Here’s an excerpt from our conversation together.

Juan, tell me a little bit about how you got started as a postpartum doula.

I am Juan Irby. I am a postpartum doula for dads and also for families. I'm located in the North Carolina area--the Charlotte/Concord area. I started my journey with my first son, my first child. I went through postpartum depression and anxiety. You know I was having those feelings, okay, I'm not getting enough sleep. Is he okay? My life is changing; my life is not normal anymore.

And as a man, we're taught, “Don't cry. You're okay. Man up.” Things like that. But it's okay for men to cry. It's okay for men to seek help. Seeking help does not mean being defeated at all. And so, when I looked at go seek help there was no help in my area.

So, years go by, a friend of ours came over for Memorial Day, and we started talking about being a postpartum doula. So, I looked into it. I signed up that the next month. And in June, I became a certified postpartum doula and my business is called From Dad to Dudla. So you can find me on Instagram at dadtodudla and my website is www.dad2dudla.com, and I provide services for families, for dads. If you just want to talk and have one-on-one connection, you can share your story; I can share my story. And we can just chat, and go from there. But, my background is in business.

How much do you work in person versus virtually?

So I haven't done any in person yet. I've just done more virtual. I've had a few clients in Seattle, and one in Arizona, and we talk on a weekly basis just to get to know each other and also for me to see where their head space is. I want to make sure that, as a dad that they are not being forgotten in the fourth trimester, and because most dads are forgotten either in the birth or after birth, and I want to make sure that they are not forgotten because they play a great role in their child's life.

What are some of the challenges that dads often face?

Some of the challenges that I've seen, were dads being afraid of not having that one on one bonding time with their child or children. And what I would totally recommend is skin to skin contact. Skin to skin contact is very important within these first few hours of the child's life. And because having skin to skin contact is having your child listen to your heartbeat so it's going to regulate you and also going to regulate your child. It's going to catch on to your hormones, and it's going to calm you down, and also going to calm your child down as well. And just having that skin to skin contact is also going to regulate your child's temperature as well. So just making sure that that contact is there, that's going to start the bond of you and your child and you can do it from an hour, two hours, three hours, as long as you want to.

I love that so much. What else do you like to focus on when you're working with families?

What I like to focus on is the mental health of mom, dad, brother, sister, and everybody that want to be involved in that family. I know most people don't talk about it but I like to prepare a postpartum plan. And by having a postpartum plan, that lets you know, okay, who is going to be allowed to come into my house? Who's going to be allowed to touch my child or children? Who can, you know, do this and do that? And by having that plan and posting it on the refrigerator, or whatever, that gives them, Okay, this is what we need to do. If a baby is crying, okay, why is the baby crying? Is it hungry? Does it need to be changed? And just making sure that all of those options are there on that plan, so that mom can know, dad can know, because we have a lot of first time parents, and they really don't know how to do those things or how to change the diaper how to babywear, and I'm a huge fan of babywearing also.

Do you have any tips about babywearing?

I love the Moby Wrap classic. It's a large sheet of fabric. And I would use that for my skin that skin. So I will take off my shirt, wrap my son up in the Moby wrap, And he will be up against my chest, and also allowed me to get housework done, because he would fall asleep in the Moby Wrap. So while he's still asleep I was able to get things done, and have a sense of normalcy, while he was sleeping. And there tons of wraps out there. You have the Moby Wrap. You have the Katan. There's so many out there and I do recommend babywearing as skin to skin contact. Or just open up your shirt, put him in a blanket and just hold him close.

Do you have any favorite resources that you like to tell parents about?

I do actually, I like to tell people about Postpartum Support International, and being a PSI coordinator for dads. I like to recommend dads to come to the support groups that we have at Postpartum Support International. And they can share their story. They don't have to talk. But if they choose to talk, it's a group of men in there who share their stories. We come together. We have a whatsapp outside of the meeting that we have every month. And so, we check on each other. We say hey, has anybody gone through this yet? Or has anyone tried this? Or has anyone tried that? And that's how we as dads can communicate amongst ourselves. And so that way we can support each other, even though we may not be there in person. We can be there to support them and give them advice via that app.

How would somebody find that and get involved in Postpartum Support International?

So you would go to www.postpartum.net and or just type in Postpartum Support International, and there are a ton of resources on there from therapists to doctors to doulas to postpartum doulas, and there are coordinators that help you find someone located in your area with PSI.

How did you get started being a coordinator with Postpartum Support International?

I was in a doula group on Facebook, and someone reached out to me and said, I think you would be a good fit for this right here. So I did some research on being a PSI coordinator, and I emailed the manager. I was like hey, I would love to do this. My name is Juan Irby. I'm a postpartum doula for dads. I specialize in dads. I want to make sure that they're okay. If I need to lead a support group I can, and go from there. And so she emailed me back and was like, I love this. This is fantastic. I really need you on board ASAP. So, I went through the training, and I am now a PSI coordinator, specialized for dads, and we have a dad Zoom call. It's once a month right now, but we're gonna open it up to maybe once or twice or maybe three times a month. So dads can come in, express themselves and just get things off their chest, and we also have a support group for moms as well. And we also have a support group for women of color, BIPOC, and everything else. Anything you could think of, PSI has it.

Do you have any thoughts on teamwork for new parents?

I do actually. I am a huge advocate for parenting as a team. I would suggest that before you bring the baby home or right when you know that you're pregnant, come up with a plan on who's going to be doing what at home.

Are you guys going to breastfeed or bottle feed? If you do bottle feed, who's going to clean the bottles? Who's going to prepare the bottles? Who's going to make sure that the bottles are sterilized? That plan needs to be put in place because it's okay if one person does it and it's okay if both people do it.

But if we have that plan already, then we can say, "Okay, I'm gonna go down here to warm up the bottle if you can go get the baby." Or, "if you can go and get the baby, I'll go take care of the bottle," and we can tackle this together. And if and when baby does poop or pee then dad can change the diaper while mom gets the bottle, or mom can change the diaper while dad cleans the bottle. Just having those small conversations about that can really benefit the whole entire team. Who's going to take the first shift? Who's going to take the night shift? Who's going to take the day shift? Who's going to take the nap time?

When the baby sleeps, everyone should sleep, and I truly truly recommend that if the baby's sleeping, you need to get some rest as well.

I will also suggest hiring a postpartum doula. Because, while the baby is sleeping, the doula could be doing some laundry. The doula could be preparing a meal or doing those small things that you normally do on a daily basis. Until you guys get back into a routine with this new person, we're going to hire someone to help us out to just do the things that we normally do, because mom just gave birth or just had a c-section, and can't do a lot of going up and down the stairs or walking or things like that.

Dad is here. Dad can go up and down the stairs. Dad can do the laundry. Dad can do this, but dad also needs to rest. Dad also has his own birthing experience. And dad also has his own birthing story. Mom has her birthing story and dad has his birthing story. So I think it's very important for those things to be talked, those things to be expressed to one another, because communication is a big factor when it comes to parenting. And you have to communicate with each other in order for these things to get done.

Have you heard of the Gottman Bringing Baby Home program?

Have you heard of the Gottman Institute and their Bringing Baby Home program? I think it would be like so right up your alley. So the Gottman Institute studied marriage for many years, and they found they can predict, divorce, with like 90-some% accuracy. And so then they studied what happens to marriages when a baby is born. And they found that two thirds of the couples they studied experienced significant amounts of hostility. They created the Bringing Baby Home program to help with that communication that you were talking about, and the teamwork and asking questions, similar to what you're saying about creating a plan around what you're going to do for feeding. There are all kinds of activities in there about what kind of plans you need to make together as a team, and managing conflict and building friendship and intimacy skills. It's one of my many favorite things I like to teach. It’s been a good tool in my toolbox. It has a whole section about why dads are important. In general, dads tend to be super playful, and that is one of their superpowers. The play and the soothing are both things that dads can be really great at. And that's really powerful for the relationship as a couple, and for equality and both parents feeling confident and capable. You’re so right up my alley that I feel like I could just keep talking. But I also was totally hear what you have to say, so anything else that you want to add or anything else that comes to mind, I just love everything that you've. I love your work and and all the stuff I want to thank you so much for being here even, I don't know how much you want to say about where you are right now but congratulations.

Thanks so much for sharing your story with us, Juan! I can’t wait to chat again soon!

Resources

Find Juan Irby on Instagram at dadtodudla and www.dad2dudla.com

www.postpartum.net

Find Bringing Baby Home at little-elf.org/bbh or The Gottman Institute

Watch Juan’s interview here: https://www.facebook.com/placerbirthconnection/videos/557183272376797

Interview with a pelvic floor physical therapist on having a baby during a pandemic

I have been interviewing parents and professionals about what it’s like to have a baby during the pandemic. Recently I interviewed Dr. Romy Havard (she/her) of Peregrine Physical Therapy. Dr. Havard provides the East Bay Area, CA with orthopedic, prenatal, postpartum, pelvic floor, and wellness services. She went to UC Berkeley for undergraduate and later attended the UCSF/SFSU Joint Graduate Program in Physical Therapy with MS and DPT degrees. She is also Board Certified in the Orthopedic Section (OCS).

While she uses a broad variety of skills, she is most influenced by the Institute of Physical Art and utilizes functional manual therapy for optimal efficiency. She is also enthusiastic to incorporate concepts from Herman Wallace in pelvic health and contribute to advocacy for postpartum, incontinence, and transgender care.

Here is what we talked about (all emphasis mine):

Me: What are some of the challenges that you have experienced serving families during the pandemic?

Dr. Havard:

For the past 6 months, a lot of the major hospitals have ceased doing in person care for the majority of prenatal appointments. Unless you have dire deliveries, even the one postpartum follow-up is done online with OBGYN. So women who are delivering have little to no before or after care according to ACOG (American College of Obstetricians and Gynecologists) standards. Normally you have all of your check-ups.  Everything except the ultrasound and the diabetes test is done online unless you have preeclampsia.  New moms are particularly isolated. Some are traumatized. Resources are few. Normally you would meet other moms in a mom group. They don’t have that extra help. They are wondering if their pain and lack of function are normal. I’ve been extraordinarily busy because I’m doing in-person visits. People are driving 45 minutes to see me because they could not be seen closer to home.  I often have women who cry through their appointments.  I have some days where half of my women are crying through their appointments.  

Two years ago ACOG had an article that they released about how postpartum care in the US is substandard.  That one appointment postpartum is not enough. But they didn’t really define what better care would be.  Pelvic physical therapy should be done with all our moms. And even that isn’t being done.  

Me: What are some of the frustrations that you have experienced serving families during the pandemic?

Dr. Havard:

I’m outside the electronic medical system. Smaller offices are easy. I fax them and they get back to me. If I think that this patient needs something specific, those offices are easy to deal with. But most of my patients come from giant Kaiser or giant Sutter. I write them. I fax them. It’s very hard to get them to get the patient what they need. I’m asking for things that are out of my scope of practice. Their lack of participation is alarming. These are things that I can’t do for them. Way more so during the pandemic. A lot of physicians doing Telehealth are doing it from home. If they are never going into the office. If no one is scanning notes and they can’t get to it… I’m not sure what is happening there. It’s even harder to contact doctors. I’m still in the medical system. I still need medical and surgical consultations from doctors. These people are already being seen by these people. I don’t know what’s going on over there. I don’t know if they have had a COVID breakout or what they are going through, but there’s only so many ways that I can send letters through.

Me: What are your fears for new parents at this time?

Dr. Havard:

I just don’t want something to be missed. In pelvic therapy, it’s not life or death, but there are issues around it that I worry that women not pursuing more medical care for things are going to make things worse later. I’m getting more severe diagnoses than I used to as well. I’m having more fecal incontinence patients than I used to and that’s alarming. They should be having consultations with colorectal surgeons, but these are considered non-essential services. I am worrying about their fecal incontinence long-term. I’m trying to be supportive and educate but not be triggering. I want moms to have all the tools, but I don’t want to say “and you need to do this now.” It’s easier when you are treating within a group of integrated professionals. I am not meant to be doing PT on my own with patients. They should be having medical support, nutritional support, GI support.

Me: What do you wish that new parents knew?

Dr. Havard:

New moms should seek care early and really consider preventative strategies. The more you can do to avoid more acute and serious issues, the better you will do and the more options you will have. Pelvic physical therapy is inseparable from the postpartum experience and should be part of postpartum care. Especially for moms who may not even get physicians to look at their pelvic tears. At 3 months, maybe you want to go back to having sex. At 6 months, you want to go back to running. 

… The women who are crying in my office are months from birth and they have been waiting for things to fix themselves. If they had started earlier, it would be a small thing. It wouldn’t interfere in their marriage. It wouldn’t make them start to wonder if they could have another kid.  There are lots of difficult thoughts. 

OBGYN postpartum just wants to make sure your cervix is closed, you’ve passed the placenta, that you don’t have infections, that you have contraception. They are not addressing the pelvic floor. If you are leaking at 6 weeks, that’s not normal. OBGYNs take care of general health, deliveries, general wellness, infection, venereal disease, contraception. Dealing with preventable testing like pap smears. They are not really treating leaking, prolapse, and pelvic pain issues.  Some of them are so helpful, quick to get back to patients.  

On one hand, just doing postpartum care is a little after the fact. Currently in the US and Britain 85% of women will have a perineal tear, 75% will require sutures.  I have one visit during pregnancy to decrease their chance of injury in delivery.  It’s not the same as childbirth education.  It’s just things that moms can do to decrease their injury. OBGYNs don’t necessarily work from the position of the mother ergonomics. It’s more about the baby. Working on the preventative side is great. I do recommend a visit with pelvic physical therapist before or during pregnancy week 30.  You need to start doing the exercises I prescribe daily easily 6-8 weeks before delivery for them to get maximal benefit.  I just had a mom who went through it and had no tearing. This is where we need to move - to not just care for tears postpartum.  In Australia a lot of people have a pelvic PT during labor so mom doesn’t get hurt.  Pelvic physical therapists in the United States don’t have hospital privileges to attend labor and delivery. The least I can do is to do education with moms about taking care of you to avoid tearing, prolapse, urine prolapse, etc.  and sometimes c-section.  

Me: If you were to look ahead to the future and everything amazing that you can imagine comes true, what would that look like?

Dr. Havard:

In Britain about 2 years ago they voted to add pelvic physical therapy to the standard of practice to be included in national health care.  Now even low and middle income women can have this as part of postpartum recovery.  Our mortality rate is equal to Mexico. A lot of the moms I see are also more into progressive prevention. I recommend if I was doing bare minimum for someone who is doing great otherwise is:

- one visit during second trimester in case you need a C-section or to minimize injury

- one visit at 6-8 weeks.

- Another visit ideally around 3-4 months. There’s a big hormonal shift then and a lot of women their repairs get worse at 3-4 months. 1 of 9 births will have a Hashimoto event.

- A visit around 6 months for women if they’re doing great. If they are fine with walking or jogging, a 6 month visit may be enough.

- For cross fit or heavy runners, another visit at 12 months as well.

I just want to send a big shout out to Dr. Havard and thank her for sharing her wisdom and experience. She serves in the East Bay in California. You can find her at https://peregrinept.org.