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  • 17 Oct 2019 2:23 PM | Michelle Deerheart (Administrator)

    Written by Stephanie Kieu.

    Dakota’s birth was immensely evolutionary and evocative. I birthed her into this world the way Mother Nature intended. No drugs. No bright lights. No institution. Peacefully. Intimately. Safely. This is my sacred rite of passage.

    This is my natural birth story.

    (Please note: I used Hypnobabies hypnobirthing techniques. I’ve been taught to use different vocabulary without negative connotation – “pressure waves” refers to contractions, and “birthing time” refers to labor)

    I was 9 days past my “guess date”, so I went to see my midwife Liz at 11 am on October 27, 2017, to get my progress checked. I was 3cm dilated, which surprised me because I hadn’t felt any pressure waves, only mild menstrual-like cramping. Knowing that my birthing time was near, I went home and practiced my hypnosis techniques.

    My water broke at 4:15 pm when I awoke from hypnosis. Things moved fairly quickly because I was in a relaxed environment. My doula Kelly arrived around 7 pm and I instantly felt soothed by her presence. She applied counter-pressure on my back and spoke to me in the most absolutely calming voice. Liz and her assistant Annette arrived around 8:30 pm.

    At 10:22 pm, I got in the tub as I could sense my transformation stage was near. With each pressure wave, I curved my back as if I was cradling my baby and Christopher poured warm water on the exposed parts of my back and belly, nurturing his creation from the outside dimension.

    As my pressure waves got stronger, I rooted myself deeper into hypnosis, yet I was still present in the moment. Passionately alive. Liberated by the ability to feel the magical life force inside me. I surrendered to the storm of sensations, letting the current take me back home. I knew that every vibration and every movement was bringing my baby closer to being in my arms.

    At this point, I had a fleeting thought that I would have to go to the hospital because my energy was so depleted. I looked at Kelly and told her how tired I was. “Sleep,” she gently whispered. So I did as she said, and I slept for 30 seconds in between each pressure wave.

    Progress slowed down as I experienced an anterior cervical lip complication, meaning the edge of my cervix was swollen and in the way of baby’s head. Liz assisted me through it and I reached full dilation at 3:32 am, but I still had difficulty crowning my baby in the tub.

    I looked over at my birthing team and saw how tired they were. I was trying to get this baby out as quickly as I could, but something was holding me back. Something didn’t feel right. Deep down to the marrow of my bones, I knew that I wasn’t meant to have a water birth.

    At 4:24 am, I followed my intuition and moved to the floor, and with unshakable strength, my baby started crowning. “Be brave,” said Liz. She gently guided my fingertips towards the top of my baby’s ethereal head. When I felt her bare skin blanketed by a sheet of purity, I drifted within myself and poured every ounce of love and light energy into the final moment of transcendence. I felt the release of pressure alchemizing the expansion of my soul in certainties and drowned in an ocean of divine bliss as tears cascaded down my face. “We did it, we did it.”

    Dakota was caught by her father on October 28, 2017 at 4:42am. This was the moment I transformed from maiden to mother. This was the moment I gave birth to my daughter. This was the moment I gave birth to my truest and highest self.

    Through the power of belief, I had the birth of my dreams. I didn’t tear (thanks to Liz for applying olive oil to my perineum), and I felt no pain during my birthing time (by putting myself under hypnosis). I honestly couldn’t have asked for a better first birth experience. I truly hope my story empowers other women to not fear childbirth, but to embrace it. Our bodies were made for this.

    Mother: Stephanie Kieu @steffykieu

  • 17 Oct 2019 2:14 PM | Michelle Deerheart (Administrator)

    By Michelle Deerheart, Co-Founder of Empowered Parenthood and Consultant Midwife.

    I asked a group of natural birth Mamas to name one thing they wished they knew about during pregnancy and labor/birth, here is what they came up with...plus a few I have added that many women are surprised about in my work as a midwife.  This is not an exhaustive list but hopefully, you will learn something! 

    Pregnancy hormones can sex you up….or down
    Your libido when pregnant can equally increase or decrease, both is ‘normal’ so don’t be hard on yourself.  And really good to have an open discussion about sex with your partner as some men struggle having sex with their pregnant partner for various reasons so good to get these concerns out in the open.  It can be difficult for a couple if their is a mismatch in libido, like if the woman’s libido increases during pregnant but the man doesn’t want to, the woman can feel super unattractive and vice versa so keep those communication channels open.

    Sensitive about your bump size - too big, too little
    Many women worry about the size of their bump and a lot of this worry comes from other people’s comments.  Helpful things to say to a pregnant woman:

    ‘What a lovely bump you have’

    That is all.

    Don’t really want to hear your negative birth story
    If you see a pregnant woman, don’t take it as an invitation to tell her your traumatic birth story - what happened to you was traumatic and you need to process it but don’t traumatise every other woman unless it is to empower her and give her advice about how to not have a traumatic birth.  I highly recommend talking to a therapist to help you process through it.

    You can start producing milk months before your baby is born
    You may or may not leak milk and neither is an indicator of breastfeeding success.  Looking into expressing and harvesting colostrum from 36-37 weeks for 10 minutes a day can be highly beneficial for your baby (reduces the need for other supplementation straight after birth) and your breastfeeding relationship (helps you get to know your breasts and how they work and also helps you keep the power in terms of feeding your baby).  You can learn how to express colostrum in our tutorial here.

    Shaving your tender bits for birth - don’t!
    I am not sure where this habit started but let’s reclaim the normality of body hair.  Aside from the logistics of shaving and pain if waxing, you really don’t want to be dealing with ingrown hairs or chafing with your stubble growing back when you have just had a baby.  Believe me, as a midwife, we are not looking at or judging your bush!

    Staying at home to labor as long as you can increase your chances of achieving a natural birthThere is a lot of research to support this, if you labor at home for as long as you possibly can then the chances of interventions and ending up in an instrumental or cesarean birth are greatly reduced.  There is no law to say when you have to go into hospital when you are in labor or if your waters have broken - it is only ‘recommendations’ by your care provider and YOU need to give your informed consent for anything to do with your pregnancy and birth - your health in general.  

    It is normal to get the shakes and or vomit during the later stages of labor
    As labor gets very intense, things can get overwhelming for your body and cause the shakes and nausea or even vomiting usually around 7cm to transition although some women can vomit earlier in labor too.  You can also get the shakes after your baby is born.

    Pooping during birth - don’t make it a thing
    Let’s talk about physiology for a moment - when your baby’s head enters and traverses through the birth canal it also pushes past your rectum.  And when you push your baby out whether it be involuntarily or purposefully, you are pushing with your pelvic floor.  This means you might poop.  And that is totally OK.  Midwives actually get excited when they see poop as it means the baby will be here soon!

    Ask for hot cloths on your perineum when you are pushing
    This practice helps soften the perineal tissue, research has shown it can reduce tearing and also helps reduce the burning feeling when baby is crowning.

    When you feel the ‘ring of fire’, JUST BREATHE
    Speaking of the burning feeling, you actually want to feel this for longer than you think you can cope with.  And when I say longer, I am talking minutes not hours!   The normal reaction to pain is to want it to stop, but if you can let baby’s head stretch your perineum gently and with a bit of time rather than blasting baby through to get rid of the pain, you will probably ‘save your ass’.

    If your baby is posterior, you can feel the urge to push before you are fully dilated/open
    This is physiology playing tricks on you, when your baby is posterior, the widest part of their head (diameter) puts pressure on your rectum prematurely (usually around the 8cm dilated mark) giving you the urge to push before you actually can.  This is hard for two reasons, one is that if you don’t know your baby is posterior and are being told to go with your body then you could start pushing at this point and cause swelling and edema to your cervix which can cause it to stall in dilation.  The other reason is mental, it is so so hard to ignore that urge to push as when you are able to push it is a huge relief and can actually feel amazing, so when you are told you can’t push if someone checks your cervix, it can be really difficult to hear and to ignore those urges until you are fully dilated.  So...it is much easier if you can ensure your baby is in the optimal position for labor prior to the event which we talk about a lot in our classes and also you can see this tutorial here about how to turn a posterior baby in labor using the Rebozo technique.

    Using your BRAIN for a better birth (Research, Inform, Relax)

    This message is two-fold, one using your actual brain - read, watch, research, do prenatal or childbirth education, if you are going to an Ob or Dr appointment, make sure you have a basic knowledge about what it is you are seeing them for.  And if a Dr quotes ‘research’ for you, ask for the link or name of study so you can read it yourself.  There are times when research or statistics may be misquoted whether it be on purpose to achieve compliance or not hence if you ask about the research they are quoting, you can read it for yourself.  Pregnancy and birth are normal life events, not medical emergencies, this does not mean they are without risk but these can be managed by experienced care providers.  It is riskier getting into your car every day.

    The other brain you should use is the BRAIN model, we talk about this in our classes too, if a situation is presented to you during your pregnancy, labor/birth, postpartum or with your newborn, ask yourself and your care provider these questions:

    Benefits - What are the benefits of this procedure or care they are advising?
    Risks - What are the risks?
    Alternatives - What are the alternatives?
    Intuition - What is your intuition telling you?
    Nothing - What would happen if we did nothing or waited a while?

    Just because someone has a medical degree does not mean you have to do everything they say - you have a voice, use it.

    Have something to add? Leave your comments telling us things that surprised you about pregnancy and birth. Look out for ‘Things that may surprise you about after birth’ in our next post

  • 17 Oct 2019 1:56 PM | Michelle Deerheart (Administrator)

    By Michelle Deerheart, Co-Founder of Empowered Parenthood and Consultant Midwife.

    "Has the baby arrived yet?!"

    So, baby has not arrived yet, you are past your “estimated due date”. Statistics show approximately 90% of babies are born between 37 and 41 weeks gestation.  If you have told people your estimated due date (EDD), they may start pestering you as early as 37 or 38 weeks about whether you have had baby or not.  Some may even ask when you are ‘booked’ to have baby assuming you will have an induction or cesarean as this seems to be getting more and more common.  

    This is a really good reason to introduce, at the start of your pregnancy, a “due month” so this will hopefully buy you time and be less stressful at the end of your pregnancy.  For instance, if your EDD is 22 August then you might tell people you are due around mid-August to mid-September. Some may push you for the actual date but you can just remind them that the date is superfluous and baby will come when they are ready.

    Here some things to say to people, when baby is overdue... and people keep asking!

    “You will be one of the first to know”
    Tell people that you have made up a ‘birth notice’ group on your phone and you or your partner will send out a group text letting people know when baby has arrived and when it is OK to visit.

    “I am feeling calm and relaxed about baby coming when they are ready, please stop asking”
    This is letting people know that you are going with the flow and surrendering to the process - if you are not stressed, why should they be?

    “Believe me, I want to meet my baby as much as you obviously do, please be as patient as I am being, baby will come when they are ready!”
    This speaks for itself, I mean really, we are not going to be pregnant for 2 years like an elephant is, the baby is going to be born, stressing the Mama out is not going to do anyone any good.

    “I notice you are asking me regularly if baby is here, I will post on Facebook when baby is born so can you keep an eye on my page rather than texting or messaging me?”
    These days, births are generally announced on Facebook or other social media pretty quickly and so re-directing people to there will hopefully get them off your back! 

    “Thanks for asking if baby is here, nope, I am still pregnant but I am really enjoying everyone asking me if baby is here, as you can imagine!”
    Sometimes a spot of sarcasm is called for in these situations!

    And just for fun…

    “Oh didn’t you hear, I had the baby 3 weeks ago!”

    “I haven’t had the baby as I have signed up to be part of an experimental trial where women stay pregnant for 2 years to see if babies are as healthy as elephants when they are born.”

    Just remember, this is your journey and you may not necessarily be able to have much control over what people say to you but you can control how you let it affect you.  If people say something stupid to you during your pregnancy, whether it be about your size or when the baby is coming.  Stop.  Take a breath.  Or three.  Let the words zoom past you.  And repeat after me, “I am cool, calm and collected”, “I am staying calm for my baby”, “What other people say does not affect me - it is their stuff”.

  • 17 Oct 2019 1:14 PM | Michelle Deerheart (Administrator)

    By Michelle Deerheart, Co-Founder of Empowered Parenthood and Consultant Doula.

    The vital first few days of breastfeeding and the importance of the Mama and her support network in the success of it.

    How to start a successful breastfeeding journey

    First off, let me say, that how you choose to feed your baby is up to you.  Yes, research shows that it is most beneficial for a human infant to be fed with human milk whether it be their mothers or another mother’s (donor milk) and there are future health impacts on the infant if they are formula fed, BUT there are some physiological and mental health reasons that a woman may not be able to breastfeed.  We need to support mothers in their well informed choices.  We also need to support a woman to be successful in her breastfeeding journey if this is how she chooses to feed her baby.  

    This includes normalising breastfeeding – breastfeeding in public, letting children grow up seeing breastfeeding - friends, cousins, siblings, endeavouring to change societal perceptions of breastfeeding, and letting go of the construct that it’s ‘Breast is best’ versus ‘Fed is best’.  There are many arguments for and against both of these – as I said there are medical and emotional reasons a woman cannot or chooses not to breastfeed, what if it was normalised that she consider donor milk instead of formula so that her baby is fed with the same mammal’s milk.  What if donor milk was as easily accessible as formula.  Let’s not let the reasons a woman makes the choice not to breastfeed be surmountable with the right investigation and solution-oriented woman-centred approach.  Reasons like excruciating pain, recurrent mastitis, undiagnosed tongue and or lip ties, poor postnatal care/support or family/societal pressure.

    Picture this:  A woman has just birthed her first baby hours prior and has been transferred to the postnatal ward.  She is exhausted from being in labour all night.  She ended up with an episiotomy and a ventouse delivery.  Her partner has had to leave as it’s not OK he stays the night.  Every muscle in her body is aching, her bottom is raw and swollen.  Her heart is full of a newfound love, she is more tired than she has ever been in her whole life, her mind is a whirlwind of thoughts, good and bad, her baby is screaming and the care provider on duty has just come in and said ‘Your baby is starving, I will need to express some milk off for him, has anyone shown you how to hand express?  Here, it will just be quicker if I do it, is that OK?’.  

    The woman had not done hand expressing before and as can be normal for the first few times, no colostrum is able to be expressed.  The care provider then tells the woman she does not have enough milk and suggests because the baby is so unsettled that it would be best if the baby had some formula.  This does a few things – firstly, it leads the mother to believe that she can’t and or won’t make enough milk for her baby; secondly, it takes away the mother’s autonomy around feeding and nurturing her baby.

    Antenatal Milk Expression (AME)

    This is the practice of hand expressing, collecting and freezing colostrum in the antenatal period for use in the first few days post birth (and if you have some leftover leave it frozen as it is amazing to give your kids to help recover from sickness!).  Research shows that women between 36-39 weeks that antenatally express no more than twice a day for no longer than 10 minutes at a time were at no higher risk of pre-term birth and their babies, if they had hypoglycaemia, were less likely to receive formula supplementation.  Given research that giving a baby formula puts it at risk of developing diabetes, metabolic and immune disorders in the future, it may be important to endeavour not to give babies formula unless absolutely necessary.

    Empowering yourself with the knowledge of how to hand express can give you confidence of how your breasts work, give you colostrum to be able to give your baby in the first few days (if needed) while your milk supply is establishing, and can mean you keep the power in terms of body autonomy and dignity.

    Dispelling myths

    • If you or your care provider is unable to hand express colostrum from your breasts, that does not mean you do not have any colostrum or that the baby is not getting any colostrum when they are suckling themselves.

    • An unsettled baby does not equal a 'hungry baby' (please see below ‘Reasons a baby cries in the first few hours/days/weeks of life’).

    • Babies (healthy & term) do not need to feed 3-4 hourly in the first 24 hours - that normal input as little as 4ml of colostrum in the first 24 hours is normal.

    • If babies are unsettled, mothers need to be helped with settling their babies into tubigrips or skin to skin shirts if they are not feeding.

    • Normal newborn behaviour such as not wanting to be put down and crying need to be reassured as such.

    • I believe it would be very helpful to have a supply of hydrogel breast discs to be able to give mothers a pair in the first 24 hours to allow them time to get their own and also to decrease occurrence of nipple damage.

    • I also believe there are a lot of missed tongue-ties that cause much pain and eventually for women to give up breastfeeding altogether because of the pain so having these professionally assessed if there are signs of ties - lipsticking of or ‘squashed’ nipples after a feed, feeding is excruciatingly painful even though latch looks outwardly good (differential diagnosis here is Raynaud’s Syndrome), baby is very irritable at breast and very reluctant to latch or latches on and off (differential diagnosis here is an instrumental birth and does not like head or neck touched), baby cannot poke out tongue very far, baby has a line at tip and middle of tongue or ‘heart-shaped’ tongue or a ‘double furrow’ usually best evident when crying.

    Reasons a baby cries in the first few hours/days/weeks of life

    • Adaptation to extra-uterine life – being born is scary shit, one minute you are happily snugged up inside your cosy womb home surrounded in warm fluid and hearing Mama’s heartbeat, next minute you are thrust into the cold air, you have to breathe air, get fluid (mucus) out of your lungs, your blood and heart circulation completely changes direction and path, your immature stomach is having to digest actual food (milk), you see (bright) light, you hear noises, loud and not muffled, there are all sorts of new smells and bacteria, you are immediately laying down your immune system foundation, you are wearing clothes and a nappy, you are having to learn how to breastfeed, people expect you to sleep by yourself in a plastic bowl, you might be being touched, assessed and moved by various people, care providers or family and friends, all.for.the.first.time.  In the space of a few hours.  I would cry too if I had to experience all of that in such a short space of time.  

    • Mucus – many babies are ‘mucusy’ post-birth as they are trying to get the leftover third of fluid (surfactant) off their previously entirely wet lungs - and depending on how babies are born (vaginal or cesarean), they may have more mucus to shift than others.  This can last a couple of days and can mean a baby is less interested in feeding as they bring/gag the mucus up into their mouth from their lungs and either spit it out or swallow it.  It is fine either way, if they swallow it, it is composed of lipids and proteins so has some caloric benefit.  It can be quite a yellow colour and sometimes when they bring it up it can be mixed with colostrum or even old or fresh blood which can be a normal part of the birth process.  Bringing up mucus can be upsetting to the baby as they really have to gag to bring it up and they can easily cry because sometimes it blocks their airway – if you see your baby gagging, sit them up to help them bring up the mucus.  Call for your care provider if you are worried about them at all in this process.

    • Instrumental or fast birth – baby has a really sore head and probably neck after being pulled/zoomed out of the birth canal and in the first few days, they do not like being moved around.at.all.

    • Need a cuddle.

    • Needs reassurance.

    • Is scared.

    • Has a sore tummy/wind.

    • Is tired/overtired.

    • Wants to suckle for comfort/sleep/colostrum/to bring milk in.

    How to establish a good supply for your baby

    • Make sure you are positioning and latching the baby well (deeply) and always seek help if you need it.  Watch your nipple shape after baby has fed - it should still be the same shape as when it went in the mouth, not squashed or like a lipstick.  Learn different positions to feed baby and do what feel comfortable to you both.  If you are experiencing nipple pain or lipsticking, sometimes laid back feeding can be helpful in achieving a deeper less painful latch and always check that babies’ lips are out and not tucked in (you can flick out the lips once latched if either is tucked in rather than having to re-latch and pain should subside if it was this causing the pain).  Letdown and the initial latch and suckling can be painful for some women but if it is still painful after 30 seconds of initially latching then I recommend either re-latching or asking for help with your latch.  

    • Breastmilk production is all about supply and demand - feed on demand and be aware of baby’s feeding cues especially when being cuddled by someone else.

    • Drain one breast before offering the other - a drained breast means faster milk production and a fuller one means slower milk production.

    • Check in with your care provider about starting on a breast-pump - introducing top-ups or replacing feeds with expressed breastmilk or formula can hinder your supply - the best possible way to make more milk is for your baby to remove it from your breast, not a pump.  If however, you have delayed lactation or have a baby in NICU then pumping can be important.

    • Skin to skin cuddles.

    • Educate yourself about cluster feeding - in the first 6 or so weeks, your baby will do a big cluster feed at least once a week to ‘order’ more milk for the following week or few days depending on how fast they are growing.  It is also normal for a baby to have a 2 hour cluster feeding in the evening before they go down for their first night sleep - it could be 5-7pm or 9-11pm, totally depends on your baby.  You can try and encourage them to do it earlier if it is too late for you.  Your baby is not cluster feeding because they are hungry, they are cluster feeding to order more milk because they are growing.  If you introduce a bottle or top-up during this time you will not make enough milk for the subsequent days for your baby and then it can be difficult to get your supply back on track.

    • Seek help early on if you have any pain with feeding after letdown as some women have a painful letdown and this is normal for them.

    • And make sure you eat well (use moderation as a lot of one thing will usually upset a baby’s immature digestive system) and drink at least 3 litres of water a day.  A really good way to ensure this is every time you feed baby, pour yourself a drink of water before you sit down.

    How to increase your supply if needed

    • Feed, feed, feed on demand.

    • Eat galactagogue foods such as dark leafy greens (like spinach, collard greens and kale), oats and other wholegrains, nuts and seeds, like almonds and cashews, garlic, ginger, spices notably fennel/cumin/anise seeds and turmeric, chickpeas, papaya (especially green).

    • Drink a daily smoothie with enriching and milk boosting ingredients like brewer’s yeast and moringa powder (see our Breastfeeding Recipes blog post for some suggestions).

    • If you don’t like smoothies you can take herbs like goat’s rue, fenugreek or a tea blend made specifically for breastfeeding Mama’s to boost supply.  It is always good to talk to a qualified Herbalist when taking herbs to make sure you are taking the right herb for you and your issue.

    How can you best support the breastfeeding Mama?

    • Tell her what a great job she is doing.

    • Thank her for nurturing and growing your baby/grandchild/niece/nephew.

    • Feed her!  Make her nutritious and delicious food that sustains her because she needs nurturing too.  Make her cups of herbal tea and smoothies to drink.  A really good idea before baby arrives is to make up freezer packs with pre-prepared food like snaplock bags with smoothie ingredients and soups, lasagnes, stews, casseroles and breakfast muffins - things to make easy snacks, lunches and dinners.

    • Do the dishes.

    • Hang out the washing/Bring in the washing/Fold the washing.

    • Do errands.

    • Take the toddler out to the park.

    • Hold the baby so Mama can shower.

    • Protect her sleep space.

    Key points:

    • Learn about and consider antenatal expression of colostrum.

    • Ask that your baby is checked by an expert for a tongue and lip-tie in the first few days.

    • If breastfeeding is excruciatingly painful - thinking outside the box of a bad latch - consider Raynaud’s, nipple thrush and tongue-tie (possibly posterior/sub-mucosal which are easy to miss).

    • Have a lot of skin to skin cuddles with your baby in the first few days, using a Kangaroo Care shirt or pocket carrier such as Milk & Baby, NuRoo,VIJA or Nesting Days or just a tubigrip  – ask your care provider to show you how to do it safely - you should have baby high enough to be able to kiss the top of their head, their head to the side and their face clear, that their feet are up under their bottom (“frog legs” or “M” position) and that the tubigrip or skin to skin shirt you are using is tight enough to prevent baby falling off you.

    • Empower yourself with both belief in your body and your baby to be able to breastfeed successfully; and also knowledge of normal newborn behaviour and the physiological process of lactation.  Learning this antenatally as well as learning how to hand express can help in this and if you have any problems along the way then you can discuss them with your care provider and troubleshoot so you are prepared before the baby is even born.  You can also discuss the shape of your nipples with your care provider or a lactation consultant as you made need different tricks if you have flat or inverted nipples.  There are also breastfeeding classes or tutorials you can take or watch prior to baby being born so you are armed with the best knowledge to commence your breastfeeding relationship.

    • Ask to change care provider (whether it be in a facility or not) if you feel the language being used by them is not conducive to successfully establishing your breastfeeding relationship.

    • Ensure the team around you are 100% supportive of how you would like to feed your baby – however that may be.

    • Know that if the first breastfeeding relationship was unsuccessful, it does not indicate your subsequent ones will be.

    References

    Bazzano, Alessandra N., Lauren Cenac, Amelia Brandt, Josephine Barnett, Shelley Thibeau, and Katherine P. Theall. "Maternal Experiences with and Sources of Information on Galactagogues to Support Lactation: A Cross-sectional Study." International Journal of Women's Health Volume 9 (2017): 105-13. Print.

    Berens, Pamela. "Antenatal Milk Expression for Women with Diabetes in Pregnancy." The Lancet 389.10085 (2017): 2167-168. Print.

    "Changes in the Newborn at Birth." MedlinePlus Medical Encyclopedia. Web. 29 Aug. 2017.

    Dhakar, Ramchand, Brijendrak Pooniya, Manisha Gupta, Sheodatta Maurya, Narendra Bairwa, and Sanwarmal. "Moringa : The Herbal Gold to Combat Malnutrition." Chronicles of Young Scientists 2.3 (2011): 119. Print.

    Martin, Camilia, Pei-Ra Ling, and George Blackburn. "Review of Infant Feeding: Key Features of Breast Milk and Infant Formula." Nutrients 8.5 (2016): 279. Print.

    Santoro, Walter, Francisco Eulógio Martinez, Rubens Garcia Ricco, and Salim Moysés Jorge. "Colostrum Ingested during the First Day of Life by Exclusively Breastfed Healthy Newborn Infants." The Journal of Pediatrics 156.1 (2010): 29-32. Print.

    Zhou, Yin, Shasha Bai, Joshua A. Bornhorst, Nahed O. Elhassan, and Jeffrey R. Kaiser. "The Effect of Early Feeding on Initial Glucose Concentrations in Term Newborns." The Journal of Pediatrics 181 (2017): 112-15. Print.

            • 17 Oct 2019 1:00 PM | Michelle Deerheart (Administrator)

              By Michelle Deerheart, Co-Founder of Empowered Parenthood and Consultant Midwife NZ. Birth story shared by Rebecca.

              Welcome to Empowered Parenthood's first birth story. Birth stories are a wonderful way to connect to birthing women all over the world, and discover the mystical power we all hold within us. No matter what kind of birth you have had, there is power in sharing. Sometimes they are traumatic and painful, sometimes they are empowering and blissful - but they are all raw, powerful, real. That's what being a woman is. We create life within us, we surrender to universal life source to endure more than we have ever experienced, and bring another being into this world. Our hope is you find encouragement, empowerment, understanding, connection, and courage within the words of women sharing their most intimate adventure with you. So grab a cuppa, snuggle down and let's share this magical journey together..

              All birth stories are shared, exactly as they are written by the strong women who share them. This is their journey, their words, and their experience. We are simply the vessel to share far and wide the magic that comes when women own their experience. 

              Rebecca's story: 

              It’s the afternoon of Saturday 3rd July and I’m vacuuming the cobwebs on the ceiling. I should have known that was the start of something because I have never done that before! Nesting was next level! I was having Braxton Hicks that night and thought hmmm I wonder if something was going to happen but didn’t want to get my hopes up! I woke up at 1am Sunday morning and realised I was having contractions. I started timing them using my trusty Contraction App on my phone. For an hour I was having contractions every 10mins lasting for approx. 45seconds. Yeeee I’m in labour! Ok, must try to go back to sleep as my research told me to rest and try sleep as I might be in for the long haul! I drifted on and off to sleep until the morning and got up like normal. Contractions are still regular – moderate in strength. I finish off the last of our wedding thank you cards (because what else do you do while in labour, right!).  Husband wakes up later that morning and I excitedly tell him that I’m in labour – again, my research had me thinking there’s no point in waking him up in the night as he needs his rest too! So we carry on the day, timing contractions like it’s some kind of game – are we winning? I text my midwife that afternoon “I’ve been having regular contractions since about 2am, spacing between 10-30mins. I don’t think they are increasing in strength and frequency at the moment. They’re intense enough for me to concentrate on my breathing to work through them.” I was feeling calm and had complete faith in my body’s ability to do what it needed to do. I was in no rush as I knew that my labour would take as long as it needed to. I was still in good spirts as the sun went down, albeit I was tired and worried that I wouldn’t sleep overnight. I assumed that exhaustion would take over and I’d get some rest…..not quite! Sunday night comes, and goes. Wow that was a loooooong night! A sent a message to friends that morning “Contractions ALL night. No further than 10 minutes apart but not quite 5mins yet! I am exhausted! Thank god the sun is coming up”.  My contractions were regular but never getting down to that magic 5-1-1 (5mins apart, lasting a minute, for at least an hour). An update text to my midwife “I’ve been up all night having very strong regular contractions but not quite at established labour yet! Very tired and resting in between, although unable to sleep with them coming so frequently. Started losing mucus plug about half hour ago.”  I’m tired. Hubby is tired. We ran out of hot water from the baths I was having overnight. Crap. It’s Queen’s birthday Monday and my sister comes over to pick up one of our dogs. She stays for a couple of hours to give hubby a nap. I’m falling asleep on the couch in-between contractions. I message my Dad around midday “Labour has stalled a bit so the contractions have slowed down which allowed me to have a few naps. Life savers!” I remember messaging my bestie that I managed to get a 5 minute nap and felt so much better – she thought I was crazy but that’s sleep deprivation for ya!  By 4.30pm it is all back on and I send an update “Back to regular contractions now. Hopefully they turn into active labour. Don’t know how I’d cope with another night like last night”. Well, I did another night. I don’t know how, but I did! The hardest part was those early hours in the morning, 3-5am when you felt like the only soul on the planet. Time seemed so distorted and I wished for the sun to rise. I was beginning to worry about how much sleep deprivation a woman can handle and still have the energy for the active stage of labour. I knew the body was capable of some extraordinary things, but come on – there’s gotta be a limit? Hubby and I laboured at home together from 1am Sunday morning until we went to the birth centre at 3pm Tuesday afternoon. We gave my midwife updates via text and phone but only at necessary intervals (Sunday afternoon, Monday morning, Monday night, and then regular contact from 7am Tuesday). We knew there was nothing more that my midwife could do for us and that we needed to keep calm and relaxed while labouring together at home. I knew the moments that I felt I needed to update her and that there was no point in being on the phone to her 24/7. I needed her to be at the birth and I did not want her to be exhausted from being up all night, like I was! My midwife came over about 8am on Tuesday morning and did a Vaginal Examination. Our birth plan was not to have any VE but considering I’d been in labour for 2 days, we felt it was a good idea. I was 2cm dilated and 70% effaced however I was not discouraged to hear this. My baby had always been hanging out of the right side of my body and he was not quite centre on my cervix. My contractions were trying to get him straightened up and ready for the grand reveal! As I understood why contractions happened, I was not scared or fearful of them. There was no confusion or anger about the pain I was in. My body was doing what it needed to do. Yes, I worried that something may have been wrong but seeing my midwife put my mind at ease and I had complete faith and trust. She empowered me and made me feel safe. I was prescribed a sleeping pill and pain killers to try and help my body rest. This came as a surprise to me as my midwife is not quick to prescribe drugs and I did not think there was anything that could be done to help me. I didn’t even ask. I was comfortable to take the drugs as I’d taken them on numerous occasions in the past (not pregnant). She also said to stop timing the contractions (yep, we were still playing that game but not advancing to the next level!!) and really try to relax. I popped the pills, put my eye mask on and got into bed. 20mins later I was awoken to the incredible pain of another contraction. They were so much worse lying down and being rather big (at 9months pregnant!) I would struggle to quickly get up in time. I felt paralysed lying down and trying to breathe through the pain, counting down for the wave to pass over. And it did, they always did. But then another would start to build and we’d go through it again. Contractions are a funny thing. You feel it coming, it’s like the tide being drawn out to sea, building up into a wave, peaking at its highest peak, and again at its actual highest peak (you think it’s the highest first but it gets more intense!) and then it starts to fade, and doesn’t come crashing down but slowly goes back down and you can resume life as you were, continue the conversation you were having, the cup of tea you were drinking, or in my case continue applying make-up before heading to the birth centre! 12.42pm I sent my midwife a text “unfortunately contractions are overpowering the meds. I’m delirious but contractions are painful.’ I don’t think this text quite made sense, probably from popping a sleeping pill 2hrs earlier….oh and the sleep deprivation! Hubby is on the phone to my midwife and we’re told to come to the birth centre at 3pm. During this time at home I feel like the contractions are coming more frequently so I decide to start the game again and press stop/start; 5.14mins, 5.07mins, 5.06mins, oh my gosh they are getting closer!! I continue timing for the next hour and all the contractions are approximately 5mins apart and lasting around 1 minute. YUS established labour!!! Make up is applied (I paid a lot of money for a Birth Photographer, I haven’t slept for 2 days and I brought water proof mascara just for this event so the makeup is pivotal!) and Hubby puts the packed bags that have been waiting patiently for the last few weeks into the car. We wait for a contraction to pass and then get into the car to make the 2 minute car ride to the birth centre (that probably includes parking and walking into the building!) so I’m lucky to not have to experience a contraction in the car.


              We arrive at the birth centre and are greeted by my midwife. Unfortunately our preferred birth suite is not available but I’m not bothered at all – both of the suites are beautiful. It’s 3.30pm and my midwife performs another VE and I’m 6 cms dilated and 90% effaced. I’m given an enema to empty my bowels and I pass more blood and mucus plug. I decide to have a shower before getting into the birth pool. Hubby has got the hypno-birthing Spotify playlist going and the lights have been dimmed. The atmosphere is beautiful, like being at a day spa (minus the beauty therapy treatment!). It’s 4pm and I get into the pool. Our birth photographer is there and taking photos but I barely notice her presence. I’m continuing to sip on water and attempt to eat a cracker and a soft lolly (one bite and I’m done!). I’m moving around in the birth pool a lot to find my ‘optimum’ birth position. Hubby is constantly near me, helping me, guiding me, loving me. Now the birth affirmation hypno-birthing track is playing. I can hear ‘breathe your baby down’ ‘I trust my body’ ‘I trust my body to birth my baby’ and hubby reminding me to relax my jaw. 4.40pm and I’m feeling hot, like you do after being in a spa pool for too long (though the birth pool temp was 36c) and a fan is brought in. I’m feeling so much better with the cool air blowing on my face and cold flannel on my forehead. 4.45pm and I’m feeling nauseous and wonder if I’m going to vomit. The surges are feeling more intense and my midwife encourages me to trust my body – acknowledging that I am tired but clinically well and to loosen my hips and rock through the surges. Just after 5pm I pass a decent amount of mucous plug (I thought I’d passed some earlier but that was nothing compared to this!) along with poo and wee! Yip, the sieve (or pooper scooper!) was used several times and I was totally OK with that! I’m feeling more bowel pressure and it’s intense. Hubby continues the loving hypno-birthing affirmations and my midwife praises the amazing job I am doing of bringing my baby down. At 5.46pm more hot water is added into the pool and I say ‘I can feel him coming down’. My midwife encourages me to slow my breathing and let my body stretch. More blood comes with each contraction. I concentrate on taking the biggest poo of my life because that is what it feels like and I had comfort in knowing how to push a big poo out; I wasn’t so sure how to ‘push’ a baby out – turns out, it’s the same thing haha! I feel for the head but it’s not a head that I can feel. It’s squishy and I’m thinking that I’m having some kind of prolapse! Is it my uterus? Turns out my baby is still in the caul and my waters broke once his head popped out! One more contraction and the rest of his body comes out and he’s guided by me and hubby up to the surface.


              “Hi Charlie” I greet my baby and wonder at his hair on his head. I’m in awe. I’m amazed. I’m shocked that he was inside me! I try to move around the birth pool to the seat and get comfortable. ‘Blow on his face’ my midwife tells us.  We’re smiling and so happy but then I can hear the concern in my midwife’s voice. She grabs the Neopuff mask to help Charlie breathe. It’s no good. The emergency buzzer is pushed, a staff midwife enters and my midwife cuts the umbilical cord to take Charlie onto the table. I’m in shock. What’s happening? Is my baby OK? I’m still in the pool, watching as my helpless baby lies on the table with a breathing mask over his tiny face. My amazing birth photographer sits with me and tells me everything will be OK. Do I believe her? My midwife returns and gives me the injection to release my placenta. I’m freaking out and just staring blankly. I can’t speak. What feels like a lifetime turned out to be a matter of minutes and Charlie’s breathing improved. I exited the pool with the help of my midwife and birth photographer and lay on the bed. Charlie was brought to me for skin-to-skin and breastfeeding.


              From there, our journey has continued to be the most amazing experience and I can honestly say that I cannot wait to give birth again…..next time at home! While I endured a two and a half day labour, I still consider myself to have had a positive, beautiful birth. Not everything went to ‘plan’ – taking medication (sleeping pill and pain killers Tuesday morning), emergency cord clamping and cutting, synthetic release of placenta, unable to have continuous skin-to-skin for 48hours (due to sleep deprivation). I was concerned of how I would feel in the days after the birth and whether I would experience some degree of post-traumatic stress (from Charlie’s resuscitation). However, after reading my midwife’s notes of the labour I felt at peace with everything that happened. Her chronological timeline of events helped me process what had happened and clarify my distortion of events – the cord was clamped and cut after 6minutes (not straight away like I imagined) and Charlie was away from me for less than 10mins (it felt like forever for me!). The mind is a powerful thing, and it can play tricks on you!


              I am blessed to have had a positive and beautiful birth; however I do not consider it luck. My husband and I did a lot of preparation, starting with our hypno-birthing class (which we attended when I was around 28-33weeks pregnant). No, we didn’t listen to the Rainbow Relaxation every night, or practice the breathing and visualisation religiously. But we did continue our positive thinking, affirmations and excitement of the upcoming birth. Mindfulness can be so powerful and if you believe you can, your chances are a lot better than if you believe the opposite. I took comfort in knowing how confident I was about giving birth, without arrogance. I knew if I needed help, I would receive and accept it. However, that was to be considered at the time, not decided on before I was in labour (e.g. pain relief, transfer to hospital etc). I had the right team around me to support and guide me through the experience. Yes, I gave birth to our son, but my husband gave me strength during my weakness, confidence during my doubts and love during my pain. “I can’t do this” “Yes, you can and you will. Breathe our baby down.” “Please help me!” “I love you”. We did it together and our birth photography portrays that so well. He was right there with me, connecting with me and sharing the experience together. That is why I believe it is so important to have the right team around you, the right birth partner and midwife whom you trust and know has your best interests at heart. I’m thankful to every person that had a positive influence during my pregnancy, birth and early parenting journey as they have contributed to the mother that I am today.


            • 17 Oct 2019 12:50 PM | Michelle Deerheart (Administrator)

              By Emily Holdaway, planning for her Home Birth.


              For the birth of our second child, the decision to have a home birth was made before we decided to have another baby. We were driving back from the birth centre, three days after Ziggy was born and AJ said ‘Well, that was easy, if we do it again we’ll just do it at home’.

              I am not sure if I agreed with him, or if I just looked at him thinking Easy? Easy? You try shitting a watermelon then tell me you want to do it all over again, but in your own toilet.

              But there was already a tiny part of my brain thinking ’yeah, I could totally do that again’, and the idea of a home birth just made sense.

              In the weeks leading up to our baby's birth, I surrounded myself with positive images.

              There was so much I liked about the idea. That our second child would be born in our home. That I wouldn’t have to worry about getting a bag ready, or brave that horrible car ride to the birth centre. I liked the fact I’d be in my bed, have access to my fridge, be able to spew in my toilet. I had a slight worry that my labour noises might wake the neighbours, but considering all the late night early morning parties they had subjected us to, I figured it was payback time.

              It didn’t matter that, apart from birth stories and watching birth videos, neither AJ nor I had personal exposure to home births. We had trust in the process and there wasn’t really anything worried us. Plus we had a big consideration for this second birth that we didn’t for our first. Our toddler, Ziggy.

              Ziggy is a big part of our lives, and by having a home birth we didn’t have to worry about what to ‘do’ with him. We don’t have family nearby, so even if we wanted to leave him at his grandparents for the night, that option was out. Ziggy was going to a part of this birth, whatever ‘being a part of’ may look like at the time.

              And so the preparations began.

              A lot of people ask me ‘what do you need for a home birth’ and I can say from experience – hardly anything. I mean, I could write you a list 100 items long, but you don’t really ‘need’ any of it. A lot of things are ‘nice to have’ like a personalised birth mat, or a birth pool, or delicious snacks, or heat packs or swiss balls. But long lists also make people thing ‘oh crap that’s way too much hard work’ and one of the beautiful things about a home birth is that it’s as much or as little preparation as you want to put into it.  

              You need a home.
              You need a midwife that is supportive.
              You need a partner that is supportive.
              Almost everything else you need, you either have in your home or your midwife has in her bag of tricks.  

              For us one of the key things we needed was a support person for Ziggy. We were unsure how things would go and how he would react to seeing me in labour. We didn’t know how bedtime would work, or if he would get upset. And so, we asked a very good mate to come and be part of our birth experience. I also watched birth stories with him and talked to him about what was going to happen. When I was on the toilet I would pull funny faces and make straining noises until he laughed – trying to make ‘mum having a poo/giving birth face' something he would be familiar with.

              As it turned out our Ziggy support person was in Auckland when I went into labour, and Ziggy slept through the birth part of the birth, so the preparations weren’t needed. But, it was good to have the plan in place for peace of mind during my pregnancy.

              Another question people have is ‘where do you birth’. Do you need a special room? Do you need special preparations? It’s your home. You can do as little or as much as you like. I wanted a pool, as my first birth centre birth was a water birth and water allowed freedom of movement and a level of comfort I couldn’t find on a bed or a couch or the floor. I also laboured on the floor in front of the fire and I took some quiet ‘time out’ in our bedroom. Being in our home, our space gave freedom (well as much freedom as contractions allow) to go anywhere.

              For our home birth experience, I wanted to create a special space within our home in which to birth. There is a fabulous video out there about how having a baby is like making love **, and if the conditions are right for making love, then they are perfect for having a baby. But, too many women have to give birth in an environment where making love would be impossible (think harsh lighting, interruptions, being told how to lie and when to thrust) and it makes getting in the mood a lot harder.

              Our space was very important to me and beautiful hours were spent making it ‘just so’. A lot of this was a way to connect with my baby through our pregnancy. Apart from pregnancy yoga, I was finding it hard to make time for my belly baby. There were no long walks in solitude like I enjoyed while pregnant with my Ziggy, and so in a way it was more than just making the room special, it was a conversation with our unborn baby.

               

              Many home birth midwives have a pool you can use, with all the bits and bobs needed. If not, they can point you in the direction of where to hire one. One consideration with the pool is how you get your hot water. If you have a small hot water cylinder, you might need extra pots and pans to heat water in. For us, we have an infinity gas system so the hot water supply was no issue . . . just remember to fill your gas bottles beforehand! Whoops.

              The funny thing about our decision to have a home birth was how worried some people were for me. And then how relieved they were once it was all over and done with. People said things that I imagine they thought was comforting, but was just hoha like ‘well at least the hospital is close by’, or ‘yes well I did take you for that type’ and afterwards ‘well you were very lucky weren’t you’. It’s so strange, the idea that a home birth is risky, or only for a certain ‘type’ of person. Which is rubbish.

              A home birth is not dangerous, it is not risky. If anything a home birth has lower risk of intervention than birthing in a hospital, and often has a more favourable outcome*. The midwife, in her bag of tricks has pretty much everything you could possible need. Pain relief, adrenaline, IV fluids, needles, a doppler, a heartbeat taking things, she even has pads to put on the floor. And most importantly, she has training and experience to help you and support you as you birth. For the majority of home births, this is more than enough.

              Neither is a home birth for any ‘type’ of person. Actually no, a home birth is 100% for a type of person. Pregnant persons. With a home. If it’s something you are considering, do your research, talk to your midwife, look at your options. It is your body and your baby and there is no one more invested in the safety of your unborn baby than you.

              Our midwife was a home birth specialist. That was a big factor for us, as, being our first experience home birthing, we wanted to know that our midwife was with us all the way.  Which she was.  She would come to every appointment at our house, and over time I showed her where the important things were. Towels live here, extra toilet paper is here, cups live here, and tea and coffee can be found here. Ziggy got used to seeing her, and by the time my due month rolled around, we were as comfortable with her, and she with us as it was possibly to be.

              The night I went into labour, was so much more relaxed than our first birth. AJ and Ziggy made pizza while I sat at the table, rubbing my belly and watching them. Pizza was followed by a movie. We were relaxed, excited, and enjoying these last moments before our new addition arrived. The only decision we had to make was when to fill the pool, apart from that, we kicked back ‘as much as one can kick back in early labour’ and let things unfold.  

              But that’s a whole different story.

              * https://www.health.govt.nz/your-health/pregnancy-and-kids/services-and-support-during-pregnancy/where-give-birth

              ** https://www.youtube.com/watch?v=lZG0T7xHy6A

              Empowered Parenthood resource addition, a great article on momlovesbest.com ‘How To Have A Home Birth And Why You Might Want To’ 

            • 17 Oct 2019 10:41 AM | Michelle Deerheart (Administrator)
              By Claire Cardno, Co-Founder of Empowered Parenthood and Doula.

              Congrats Mama, you’re pregnant! And you understand the importance of reducing stress during pregnancy; otherwise you wouldn’t be here reading this. So first of all, big ups to you for acknowledging how much of an effect stress can have during pregnancy, but also realising in this day and age it’s almost impossible not to feel stressed over something.

              So I’m going to be sharing some tips on ways to reduce stress so you can enjoy this time growing the miracle of life inside you; at least until you get to the uncomfortable point where you can’t see your toes and shaving your legs is a long forgotten activity.

              Floating: 
              With the aches and pains that can be associated with pregnancy, the idea of being completely weight-less can seem like a dream. Now it’s a completely possible dream with the popularity of Sensory Deprivation Tanks becoming more accessible!

              There are many benefits to floating during pregnancy, including the extra dose of magnesium absorbed during your skin while you bliss out and connect deeply with your wriggling babe. Being completely shut off from external stimulation provides a quiet sanctuary to listen to your own AND your baby’s heartbeat from the inside. Suspended in 300lbs of Epsom salts, your completely buoyant causing a disconnect from your physical senses – ideal if you suffer from lots of pregnancy discomfort!

              To find out more about my personal experience with Floating during pregnancy, check out my video here 

              Meditation: 
              Similar to above, except planted firmly on the ground, meditating is a great way to connect with your growing baby while quieting your mind.

              There are several ways to meditate so you need to see what works for you, whether that is using a mantra, focusing on your breath, or practicing mindfulness.  Don’t worry if you struggle to sit for very long, its called ‘practice’ for a reason – we can’t all be Zen yogi masters the first few times we sit down! Do as many minutes as you can, as often as you can to catch a breather in your busy day. Your body, mind and baby will thank you for it. 

              Need some helping starting a meditation practise? Check out our beginners guide to meditating here. 

              Exercise: 
              Perhaps meditating or suspending in a dark tank isn’t your cup of tea – if you are a more physical person, getting in some exercise is a very effective way of releasing stress. Going for a walk along the beach, doing some yoga or even a rigorous sweat burner (check with your care provider that it’s okay for you to do intense work-outs.) Let us not forget those endorphins that are released with exercise, (or from sex, or eating chocolate so take your pick!) it’s a sure fire way to put aside your woes and bring you into a state of ease.

              Sleep:
              Well you can’t be stressing while your sleeping, but now is a good a time as any to prioritize sleep and replenish your stores. Sleep is crucial to the health of your adrenals, which regulate our stress hormones like cortisol and adrenaline.  

              Birth Affirmations:
              If your pending birth is a source of stress for you, become empowered with the use of birth affirmations and visualisation. Preparing your mind for a positive experience and visualising how it will go can leave you feeling ready and excited rather than fearful. It’s been proven that wiring your brain with positive affirmations and expectations are more likely to result in a positive outcome, so spend some time each day focusing on your baby and the birth of your dreams.

              There are tons of other ways to reduce stress in pregnancy including but not limited to: taking a relaxing bath, using essential oils, catching up with a girlfriend, watching Netflix, being in nature, and the list goes on. Find what works well for you and get in as much down time as you can, you are growing a human after all.

            • 17 Oct 2019 5:30 AM | Michelle Deerheart (Administrator)

              We love this homemade electrolyte drink. And you will too! 

              It's a great alternative to the sugar-laden, questionable ingredient electrolyte drinks on the market - such as Gatorade or Pedialyte. This is a sugar-free, whole foods alternative that will serve you in times when you need rapid rehydration. Perfect for stomach flu, labor, and birth, hot days - or anytime you want a yummy, rehydrating drink!

              Ingredients:
              1 litre of coconut water (can add 1-2 cups filtered water and sub out coconut water - to taste)
              Up to ½ cup Lemon or lime juice (to taste)
              Up to 1 Tablespoon Raw honey (to taste)
              1/4 t sea salt

              Mix all together and keep in a glass jug or bottle in the fridge

            • 17 Oct 2019 12:00 AM | Michelle Deerheart (Administrator)

              By Michelle Deerheart, Co-Founder of Empowered Parenthood and Consultant Midwife NZ.

              The word midwife originated from “mit wif” an Anglo-Saxon phrase meaning “with woman” and this definition is still used today (Kate Sheppard Midwifery, 2010).  In learning about what a midwife is or does, it is mentioned frequently that they are the guardians of normal childbirth.  Normal birth has been defined in numerous ways by numerous people and organisations.  There is debate about whose definition should be used - the woman birthing the baby, the midwife who might be catching the baby or the hospital or birthing unit where she might be delivering.  We will explore different definitions, it will be discussed what the significance of normal physiological birth is - to mother, baby, family and wider society and how it relates to the role of the midwife in protecting and promoting  physiological birth.

              What is normal birth?

              Normal physiological labour is a beautifully choreographed dance of nature between the woman and her baby (or babies).  The feature role in this dance, with many of the instigating hormonal changes coming from it, belongs to the baby.  Supporting but still vital roles are played by the fetal membranes, the placenta and the endocrine system of the woman.  In New Zealand, the Ministry of Health (MoH) uses the definition of normal birth published by the World Health Organisation (WHO) which is “spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex (head down) position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition.”  This definition does not however mention interventions, pharmacological or otherwise.  The use of the words spontaneous and low-risk does not exclude the use of, say, an epidural or episiotomy which many would consider to not be within the limits of normal birth.  

              The Information Centre of the NHS in England go further with their definition of normal birth which is “without induction, without the use of instruments, not by caesarean section and without general, spinal or epidural anaesthetic before or during delivery”.  Gould (2000) illustrates the many definitions given for the word 'normal' and for the word 'labour' in her article, Normal Labour: a concept analysis.  In her research with the Association of Radical Midwives (ARM) she found that they described normal birth as a 'purely normal physiological event with no interventions'.  

              ARM identified artificial induction of labour, syntometrine, syntocinon, artificial rupture of membranes, directed pushing and episiotomy as interventions as part of an 'abnormal' birth.  Gould went further to denote four distinct characteristics of physiological labour – it occurs in a naturally defined progression; continuous cervical effacement/dilation and appropriate fetal descent, both caused by consistent and painful contracting of the uterus climaxing in the natural birth of a well fetus followed by expectoration of the complete placenta and all membranes and without obvious issues in woman or baby; it is hard work; and mobility is essential.

              Many midwives believe it is the definition of normal birth or labour by the woman in labour that is most relevant. (Gould, 2000; Gilkison et al., 2005)  Downe (2004) proposed that each woman had their own 'unique normality' of birth.  Walsh (2001) found that many midwives experienced a polarity between textbook definitions of birth and what actually happens in practice.  Hence, the definition of normal birth ebbs and flows with the fluidity of individual experience.  For example, one woman may see acupuncture as an intervention in birth where the next may not and another woman could class the midwife performing a vaginal examination as an intervention while her friend does not and so forth.  (Walsh, 2001)  Birth is an interpretive realm, an incredibly individual journey and, even where two women have had similar experiences and outcomes, their personal interpretation of it can be vastly different.

              Midwive's perspectives

              As already alluded to 'normal birth' means different things to different people.  Earl (2004) in her Masters thesis entitled 'Keeping Birth Normal: Midwives’ experiences in a secondary care setting' found that midwive's definitions of normal birth widely varied.  Here are three midwive's perspectives:

              'Normal means with a reasonable amount of time, with the woman remaining in control, with a baby that's happy throughout the labour and delivery'  (p.65)

              'Normal birth to me would be, most deliveries other than forceps ventouse caesarean, and I probably now would exclude an epidural.  But I would accept syntocinon and an episiotomy...' (p. 66)

              'A normal birth is when a woman delivers a baby vaginally by herself with some encouragement from a midwife or doctor or support people and the baby and mother are healthy afterwards...(y)es I think epidurals are part of a normal delivery.' (p. 67)

              Women's perspectives

              I posed the question of what normal birth is was posed to three women who all experienced very different births -  two were having a subsequent baby and one was having her first baby.  

              'Given my two very different experiences I don't think one can define what a "normal" birth is. I think due to circumstance and situation it is whatever is right for the mother and the circumstances at the time...I think without intervention on both my babies (Baby 2 almost arrived at 32 weeks) by the medical fraternity they may not have made it. And given Baby 1 was an IVF baby, there was no "natural" in his entire process.'  

              'For me personally I think a normal birth is ideally a natural birth (although I know from friends and people at Playcentre that the norm is to take some level of pain relief. Most people have gas and heaps succumb to epidural when it gets too much)...I know it hurts for everyone and some people have a really hard labour but I definitely think pain threshold, length of labour and state of mind play a huge part in your labour experience.'

              'For me normal birth meant home birth, no pain, except when baby head came out and 5 hours labour. Most people I know are more obsessed about "having pain", that they actually don't enjoy it and get tense and of course when you get tense you feel pain and labor gets longer.'

              The physiological, psychological and social importance of physiological birth

              The significance of normal physiological birth is far-reaching and not necessarily quantifiable, especially long-term.  The physiological, psychological and social benefits to the women, babies, their families and wider society are intricately linked.  If we analyse the perspectives of women and midwives above, a central theme in most of them is pain – or relief of it.  Pain is a physiologically necessary part of labour as without it there is something wrong although how it is experienced by individual women is as varied as birth itself.  Pain means that the uterus is contracting well and consistently so the cervix is effacing and dilating and the baby descends through the birth canal ready to be born.  The feeling of pain during labour can be looked upon as a brief moment in time where something that may not be enjoyable has to be experienced to achieve something amazing in the end.  It has been reported by women that experience normal physiological birth that the pain is extraordinarily temporary and once the baby is placed upon your chest, the pain melts away.  

              Humenick (2006) analysed a few studies from the 1970s that examined the correlation between pain and birth experience.  They found women that were awake and feeling the pain during their birth gave their experience a much higher rating than those women that were not conscious.  It was found that significant psychological benefits when normal birth is the outcome include a 'sense of accomplishment' and that women's self-esteem and improved familial connections can be eternally influenced by their childbirth experience.   It is important to note these studies as numerous health professionals take it upon themselves as their sole purpose to decrease the level of pain experienced by women in labour.  In protecting the birth environment, our job as midwives is to protect the woman through her pain journey, offering natural alternatives, making sure she is as prepared as she can be and managing her fear around it.  Although pain is a physiological experience it is closely linked to psychological and believe it or not social issues.  

              Society through the media and medical mindsets has created a situation where women have an irrational fear of the pain of childbirth and have lost belief in their natural instincts and processes.  Pregnancy and birth is portrayed as an illness for which medical intervention is necessary and that hospital is the safest to birth.  This societal thinking and lack of confidence in women to birth normally has undermined both midwives and women themselves.  (Parker, 2009)  There seems to be a common view that birth is something negative and it is better to not actually experience it, ie. have an epidural and or caesarean section.  The media communicating predominantly negative stories (fictional and non-fictional) about birth and midwives exacerbates the fear based moral panics that only seem to serve the medical maternity industry.

              In 2008, the MoH released a Maternity Action Plan 2008 - 2012 in which it stated the vision for maternity services being '(w)omen will experience pregnancy and motherhood as normal life events with confidence in their ability to give birth.'  The most common alternative outcome to or disturbance of normal birth is caesarean section  followed by instrumental delivery.  According to the provisional 2008 MoH statistics, the caesarean section rate was 24% and instrumental delivery (forceps and vacuum extraction - ventouse) was a total of 8%.  Within a 20 year period the caesarean section rate has increased by over 50% - the rate being 11.7% in 1988.  This is alarming not only because 11% of the 2008 total caesarean section rate were for electives but also that the WHO recommended caesarean section rate is 15%.  

              There is also the cost to society and family when a woman has a caesarean section – apart from the initial cost to the taxpayer of the invasive surgery which is $3,000 to $4,000 (“C-section risk to babies: study”, 2008), there is the amount of time for healing which can be up to six weeks excluding any subsequent complications.  This puts pressure on the family unit with more extensive care required for the woman and baby and in turn society if the partner, grandparent or other family member is unable to work due to providing this care.  There is also the physiological effects of the fetus when not born vaginally – the fetus is prepared for life 'on the outside' by the natural birthing process.  This process is bypassed when a baby is delivered by caesarean  hence recovery time for the baby is also increased.  

              Another aspect of having a caesarean section is the psychological effects it can have.  As in the previously mentioned studies regarding pain in childbirth, Clement (2001) also found that women than did not have a normal birth but had a caesarean section gave their birth experience a lower rating. It was also discovered that there seems to be some indication that women that have caesarean sections have a higher likelihood to have issues in bonding with their infant, their self-esteem and to suffer from postnatal depression and puerperal psychosis.

              Breastfeeding can also be affected by the mode of birth.  Cunningham, Jelliffe and Jelliffe (1991) found some of the physiological benefits of breastfeeding are to boost an infant's immune system and help to prevent some illnesses (especially respiratory and gastric) and infections. It can also assist the mother's body to return to normal (contract the uterus and lose pregnancy weight) and delay the resumption of menstruation.  In their study regarding the link between caesarean sections and the early initiation of breastfeeding, Rowe-Murray and Fisher concluded that having a caesarean section was a significant barrier to the early commencement of breastfeeding.  

              Protecting and disturbing physiological birth

              The primal cycle of birth can be easily disturbed hence a midwife's role in protecting and promoting normal labour is essential to the achievement of a successful outcome.  The WHO has named four practices supported by the guardian of birth – whoever that may be – that encourage a normal birth and two additional practices were put forward by Lamaze International.  The six research-based practices are 'labour begins on its own; freedom of movement throughout labour; continuous labour support;  no routine interventions;  spontaneous pushing in non-supine positions;  and, no separation of mother and baby.' (Romano & Lothian, 2008)  Skin to skin contact is a well researched practice where both mother and baby benefit.  It helps solidify the bonding process, increases the release of oxytocin for quicker expulsion of the placenta and also to encourage the let-down reflex for colostrum and in turn milk (New Zealand Breastfeeding Authority [NZBA], 2003).

              The protection of the birth environment as part of the midwife's role can mean the difference between a straightforward physiological birth and an 'abnormal' or traumatic one.  (Odent, 1996; Odent, 2000; Parker, 2009, Eddy, 2006)   'Cascade of intervention' is a term used in childbirth circles to explain where one intervention can lead to another and another instigating a cycle of intervention.  For example, having a epidural can mean that a woman may have difficulty urinating and pushing, labour can slow down and mobility is minimised.  These side effects can mean that further interventions such as the use of syntocinon to strengthen contractions, a catheter to assist with urinating, fetal monitoring, fluids intravenously and an instrumental delivery (forceps or ventouse) are necessary for labour to proceed (Childbirth Connection, 2009).  Hence, it is part of a midwife's role in upholding the principle of informed consent, that a woman wanting an epidural has the 'cascade of intervention' explained to her so that she is making a fully informed decision.

              Odent (2000) states that any disruption of the birth environment can stop a naturally occuring reflex called the “fetus ejection reflex”.  This reflex was first pioneered by Niles Newton in 1966, revisited in 1987 and Odent expanded on it further in 2000.  During well established labour, the fetus ejection reflex is said to be characterised by a brief and sudden period of irrational extreme fear.  The woman may say things like 'just give me a c-section' or 'I can't do this anymore'.  This period is accompanied by a marked increase of oxytocin (a hormone in labour that enables contractions and milk excretion) and adrenaline levels.  A collection of strong contractions follow where the woman has renewed energy and can not help but push.  An erect leaning forward position is usually preferred during the fetus ejection reflex as this position opens the pelvis and allows an easier journey through the birth canal for the baby (and woman).  Odent suggests that 'the true role of the midwife is to protect an environment that makes the ejection reflex possible’ and supporting this that a woman must feel ‘private, safe and relaxed’ in order to facilitate the normal birth process.

              Promoting physiological birth

              Eddy (2006) proposes five interventions that should be part of a midwife's arsenal in order to encourage birth's natural processes.  Maximising the environment and position have already been mentioned but eating and drinking in labour as desired, reviewing the woman at home early in labour and using evidence based fetal monitoring have not.  The necessity for a woman to be able to eat and especially drink in labour is very high.  Dehydration can slow contractions as muscles need water to be able to function properly.  Ketosis (a condition where an excessive amount of ketones (metabolised fat by-product) are in the body because it has no carbohydrates to metabolise and hence is metabolising fats as an alternative) (Gray, Smith & Homer, 2009) which can also slow contractions can be averted by an appropriate nutritional intake during labour.  

              Walsh (as cited in Eddy, 2006) found that assessing women early on in their labour can lessen avoidable interventions.  If they are intending to birth at a hospital, ensuring they do not transfer before labour is convincing and effective.  Fetal monitoring is another area of debate in Midwifery and the New Zealand College of Midwives (NZCOM) released a statement in 2005 regarding this issue purporting that 'intermittent auscultation of the foetal heart is the most appropriate method of assessing foetal wellbeing in an uncomplicated labour'.  In other words, a midwife should only need to use electronic contiuous fetal monitoring if there is concern for the woman or baby.

              The role of the midwife in protecting and promoting normal birth is a delicate balance between not implying time limits based around stages of labour in textbooks, acting as a strong, supportive, non-judgemental partner and guardian in the birth space and, keeping the woman and baby safe.  It is a constant internal assessment whereby the midwife supports the normal physiological birth process while ensuring the principles of midwifery practice in New Zealand - partnership, continuity of care, women-centred care and informed consent are upheld.  (NZCOM, 2008)  

              Roles between different kinds of midwives may vary – the role of a homebirth midwife in promoting normal birth may be to guard the environment and 'do nothing', just be there.  However, the role of an independent midwife attending a woman birthing in hospital or a hospital midwife may have a harder job in protecting the birth environment and promoting normal birth.  However, the four aforementioned principles can still be upheld regardless of what kind of midwife is supporting or the location of the birth.

              So let’s wrap it up…

              There are numerous significant benefits in having a normal birth – physiological, psychological and social.  In today’s day and age, even with the huge amount of  research in favour of normal birth and a less medicalised experience of labour, there is still somewhat of a negative public view of childbirth.  Maternity services throughout the world do appear to be aware of this and are working towards achieving a more positive attitude to the awesome, natural and instinctual process that is pregnancy and labour.   There is also the positive birth movement of which there are many initiatives and organisations facilitating the reclamation of the pregnancy and birth process as a normal life event where the way women are treated and the language used throughout the process is vital to the success of it.

              Empowering women throughout their birthing journey and as a midwife to protect and promote physiological birth, we should let women use their own definition of normal birth.  We must protect and promote their individual definition whilst ensuring we are able to uphold this in our own minds.  As a midwife promoting normal physiological birth we must use all the tools available to us, be fierce, non-judgemental guardians of the birth space, foster the partnership between midwife and woman through continuity of care, woman-centred care and, informed consent supported by appropriate communication and currency of evidence-based information.  

              References

              Childbirth Connection. (2009). Cascade of Intervention in Childbirth. Retrieved September17, 2010, from

              http://www.childbirthconnection.org/article.asp?ck=1018

              Clement, S. (2001) Psychological aspects of caesarean section. Best Practice & Research Clinical Obstetrics &Gynaecology.15(1), 109-126.   doi:10.1053/beog.2000.0152

              C-section risk to babies: study. (2008, January 27). Sunday Star Times. Retrieved from http://www.stuff.co.nz/sunday-star-times/238144

              Cunningham, A. S., Jelliffe, D. B., & Jelliffe, E. F. P. (1991). Breast-feeding and health in the 1980s: A global epidemiologic review. Journal of Pediatrics, 118(5), 659-666. Retrieved from http://www.jpeds.com/article/S0022-3476%2805%2980023-X/pdf  

              Downe, S.  (2004). Is there a future for normal birth? In S. Wickham (Ed.), Midwifery Best Practice Volume 2 (pp. 2-5). Elsevier: Edinburgh.

              Earl, D. (2004). Keeping Birth Normal: Midwives’ experiences in a secondary care setting. (Master thesis). Auckland University of Technology, Auckland, New Zealand. Retrieved from

              http://repositoryaut.lconz.ac.nz/handle/10292/267

              Eddy, A. (2006). Midwifery interventions for the promotion of physiological birth. O&G Magazine. 8(4), 14-15. Retrieved from

              http://www.ranzcog.edu.au/publications/o-g_pdfs/O&G-Summer- 2006/Midwifery%20interventions%20for%20the%20promotion%20of %20physiological%20birth%20-%20Alison%20Eddy.pdf

              Gilkison, A., Holland, D., Berman, S., McAra-Couper, J., Waller, N., Gunn, J. & Lennan, M. (2005). Defining normal birth: A student perspective.  New Zealand College of Midwives Journal. 32, 11-13.

              Gould, D. (2000). Normal labour: a concept analysis. Journal of Advanced Nursing. 31(2), 418-427.  doi: 10.1046/j.1365-2648.2000.01281.x

              Gray, J., Smith, R. & Homer, C. (2009). Illustrated Dictionary of Midwifery. Elsevier: Australia.

              Humenick, S. (2006). The life-changing significance of normal birth. Jounral of Perinatal Education. 15(4), 1-3. doi: 10.1624/105812406X151330

              Kate Sheppard Midwifery. (2010). History of Midwifery.  Retrieved September 6, 2010 from http://www.ksmidwifery.co.nz/History.html

              Maternity Care Working Party. (2007) Making normal birth a reality: Consensus statement from the Maternity Care Working Party. Retrieved September 17, 2010, from http://www.scribd.com/doc/2520271/normal-birth- consensus

              Ministry of Health. (2008). Maternity Action Plan 2008–2012 :Draft for consultation. Wellington, New Zealand: Ministry of Health.

              Ministry of Health. (2008). Maternity Snapshot 2008: Provisional data. Retrieved from http://www.moh.govt.nz/moh.nsf/indexmh/maternitysnapshot-2008

              New Zealand Breastfeeding Authority. (2003). Skin-to-Skin Information. Christchurch, New Zealand: NZBA. Retrieved from

              http://www.babyfriendly.org.nz/bfnz/pdf/Baby%20Friendly%20Commu _ nity%20Initiative%20Seven%20Points/Point%20Four/skin%202%20ski _ n%20brochure%200309.pdf

              New Zealand College of Midwives. (2005).  Foetal monitoring in labour. Retrieved September 17, 2010, from   http://www.midwife.org.nz/index.cfm/3,108,559/foetal-monitoring-in- labour-2005.pdf

              New Zealand College of Midwives (Inc). (2008). Midwives Handbook for Practice. Christchurch, New Zealand: New Zealand College of Midwives.

              Odent, M. (1996). Why laboring women don't need “support”. Mothering. 80(6), 46. Retrieved from http://find.galegroup.com.ezproxy.aut.ac.nz/gps/retrieve.do?content Set=IACDocuments&resultListType=RESULT_LIST&qrySerId=Locale %28en%2C%2C%29%3AFQE%3D%28ke%2CNone%2C37%29why+la boring+women+don%27t+need+support%24&sgHitCountType=None &inPS=true&sort=DateDescend&searchType=AdvancedSearchForm& tabID=T003&prodId=IPS&searchId=R1&currentPosition=1&userGroup Name=aut&docId=A18486233&docType=IAC&contentSet=IAC-Docu ments

              Odent, M. (2000). Insights into pushing. The second stage as a disruption of the fetus ejection reflex.  Midwifery Today. 55, 12. Retrieved from: http://proquest.umi.com.ezproxy.aut.ac.nz/pqdweb?index=12&did=4950 _ 46241&SrchMode=3&sid=1&Fmt=3&VInst=PROD&VType= PQD&R _ QT=309&VName=PQD&TS=1284797126&clientId=7961&aid=1

              Parker, C. (2009). Primary Birth Centres – helping to protect, promote and support normal birth. Women's Health Update. 13(3), 3. Retrieved from:

              http://www.womens-health.org.nz/uploads/pdf/WHU/0908%20NEW S%20v3.pdf

              Romano, A. & Lothian, J. (2008) Promoting, protecting and supporting normal birth: A look at the evidence. Journal of Obstetric, Gynecologic and Neonatal Nursing. 37, 94-105. doi: 10.1111/J.1552-6909.2007.00210.x

              Rowe-Murray, H. & Fisher, J. (2002). Baby Friendly Hospital Practices: Cesarean section is a persistent barrier to early initiation of breastfeeding.  Birth. 29(2), 124-131. doi: 10.1046/j.1523-536X.2002.00172.x

              Walsh, D. (2001). Are midwives losing the art of keeping birth normal? British Journal of Midwifery. 9(3), 146. Retrieved from http://www.intermid.co.uk.ezproxy.aut.ac.nz/cgibin/go.pl/library/article.

              cgi?uid=7999;article=BJM_9_3_146

              World Health Organization. Safe motherhood. Care in normal birth: A practical guide. 1996. Retrieved September 12, 2009, from http://whqlibdoc.who.int/hq/1996/WHO_FRH_MSM_96.24.pdf.

            • 15 Oct 2019 8:18 PM | Michelle Deerheart (Administrator)

              By Dulce Piacentini, Holistic Sleep Consultant and Postpartum Doula at Motherly Hug

              In the beginning of May, just 2 days after Meghan Markle gave birth to a baby boy, she was asked during interviews if her baby was sleeping well and if he was a good baby. I cringed when I heard that, as every baby is a good baby, and “sleeping well as a newborn” is a concept that definitely needs an update! You don’t need to be royal to be asked if your newborn baby is sleeping through the night. This is a question that comes up in everyday conversations, even among mums! And where the idea of “a good baby is one who sleeps well” comes from, when most babies don’t sleep through the night in the first few months, many not in the first year, is something I really wonder. Why does our society have this expectation of a baby so young sleeping through the night when even science has proven it’s not natural for a newborn to do it?

              Sleep has been more and more researched in the last couple of decades, and science tells us that a newborn sleep is polyphasic (they sleep multiple times in a 24-hour period), they spend 50% of their sleep in REM, that is light sleep, and nature has made them this way as a surviving tool. It’s important for a newborn to wake up several times overnight, since that decreases the risk of SUDI (sudden unexplained death in infancy), allows them to be fed regularly – we know their stomach is really small and breastmilk digests really fast – and allows babies to wake up and cry with any discomfort. Clearly all very important to make humankind thrive!

              But science hasn’t stopped there. In December last year, Pediatrics published a study by Canadian doctors who worked with 388 babies when they were 6 and then 12 months old to know if they were sleeping through the night. Bear in mind researchers considered a night when they slept blocks of 6 or 8 hours uninterruptedly. So, before I tell you their conclusions, even if 100% of the babies were sleeping 8 hours straight, in many cases this would still mean a broken night for parents, as babies usually have a night 11-12 hours long.

              The results? At 6 months, 38% of the babies didn’t sleep six hours without waking and 57% didn’t sleep eight hours at once. At 12 months, 28% didn’t sleep six hours straight, and 43% didn’t sleep eight hours. We have even more exciting news out of their research: there was no difference in the mental development of the babies if they slept or not through the night.

              Science has also shown us that melatonin, the famous sleep hormone that relax body and mind and therefore paves the road to sleep, starts being produced by baby’s brain around 3 months, and baby’s body clock – a group of cells in our brain that produce our circadian rhythms, which controls our daily activities – won’t be fully developed until that same age.

              So there you go: super normal for young babies to not know the difference between day and night. Are there things you can do to support their brain development regarding that? Yes, there are. But again, whatever we do it won’t make newborn babies sleep through the night.


              Some of you might be thinking: “But I have a friend whose baby started sleeping 8 hours in a row when he was 4 weeks”. Indeed, there are babies that, for several other reasons (but not because they’re “good babies”!) that don’t fit in this post, will sleep through in the early weeks. I had a baby like that myself – when my daughter was 8 weeks old, she was sleeping 9 hours straight. That didn’t mean though I was sleeping 9 hours straight too. After two episodes of mastitis (because milk production is higher during the night and as baby was sleeping – and not having a feed – my breasts got so full that I ended up having mastitis), I had to wake up in the middle of the night anyway to pump. Also, the fact that I wasn’t breastfeeding during the night when the levels of prolactin, an essential hormone for milk production, are at their highest, ended up affecting my milk supply and I wasn’t able to breastfeed exclusively for 6 months, as I wanted to. So, is it always an advantage to have your baby sleeping through from the early days? Not necessarily.

              Of course, if a baby has been waking every hour during the night for weeks in a row, this will affect their parents, who will probably go really sleep deprived, and that situation can start affecting baby as well. Again, science has already given us tools to help improve the situation in sleep-deprived families. But we should never expect a newborn baby to sleep through the night.

              So, it’s about time we stop asking Mamas of young babies if they’re sleeping through the night. On the contrary, we should accept it’s their nature NOT to sleep through and ditch any expectations we put on new and experienced Mamas regarding baby sleep. What we can do instead is offer Mamas help, is to support them in their daily tasks so that mothers can have more opportunities for a rest and really make use of them.

              Supporting a mum in having more time to bond with her baby, in going through the emotional roller coaster that is typical of postpartum feeling supported, in giving her the time and space she needs to find out who she is as a mum, among other challenges that come with the arrival of a baby, is essential to promote a healthy sleep for families with a newborn. And now we know that a healthy sleep doesn’t mean sleeping through the night.

              Newborn sleep definition = Updated!


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