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Alternative Methods of Checking Dilation {The Purple Line and More}

Alternative Methods of Checking Dilation {The Purple Line and More}

Through several years of being a part of the birth world I have noticed a trend. Dilation is *the* birth topic. No matter how a mother plans to birth, when the time draws near, dilation is the one thing on her mind. Why? Cervical dilation tells us one thing and one thing only – where you are right that second. It tells you nothing about what came before that check (when you compare to other labors or women) and it tells you nothing about what is to come. It only tells you about the here and now.

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The news of little or a lot of dilation can either help or hurt a mother’s mental state in labor. If the mother has been in early labor for days (which is normal), the news of a only 1 or 2cm of “progress” can completely take her out of a peaceful state of mind. If the mother has only been in labor for a few hours and finds out she is already at say, 7cm, she may think her time is nigh…only to find out that she has many more hours of work ahead. Basically – the information can back fire on you.

But there are times when the information can be of use. For instance, a mother may plan to wait to get an epidural until “x” dilation. Or she may be waiting to call her family until she is sure things are really cooking. So what are the ways of getting this information? The first thought that comes to mind (and the only thought usually) is that you must have a vaginal exam.

Guess what? You don’t! That’s right – no one has to put their hands in your vagina to give you this information. Vaginal checks come with their own set of risks, from accidental rupture of membranes (or not so accidental – some care providers have used it as a good time to break mother’s water without asking) to increased risk of infection.

Studies also show that vaginal exams are not really accurate. When checking for exact dilation, studies show the accuracy to be around 48-56%. When allowing a margin of 1cm (which is a large margin of error when this information is used to time interventions or labor “cut-offs”) the accuracy is around 89-91%. [One such study abstract from real women in labor. And another study abstract which was done on models.] When you add in multiple people checking, the accuracy gets even worse. Yet, vaginal exams are considered the “gold standard” of assessing labor progress. And lets not forget that vaginal exams are just plain uncomfortable at the best of times – in labor they can be downright hellish.

So what are some ways of figuring out your dilation without actually touching the cervix?

The Purple Line or Bottom Line

This is a purple/dark line that shows up and extends well, to put it delicately, along your natal cleft. Or rather – your butt crack. The line starts at the anus and moves up the cleft. When it is all the way to the top, you are 10cm. Normally – you do have a bit of a line there. But this Purple Line or Bottom Line is not he line that is normally there (which is usually pink). This is a dark purple line. My suggestion is to check out your bum in early pregnancy so that you know the difference.

A study was done in 2010, and published by BMC Pregnancy & Childbirth, that proves the existence and accuracy of the purple line for many women. In this study, the line itself was present at some point in labor for 76% of women. The line was more apt to show in women with spontaneous labor than in those with induced labor (80% vs. 59%). The further dilated a woman was, the more likely she was to have the line show up. The line showed up most when women were around 7-8cm dilated, and seemed to fade in some women at almost complete dilation. And according to this study sample, the line seems to first show for most women around 3-4cm.

An earlier study was done in 1990 and published in the Lancet which also proved the existence and accuracy of the line, though the sample size was smaller. In this study, the line was seen about 89% of the time and was only completely absent in 10% of women. They noticed a significant correlation between the station of the baby’s head and the length of the line.

The reason for the Purple Line is believed to be due to the increased pressure on the veins around the sacrum. This pressure on the veins creates the dark line where the thin skin of the cleft can show it. This pressure from the head creating the line also means that you can reasonably assess the station of the baby’s head as it moves down. Lower head = more pressure = higher line.

Here is a great example of the Purple Line from a wonderful mother in our support group. Obviously – she is complete in this photo, and baby is on its way out! But you can see the Purple Line so clearly (though I did take the liberty of highlighting it for you). Thank you Sara for sharing this moment with us!

purple line

With the relative accuracy of this method, and especially considering the inaccuracy of vaginal checks, this is a great way for women to check themselves without “checking”. This would also be a pretty accurate way of judging when to head to the hospital (if that is your plan) if you are one of the 76% of women this line shows up for.

The photo below is from Jackie, who was so excited when her purple line showed up around 8cm she actually asked her photographer to snap a photo!

Purple LIne

Sounds of Birth

The sounds a woman makes in labor can tell a care provider (or partner) much about where the woman is in labor. Obviously, this will not work the same for all women. Some women are noisy all the way through – which is fine. Some women are quiet until the very end – also fine and normal. However, there does seem to be a pattern for most women in the way they vocalize in labor.

In early labor (0 to 4cm) a women can normally converse easily or with little effort during contractions. She does not feel the need to rest between them very much, and will most likely continue or pick the conversation right back up after each contraction. In active labor (4 – 6 or 7 cm) the woman usually has to do some breathing or vocalizing during contractions, and normally stops speaking during them. She may have to rest more between them.

In transition (7 – 9cm) the woman tends to really need labor noises – groaning, moaning, and sometimes repetitive mantras or noises. At full dilation the women may really retreat within and become quiet. She may not want to speak at all, even between contractions. Pushing of course has its own set of noises. And just a note on noises – low and open noises seem to help women dilate. Keeping the jaw slack and not clenching helps the pelvic area to open and not clench as well.

Smell

This is something that birth workers will talk about and recognize. Just before the start of transition, the woman emits an earthy and very “birthy” smell. Musky and deep, it speaks to some inner part of our being and psyche.

Fundal Height

This is a documented way of measuring dilation externally. When not in labor and full term the fundal height is normally 5 finger-breadths between the fundus (top of the uterus) to the bottom of the breast bone. As labor progresses, the uterus pulls up on the bottom of the uterus (which is the cervical opening) and this is what creates dilation. Think of it as the uterus “bunching up” at the top in order to pull the bottom up and open.

As dilation progresses, the finger-breadths between the fundus and the breast bone becomes smaller and smaller – at full dilation, you can normally no longer find the gap between the two. This measurement must be done at the height of the contraction, and while mother is on her back. This means it will not be the most comfortable way of assessing progress – but it does work.

Emotions

Basically – as a mother gets more serious, her dilation is increasing. Naturally (like with noise/vocalizations) this is not true for all women. However, in reading birth story after birth story (and watching video after video) I do see this trend. Mothers start out chatty and light hearted. As the harder work sets in, mothers retreat inside and tend to ignore those around them or get serious in other ways.

This seems to be a very accurate sign of transition for most women. Transition is typically the last stage of dilation and is normally the most intense. It is during this stage that mom may get irrational or scared. Usually this is when women feel the “I can’t do this” emotions and may express sudden fear or want of pain medication. When women are prepared for this stage they can be reassured that this means labor is almost over and baby is near.

Bloody Show

Many women hear about the bloody show at the start of labor. Not all women have this, but it is the “mucus plug”…basically, it looks like a large wad (or wads) of well – snot. I know, not the nicest way of saying it, but it is true. The mucus plug is probably one of the weirdest looking parts of labor and birth. However, around 6cm or so, most women get another (or first) bloody show. This usually comes out during contractions, and may be a gush of fluids and mucus and blood. If a woman’s membranes were broken before this point, she may have another gush of fluid at this point.

Estimate Without Fear

All of these methods can be used to assess progress in laboring women. Some may be more accurate than others, but perhaps we should ask ourselves about why we want to know dilation in general. In some situations the information can be very useful, for instance if a mother does not want to head to the hospital too early or if she is negotiating for more time in labor but does not want a vaginal exam at the moment (or at all).

However, my suggestion is that for the average laboring woman we learn to not equate cervical dilation with progress or lack of progress. As I stated at the start, dilation is only a snapshot of where you are right now and tells you nothing about where you will be an hour from now or even 30 minutes from now. Long labors with slow dilation can suddenly speed up and reach full dilation (and baby in arms) in mere minutes or hours compared to the slow dilation of the previous hours or days. Women who are not dilated or effaced at all during a prenatal appointment can suddenly have a baby in arms an hour later. [Though, prenatal dilation checks are another subject that will need a separate post.] Dilation is simply not a crystal ball.

If you are a mother who wants to avoid cervical checks completely, or wants to know how to assess dilation before your care provider comes (or you go to them), then these methods can serve you well. As always, continue your own research and talk to other supportive women.

Further Reading

Bellies and Babies Blog on Dilation

Science and Sensibility post on the Purple Line

A Midwife’s Perspective on Cervical Exams

I Was A Teen Mom

I Was A Teen Mom

Hi, my name is Christina, and I was a teen mom.

I was the least likely person to become a teen mom. I wasn’t a trouble maker; I made good grades; and, I had the same boyfriend for two years. Yet, when I was 17 years old, I found out I was pregnant. The way I told my mom was by handing her the positive pregnancy test while uncontrollably crying. I was confused and terrified.

Eventually I came to terms with the fact that I was going to be a teen mom. For me, it was never a question of whether I would take responsibility for my actions. The baby was mine. I knew that from the beginning. I also knew that I was going to finish my education for my baby. I went to school day after day with my baby growing inside of me. My boyfriend remained by my side throughout the pregnancy,  but he was 20 years old, so he was already out of high school. So, while he was by my side in every aspect he could be, I had to endure the constant stares and ridicule from both students and teachers by myself. But that didn’t matter to me because I was doing this for my baby.

teen mom belly photo

I attended school up until the very day I showed signs of labor. Unfortunately, these signs were false. Four days later, I still had not gone into labor. I was tricked by my own doctor into being induced. I was young and terrified, so when she told me that “some women come in at 40 or 40 and a half weeks and their baby is dead,” I was convinced that being induced was the best choice. I know now that this is a common ploy doctors use to have a baby on their terms instead of nature’s. If I could go back, I would’ve 100% refused induction because there was absolutely no medical reason.

However, I was induced on my due date with Pitocin. It was a rather traumatic experience that involved intense pain, doctors not listening to me when I was telling them something was wrong, my daughter having a bowel movement while in the birth canal, pushing for two hours, and the cord being wrapped around her neck. But, in the end, I had a beautiful, 7 pound 14 ounce baby girl.

The next six weeks were spent battling with breastfeeding issues, reoccurring RSV (which I am convinced was a result her weakened lungs from the meconium she inhaled), and sleep deprivation. And with this, I was also having to keep up with my school work from home.

After those six weeks, I had to return to school for the last semester of my senior year. I somehow found a way to balance my schoolwork and my mommy duties, and when my daughter was 6 months old, I graduated high school with a 4.0 GPA and 6th in a class of 256 students. I was able to graduate with my daughter in the stands cheering me on!

But my story doesn’t end there. After I graduated, my daughter and I moved in with her daddy. We had the summer to adjust to becoming a family, then I started my first semester of college in the fall. All was going well until winter break when I found out I was pregnant again even though we had been actively trying to prevent a pregnancy. I found comfort in the fact that I had the support of my now fiance and my family, but I was, yet again, terrified of the unknown.

What I did know was that I couldn’t give up on my education. I completed the spring semester, then endured 12 hour days during the summer semester while beginning to look and feel as if I had swallowed a watermelon so that I could take the fall semester off for the arrival of our son.

teen mum maternity photo

He measured very big the entire time I was pregnant. I was constantly told that I would probably need to be induced or else I would need a c-section. However, I had taken the time to educate myself this time around. So, when 38 weeks came and my doctor told me we WOULD induce the following week, I told him we would NOT. 39 weeks came and he tried to convince me that I was too small to deliver such a big baby (I’m 5’2″ and around 125 lbs when not pregnant), I still refused. I was not going to put this baby through what my daughter had to go through. Two days before my due date, my doctor told me that I was more than likely going to end up with a c-section, but I trusted my body and my baby.

That night, labor began, and twelve painful, yet relatively uneventful hours later, my 9 pound 15 ounce baby boy made his appearance after only fifteen minutes of pushing. However, he too had the cord wrapped around his neck. When they briefly laid him on my stomach to cut his cord, I looked into his eyes as he made not a single sound. I can still remember my doctor saying, “We’re going to have to give him some help.” No one would tell me what was going on as I continued to ask if he was going to be okay. I remember crying as it seemed like hours were passing without hearing anything from my baby boy. Then, finally, the most glorious cry came from the crowd of nurses. I was able to hold him for a few minutes before they realized he was still having some trouble breathing. They took him away from me for three hours. But he was finally brought back to me and he has been healthy ever since!

Being a 19 year old mommy of two took some adjusting, but we’ve found our groove. My son was a champ sleeper and breastfeeder (he’s still breastfeeding at 20 months old). My daughter has been an amazing big sister. And my fiance has always been a wonderful father. I consider all of things to be blessings.

After taking a semester off, I returned for the following semester and have remained in school since then. I’ve never dropped a class and have made B’s in three off my classes and A’s in all the others. In the fall, I will be entering my program of study and will only have two years left.

My children are now 3 years old and 20 months old, and I am now 21 years old. My journey has not been easy and there are things that I missed out on, but the things I have gained far outweigh anything I lost. It’s not the path I imagined for myself all those years ago, but my children are my world. I couldn’t imagine life without them.

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Unwatermarked photos by Sylvia Hill of Shades of Love Photography

Unmedicated Birth Story {Pre-Labour ROM, Induction 48 hours Later}

Unmedicated Birth Story {Pre-Labour ROM, Induction 48 hours Later}

My birth story starts with me meeting an amazing woman and deciding to start a family together. Which of course is not as easy as it sounds. First we had to decide who would carry said child as we are of course a same sex couple. Then started the hunt for a donor. We wanted someone who would like to be a part of this future child’s life.

We found a wonderful man and the journey began, which did not take long. We were fortunate enough to fall first go. We were thrilled.

This pregnancy took its toll on me as an individual, us as a couple, and the 3 of us as a family (including our 10 year old daughter) she had been the only child for 9 yrs. My partner has never had a child before meeting me and it had been 10 years since I had been pregnant and birthed a child. So all these factors came with a lot of emotions.

After a lot of ups and downs, we were told at my 22 week scan that I had a low lying placenta and if my placenta did not move enough I would be made to have a c-section. I was in tears at this news as it was something I did not consider.

I had my daughter naturally; drug free and I had planned the same with our son (we also found that out at the 22 week scan). The anxiety and fear set in as I have never had an operation.

I had a few more scans after that and was told my placenta had become lower so I was to be booked in for a c-section at 37 weeks. Something I did not want to hear. I begged to wait until at least 39 weeks to make sure it was a definite c-section and I couldn’t birth naturally.

At almost 40 weeks I went for my last scan and low and behold my placenta had moved to a safe level and I was allowed my natural birth. I was overjoyed but my partner was still anxious and scared of the pros and cons of birthing naturally.

On my exact due date my waters broke, but alas nothing happened (this also happened with my daughter). They let me go 2 days with my waters broken before I went in to be induced.

I had a great support system. My mum, partner, sister-in-law and a great midwife who was supportive from the start of my decision to birth drug free.

5 and a bit hours later I birthed our gorgeous little man Bentley weighing in at 8 pound 5 and 54cm long.

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Our family was complete.

We have a gorgeous 10 yr old and a thriving 5 month old. We are getting married in December this year, and planning our next baby that my darling partner will carry.

LOVE MAKES A FAMILY.

 

Maternity photography by R-squared Photography

 

Hello Aunt Flo {And Toxins?}

Hello Aunt Flo {And Toxins?}

aunt flo

Lets talk about PERIODS. Cycles. The Curse. Aunt Flo. Your Monthly Visitor. You know…that thing. The thing you were most likely taught to hide at all costs and were so afraid to be shamed about, be it from a stain on your pants to an “odor”, to hell…just being a woman.

Now readers – this is going to get personal. You are about to know a lot more about me. In turn, I would like you to keep gagging to a minimum. Okay? Alright. Here we go.

I come from a long line of bad periods. My mother, bless her, had a hysterectomy before she was 40 due in large part to her horrible, heavy monthly blood. I was told I was doomed to the same fate. From day 1 of my first cycle, which came ON my 11th birthday, it was heavy and annoying and painful. For years I had irregular, long, horrible cycles. Clotting. Cramping. Staying home from school and work. Nightmares basically.

I was told birth control was the answer. So I was on it for several years. Yes, the periods were shorter, but they were just as heavy. Just as painful. I still missed school and work for the first couple days so that I could lay on my heating pad and moan. Lets not even mention the many side effects of the artificial hormones on my body (that would be a whole post in itself).

I had my son and hoped that would kick my body into gear and force it to be “normal”. Not so much. I escaped cycles for 18 months total (pregnancy and then breastfeeding exclusively), but when they came back they were just as bad. What is a woman to do?

Then one of my friends online mentioned menstrual cups. What on earth was that? A cup in your underwear? She said it solved her cramps and heavy bleeding and get this – it saved her MONEY. Let me tell you – I am pretty cheap. Money saving gadgets draw me like a moth to flame. So I started my research.

Come to find out, they are not cups in your underwear. Lets liken them to flexible shot glasses in your vagina. Which sounds weird – but stick with me here ladies. Lets first look at the reasons WHY we should look at alternatives to conventional feminine products (disposable pads and tampons).

Dioxins, Toxins, and TSS

Since 1980 there have been concerns about tampons and TSS (toxic shock syndrome). That year, many women died from TSS. My aunt got horribly sick during that scare with TSS but thankfully recovered. Now we hear about Dioxin (a carcinogen) and other toxins in disposable tampons and pads. So what is all this about?

Dioxin, in simple terms, is the byproduct of wood pulp (rayon) or cotton bleaching methods when we are talking about tampons or pads. Supposedly, the new bleaching methods are dioxin free…and yet there are still detectable levels of dioxin in the products. This is due in part to the fact that dioxin is entrenched deeply in our environment due to pollution. Therefore, it is a part of the cotton or wood before the bleaching is even an issue.

The FDA states that very low levels of dioxin in tampons and pads are acceptable, though the FDA and the EPA both admit that dioxin is a powerful carcinogen. They state that the load is only 0.2% of the “acceptable monthly load” of dioxin each month. They do not include the fact that dioxin is long lived in the human body and builds up over time. They also forget to mention this is only one source of dioxin – our environmental load is large through our air, food, and water (in other words, we are adding MORE to our body through a product we don’t have to use, unlike air or water).

The EPA has done a recent study stating that dioxin is much more toxic than they previously realized. You can read the full 344 page report here (you know, light reading). They do point out, right at the start of the study, that the way they test can not take into account the ways we are exposed. They are simply injecting it and recording. They even specifically state that we don’t know how it changes when it targets a specific organ.

The targeting of of a specific organ is of special significance here since the pads and tampons are in contact with a very vulnerable part of our body – our labia, vagina, cervix, and through that – the uterus.

The list of non-cancer “endpoints” (risks) in animal trials include infertility in males and females, thyroid issues, birth defects and loss, diabetes, dental issues in both the receiving adult and in offspring, over-active thyroid, and several others. The human trials (which were done when there was a large exposure in a population in 1976) were all on children, newborns (who were exposed in utero) through the age of 10. Low sperm count/motility and over-active thyroid were both obvious results in those groups.

There is also a casual link to the increased use of disposable products over the last 50 or so years and a sharp increase in endometriosis, but further study is needed. Endometriosis is a common reason for infertility and hysterectomy. This link from the EPA talks about the casual link (pages 7-9).

There was also a survey done by a manufacture of medical-grade tampons (dioxin free) that suggests a link between one main brand of tampons and several female “issues” from genital warts to abnormal pap smears. The link is here as I don’t want to call out the brand. But this particular brand is designed to enlarge lengthwise in most types of their product and this creates more rubbing on the sensitive cervix, which can cause abrasions, which they speculate can cause more open paths for HPV and other viruses to enter.

Another (unproven) additive which may or may not be in these products is asbestos. Now, the FDA states that this is not in our tampons or pads. After all, they tell them it’s not allowed in there. However, the FDA does not have agents in each factory and rarely inspect them, and the manufacturer does not have to state any of the ingredients on the box. Hence why you rarely know if you are using an all cotton product or one which also includes rayon (which has a larger toxic load). *If* asbestos is in tampons and pads, it would create more bleeding and cramping. More bleeding equals more sales of the product. I leave it up to you, dear reader, to form your own conclusions on this particular additive.

And lastly – TSS. This is something you most likely know about. TSS symptoms are varied and the risks include death. The CDC states that rates are well down from the scare in the 1980’s – but admit that the rates are most likely under reported. Over a thousand cases are reported each year, half from tampon use, and about 5% die. The reason TSS and tampons are so linked is that the absorbent environment creates a breeding ground for the bacteria responsible for TSS. Tampons containing rayon are more likely to create this toxin overload and breed more bacteria.

Please take note that while much of this research has to do with tampons, your pads are created using the same cotton and rayon, and therefore carry much of the same risks (especially in regards to dioxin).

So now you know the truth about what is in your pads and tampons…so what do you do?

Your Alternatives

Now for the fun part! Your alternatives to those conventional products.

The main product I am going to talk about is menstrual cups since they hold the most mystery. You know, the flexible shot glass I mentioned back at the beginning.

Menstrual cups are pretty common place all over the world except in America. One brand, The Keeper Cup is approved by the FDA here, and one other brand, the DivaCup is now available in some Wal-Marts. A few brands (including DivaCup) are available in places like Whole Foods. But still, to the majority of the United States, these little cups are unknown.

There are many, many brands. Some are more popular than others, some are only available in a few countries. To name a few: DivaCup, Keeper, Keeper Moon Cup, Moon Cup UK (different from the Keeper Moon Cup), Ladycup, Lunette….I could go on and on. Really, there is a whole smorgasbord of cups out there. Which means you have to choose one that is best for you.

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Each vagina is a bit different. That is the fun part about the human body – we are not all alike. Therefore, cups come in different shapes and sizes and with different features. The cup that fits me like a glove may not work for you. A cup for a teenager is going to be smaller than a cup for a mother who has had a vaginal birth (this is why cups come in two sizes – before and after birth). I will post LOTS of links to help you figure this out at the end of the article. Don’t worry. The opinions vary but you can piece together which will be right for you with a little thought.

  1. Have you had a baby? Think about this one…did another person emerge from your vagina lately? Ever? Keep in mind that for some women a Cesarian birth also changes the size of the vagina. Don’t ask me why…no idea. After childbirth = the larger size cup. No children = the smaller cup of your chosen brand. You may also need the larger size if you are over the age of 30/35 even if you have never had a child.
  2. How long is your vagina? (I told you we would get to know each other well). Squat down on your ankles and figure this out. When you reach in with a couple fingers, do you hit cervix easily (it feels like the end of your nose if you are not fertile right now, or more like a squishy bump if you are)? Congratulations, you have a “shorter” vagina. If you reach back and feel nothing…and more nothing…you most likely have a longer vaginal canal or a very posterior cervix. Please check this a few times over the course of your cycle since your cervix does move around depending on if you are in your fertile phase or not. Short vagina = shorter cup (not cup and stem, just cup).
  3. How sensitive do you feel your vagina is? Also think about the connection between your bowels and your vaginal canal. If you push on the canal from the inside back towards your bum, does it get rather uncomfortable? (Please, do not do this too hard – just gentle nudges). If it bothers you a good bit, you may want to consider a cup with a softer rim.
  4. Do you have a very heavy flow? Now this is tricky. I would have told you before the cup that my flow was very heavy. I would not give that answer now. But just think on it. If you use pads, or if you did, how often would you change them? If you use tampons, are you needing to change them all the time due to leaks? You may want to avoid the few cups who have smaller capacity unless you want to empty it more.

There are a few common questions that I always get when I talk about cups. If yours is not here, please feel free to comment below and I will try to answer them for you or find information.

  • Does it hurt? Let me be honest. The first clumsy attempts are a bit uncomfortable. Not horribly painful, and I did not injure myself. Once you get the hang of it, it is no more uncomfortable than a tampon going in.
  • Do you get leaks? Honestly I never had a leak. Not even the first time wearing it during my period. However, I practicing inserting it before my bleeding began (use a tiny bit of lube as the vagina is more dry most of the time than it is during menstruation). I also researched as much as I could to get the cup I thought would fit me best. If you are worried about leaks the first few times you use it, wear a cloth pad as well.
  • How do you put it in there? This boggles the mind when you first see one. It is round…like a cup. So how do you put it in? You fold it and once it is inside you let go and it opens up. A firmer cup is better at the “popping open” then softer cups. My cup (the Keeper Moon Cup) is considered to be a cup with a firmer rim. The DivaCup is considered by many to be a softer rimmed cup. (Just as an example)
  • Isn’t it gross? Not really. Once you know how to take it out, you don’t even have to look. You just take it out, tip it into the toilet and walk to the sink and rinse. No matter what, we see blood during our cycle at some point. And let me tell you, the blood in a cup looks way better than the brown weird blood that was always on my tampons.
  • How often do you empty the cup? Most people empty twice a day and that is with a regular to heavy flow. I empty morning (when I wake up) and night time before bed. I have never needed to empty it while out and about. However, if you did do that, you can simply wipe it out with a tiny bit of toilet paper or use the handicap stall which usually has a sink. Or you can carry some of the wipes that are made to clean cups!
  • Is it sanitary? Yes. If you follow directions and you know, clean it, then of course it is! Most (except the original Keeper Cup which is latex) are made of medical grade silicone and very easy to keep clean. You simply rinse it out with warm water. At the end of your cycle you can give it a quick dip in boiling water to really be sure – but be aware with some cups that can discolor them a little. Harmless, but worth knowing. The original (brown) latex Keeper cup is even approved by the FDA for safety. Also – there has never been a case of TSS from cup use.

Now, there are other things to think about too. The fun stuff. Some cups come in COLORS! Yes, I know – exciting! Your vagina and cervix can be treated to a pretty color during this process. For some people the reason for a color is practical – you don’t see the blood as much as you would in a totally clear cup. It also hides the slight discoloration that can happen over time (which is harmless). The Lunette is a popular brand that comes in several colors.

Some cups come with goodies. The new DivaCup package comes with a swag pin for your purse…or shirt…or to never see the light of day. Your choice. Some come with very pretty storage bags or with wet wipes or specially made washes for your cup. As a side note – never store your cup in an air tight container. Please store it in the fabric bag it comes with. If you cut off the air, the product can degrade.

Some simple “trouble shooting” tips include cutting the stem (shortening it or cutting it off totally), turning your cup inside out (helps with some brands – cut off the stem first), learning to bare down for easy removal, adding a small “twist” after insertion to seal your cup, and learning new folding techniques if you have a hard time inserting the cup.

Cups normally last about 10 years. So for your $20-$40 investment, you get 10 years of not paying for disposable products.

So…enough about cups right? I will include lots of links at the end – I promise!

Alright Lady…what are my OTHER Alternatives?

Cloth Pads are a great option. I think they are pretty easy to understand. Most are designed with the same shape and style of disposable pads, but you wash them. For those who cloth diaper, this is not a foreign idea. A popular company is Gladrags, but there are many brands – just do a search on Etsy and you will be amazed.

These are really fun. You get the basics of absorbancy levels and lengths/widths. But you also get to look at all types of fabrics, pretty colors, organic or conventional fabrics, things that sound exotic like sherpa or minky. The options are endless. And if you are crafty you can make them yourself. These are reusable for several years with proper care and they save money and the environment.

The range of prices with these is pretty large but affordable – especially considering you use them many, many times. You will need 4-6 heavy pads (for overnight and heavy days), 10 or so regular pads, and 6 or so light pads/liners. Or – just keep track of how many disposable pads you are using right now.

Expect to do laundry with these every other day (much like cloth diapers). You can wash them with your cloth diapers by the way, but I would suggest keeping the wet bags seperate so you do not stain your diapers before you wash. Many women just hang a wet bag in their bathroom for “disposing” of cloth pads until wash day. Some women prefer to get enough for their whole cycle and wash one load at the end.

You can pre-rinse the pads to help keep away staining (keep in mind some fabrics stain more than others), or simply buy a color or pattern dark enough to cover stains if you think it will bother you.

Organic Disposable Pads and Tampons are available. Seventh Generation, Organyc and Natracare are three popular brands. These are all cotton and organic. They give you a bit more piece of mind about toxins and fragrances and all that. However, you still have the cost, the pollution aspect, and the chance of TSS (with the tampons).

Another option is Sea Sponges – I will not pretend to be an expert on these. But basically, it is a natural sea sponge that is trimmed to fit inside the vagina (think, smoosh and push up there). You then rinse them and reuse them. You can use them for about 3-6 cycles. They contain no toxins and should be sustainably harvested. This is actually an ancient method of both menstrual bleeding control and contraception. Make sure you get yours for a reputable source of sponges for menstrual use and not Bath and Body Works.

My Testimony

You know all about my horrible pre-cup periods. But how are they now? Since my switch to the Keeper Moon Cup my periods went from 6 or more heavy days to about 4 regular/light days. They no longer cause me to double over in pain or run to my heating pad. I have maybe a small back ache the first day. That’s it. Truly, it has been life changing for me. I no longer spend a crazy amount of money on disposable products every year. I spent $20 and I am done buying for about 10 years. I don’t have to keep up with tampons in my purse or send out my husband in the middle of the night.

I cannot stress enough how much I want women to try something different. Apart from the fact that tampon and pad manufacturers have taught us that our periods are weird, smelly, to be hidden, or shameful (or the opposite spectrum of fit athletes running around with no bloating and sexy ladies in lab coats), I really do feel that this can improve our health.

The FDA and EPA seem to think that there is an acceptable level of toxins we should snuggle up by our cervix every month. But really – do we want to risk that? Knowing that we already have a toxic load just from the air we breath and the food we eat, do we want to add to that? I hope that this has given you some insight into a different way of embracing your cycle and protecting your health. Again, comment below with questions!

Now….all those links I promised! Please note that the brands/shops linked are not endorsed by BWF, but are simply helpful tools. Feel free to buy from where you wish.

Brand Comparison Photos (this also has many helpful links to the right of the page)

Helpful WikiHow Article

Cup Comparisons (also with lots of links to more posts on the right)

Videos on YouTube (comparisons)

Videos on YouTube (folding your cup)

 

The photo of the cups if from this lovely website which has more comparison information as well.

Supporting Women in All Birthing Choices

Supporting Women in All Birthing Choices

It has taken me about a year and a half of blogging to get to a place that I feel I am really doing this and that others see it too. I’ve always had this vision…to passionately share my views about childbirth and inform woman they have choices in how they birth, but not alienate anyone.

You have a few natural birthing communities that freak out at women who have interventions or cesarean sections. They exclaim the mother was not patient enough, strong enough or educated. When a mother shares a loss, they are shunned. Not always because other women want to hurt a loss mom, but because their own fears of loss in childbirth cause them to do so. Then you have ‘mainstream’ communities that say VBACing is dangerous! That if a mother cared for her child she would never birth at home and that home birth is for hippies.

There is a lack of knowledge, understanding and support on both sides. It has taken time, and a lot of criticism on all sides, but I think I am here. I think we are here. I think there is finally a true Birth Without Fear COMMUNITY coming together. A place where we all want to inform women that yes, they have choices in their births! A place that women can get support in the informed choices they do make, even if different from what we would do. A place ALL women can share their stories.

That is not becoming mainstream. That is not people pleasing. That is amazing! In our private support group, a woman announced tonight that she decided to have a repeat cesarean section and was on the way to the hospital to do so. Instead of other women asking her why or criticizing, she has received nothing but an out pour of love, understanding and support. Women share they are educated and informed and having a home birth and even if other women wouldn’t do that, they get support and understanding.

That is amazing.

I’ve had this vision since I started BWF. I have evolved. I have let my guard down. I have been open and communicated more. I have worked on finding a way to not lose my passion or my opinions, but also have more balance. To also support all women. Not every post I do will be for everyone. Not everyone will agree with every post I write or birth story I share. However, there is something for everyone.

I can and will still share different births from breech, to home twin births, to unassisted birth, to midwife assisted home or birth center birth, to hospital birth with midwives or doctors, to cesarean birth. No matter what I feel is best for me (or even you), I still think all birth should be celebrated. I believe all women should be supported.

We can share information, we can educate, we can inform women that they actually have choices. Then we support. When a woman is in labor and gives birth, why criticize? Why say, ‘How dare you share this?!’. It’s done. Having a child is a blessing. A pure and incredible blessing and no kind of birth takes that away.

A woman is beginning her motherhood and it should begin with love all around her. If a woman has a birth she sees as traumatic, no matter what kind of birth it is, give her support. If a woman chooses a different path that you would, remember it is HER journey. When you want to put a woman down, remember that if you want her to come to you with questions, be the person she wants to receive answers from.

44 Questions For Your Midwife

44 Questions For Your Midwife

Written by Svea

Just last week I had the privilege of meeting with two fantastic midwives. Recommended by a friend, they are the women I hope will accompany me through my second pregnancy and delivery. They are kind, empathetic, knowledgeable, and funny. Exciting!

When I told my husband the news, he had a lot of questions. Most of them (“How much does it cost?” and “Do they know what they’re doing?”) I could answer. But some, I couldn’t. Hubby wanted to know exactly what they would do in an emergency – “Tell me about a time when things didn’t go well. What did you do?” and, “Have you ever lost a baby? Why?”

I got all defensive and said that well, I had asked the questions thought were important, and I’m pretty informed about birth and doesn’t he respect anything to do with intuition? Then I got mad and started defending the scientific realities of emotional support (emotionally supported births are not just happier, they’re healthier!) and he said something about how he’s always the one asking the hard questions and it turned into a whole late night conversation that, I guess, we’d been needing to have for a while.

But anyway, I thought I’d share some of the questions I asked in the interview. The query of what to ask a potential midwife used to come up a lot on the BWF support group (and probably does now on the BWF Fans group, but I’m left out because I’m not on Facebook, *sniff*); some of the items below are taken from those conversations. I personally think that ‘goodness of fit’ is the best thing to look for, but we all have to decide what that means for ourselves. The first few are the questions I asked (and the answers that made me so happy).

  1. I plan to refuse almost all vaginal checks. Like, maybe I’ll allow one. What do you think about this? (they don’t check unless the mama requests it! woot!) 
  2. Are you familiar with other ways of assessing dilation? (yes, e.g. vocalization)
  3. Do you deliver breech? Do you deliver all kinds of breech? Do you have training and experience in this kind of delivery? If not, do you have a midwife you would refer me to if the baby had not turned? (No, but a neonatologist who trained under a midwife in Chile works at a hospital nearby and he does)
  4. Do you have experience with turning babies, not hospital version-style? (Yes – almost 100% success rate)
  5. At what point would I get ‘risked out’ of your practice, e.g. how many weeks ‘overdue’ could I go before you transferred my care to a doctor? (As long as baby’s healthy, as indicated by Non-Stress Tests, you can stay with us) 
  6. What do you do in the case of a nuchal cord?
  7. Speaking of cords, we intend to do delayed cord clamping. What do you think about this?
  8. How long have you been practicing midwifery?
  9. Why did you become a midwife?
  10. What is your training/education/certification?
  11. Will you deliver the baby, or will you assist me in birthing him/her/them?
  12. Do you have experience and recommendations for prenatal nutrition?
  13. Do you deliver twins?
  14. Are you connected to a natural birth/natural parenting community I could get to know?
  15. Do you do the Gestational Diabetes screening? Is there an extra cost associated with it? Do you ‘allow’ your clients to eat a specific meal before the test, or do you make them swallow a sickeningly sweet orange drink?
  16. Do you continue to see clients with Gestational Diabetes, or do you refer them to an obstetrics practice?
  17. How much do you charge, and by what date would the full amount be due?
  18. Do you accept payment plans? What is your refund policy if we decide to switch care providers?
  19. How often do your clients succeed in having their health insurance provider reimburse them?
  20. Do you work with doulas?
  21. Do you work with birth photographers?
  22. Who is your back-up pair of hands/midwifery assistant? When can I meet him/her?
  23. What is your hospital transfer rate?
  24. Do you do routine episiotomies? Do you do any episiotomies?
  25. What equipment do you bring with you to a birth? Are you legally allowed to carry Pitocin (for rare post-birth hemorrhaging)? Do you?
  26. Are you trained in neonatal resuscitation?
  27. How many births do  you take on per month/year?
  28. Are you planning any vacations, trips, major surgeries, or other events that would interfere with your attendance at the birth?
  29. I am an abuse survivor and this may affect my experience. Do you have training in counseling or other trauma-healing work?
  30. What kind of postpartum care do you offer?
  31. Do you do placenta encapsulation? Is there an extra charge?
  32. Do you facilitate water birth?
  33. What methods of pain management do you recommend?
  34. My partner has x, y, z fears about home birth. How have you dealt with this in the past?
  35. What is your preferred method of communication, prenatally (phone, email, text)?
  36. Midwifery is a challenging profession, and often a labour of love. What can I do to make this experience easiest for both of us?
  37. Have you had any loss (baby or mother)? Why and what happened?

Also, here are some questions I asked myself after the visit:

  1. Would you be friends with these people? Why/Why not? (Yes. I hope we become friends)
  2. Does either remind you of your mother? How do you feel about this? (Not much – and only in the best ways)
  3. Were you able to ask all the questions you wanted to? Why/Why not? (No – I didn’t ask about hospital transfer rate because I already felt that we’re on the same page)
  4. How did you feel about the birth when talking with them, compared to how you feel about it normally? More or less excited, more or less anxious? (More excited! Not anxious at all)
  5. Was the visit enjoyable? (I didn’t want it to end)
  6. If there were other family members present, what was their experience of the interaction? (My husband was at work but they were kind to my toddler and flexible with his needs)
  7. Did you sense that either was intimidated by your birth nerdiness and stance as an educated consumer? (Nah, we’re all passionate about birth, why would that be a problem?)
While it doesn’t make sense to ask a potential midwife all of these questions in an interview, this is also by no means an exhaustive list. You can pick and choose according to your own needs and wishes. And add your own – if you have a suggestion, please let us know in the comments and I will add it above.
*All photography in this post by NHance Photography
Petition to Support a Midwife and Midwifery Care

Petition to Support a Midwife and Midwifery Care

Daja, a long time BWF follower emailed me that her midwife is being wrongly persecuted and needs our help! Please sign this petition!

She writes…

She was arrested for “practicing medicine without a license.”  But, as you and I both know midwifery isn’t medicine!  She’s been safely supporting women in birth for 22 years.  This arrest was not the result of any bad outcome, no hospital transfers or injury to mother or child.  It’s simply the fact that the California Medical Board is cracking down on midwives and doulas in California.  It’s, unfortunately, happening all over.

Brenda, who has supported me in the births of six of my seven children. She is completely upfront with all her clients that she is not licensed.  She is a direct entry midwife, not a CNM.  She practices under the “religious exemption clause.”  Meaning, that all of her clients sign a statement that they are choosing to birth at home and employ her services for their own religious/philosophical reasons.  She has never misrepresented herself...

In addition, unlicensed midwifery is not a crime in California.  The California code only states that it is a crime to use the term “licensed midwife” if you are not licensed.  So, this case really has no legs.  However, there is a lot of money and power behind the California Medical Board.  Brenda is potentially facing a felony charge when she is arraigned on Dec.14.  Which just boggles the mind.  She’s 60 years old, a mother, grandmother, wife of a retired pastor.  I cannot imagine anyone less likely to face a felony!  In the twin birth on the BWF blog the mom called her “mother earth embodied” and such she is.  Gentle and kind and nurturing as anyone you’ll ever meet.

You can read the details of this case here: California Midwife Arrested.

This battle for birth freedom in California has been going on for decades.  In fact, my own mother went to court to defend her right to birth my brother and me at home.  (If you’re interested you can read that here: The Most Political Thing I’ve Ever Done.).

THANK YOU for spreading the word!  This petition isn’t just about Brenda (but of course that is hugely important to me personally, because she’s like my mother!), it’s also about the freedom for women to choose how they want to bring their children into the world.  It’s religious rights, women’s rights and parental rights.  Thanks for signing and sharing the petition:

 

Newborns and Parents with Tattoos

Newborns and Parents with Tattoos

So, I get this email from a photographer and what does she tell me? That she takes pictures of newborns with their tattooed parents.

Rad.

So I ask Jamie to send me some of her favorites, because I of course want to see them. I love our moms and dads with ink! Want to see too? Why not?! Here ya go!

Hope you enjoyed as much as I did and for more you can check out this and that.

Thank you to Jamie Siever Photography!

Moi aussi, j’aillaite: Can a Nursing Mom Be Sexy?

Moi aussi, j’aillaite: Can a Nursing Mom Be Sexy?

Earlier this fall, a public health campaign in Québec, Canada, ruffled feathers all over… well, all over Québec, Canada.

The 15-second ad aired on public TV during prime-time viewing hours, invoking public outrage on social networks and in the media. A good friend of mine wrote a letter to the government agency responsible, elaborating her grievances: “In Québec we have worked hard as women to be able to make informed choices about our bodies and our lives. Take this ad off the air, and please apologize to the public for insulting our intelligence.” (translated)

What was so offensive about this campaign? Watch it and see how you feel.

(the text says: “I too breastfeed; breastfeeding, it’s glamorous,” with a little pun on ‘amour’ and glamorous)

The complaints made about this campaign – that it depicts breastfeeding in a sexualized light, that it further objectifies women, and that it puts pressure on new mothers not only to nurse but also to wear lingerie while doing it – are valid. I’m the first to say I find it gross when someone makes a sexual comment about me breastfeeding my son (“I’ll have what he’s having!” and “Hey little man, I like boobies too!” are a few of my personal outrages). But I have to admit, there are a few things I like about this public health breastfeeding campaign.

First, it’s a public health breastfeeding campaign. Good public health campaigns draw attention, get people talking, and are effective. They give the public the benefit of the doubt, assuming that we have some agency in our own health choices. And they aren’t commercial advertising. Like many countries with a minor socialist bent (or major – in Cuba they run soap operas about recycling), Canada has a vested interest in preventing sickness in its populace through simple, affordable lifestyle changes. Like breastfeeding.

18 months ago I was sitting in a public health clinic in Montréal and looked up to see a poster of a mother tandem-nursing her toddler and newborn (YES!). The poster had great information about the benefits of full-term breastfeeding, including, “My husband appreciates the fact that I have a secret weapon in combatting toddler tantrums.” Since moving to the US almost a year ago, I have seen precious few public health campaigns, and none about breastfeeding. Instead, I see more advertising and sponsorship from large corporations. Hospitals advertise formula on baby incubators and breastfeeding is no longer shown on Sesame Street.

Second, the mother, Mahée Paiement (a TV personality-cum-spokesmodel), is actually breastfeeding her baby. An image surprisingly rare on either side of the border. Even on products that are supposed to ‘promote’ breastfeeding – from the Boppy Pillow to nursing bras to nursing pads – real baby-on-the-boob nursing is still taboo for advertisers. This refusal to show the actual process of the “beautiful and natural experience” (as one “I-nurse-my-baby-through-my-shirt” nursing bra purveyor calls it) sends a message that, while breast is best, it’s still kinda’ dirty.

Finally, I think this ad could make a difference in some women’s lives. A small but significant proportion of women choose not to breastfeed because their husbands/boyfriends/significant others want the boobies all to themselves. This kind of pressure disproportionately affects poor women without formal education, for whom the social and financial support of their baby’s father is more likely to be a matter of survival. The men don’t want to share; the women can’t afford to lose their men.

This ad could help a man see that he need not lose attraction to his partner if she breastfeeds their child. In becoming a mother, she need not be entirely reconceptualized as sexless. She could be sexy and still nurture their child. Why is this so hard to accept? It links back to the millennia-old madonna/whore dichotomy. A culturally ingrained idea that women can be either sexual or maternal, and nothing in between.

This kind of thinking is damaging because it forces women into the extreme ends of the continuum of human sexuality. You’re seen as either a depraved slut, or a sexless, beatific mom – neither of which is an accurate characterization of any woman 100% of the time. As Robert DeNiro explains in the film Analyze This, he has to have a mistress. Why? Because hey, his wife, “…that’s the mouth she kisses my kids goodnight with. What, are you crazy?”

Some other feminist critics have said that this ad is ‘completely unrealistic’ and that, “Not a single mother nurses like Mahée Paiement does in this ad,” (translated) but that’s simply untrue. Obviously, Mahée Paiement breastfed, at least once, in the way in which she breastfeeds in this ad. Let us not forget, Mahée Paiement is a mother. The assumption that if a woman is dressed up (or not dressed at all), she must not be a ‘real mother’ is false and simply exacerbates the polarization in our thinking about the roles women play and the choices women make.

Women of all stripes and colours breastfeed: women who dress revealingly and women who wear burqas; women who work in the sex industry and women, like Licia Ronzulli (below), who work in parliament; women with all the riches in the world and women who cannot afford formula. The problem with this campaign is not that it shows a conventionally sexy young mother breastfeeding her child. It’s that this is all it shows. A better campaign would show women of all social classes and from a range of ethnic backgrounds nursing their infants.

We should all be free to nurse our children and to define our sexuality as we see fit. Moi aussi, j’allaite.

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