Updates

I just thought I'd check in to let everyone know that the majority of my blogging time is now spent at my new doula training website.  You can find it here:  www.trainingdoulas.com

Healthy Pregnancy Exercises

I'm starting a group at this sight for pregnant moms who want to get/stay in shape for a good pregnancy and birth...please pass on. Sign up then look for New Beginnings Natural Mamas group...http://www.slimkicker.com/

Childbirth classes in Maricopa Arizona

I'm starting up a series of childbirth classes.  This will be offered cont. on an as needed basis.  So e-mail me if you have questions.  They should last two hours each.  The course outline is as follows:
Week 1: Late pregnancy, onset of labor, early labor
Week 2: Active labor and delivery
Week 3: Interventions, variations and pain meds
Week 4: Postpartum, breastfeeding and newborn care


The cost is $100.  I include lessons on essential oils for pregnancy,
birth, recovery, and infants as a part of the class.  If you just want
one class that is more tailored to your needs, I can do that for $20 a
class and I can meet whenever, where ever you want.  I will also offer
a class strictly on pain medications during birth for those who
desire.  It is designed to be 45m and is 15$ a course.  The purpose of
this course is to help pregnant women and their partners understand
causes of pain in childbirth and pharmacologic options for pain
management.  It will also provide an opportunity to review coping skills
which may be used in labor and birth as well as ways to minimize the
side effects of medication.


E-mail me at rachel.leavitt@gmail.com for more information.

Childbirth classes

View more documents from Rachel Leavitt.

Childbirth classes

View more documents from Rachel Leavitt.

Reflexology course

I am just starting up a reflexology course from the Michigan State University.  I'm excited to see how to utilize this mode of healing for childbirth.  I'll keep you all updated on what I'm learning.....

The birth plan and the nursing process-a new model.

I've been working on writing up birth plans in a fashion that is more for the client and doula to make sure they include everything that the birthing mother wants/needs.  To do this, I've utilized the nursing process theory.  So, for your enjoyment:)  here is a case study I just finished working on for my course.

Case Study 3

Gestational Diabetes

Occasionally I will be presenting case studies separate from the lesson to help you integrate the information you have learned as well as reinforce concepts taught. This particular case has come from a client I had with the names changed. Her main need did not have to do with gestational diabetes, but this definitely played a role in her choices and her goals. I begin with my notes and assessment during the interview process, then move on to finding out her needs and planning accordingly. At the end of this, a birth plan was made that followed her goals and ideas.

Goals

• To understand how to apply knowledge of a specific medical diagnosis to your role as a doula.
• To provide an example of how to incorporate the assessment and interview into the birth plan and your practice as a doula.
• To provide an example of the all steps in the nursing process.

Reading assignments:

Pages 244-247 in The Birth Partner by Penny Simkin.

Read the medical terminology in the lesson.

Listen to the link below:

http://obgynmorningrounds.com/blog/afternoon-lectures/2-72-medical-problems-in-pregnancy-diabetes/

The Interview,

Assessment, and

Birth Plan

Initial Interview Data

First baby

She had gestational diabetes and took medication for this. She possibly also had pre-eclampsia. At 37 weeks, she went in for a NST and found some problems, she was then induced. She labored for a while and got an epidural. Due to fetal distress, she had an emergency c-section. During this birth she was separated from her first husband, but he was there along with her mother. She had a hard time with him there and didn't want much to do with him.

Second baby

She had a normal pregnancy and had a planned c-section at 39 weeks. I'm unsure if VBAC was even offered to her. She had pre-term labor that was controlled with medications. She had difficulty breastfeeding because she felt like she was not giving her baby enough milk. Baby lost weight in the hospital and was supplemented with formula. This continued at home.

This pregnancy

She possibly may be type 2 diabetes but it is controlled with diet. She has seen a nutritionist for this and wants to avoid taking medications for it. She would like a repeat c-section because she feels more comfortable with this. She already has other complications going on and her husband also feels more comfortable with this. She is also having numerous urinary tract infections.

Other

She has anxiety/panic attacks but is not taking medication for this. During her births she had a few panic attacks and would like help with this. Deep breathing and visualizations help with this, as well as having a support person close by. She does not like the oxygen mask. It makes her anxiety worse. She's okay with it if it is held close by, but not on. She was frustrated with how long her baby was taken away after her last two births and wants to make sure they are with her as soon as possible.

Care provider and place of birth

She will be delivering with Dr. X. Right now she is trying to decide which hospital she wants to go to and would like help choosing.

Client goals or desires

• She would like to have the baby with her unless there is a serious medical reason.
• Would like help with breastfeeding
• Help with anxiety.
• Would like to find a hospital that will support her desires.
• Wants help with shoulder/gas pain after c-section.

Needs Identification, Prioritization and Doula Actions

Physiologic Needs

• Risk for imbalanced nutrition status related to NPO status during c-section and gestational diabetes.
  -Actions implemented: Provide clear liquids or other food according to what is ordered or desired. Plan to have foods that she likes available.
• Risk for dehydration related to NPO status during c-section.
  -Actions implemented: Remind your client to drink. Plan to have drinks available that she likes.
• Risk for fatigue related to anxiety about birth.
  -Actions implemented: Address anxiety the day before as well as the day of her c-section.(See below for actions taken for anxiety).
• Body temperature fluctuations related to c-section.
  -Actions implemented: Provide warm blankets or heating pads immediately afterwards. Provide warm fluids if desired. Request warm iv fluids be hung right after the c-section is finished.
• Impaired mobility related to epidural and c-section.
  Actions implemented: Help control pain to allow movement sooner(see actions addressing pain below).
• Nausea related to c-section.
  Actions implemented: Offer peppermint tea or peppermint oil for nausea. Offer liquids and foods slowly. A fan may also be used.
• Risk for shaking related to epidural use.
  -Actions implemented: Make sure that warm iv fluids are used intraoperatively and immediately afterwards. Request warmed blankets during the operation and afterwards Request warm blankets while being before, during, and after the surgery. Diffuse peppermint in the air afterwards or rub some on the feet.
• Risk for itching related to epidural use.
  -Actions implemented: Find something to distract your client from the itching while it wears off.

Safety Needs

• Desires control related to birthing place.
  Actions implemented: Research the hospitals in the area to see what their protocols are regarding infant care afterward, particularly as it relates to babies born by c-sections and from mothers who have gestational diabetes.
• Desires control related to infant bonding.
  Actions implemented: Make sure staff knows that your client wants the baby with her as much as possible. Encourage skin-to-skin.
• Pain related to should/gas pain after c-section.
  Actions implemented: Hot packs to shoulders. Distraction techniques. Get your client up and moving quickly.
• Pain related to incision after c-section.
  Actions implemented: Ice packs for the first 24 hours, then heat packs.
• Pain related to iv
  Actions implemented: Use heat or ice(whichever feels better). Before the iv is put in, warm the hand where is is going to be placed.
• Information seeking behavior related to breastfeeding as manifested by desire for more knowledge and difficult past experiences.
  Actions implementd: Find the closest LLL group. Make sure your client is able to see a lation consultant. Encouragement. Reassurance. Place a sing on babies crib that says not to give this baby anything else by mouth.
• Anxiety related to c-section.
  Actions implemented: Reflexology. Lavender oil. Music therapy. Encouragment. Make sure spouse is close by. Teach spouse light tough to use during c-section.
• Anxiety related to gestational diabetes.
  Actions implemented: Point out what your client is able to control(i.e. Food choices). Focus on signs of good health. Connect them to a nutritionist if possible. Make sure your clients have any medical questions answered by their chosen care providers and provide information they are unablet to obtain.

Social Needs

• Opportunity for enhanced parent/infant bonding.
  Actions implemented: Provide resources on breastfeeding. Provide resources and information on bonding.
• Risk for impaired parent/infant bonding related to c-section and complications from gestational diabetes.
  Actions implemented: Research hospitals to find one that is committed to mom and baby staying together. Make sure the staff understands that your client wants her baby with her as much as possible.
• Opportunity for enhanced relationships.
  Actions implemented: Discuss plan of care with spouse or significant other. Make sure spouse is doing all that he wants to do. Discuss what your clients spouse can do to be involved.
• Isolation related to c-section policies.
  Actions implemented: Make sure that someone is always with your client afterward. Get the majority of the prep work done before your client goes into the operating room.
• Opportunity to enhanced connection to the birthing process.
  Action implemented: Allow your client to see as much as she desires of the c-section birth. Ask to do skin to skin as soon as possible afterward.

Esteem Needs

• Risk for body image disturbance related to physical changes and c-section.
  Actions implemented: Mirror therapy.
• Opportunities for enhanced feelings of empowerment.
  Actions implemented: Make sure your client understands her choices and is given choices.
• Opportunities for keeping environment focused.
  Actions implemented: Request music that your client would like. Make sure choices made are in accordance with your clients wishes. Speak in soft tones. Dim lights as much as possible. Be aware of your clients privacy needs and ask that those be respected as much as possible.
  
  
  
  

Obviously this is not the short and sweet birth plan that you would give to your care -providers, but rather a working birth plan that can be reassessed and changed and is mainly for the doula and her client to understand what exactly the birthing mothers needs are.

Because of the birthing environment we have in our culture, birth plans are viewed as unuseful and sometimes hostile by some medical personnel. Therefore, I do not always recommend giving one to the medical personnel at the hospital, but leave it up to you and your clients discretion. 

In the absence of hostility, a birth plan can be a good way to let your care providers know what your desires and wishes are, so that they can be prepared to offer you the care that you desire.  The one that you write for your care providers will be a lot shorter and mostly just express the birthing mothers immediate desires for her birth.  

The wonderful world of doula training

I thought I'd just give you an update on what I am learning and doing with the doula courses.  This has now become my focus, so forgive my absence:)

This has been such a fun journey for me.  I love seeing the passion people bring to this topic and I love being able to help add to that passion.  Most of all, I love being able to think that I am helping to make a little bit of a difference in a birthing women's life somewhere, because the more people I can train, the more there will be out there to help support and care for women during this time of life.

Right now, I am working on creating a way to help doula's use a theory that will help in their ability to assess and then provide care according to their assessment.  It is a great way to help new doula's in particular utilize the new knowledge they are gaining, as well as help a woman work through their birth plan.  It's called the nursing process.  While it was made for nursing students, I find it works just as well for those in the doula world.  As a part of this, I have been listing just about any sort of thing a doula does for a mom to help with her needs.  This has been amazing to see also because the list just keeps growing.

I also am refining my beginning unit on what a doula is and the benefits of having a doula.  That is also pretty amazing to see.  There is so much research out there on how a doula can benefit a mom.  You can check out my first course for free.  It describes all those great benefits.  Feel free to share with anyone.  The course is still in it's infancy, but it's getting better with everyone who takes it, so it's still only $50 for certification.

And, I have now been able to take on a few postpartum doula clients.  So, that's what's up.  I'll try and keep up more here on this blog, but most of my research energy is going into my classes right now.  I will still try and post any great tidbits I find though here for you guys.

New doula certification website

I just got my new website up.  It needs work:)  But at least it's up.  I'm still in the beginning phases, so if anyone is wanting to take advantage of certifying for $50, let me know.  I'm debating what to do with this blog, though.  It's kind of become my baby, but I think I may retire it soon.  I will have a new one up on my new site...and you are welcome to come there.  I am also going to work on keeping up with my newsletter and fb page.  So check me out here(and I promise, it will get better:)).

www.trainingdoulas.com

maternal mortality vs injury related mortality...an interesting contrast

"Over the years, researchers and clinicians have made great strides in reducing the number of maternal deaths associated with cardiac disease, infection, and hemorrhage. However, the rate of maternal morbidity from injury has not changed, and researchers now suspect injury is a leading cause of maternal mortality as well as an important, preventable cause of death among pregnant women."-http://hcp.obgyn.net/pregnancy-and-birth/content/article/1760982/1981701

This is just I thought I had...first off, I'm not not really for or against homebirth...I'm for creating safer, more woman centered birth, where ever that may be.  But this quote made me think about how we look at birth.  We go to the hospital during birth because birth carries some risk.  From this article, though, it is talking about how more women die from injury than in childbirth...so my question is, if we believe we have to be in the hospital to give birth and yet more women are dying from other causes, why do we not believe that we should just always be in the hospital?

It's a tricky maze of research and logic when we talk about homebirth.  This just made me think a little bit more about our reasons for birthing in the hospital and why we feel more comfortable with it.

A motherhood blessing

This poem was written by Marcella Capasso, Darin Epperson, Melissa Erekson, Rachel Gee, Lori Hulbert, Melissa Inouye, Neesha McKay, Leslie Paugh, Tanna Romero, Donna Simon, Kim Wilson, and Gwendolyn Wyne
Mothers’ Poem
As sisters in Zion, to cheer and to bless

Dear Sister:

As you prepare to birth your baby, we stand around you, united. May you feel our love and support as women who have crossed over the same threshold into motherhood, and as women of faith who offer prayer on your behalf and know that God will hear.

We rejoice with you in this time of celebration, as you prepare to reap the reward for the hard work of many weeks and months. Finally, your baby is coming.

Remember how pleased Heavenly Father is with your desire to give birth to His spirit children in a world in which a growing number of women choose not to become mothers. Cherish the special spirit that will fill your home with this new child who just left the presence of God. We are sure that ministering angels will be at your side and the side of this new infant as it gets accustomed to its new existence.

We release you from your everyday concerns: from professional, church, and family responsibilities, and even from your obligation to interact socially with people around you. Feel free, instead, to focus entirely on yourself and on your baby, to get comfortable, to preserve your strength.

We pray that your mind, heart, and body will be one as you prepare to birth your little one. Remember that this is a means to an end. The moments of pain are nothing that time won’t mend. Think of your baby’s tiny hands, feet, and face, and the beautiful spirit that you are bringing into the human race. May God grant you strength and peace of mind preceding his gift of the greatest joy you’ll find.

We bless you with strength through your faith and Divine Nature, with the knowledge that you were chosen by Heavenly Father to fulfill this beautiful role; and may you feel honored to do so.

We invite you to be filled with peace, that you will welcome this wonderful time of motherhood. Understand that your body has been divinely designed to birth your baby and that you are doing so beautifully. As your birthing continues allow your mind to be at ease knowing that your body and baby are working in harmony. We ask that you receive patience to pass through time as your baby descends.

We bless you with our diverse experiences and perspectives. We remind you that our babies came in many different ways, sometimes in ways that we did not expect or see as ideal at the time. We assure you that courageously adapting to changes as your birthing progresses does not make you any less important, committed, or successful as a mother.

We give you assurance that even when things seem to be going “wrong,” you are entitled to seek and receive the Spirit’s confirmation that God is mindful of you and that all things will work together for your good.

We say to you: be strong; have no fear.

We bless you that pain will help you understand how much the Savior values you; that just as the pain of this pregnancy and birth has taught you how precious your child is, so the pain of the Atonement must make you more precious to the Savior than you can possibly imagine.

Once your new little one has arrived, we bless you with the patience and endurance to make it through each new day having had little sleep, and a fair amount of frustration. It will all be worth it as you watch that precious little baby sleeping quietly, and loving you unconditionally.

We bless you that in your birthing and new motherhood, when the time comes to search for courage and grace, you will remember us, your sisters. You will remember that we have felt what you feel, that we walked with God through the shadow of the deep valleys, that we laughed and cried for joy when at long last our baby came.

If you want to see the history behind this poem, go here.  It's really very touching.

Pregnant and squatting-anyone up for a second round

Ever tried squatting while pregnant.  I got to work with a group of ladies tonight where we did just that(well I not pregnant, but they are).  We had so much fun learning how to rock and roll with a little bun in the oven while learning how to squat and help facilitate labor, as well as strengthen and stretch muscles that will help us the rest of our lives:)

Anyone up for another session?  I would love to do this again.  While it's way more fun hanging out with each other, you can see a little bit of what we were doing from this article.  Also, check out this thread for a discussion on squatting, pushing, and our habit of tucking our tailbones under(which is bad btw).  I don't know why I never connected two and two before now, but there you go.

I think I may write up exactly what we did in my next newsletter.