Tag: evansville

Your Feelings Matter for Birth & Postpartum

Your feelings during labor and delivery make a difference not only on the big day, but also in how you remember your birth experience.

Our thinking brains like to imagine that our hearts and feelings don’t influence the way our body or brain works, but it is so wrong. Your emotions affect so many things, and keeping that in mind when you are going through pregnancy, labor, delivery, & all throughout postpartum can be a little daunting. For me, protecting my emotional health during that time felt like one more thing that I didn’t have time to worry about really. First, let’s talk about why your emotions matter and a few things that may challenge you during this time. I promise, this blog post is going to end with some helpful ways to keep your peaceful mindset, because we all need some extra tools to handle this whole wildly human experience.

Because of Hormones

Your hormones are little messengers that run around your body telling it what to do. They are really important for pregnancy, labor & delivery, & postpartum for so many reasons, but I’m going to outline two big ones here. The first thing they do for you in labor and postpartum is they keep things going. Anxiety & stress produce hormones that make your labor slow or even stop, and does the same for your milk production. The giant flood of hormones you get during labor and early postpartum also means we remember MORE and in greater detail. Seriously, ask anyone who has given birth about their story, and they will share far more details than you can even imagine even MANY years later. There are all kinds of evolutionary reasons that our bodies have adapted to do this by the way, because we’re mammals. Anxiety & stress produce these hormones because if we were an animal giving birth in the wild and a predator started stalking us, then we would WANT our bodies to stop labor so we could get up and run away. (Also a reason for animals to eat their placentas–to hide the evidence.) The distinctly human part of this is that our anxiety & stress can be triggered by all kinds of things, including just thoughts inside our amazing brains or even just a sideways look from someone.

Challenges

There are all kinds of things that can increase our likelihood of our anxiety and stress being triggered in labor, delivery, and early postpartum. Things like a lack of privacy & interruptions in your flow can inhibit your ability to relax and for your body to make the hormones to keep your contractions going. People with a history of abuse, assault, or other trauma can really feel their stress hormones escalate in labor and delivery, which is another reason that trauma informed care is sooo very important. Bright lights, strange noises, & smells can all bring those stress hormones whooshing around our bodies. No matter what your specific challenges are to keeping calm and relaxed, developing the tools you need before you have to use them will help you meet any challenges that might arise!

Tools to Help

Don’t be shy about asking for what you need to feel better during labor and postpartum. Keeping the lights low in your room can be really helpful for decreasing anxiety & making a space more cozy. Some people bring twinkle lights to hang up or a tapestry to hang to make the space more their own too. You can even bring a sleep mask and earplugs if they help you. I always suggest packing your own pillow and blanket to make the space smell and feel more like home too, and keeping your partner close definitely helps some people relax more. You can make a sign for the door to remind people who enter to please use hushed voices and respect the energy in the room. Nothing ruins your flow more than someone walking in and talking loudly while you’re just trying to get through your contractions or trying to get your fussy baby to latch. Protect your space and communicate your needs, and if you need some help with that, a doula might be someone to consider adding to your birth or postpartum team.

You can’t live in a bubble, but you can hold space for yourself for this profoundly human experience of bringing a new baby into the world. Developing tools such as breathing techniques, body awareness, meditation, self-hypnosis, & grounding techniques can help you not only stay calm for labor and delivery, but also for postpartum. Psst, these techniques even work for parents to teenagers—ask me how I know. With 20 minutes a day of calming practice, you can learn to bring your nervous system back to calm and keep those good hormones flowing. Your feelings matter!

The Latest Local Maternity Statistics

Statistics reflect the culture of a hospital and the institutional priorities. What has changed here since 2017?

Anyone who has met me can tell you that I’m a huge fan of data! Words and images can hide a multitude of things, and opinions can be influenced by those too. But basing ideas and approaches to things on DATA is honestly my jam. Seriously, I get very excited about this stuff. Every year, Leapfrog Group publishes data they collect from hospital surveys about standards of practice. They measure all kinds of things, but naturally as a doula I’m the most excited to learn about the maternity care statistics. I’ve been collecting this information for our area hospitals since 2017, which is exciting because we’re definitely seeing some changes in the data. If you’d like to read my previous posts, you can do so here, here, and here. Please note, I did not collect the 2019 statistics because they were published in April 2020, and well, you all remember that year right? Without further fanfare, here are the 3 data points I’m always interested in seeing for our local hospitals.

Episiotomy

data from https://ratings.leapfroggroup.org/

I’m REALLY excited to see the episiotomy rate in serious decline because the evidence has been telling us they aren’t an evidence based routine procedure since the late 1980s!! It shouldn’t take this long to change, but at least it is changing. Don’t take my word for it, this paper concluded that, “Our systematic review finds no health benefits from episiotomy,” in 2005. Despite that scientific fact that has been repeatedly proven, as a doula in 2021 I heard a provider at a local hospital say that cutting an episiotomy would help prevent my client from “tearing too much.” I’m not naming names here, but I will if you call me. I have heard that the hospital this doctor works at requires all their physicians to provide explanation for every episiotomy they cut, so this particular doctor must be quite busy with those reports.

Early Elective Induction

Defined as scheduled cesarean sections or induction of labor prior to 39 weeks gestation without a medical reason, early elective induction can happen for a lot of reasons, but there are definite consequences to it. Here is what the picture looks like in our local facilities:

Hospital Goal: 5% or less2017201820202021
The Women’s Hospital Newburgh, IN1.4%1.7%6.8%4.1%
Ascension St. Vincent Evansville2.1%.8%0%0%
Owensboro Health2.1%1.4%.7%1.6%
Memorial Hospital & Healthcare Center Jasper, IN–0%5.9%6.3%
Daviess Community Hospital Washington, IN–1.9%0%Declined 
Deaconess Henderson Hospital–2.4%0%0.0%
Good Samaritan Hospital Vincennes, IN––4%0%
Local Statistics for Early Elective Induction

Cesarean Rates: what everyone really wants to know

Before you look at this chart, I want you to know what the data is telling us. An NSTV Cesarean is defined as first-time low-risk mothers giving birth to a single baby at full-term in the head-down position delivering their baby by C-section. Hospitals should have a rate of C-sections of 23.6% or less according to Leapfrog Group. Some people will argue that this rate should be 10% according to the WHO, but honestly that isn’t true. So what does this data tell you then? This chart shows you how many people pregnant for the first time with a low-risk pregnancy with one head down baby delivered their baby via cesarean surgery. This is also retrospective data, so it really isn’t predictive of the future or exactly what will happen to you either, but it does at least give you an idea of the culture of a place and what their staff sees.
The actual NSTV Cesarean Rates for 2021 are as follows:
  • 36.6% Ascension St. Vincent
  • 30.5% Deaconess Henderson
  • 28.9% Owensboro Regional Health
  • 24.5% Deaconess The Women’s Hospital
  • 17.6% Good Samaritan
  • 17.5% Memorial Hospital in Jasper
  • Daviess Community Hospital declined the survey this year.

What I Wish We Knew

As a doula, I always try to make sure my clients have the best most up-to-date information about their decisions. There is of course such a thing as having too much information, but I don’t think we’re anywhere near that right now with regards to choosing providers and birthing locations. These numbers honestly hide sooo much in the aggregated hospital data. How do I know what my provider’s rates specifically are for these things? They know them, but I have yet to find any providers willing to share that information readily with us. In fact, I’ve encountered a bunch of providers willing to say they don’t know them, when they get monthly reports from the hospital about their own statistics. What are they hiding & why? Why isn’t that information made public so that we can make more informed choices? I’d love to know about VBAC rates, induction rates, & percentage of high-risk vs low-risk deliveries. What about NICU admissions percentages and average length of stay in the NICU? Are there numbers you wish you could see when deciding on a provider and birthing location?

I’m going to keep watching to see how and if things change. I’m going to keep asking questions, as annoying as they might be. I’m a data geek after all. Transparency helps build accountability. Accountability can help push change and improvements. We’re all about improving the way things are done in our area, because seriously it is past time.

Want more? Sign up for our FREE Biweekly Newsletter.

Birth Planning During COVID-19

Knowing what to expect can really help, especially right now.

Preparing for birth is important. Preparing to give birth during a pandemic can be even more important. Birth planning is something that I do with all my doula clients. Writing a birth plan is less about mapping out exactly how you want things to go, because birth isn’t about control. Birth planning is more about exploring all your options so that you can communicate them clearly to the people trying to help you.

Know Your Options

Learning what your options are is really important usually, but some of those options are more limited because of COVID-19. My friend Alice is a doula in Seattle, and she made this great video full of tips for giving birth during a pandemic and talking to your provider. One of my other favorite resources for information Evidence Based Birth made a FREE online birth class for this specific situation. I am writing a separate post about more general childbirth classes, but these are both really great situation specific resources for right now. It is really important that you talk to your provider about all your wishes and make sure you know what policies are in place wherever you are planning to give birth.

Supporting Your Partner

Birth planning during COVID-19 is important, and now more than ever it is important to learn how to help your partner cope with labor. Maybe you planned to have a doula present and now that isn’t an option. My friend Alice has a very inexpensive online class** designed just for partners, and I highly recommend it. She has even added a module on practicing labor! If you are looking for a book to learn more, I highly recommend The Birth Partner by Penny Simkin. She was one of the founders of my doula training organization and this book is an excellent resource. My doula friends in Quebec have also produced a FREE download on labor support that you might find helpful.

Helpful Experience

In the last 6 years I have attended over 140 births as a doula. Keeping abreast of all the local hospital policies is important to me, and am a certified childbirth educator. I have lots of experience, and I would love to sit down and talk to you about your birth plans. I am offering virtual birth planning sessions for $150 that include a 2 hour meeting to talk about your birth plans, a PDF copy of my 96 page childbirth education booklet full of information for you to learn about childbirth, example birth plans, email support to review your birth plan to get it just right, and bonus handouts including a birth themed coloring book. This doula would love to help you walk through your options and decide what is right for your family right now.

I have been able to attend one birth recently at a hospital, and it honestly was wonderful. The staff was honestly impressive and the entire experience wasn’t nearly as scary as I had imagined it would be. It was great to be able to support my client in person, but I don’t know how much longer that is going to last during this pandemic.

Birth planning during COVID-19 can help you feel more secure and ready. Knowing what to expect can take so much of the anxiety out of the process. I’ve been there, and I would love to help you.

P.S. If you haven’t heard, you can now stream all parts of the movie The Business of Being Born here if you are interested!

**This is an affiliate link and I will receive money if you click through and purchase the course. This is not a way I am planning to get rich, but a nice bonus for recommending products that I really do believe in to my clients. I’m happy to talk to you about it if you have any concerns.

Home Birth in Evansville, IN

Home birth is an option here in Evansville, and I love attending home births as a doula. This post will help you think through some of the considerations.

As a doula, I often get asked about home birth here in Evansville, IN. There are plenty of myths and misconceptions about home birth, midwives, and doulas, and plenty has been written on these. My purpose with this post is to give you Evansville area specific resources and a little bit of advice too. As always, I am happy to chat with anyone who has questions about home birth here, and about my experiences as a doula at home births as well.

Choosing Home Birth

There are plenty of reasons that people choose to birth at home. Currently, I am fielding concerned messages about the safety of the hospital and visitor policies. We haven’t seen a restriction of zero visitors here yet, but it could come in the future. One important fact: only low risk parents are able to choose home birth. That means if you have any risk factors such as insulin controlled diabetes or placenta previa, then you are not a candidate for home birth. The good news is that 85% of pregnant people are considered low risk!

Finding a Provider

There are currently 2 home birth midwives that serve the Evansville area: Michelle Sanders, CPM & Jennifer Williams, CPM. They are both Certified Professional Midwives who carry emergency supplies such as oxygen & medicine to stop bleeding. Both are newborn CPR trained, very experienced, and have local assistants in Evansville. They both hold prenatal meetings at their office spaces around 2 hours away. I believe they are both doing virtual visits currently because of the concerns about COVID-19.

Both midwives also require you to have a parallel care provider. That means if you hire a home birth midwife, you will still need to have another provider with hospital privileges such as an OB or family doctor. There are not many providers locally who are able to openly support home birth. That may be changing, but I am also happy to talk to you about which providers we have found to be supportive. It is important that you have an open and honest conversation with all of your healthcare providers about your wishes and plans for your birth.

Cost

Home birth is not cheap. It is also not covered by most insurance companies. You can ask your insurance about a “gap exception” for covering the cost of your midwife. The midwives are not able to bill your insurance, and you should expect to pay your midwife out of pocket and then to perhaps be reimbursed from your insurance company. Some people may be able to use their HSA or FSA for these costs, but again you should consult your individual company.

In addition to the cost of the midwife, you also need to factor in the cost of either renting or purchasing a birth tub and supplies for it if you want one. You will also need to purchase other supplies; your midwife will give you a list. I always recommend getting more towels than you think you would ever need and that you don’t mind throwing away if necessary.

Other Considerations

  • If you are thinking about a home birth, call early! Both of the midwives who travel here get busy very quickly, so don’t wait to contact them.
  • Study up on childbirth and coping techniques! You will want to know what to expect even more at a home birth. I will have a blog post up soon about online childbirth education options.
  • Unassisted Birth or Free Birth is not an option you should choose lightly. If this is something you are thinking about, please reach out to us so we can talk to you about some of the things you might want to consider. Home birth with a midwife and free/unassisted birth are NOT the same thing.

Home Birth Doula

I love being a doula at home births. I have worked with both of the above mentioned midwives. My job as a doula is very different than their job as a midwife. I have balanced on the end of a bed while holding my client in a supported squat position as she pushed her baby out. One client gave birth sitting on my lap. I’ve poured warm water over one clients back as a she labored in a birth pool for hours. As a doula at a home birth, my job remains to help my client ask good questions, move around, be more comfortable, & be emotionally supported. We doulas always try to fill in where we are needed, no matter the location. I often arrive before the midwife and their assistant. I am there to help you.

Reach Out

If you are thinking about home birth in the Evansville area and want to talk about your options, please reach out to us! I love talking about my home birth experiences. Birthing at home might not be the right choice for everyone, but it is an option here. I have spent the last 6 years gathering resources, making professional connections, and learning all I can to help support families in all kinds of birthing situations. I would be happy to talk to you about all of your options.

The Induction Discussion

Ask good questions & know your options!

Induction of labor has been a very hot topic in the birth world, most especially since a huge study published in August 2018 seemed to say that if we just induce everyone’s labor, it will help reduce the cesarean rate. If you are a super geek like me, you can read the actual study here, along with Henci Goer’s full critique and dissection here, and the California Maternal Quality Care Collaborative message about how to apply this study to medical practice here. Long story short: no, that is not actually what that study said and the circumstances that those included in the study had are NOT what most people are looking at when it comes to induction. I know academic discussions are not everyone’s cup of tea, and that is not the purpose of this post. I want to talk about ways that you can approach the induction discussion with your provider. 

I would be remiss if I didn’t start with a little information about induction. There are 2 basic reasons that people choose to be induced: Medical and Elective. A medical induction means that there is a medical reason that it would be better for your baby to be born instead of continuing your pregnancy. There are plenty of important reasons that induction exists for the safety of parents and babies including high blood pressure, high levels of protein in your urine, blood sugar issues due to gestational diabetes, and many more. Some people choose to be induced for all kinds of reasons like family flying in from out of town, pain from the end of pregnancy, a history of very fast labors, and many more. Induction is forcing your body and baby to get the process started before they are ready, so it isn’t always fast, ESPECIALLY the 1st time. There are all kinds of ways to induce labor medically, though providers typically have a way that they like to get things rolling depending on what is already going on with your body. 

What I really want everyone to do, is to have an informed discussion with their provider about induction. The old saying goes that if you don’t know your options, you don’t have any, and that is also true for induction. I always encourage everyone to have an open and honest conversation with your provider, ask great questions, know your options, and know the evidence for those options. 

Here are 6 questions that might help you start the induction discussion with your provider: 

  1. Why are you recommending induction? 

Some providers recommend everyone be induced at 39 weeks. Some providers only recommend induction for medical reasons. Asking why is a great way to start the conversation and communicate your preferences about whether or not you want to be induced.  

2. Can you tell me what my Bishop Score is? 

A Bishop Score is used to help rate the readiness of your cervix for induction of labor using five different measurements. How open is your cervix (dilation)? How soft is your cervix (consistency)? Is it pointed toward your back, middle, or front (position)? How thin is it (effacement)? How far down in your pelvis is baby right now (station)? All of this adds up to the score that will tell you how likely it is that you will deliver vaginally if induced. A score of 8 or more means you are favorable for induction. (Please note: this score is NOT a guarantee!!!) 

3. What is your recommendation for how this induction will start and proceed? 

Most inductions start with a medication to soften your cervix and get it ready. There are 2 medications that they use for this. Cervidil is essentially like a tiny tampon (with a string and all) that they place next to your cervix. Cytotec is a tiny pill that is cut into smaller portions and can be given three different ways: placed next to your cervix, swallowed, or allowed to dissolve under your tongue. You can read more about these drugs here and here if you would like. 

After your cervix is ripe there are different options to proceed, and you may want to discuss things like: a foley bulb for opening your cervix mechanically, your feelings about artificially breaking your water, pitocin for getting contractions going. These are all options that should be considered beforehand so you can be an active and informed participant in your care. 

4. Are there alternatives to what you are suggesting? 

As with most things, providers have a way that they normally do things, this is their job after all. Sometimes there are alternatives that are not always presented. For example, some people get their contractions going using nipple stimulation for a release of natural oxytocin. This is something that you will want to talk to your healthcare provider about before you just start trying to do it at home though. Not everyone wants to know all the options, so providers sometimes shorthand the discussion. By asking this question you show that you are curious and trying to have an open conversation with them.  

5. Will you be there? 

You spent 9 months getting to know your provider, and some people honestly choose to be induced to ensure that their provider will be the one who is present at delivery. I completely respect that. I think that part of the induction conversation always should include knowing who is going to be there and what their schedule looks like. (BTW: one of the nice things about having a doula is that no matter if you get induced or not, you will know and have spent time with at least one of the people in your birthing space.)

6. What kind of timeline are we looking at for this? 

Scheduling things is great, and managing expectations for induction is also important. What I see most often locally is people admitted to the hospital in the evening for cervical ripening and then the active portion of the induction starts in the morning. If you don’t need cervical ripening, then often you are asked to arrive in the morning to begin the process. Induction can be quick, but it isn’t always. You will want to know what happens if your provider goes home and who will be overseeing the induction and possibly the delivery then. If they break your water, do you have a deadline for delivery?   Will you be allowed to eat and drink at all during your induction? 

As with every decision regarding your care, you will want to use your B.R.A.I.N. as a starting point for any interventions. Talk about the Benefits, Risks, and Alternatives. Also check in to see what your Intuition is telling you, and don’t forget to ask what happens if we do Nothing! Induction doesn’t have to be scary and you also shouldn’t be afraid to say no if you don’t want to do it without it being medically necessary. Only you can decide what is right for your situation, and I promise that as your doula I only want you to have the best information to make an informed decision and I will support you unflinchingly and with all the encouragement you require. 

3 Evansville Dates to Go on While You Are Still Pregnant

Fun ways to connect with your partner in the EVV before baby arrives!

The end of pregnancy can be really challenging. You might be uncomfortable with a baby kicking your bladder and sending you to the bathroom 5x an hour. You might be anxious wondering when labor is going to start. Maybe you are counting down the days until your induction and hoping things get going before then. You might be hot and hormonal and ready to not be pregnant anymore, and staring at the full moon wishing the old wives tales were right. (The next full moon will be Friday September 13th, in case you were wondering.) Instead of wishing the end of your pregnancy away, I want to give you three fun dates to go on in Evansville while you are still pregnant.

  1. First Fridays at Haynie’s Corner are so much fun and filled with art, music, all kinds of local businesses, food trucks, and sometimes even some shenanigans! I always make sure to stop by Sixth Street Soapery even if only for the amazing smells and to see Mary Allen’s smile! Walk down and grab some lemonade next to the fountain and listen to some live music. Peruse some local art and if you get hungry there are food trucks and all kinds of great spots to sit like Sauced and Walton’s International Comfort Food. If your feet are feeling swollen and you are sick of waddling around, you can even hitch a ride on an Evansville Pedicab to rest and still feel the wind in your hair. The First Friday of every warm month, this is where it is at, so check out the Haynie’s Corner Arts District page if you want to find more cool stuff going on in this little slice of fun in Evansville.
  2. If you’d like to still get out of the house and do something fun with your partner, but maybe not with such a crowd, perhaps you would consider a cooking class at Thyme in the Kitchen. You could sit a while at White Swan Coffee Lab, get a sweet treat at Milk and Sugar Scoop Shoppe, then stroll around window shopping along Franklin St. This date gives you and your partner time to connect doing things together, learning, and talking about whatever comes to mind. Connecting to your partner is such a great thing to do before a baby gets thrown in the mix and things get more complicated.
  3. Maybe events aren’t your thing at all, and you’d prefer a quieter evening out with your partner. If you love movies and being waited on like the Royalty that you are, my husband and I LOVE treating ourselves to a movie at Royal Suite. No, they won’t pause the movie for you, so definitely don’t pick a long one, BUT they will bring you food when you push a button and that is pretty great. Bonus: their seats recline and you can elevate your feet! When we’re feeling really wild, afterwards we pick up some snacks at Aihua International Market and head down for a stroll on the Evansville Riverfront Park. There might even be some kids playing at Mickey’s Kingdom Playground and you can join them in a swing just for fun! Having a bit of fun together before your baby comes is a great way to connect as a couple.

Connection is an important thing in any partnership, and marking the passage of major milestones, or even in anticipation of them, is a great thing to do. You don’t have to spend a ton of money on a giant vacation to connect with your honey before you give birth. After the baby arrives, life shifts, and making sure your relationship foundation is solid before you start rocking it is a great thing! Dates are one of my favorite ways to connect with my partner, and making time for them isn’t always easy, but is always important.

What are your favorite things to do around Evansville at the end of pregnancy? What special plans are you making with your partner for before baby arrives?