Author: Cathy Daub, PT CD, CCE (BWI)

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Covid-19 and Childbirth

 

The Corona Virus pandemic is a new disease causing massive confusion, uncertainty, suffering,
and death. We all have questions, many of which cannot be answered at this early stage of the
pandemic. We do know that the virus is spread mostly through respiratory droplets produced
when someone who is infected coughs or sneezes. We do know that the virus can live up to a
week on plastic and metal and even up to 24 hours on cardboard, making wiping down
contaminated things like doorknobs very important. We are all still learning if it spreads in
other ways, but no matter what your questions, the primary and most effective precautions to
take whether pregnant or not remain:

1. Washing your hands with soap completely and for 20 seconds including between the
fingers and thumb under the nails

2. Respect social distancing. Stay at home with your families whenever possible. Avoid
people who are sick and treat other people wo do not appear sick as symptomatic
carriers of COVID-19 i.e. keep your distance at least six feet to help prevent the further
spread of the virus. We must all do our part to help prevent the further spread of the
virus. It is only when the world works together as a team, that we can fight this invisible
disease.

3. Cover your cough and sneeze and cough or sneeze into your elbow.

4. Wipe down any surfaces that could be contaminated with alcohol wipes of at least 65-
90% isopropyl alcohol. The good news is that even though the viruses are easily
transmitted, they are also easily eradicated upon contact with alcohol.

5. Wear Personal Protective Equipment (PPE) if you are a health care worker, and follow
all the protocols and instructions for when and how to use and change PPE, to ensure
your own safety.

These recommendations hold true for most questions surrounding pregnancy, labor, birth, and
the postpartum period. This is an invisible disease that must be taken seriously. Here are
questions you may have concerning Covid 19 and birth:

Mothers testing positive for COVID-19 who have tested positive at birth for the virus: There
have been no babies born to mothers testing positive for COVID-19, who have tested positive at
birth for the virus.

If I test positive, will it spread to my baby when I’m pregnant? We still do not know at this
time but precautions must be taken like coughing into the elbow and following other
recommendations above to prevent transmission to others at birth. So far, no infants born to  mothers with COVID- 19 have tested positive for the Covid 19 virus at birth. The virus was not
found in samples of the placenta, amniotic fluid, or breastmilk.

Are my young children more or less likely to get COVID-19: At this time, it seems from the
data that very young children are much less likely to get the disease, however, since little is
known about COVID-19 all precautions above are strongly recommended. Thus far, only one
infant less than one year of age has tested positive for COVID-19.

Will pregnant women be more ill with the disease than non-pregnant women? It has always
been important for pregnant women to protect themselves as much as possible as they have a
higher risk of developing severe illnesses in general, including from influenza viruses. COVID-
19 is no exception. It is especially important for them to follow the recommendations above.

What should I do if I’m pregnant and test positive for COVID-19? Pregnant women with
confirmed COVID-19 or who are PUIs (Pregnant persons under investigation) should notify the
obstetric unit prior to arrival so infection control preparations can be anticipated.

When I’m in labor, can my partner and doula be with me? Many, but not all hospitals are
allowing only one person with a woman in labor and some even allow nobody else in the room
except caretakers. Social isolation is seen as one of the most effective ways to prevent the
spread of COVID-19 and unfortunately this includes women in labor. It is best to call your
hospital to find out what policies they have regarding these questions and they can change
quickly or sometime be negotiated separately with your care provider for special
circumstances.

Can I stay with my baby after birth if I test positive for COVID-19? Infants born to mothers
with confirmed COVID-19 should be considered PUIs. As such, infants should be isolated
according to the Infection Prevention and Control Guidance for PUIs. However, it is
recommended that separation of the mother from her baby should be made on a case-by-case
basis.

If I test positive for COVID-19, can I breastfeed my baby? “Breastmilk provides protection
against many illnesses and is the best source of nutrition for most infants. The CDC has no
specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or
Middle Eastern Respiratory Syndrome (MERS-CoV). However, much is unknown about
COVID-19. Whether and how to start or continue breastfeeding should be determined by the
mother, in coordination with her family and healthcare providers. A mother with confirmed
COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading
the virus to her infant, including washing her hands before touching the infant and wearing a face
mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric
breast pump, the mother should wash her hands before touching any pump or bottle parts and  follow recommendations for proper pump cleaning after each use. If possible, consider having
someone who is well feed the expressed breast milk to the infant.” 2

For more information visit
1. Prevention for 2019 Novel Coronavirus.
2. Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for
C”OVID-19.
3. Interim Considerations for Infection Prevention and Control of 2019 Coronavirus Disease
2019 (COVID-19) in Inpatient Obstetric Healthcare Settings.

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Sleep? What Sleep?

“The one thing nobody told me about having a baby was about sleep and how exhausted I would be! I haven’t had a good night’s sleep in over six months!”

Many new parents are completely unprepared to cope with a baby who does not sleep well, who wakes up much more often than normal during the night and cries.  Some infants begin to sleep through the night almost immediately and others do not do so for many months.  Newborns lack a regular pattern for waking and sleeping. Their sleep-deprived parents quickly reach a peak of frustration and experience intense emotions as they struggle to meet the 24/7 demands of their child, at the same time trying to balance that with their own needs for sleep. Dazed parents groggily note this night after night, when the baby wakes time after time for feeding or comforting.  For a while parents have to adapt their own sleep cycle to the baby’s irregular sleep, taking catnaps and rising out of deep sleep to attend the baby’s needs.  The situation intensifies if the parents are arguing about how to handle the situation.

These parents have a dangerous amount of sleep debt. Parents of newborns are said to lose 2 hours of sleep per night until the baby is around 5 months old, which decreases to 1 lost hour per night during ages 5-24 months.  Sleep and nap times shift steadily from day to day, so that parents might find themselves up at midnight one night and at 3am the next. Over the first year of a baby’s life, parents each lose an estimated 350 hours of sleep at night.  Preparation for parenthood needs to include a consideration of strategies for parents to cope with their own loss of sleep as well as wakeful babies.

After a long labor that ended up in a cesarean, and then nights with little sleep, my postpartum days were a fog.  I had all the symptoms of sleep debt – lack of focus and clarity, impatience, worry and anxiety, low energy, and crying.   My husband was in medical school and not home to help much.  My mother insisted on doing everything for me, even taking care of the baby which I wanted to do. My daughter cried a lot and my pediatrician told me it was because I was vegetarian – she couldn’t have been more wrong.

Most people in America today are suffering from some sleep debt and go about their days feeling that the tiredness is normal.  Birthing parents are likely in sleep debt even before they give birth to their baby being up through the night to change positions and urinate due to pressure of the fetus on the bladder.  Couple this with a long labor followed by needing to be awake night after night to feed and soothe their baby.  And what if their baby is one who does not sleep through the night for many months?

Even before pregnancy, we as a nation are sleep deprived and go about our days feeling that tiredness is normal.  This is mostly due to the invention of a single and profound technological advance – the light bulb (1879). Now we could work late into the night, or read for pleasure into the wee hours of the morning. The light bulb mimics daylight and has the ability to shift our internal biological clocks.

When I was travelling around the world years ago with my husband, we often slept in places that had no electricity.  We found ourselves going to sleep just after sunset and rising at sun rise.  We became more familiar with the zodiac moving across the night sky.  We were more in tune with the earth’s rhythms and felt more energy.  There was no light bulb to keep us up. The light bulb has upset the natural order.

When new parents know what to anticipate and expect, and when they have the support they need, the postpartum period can even be enjoyable. I wish I had known more.

Did you know….

  • Our sleep begins well before we are born. The fetus spends most of his time asleep – about 16-20 hours a day.  Many women believe their baby is awake when kicking inside, but the baby is most likely asleep which explains why pregnant women can feel kicking at almost any hour.
  • We have biological clocks and circadian rhythms: The internal pacemaker or biological clock located deep in the brain in two pinhead-size clusters of nerve cells called the suprachiasmatic nuclei or SCN, controls a profound daily continuing oscillation approximating 24 hours. These cycles are called our circadian rhythms. They can be seen in almost every function in the body, from basic cell processes to activities of the whole body.
  • Circadian sleep cycles cross the placenta

The circadian sleep cycles begin before birth by passing across the placenta.  Even though the fetus isn’t exposed to light from outside the womb and can’t tell when it is night or day, the mother is communicating this information to her baby. Research on rats and mice at Harvard University showed that these signals from the mother actually stimulate the fetus to mirror its mother’s circadian cycles.  They found that the mothers’ fluctuating melatonin hormonal levels signal the biological clock in the fetal brain, preparing the babies for the rhythms of life outside the womb.

  • The mother’s circadian rhythm seems to act as a gatekeeper, inhibiting birth during the day and promoting it at night. That is why women often go through “false labor” the night or two before actual labor begins. The mother’s circadian rhythm is opening the gate to a nighttime delivery, even before the baby’s biochemical push to be born is strong enough.
  • The fetus starts labor: The fetus signals the mother when its body is mature and ready to be born and actually starts the labor process. All mammals tend to give birth during the time they normally would be asleep, possibly to make sure the birth happens “at home” and safe from predators.
  • When does dreaming begin? Rapid Eye Movement (REM)

It was found that near term fetuses have about 60-80% of the sleep time in REM sleep, also known as “dream sleep.” Typical newborns spend about eight hours in REM sleep, about 50 percent of their daily sleep. As adults, we spend about 25% or about two hours a night in REM sleep. By old age we have only 15-20% REM sleep.

Immediately after birth, there are only two sleep stages, REM and non-REM sleep.  REM sleep is sometimes called active sleep in babies because the muscular paralysis that always accompanies such sleep is not fully developed. Non-REM sleep on the other hand is often called quiet sleep, because the baby is sleeping like a baby, perfectly still, quiet, and limp.

At birth, infants usually sleep 16-18 hours per day, distributed evenly over six to seven brief sleep periods.  They can pass directly from wakefulness to REM sleep and alternate between REM and non-Rem sleep every 60 minutes or so instead of the 90 minutes adults take to cycle from REM sleep.

Newborns can’t talk but very young children can and do talk about their dreams. Less       than two years old, a little girl was sleeping one morning and her father heard her say           “pick me, pick me.” He looked at her eyes and saw some typical rapid eye movements.        He woke her and she said ‘Oh Daddy, I was a flower.”

  • Newborn sleep states: We now know that a newborn gradually develops more sleep states and these are not random. Stages that have been identified are Deep Sleep (quiet sleep), Light Sleep (active sleep), Quiet Alert state, Active Alert State, Crying State, and Drowsy State. The best time to play with a baby is in the Quiet Alert state.
  • Baby’s biological clock matures gradually. A newborn’s biological clock matures gradually to keep track of the time of day. Therefore, imposing a regular pattern of sleeping and waking is bound to be met with distress for both the parents and baby. However, providing cues such as light in the morning and evening dim light along with regular feeding schedules, can help them along as their biological clocks are maturing. Because new infants have a strong homeostatic sleep drive, they build up sleep debt over a few hours and then pay it back right away with a nap. This continues throughout the 24 hour day until their biological clock is mature.
  • Sleep by the age of 12 months: By the end of the first year, the overall number of sleeping and waking hours has changed very little. The infant still sleeps 14 to 15 hours a day. Except for one to two daytime naps, the sleep periods have shifted to the night and the waking periods to the day.  By about 18 months of age, most toddlers are taking only one nap.  Children slowly sleep less and less until their daily sleep measures about 10 hours which holds steady until they reach puberty.
  • Dangers of sleep debt: Without warning, drowsiness can become sleep in an instant. You are only a few seconds from sleep when your eyelids begin feeling heavy. When the biological clock is not alerting the brain, the sleep debt pushes it toward sleep. The biological clock is at its lowest ebb in the middle of the night and people are more prone to distractions, lack of focus, poor memory, bad mood, and slow reaction times.  This is life threatening if for example you are driving a car.

What you can do…

  • Napping – the most important solution

Taking naps is an excellent and respectable strategy for sleep management.  Naps can make you smarter, faster, and safer than you would be without them.  They should be widely recognized as a powerful tool in battling fatigue and the person who chooses to nap should be regarded as heroic. The longer the nap, the greater the benefit and the benefits seem to be long-lasting. A 45 minute nap improves alertness for 6 hours after the nap. And for 10 hours after a 1-hour nap.  The rule of thumb for new mothers is:  “Sleep when your baby sleeps.”

  • Faith and Surrender: Surrender to the process of parenting, and even in your most tired moments, remember that amazing thing you have done to conceive, grow, and birth a baby.  Have faith that it will get easier as he/she sleeps through the night.
  • Drink a glass of water and feel the peace that it brings.
  • See birth as a miracle: Yes, your life has changed, but soon you will hardly remember the time before birth. Babies and young children make us smile. Their joy is immeasurable.
  • Breathe deeply and slowly: Take long deep slow breaths in and out when you feel you have reached your limits.  Practice awareness by closing your eyes, breathing in love and breathing out your worries.

 

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Food As Medicine (FAM) 2020 Event in New Jersey

“Let food be thy medicine and medicine be thy food.”  Hippocrates

SOLD OUT!  120 people attend our very successful Food As Medicine event held in NJ on January 25, 2020.   People attended from all walks of life, wanting to know more about how to improve their health through the food they eat.  The message of the day was, “Take control of your health!”

Anthony Masiello gave an introduction on how to get started on a plant based diet which helped him go from 360 to 195 pounds. These changes had a dramatic impact on his life in that he could now use the seat belt on a plane and sit with his son in the train ride at the park.

Sarina Pasricha MD,  gastroenterologist described the importance of our brain-gut connection.  Getting “butterflies” in our gut is a good example.  She said we are 1% human and 99% bacteria, and 95% of our bacteria are in our GI Tract – mostly the large intestine.  The gut membrane connects diet with our immune system.  Most diagnoses are linked to unhealthy gut microbiome.

Robin Wilson-Smith DO, asked us “What is the most common nutritional defect in America?”  The answer is “Fiber.” We eat too much protein and not enough fiber. She went on to say that the most common cancer in the USA today is endometrial, the lining of the uterus and obesity is the number one cause for endometrial cancer.  She emphasized that non-processed soy based foods such as tofu and edamame are healthy and help to decrease cancers, especially of the breast.

Karen Gibson, registered dietician said that every breastfed baby knows that the milk tastes different in every nursing, depending on what their mothers’ eat.  She mentioned that plant based diets provide enough iron and that when eaten with foods high in Vitamin C, the iron absorption increases up to five times.

Laurie Marbas MD, MBA presented on the topic “Chronic Disease Is it a choice?” She said that we as a country are getting sicker. Our medical education teaches one to be reactive, not proactive.  This leads to a sick care system rather than a healthy one.  20% of our children are overweight or obese.  Life span is cut by ten years when one has type 2 diabetes in their 20’s.

All speakers acknowledged that transitioning to a whole foods plant based diet is the best way to stay healthy, so long as there is also  adequate exercise and good sleep.  She said we become the company we keep so choosing to be around like minded people realizing the health benefits of a whole foods plant based diet makes the transition easier.

Cathy Daub and Karen Burzichelli organized the event, their third one in New Jersey and there was tremendous enthusiasm from the audience to return next year.  The combination of healthy food, good company, incredible learning, and yoga stretches with Kayla all made this an event not to be missed.  Be on the lookout for our event in 2021!

 

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Journey Into the World of Nurturescience!

Journey Into the World of Nurturescience!

Become Registered As A Kangaroula!baby feeding on mom with 2nd woman watching

March 21-22, 2020 in Medford, NJ (12 miles from Philadelphia)

 “Behavior is Place Dependent.”  “What is an innate fetal agenda?”  “What are primal behaviors?”  “What does brain regulation and dysregulation look like?” “ What happens to a baby when there is an allostatic load?”  “How is ‘suckling’ different from ‘sucking?’ ” You may wonder, “How do these affect the brain of a newborn baby and his growth into adulthood and what can we do to help newborns get a better start in life?”  Journeying into the world of Nurturescience  provides answers to these questions.

When I think of a journey, I think of going deeper into what I already know.  When I was in my twenties, my husband and I, newly married, decided to travel around the world for one year.  That one year became three and a half years, visiting 55 countries on six continents of the world, and becoming transformed along the way.  We made this trip early in life and have had the benefit to this day.   We found out that there is always more when you decide to dive deep and the earlier it is learned, the better.

This has been my experience travelling with Nils Bergman and hearing him lecture about Nurturescience.  In fact, his Nurturescience is the NEW Neuroscience.  The impact of what a newborn baby experiences in the first days and weeks of life is more fascinating and has a deeper impact than we realize.  With this new learning in Nurturescience, my passion to help moms and babes have healthier experiences in birth has become more intense because I see how this impacts society and its leaders at large. The beginnings of this lie in birth.

This workshop will benefit all health professionals, including neonatal nurses, midwives, lactation consultants, birth and postpartum doulas and childbirth educators certified in their field through any organization.

Come and learn:

  • How nurture matters for brain wiring of all babies, but how also to apply this for small and sick babies (premature).
  • The powerful connection of mother and baby – the two truths – Zero Separation of mother-baby is our biology, and the mother-baby dyad should never be left alone.
  • The Innate Newborn Agenda – The mother’s body precisely controls every element of her infant’s physiology, from heart rate to release of hormones, appetite, temperature, and the intensity of activity. “This creates an invisible hot house in which the infants’ development can unfold.” (Hofer)
  • How brain wiring is place-dependent – the critical moments at birth and after are when baby brain cells are fired and wired by maternal sensory inputs. There are more synapses in the brain of a newborn baby than stars in the universe, so every baby is born with the full potential of the universe.
  • Ways to help avoid infant brain dysregulation and enhance social connection through life (to avoid the tendency for later social withdrawl).

 

I wish I had known more about nurturescience when I was a young mother and am grateful for the research surrounding this new neuroscience.   We are starting a new movement of Kangaroulas in the USA.  Be one of the pioneers in this movement.

 

www.birthworks.org     Click Events.  For more information click Trainings and scroll down to Kangaroula trainings.

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Pain and Pleasure – Flip Sides of the Same Coin

What would your life be like if you knew only day but not night.
Or what if you only knew hot, and not cold? Or what if you
knew only sadness, and not happiness. What if there were only male and not female? Being
born into the world means being born into duality. Duality simply means that our
understanding of one word is determined to a large extent by its opposite. An interesting
duality is pain vs pleasure. We wouldn’t know pleasure without pain. Pain and pleasure are flip
sides of the same coin. To know one, is to know the other. This is a life principle.

Being fearful of labor pain results in many women numbing themselves to the
experience of birth. They are so fearful that they don’t even want to use the word
“contraction” preferring “surges” or “waves.” But the uterus is one amazing muscle whose
power can bring us closer to who we really are. The uterus is a magnificent muscle that knows
how to expand from the size of a fist, to encompass a full grown baby. It has two layers of
muscle fibers, the vertical outer layer and the horizontal inner layer. During contractions, the
upper layer of fibers of the uterus contract becoming a little shorter and thicker with each
contraction so that by the end of the first stage of labor, they are bunched up at the top of the
uterus and ready to push the baby out. The lower, thinner fibers of the inside layer draw up
and back, thinning and dilating the cervix. During labor, the power felt by a woman is greater
than she can imagine and can take her by surprise. She realizes she is much more than she
thinks she is. Nature has orchestrated this coordinated effort to birth a baby so well that we
can trust this innate wisdom with which all women are born.

As BirthWorks doula student Tara Thompson from VA wrote, “It’s common for us as birth
workers to not emphasize the fact that childbirth is often painful and difficult work. Reframing
the words we choose to describe it and being sensitive to not embellishing the hard aspects of

birth is common, and for good reason because focusing on a perceived negative is not always
helpful.
With that being said, I think women appreciate honesty and acknowledging that it will
be hard work and will be uncomfortable and painful at times. However, this is a GOOD thing
(and what makes our jobs as doulas important)! We need strong and intense contractions to
bring a baby down. We cannot have pleasure without pain.”

There is a saying that “Pain is the interval between two pleasures.” In conception, the pleasure
of intercourse/orgasm is followed by pregnancy and the hard work of labor, but then the new
mother looks into her baby’s eyes and is transformed for she has now become a mother.

Thompson goes on to acknowledge this principle of life by saying, “There is often a break
between contractions. Between conception and birth, there will be labor. Many aspects of life
have this pattern of pain between pleasure. To be able to enjoy the pleasures of life, there
needs to be the hard work (pain).”

Yes, having a baby is hard work but the baby is also a miracle. In fact, a woman who chooses to
feel her labor, experiences a power within she didn’t know was there and leads her to say at the
end, “If I can do this, I can do anything!” This is empowerment – supreme pleasure and
satisfaction. Understanding the role that duality plays in our lives, is what helps us to move
forward in life, becoming stronger and more confident human beings.

And during this holiday season, we can give thanks to the universe for the gift of love that has
been given to all human beings, but especially to women in birth who feel the work of labor,
regardless of birthing vaginally or by cesarean. Birth is love and love is the gift.

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Accepting Fully Who We Are

Our Birth Doula training is very comprehensive and includes not only Optimal Pelvic Positioning and “The Four Principles,” but also ways in which to enhance character development.  One of the ways we do this is by having our students complete the BirthWorks Doula Journal Workbook in which one of the exercises is to write responses to insightful quotations.  Here is an inspiring one we would like to share with you that is pertinent not only to doula work but to life itself.

 Quotation:

“The more we become ourselves, the more we change”. – Carl Rogers

This quotation speaks of accepting fully who we are.  In a society that tells us how to act, think, look and feel this can be incredibly difficult.  Many seemingly subtle experiences create a culture of how and who we should think, feel and be – a parent reassuring a child that, “That didn’t hurt” when they fell off their bike (it might not have hurt the parent but the child sure is hurt).  An Aunt insisting, “Come on and give me a hug, you’re not shy” – though the child is feeling shy in that moment. Teenagers are told who they should “like”; until recently this person must have been a member of the opposite sex.  If someone likes long floral skirts they may be seen as old fashioned, or hippy – everyone seems to have forgotten that floral skirts have gone in and out of fashion many times over the years.  As adults society has all sorts of messages – you should own your own home; you may only have one sexual partner – a dog and two kids is a complete family unit; you should be saving for retirement etc etc.

 

In this barrage of repression many people find it hard to find themselves.  It takes a lot of work to dig through perceived ideas and false personalities to find their true self.  It may even take decades of work through therapy, meditation, restorative practice and life crises.  It’s worth the journey though  for once we have found this true self we have found real freedom and real liberation.  Unshackled we are able to live in movement, flowing with the tide of life, able to shift and change with our current situation or environment.  We are free to live completely in the “Now” because we understand that we are merely consciousness flowing through a series of present moments.

 

Such acceptance is of huge benefit to us in our practice of being a doula as it allows one to be flexible and resilient.  It let’s us accept that other people are complete individuals and we are able to differentiate ourselves from them (differentiation being the ability to hold on to ourselves, our values and our opinions while accepting that there is room for more than one valid opinion and remaining connected whilst dealing with the anxiety that comes from these differences in opinion). We realize that though we may be doing things we may not be comfortable with for our own selves, it may be the best way to meet the birthing mother’s needs at that time.  It allows us to lend ourselves to our clients though they may not always heed our advice and may make decisions that we personally would not make.  It allows us to be gentle and compassionate in all our dealings with our birthing couple and with the entire birthing team.