Tuesday, August 28, 2018

A Quick Update, and, Growing as a Doula: PAIL Training (Pregnancy And Infant Loss)

Whew! I fell of the blogging deep end again, didn't I? I have more posts to share with you about different methods for coping with the sensations of labor, but before I do that, I wanted to share what I've been up to lately. I've been thinking about this blog, and how to manage it. It's evolved so much from when I first started it as a fledgling yoga teacher hoping to share my thoughts and build a following. I've shared my journey with shifting to a local diet, training as an aerialist, getting my reiki attunements, writing a book of tarot interpretations (now there's something I should revisit!), learning about the chakras, and becoming a doula! This tree has grown a loooong way from those humble roots, offering free yoga classes to the parishioners of St. John the Baptist Catholic church in Bed-Stuy! I'm wondering if the most sensible thing to do is to archive this treasure trove of the journey, and start a new blog that is more focused on what I'm up to right now. I hate to lose the continuity of having it all in one place though, and my practice as a doula, reiki healer, tarot reader, meditation coach, and even aerialist is definitely still informed by my deep dives into my yoga practice. And after all, I do still teach yoga, though it's all aerial yoga now! Maybe a little rebrand is all I need. We'll see. What I really need is to get back onto a regular posting schedule!! It's not like I don't have plenty to share! Speaking of which...

Right now, I'm taking a doula deep dive, learning how to support people experiencing miscarriage, stillbirth, critical fetal diagnosis, abortion, maternal death, infant death, and loss of a living child through losing custody. It's a lot of loss to be processing, but our trainer, Nneka Hall, is not just an expert in these issues, she's a compassionate, loving person who is always checking in on us. She cares about how we're managing the work flow of the course, but more importantly, she cares that we have the support we need to process the inevitable sadness of diving into these heartbreaking issues for weeks at a time. Her course is self-directed, so we're free to take breaks and practice self care when needed, and work through the material in chunks, or regularly a little at a time, however we work best. We share resources and connect via our facebook group, not only things that are part of our curriculum, but additional blogposts, movies on netflix, or websites that seemed useful or interesting.

In addition to running these trainings, Nneka runs the non-profit she founded: QUILT (Quietly United In Loss Together). This group provides education, support, and advocacy to those who have lost  a child from pregnancy through age 2. She also participates in other events, discussions, articles, and fund raising campaigns that center around supporting people through pregnancy and infant loss. I have learned so much through her personal story, and her example of transmuting her pain into action on behalf of others.

In the early days of the course, I remember thinking, "Ok, so I'm reading a lot of definitions, and a lot of first-person accounts of pregnancy loss, and watching movies about it...but when will we learn what to actually DO??? How do I support a person going through this?" Over time, I came to realize that it isn't about having a checklist of things to do, any more than supporting a person in labor is about that. Yes, there are tools and techniques that are often helpful, but the most critical thing is simply being present, and truly empathizing. By listening to the stories of people who have experienced this heartbreak, my sense of empathy has been stretched to a new capacity. At least on some tiny level, I'm able to comprehend the depths of grief a family who has lost a child is going through, and that comprehension is the most important tool to hold space, and offer what is needed for these families. Of course, we are learning practical information as well, such as what to include in a kit to support someone through a miscarriage, or what kinds of equipment we'll likely see used to support a baby in the NICU.

Something else that makes this course so special is that Nneka has structured it to keep it very affordable. Whether you're a new doula starting out, a loved one of someone who just got a critical pregnancy diagnosis, or are healing from a pregnancy loss yourself and are looking into how you can help others get better support than you had, this course is accessible to you! This current cohort goes through November, after that, you can be on the lookout for the next one.

Growing as a doula, and being prepared to support my clients no matter what occurs during their pregnancies is important to me, and I'm so thankful that this resource was here so that I could gain these crucial skills. Pregnancy and infant loss is far more common than most of us realize. Odds are very good you already know someone who has been through one of the situations covered in this course. You could be the person to spearhead support when someone needs it most. It's something to think about!

Live Omily,
~em

Sunday, January 21, 2018

Sensations of Labor: Acupuncture and Acupressure

These two techniques belong together because they work off of the same traditional Chinese medicine system of meridians, but they are distinct in important ways: there are a few simple acupressure techniques that you can safely try for yourself, but acupuncture should only ever be performed by a licensed acupuncturist. It is possible to hire an acupuncturist or acupressurist to work with you in labor, but most people see acupuncturists before labor, sometimes in hopes of turning a breech baby, or getting labor started if the care provider wants to schedule an induction. The acupuncturist may share acupressure points with you that you can practice at home, or try in labor. Ideally, you're getting this information from a licensed practitioner who has worked with you personally, and knows any contraindications to certain points that you may be working with.

Do some research into the training and techniques of any acupuncturist you're considering working with. They should be more than happy to share information with you regarding their training, and the safety and sterility of their methods. Since acupuncture needles do break the skin, there is a possibility of transmission of disease if proper protocols, such as using single-use needles, aren't followed. These protocols are industry standard, so it's not difficult to find a safe acupuncturist, but it's smart to do your homework and not make assumptions.

If you're using acupressure points you found online or in a book, be sure to read carefully for any contraindications for using them. A common point used for labor found on the ankle can be so effective at stimulating labor that it's recommended to not touch it at all on a pregnant person until they are term.

If you've ever had someone try to relieve your headache by squeezing the fleshy place between your thumb and pointer finger, you've already experience acupressure! You may or may not have felt that it worked; some people think the stinging sensation caused by squeezing this sensitive area merely serves as a distraction from the headache. That said, distraction is a powerful tool for coping with the sensations of labor, and traditional Chinese medicine tells us that there's more going on here. Plenty of laboring women have made it through by holding a doula or partner's hands, and having the partner squeeze this acupressure point during contractions.

So, how about some pros and cons???

Pros:

Safe! And non-invasive when done properly by a license professional!

Can help with other aspects of birth! Such as turning a breech baby, or starting labor!

Versatile! Can be implemented into your birth plan in a variety of ways

Cons:

Doesn't work for everybody. As with every technique, including the epidural, this won't provide sufficient relief for everyone.

Can be pricey, and only sometimes covered by insurance. If you're lucky enough to have a very inclusive policy, go for it! If not, sometimes there are community acupuncture clinics, or sliding scale providers to help you work this into a tight budget. But...

Can be risky if you try to go the DIY or budget route! Evaluate all potential providers and steer clear of anyone who seems cagey or offended that you're asking about their training or safety protocols.

Have you, or would you try acupuncture or acupressure during your labor? My thought is, getting poked probably got you into this mess...stands to reason it might help you get out of it again nine months later! ;-)

Live Omily,
~em


Thursday, January 4, 2018

The Sensations of Labor: TENS Units and Sterile Water Injections

Happy New Year! I hope you enjoyed your holiday season, and are ready to bounce into the new year with new goals, and new optimism about pursuing those long-term goals you're carrying forward. Yay!!! I'm jumping back into my Sensations of Labor blogpost series, and today we're talking about: sterile water injections, and TENS units! These are two basically unrelated techniques, but what ties them together is that they're both best suited for addressing back labor, and they're both applied to the back of the body.

Back labor is simply when the sensations of labor are felt primarily in the back, or in addition to the sensations felt in the abdomen. In my experience, people tend to struggle more to cope with back labor than with 'front' labor, and back labor also tends to persist more between contractions, giving the birthing person less of a break. In some cases, back labor is caused by the position the baby is in in the pelvis, so when I encounter it in my doula practice, I take steps via the miles circuit, and rebozo techniques to help shift the baby to a better position. Sometimes this works like magic! Other times, malposition isn't the problem; back labor is just the way this person's body processes the sensations of labor. Fortunately, there are specific ways to address those symptoms. In keeping with my pattern so far of working from the most invasive pain-management interventions to the least, we'll be talking about these two methods now, and circling back to position changes, rebozo techniques, and other tricks like counter pressure and the double-hip squeeze, later on. Here we go!

Sterile Water Injections:

Sterile water injections aren't used often in America, but they are a wonderful option when a birthing person needs relief, but is still hoping to avoid the side effects of an epidural. Small amounts of sterile water are injected into four specific spots on the lower back, resulting in a temporary, but intense stinging sensation, sometimes compared to a wasp sting. The stinging subsides in about 30 seconds, and the relief of the back pain immediately follows in about 85% of birthing people. Wow! That's a very high success rate for a completely drug and side-effect free pain relief option! Some doctors and midwives opt to give the injections during a contraction, so the contraction itself serves as a distraction from the stinging sensation, and as the contraction subsides, so does your back pain! The relief generally last for two hours, and more sterile water injections can be given as needed. Let's talk pros and cons!

Pros:

Drug free: no effect on mother or baby outside of the short term stinging sensation

Effective!: 85% effective at relieving back labor (even if you've been feeling labor primarily in the back, you'll usually find that the lesser discomfort in the abdomen does get more intense as your brain begins to focus more on it, but most people still find it much easier to cope)

Easy to administer: it's great when two people can give two injections each, to get it, and the stinging that comes along with it, over with as quickly as possible, but even one person can place the four injections very quickly if everything is prepped in advance.


Can be readministered as often as needed: no side effects, no concern of over-dosing!

Cons:

Sting!: The stinging sensation may be intense enough, and relief slight enough for some people to be a net loss of comfort, and there's no telling before giving it a shot (no pun intended) whether that will be the case for a particular person.

Front labor need not apply: this method won't help if abdominal labor sensations are the ones that are getting overwhelming.

TENS Unit:

TENS stands for Transcutaneous Electrical Nerve Stimulation. The unit consists of a little electronic device attached via wires to four pads that stick to your skin. You place them on the back, turn on the device, and adjust the intensity until you feel a vibrating, prickling, or tingling sensation. You may feel discomfort or pain if the machine is set too high, but it is easily turned down. This sensation diminishes your awareness of the pain of back labor, and the stimulation helps to keep the muscles from tensing up in response to the discomfort, which might be enough to make back labor bearable on its own. Like all pain management options, the effectiveness of the TENS unit varies person to person. For many people, it works best when started earlier on in labor, as it won't provide adequate distraction from intense, active labor contractions. It can't be worn in the bath, or shower, but other than that, it doesn't interfere with freedom of movement. It's a very common tool for labor in the UK, but less common in the U.S. While I'm hearing more and more about it, and even know of one hospital that has one for patient use, theirs was broken the last few times I was there, and the nurses weren't very encouraging of its use.

Pros:

Safe, and non-invasive!: As long as you start very low, and turn the machine up slowly, you should have very minimal or none at all discomfort as you experiment with where you like the machine set. You may find you want it pretty high during contractions, and much lower in between.

Accessible for home use!: All of the pain management options we've discussed thus far, including sterile water injections, must be administered by a medical professional. You can use a TENS unit wherever, and whenever you'd like!

Adjustable for individual's needs, and variations of labor: You may turn up the machine higher as contractions progress, or vary the pattern of the stimulation, to provide more effective relief as needed. You're in control.

Cons:

Unlikely to provide significant relief in active labor: You'll likely find that at a certain point, the TENS just isn't doing it anymore! This can be an excellent time to pull off those pads, and put yourself in a warm bath or shower.

Can be tough to find!: These aren't widely available yet, though they're getting easier to come by thanks to retail giants like Amazon. Your doula may have one as well. It's helpful to get one in advance and spend some time getting to know the controls, and levels of sensations it produces, and you'll want it with you when labor starts, so you can start using it before labor gets too intense for it to be very helpful.

There's no predicting who will experience back labor, and for those who do, having these low-intervention options up their sleeves can make the difference between getting an epidural and not. Even if you planned to get an epidural at some point in your labor, back labor is a good reason to hold off on that decision long enough to try some of the movements, positions, and techniques that can help a baby shift into a better position since back labor is sometimes caused by a malpositioned baby, and a TENS unit or sterile water injections may provide adequate relief for you to take those steps, and then get the epidural later on.

Have you heard of these techniques and tools before? Ever tried them in your labor?

Live Omily,
~em