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Pregnancy

Why You Should Consider Hiring a Birth Doula

A doula is an excellent addition to your birth plan!

As our patients struggling with infertility finally get pregnant, aside from the joy of finally seeing those two lines, there are many decisions that need to be made. What provider is right for my pregnancy? What type of birth do I want?

Many of our patients have never allowed themselves to consider any of these things for fear of ‘putting the cart before the horse,’ so to speak. So this process, while exciting and wonderful, can be overwhelming and stressful.

One thing we often discuss with our patients, as they get closer to delivery, is their birth plan. It is our desire for our patients to be informed about their choices and have a provider they trust and feel totally comfortable with.  One thing that can really help during your pregnancy and birth is having a doula. As highly trained, non-medical birth experts, they can walk through your needs, fears, desires, etc and help you come up with a birth plan and guide you and your partner through labor.

I asked a trusted doula friend of mine to do a post for our blog about what role a doula can play and why you would consider working with one. So, without further adieu, here is Hillary Ebling with Beautiful Beginnings Doula Services. 

Hillary Ebling, owner of Beautiful Beginnings Doula Services

Congratulations on your pregnancy! I am so glad Sarah was able to help you reach this point! Did you know, she can continue to help you throughout your pregnancy?

I am Hillary Ebling, and I am a birth doula and postpartum doula in Knoxville, TN . I own my own doula practice. Working as a doula, I work with expectant families so they may have the best chance of achieving their ideal birth. My goal is that you feel confident, cared for, and respected during your childbearing year.

As you begin researching how to have a happy, healthy childbirth, you may run across the words “birth doula” and see that this is a person who supports a family during pregnancy and birth. That sounds awesome… but you already spent money on a medical provider, birth location, and higher price tag baby items like a car seat and a crib. You may think a doula is a luxury you should go without. Before your accept this, however, check out these compelling reasons to spend the money on a birth doula.

First, what is the role of a doula?

“Doula” is a Greek word meaning a woman who serves. I’m using a more formal definition of birth doula to refer to a specially trained birth companion (not a friend or loved one) who provides labor support. This labor support includes comfort measures and emotional support. “Comfort measures” means using massage, position changes, water, hot/cold packs, mindfulness, and breathing to help deal with the intensity of labor. “Emotional support” means using reflective listening, positive presence, and reassurance to help increase your confidence and satisfaction of your birth experience.

It is important to notice that doulas play a completely “non-medical” role. Doulas do not diagnose or treat in any modality, nor do we take blood pressure or temperature, fetal heart tone checks, vaginal examinations or postpartum clinical care. What this means as a client, is that you also need a medical provider, whether that is a midwife or a doctor, to attend your birth. In short, your medical providers keep you and your baby safe, provide all medications, deliver the baby, and take care of the mother postpartum, whereas the doula keeps the mother encouraged, comfortable, and confident.

Now that we have clarified the role, what are the benefits of having a doula for my clients?

 

First, a doula is the only team member entirely focused on the laboring parent’s physical comfort and emotional well-being.

Your medical providers attention is inherently split between two different people – exactly as it should be! We all want a happy, healthy mother and baby at the end of a birth. Their training is scientific and this is where their focus should be. Medical providers are often expected to care for multiple patients at a time and usually work shifts of time in the hospital or on-call period.

A doula’s training, on the other hand, focuses on the “art of labor support,” that is, the emotional needs of people in labor, and non-medical physical and emotional comfort measures (as mentioned in the examples above). Our sole focus is on the needs of the mother, not the baby. Unlike medical providers, doulas work with one client at a time. We will join you when asked, either in early labor or later in active labor. We will stay with you throughout, often with only very brief breaks.

 

Second, having a doula can help you have shorter, more satisfying birth with less interventions.

Although the exact reasons for this are unclear, there have been numerous studies showing that doulas help families. The largest systematic review of continuous labor support, reported the combined findings from 20+ randomized controlled trials, including over 15,000 women. These trials focused on the benefits of continuous support (having a support person constantly present throughout labor, not coming and going as family and medical providers often must). Women with continuous labor support are

  • 28% less likely to have a cesarean section
  • 31% less likely to use synthetic oxytocin to speed up labor
  • 9% less likely to use any pain medication
  • 34% less likely to rate their childbirth experience negatively

Why can’t a family member or partner fill the same role for free?

Outcomes were most improved and intervention rates were most dramatically lowered in the group with doulas as their support person, not a nurse, friend, or family member.

But do you need one if your partner is really supportive?

In a perfect world, your doula and your partner work together to give you the best birth possible. We cannot possibly replace the loving, intimate relationship of your partner. We don’t stand in the way of your partner being great labor support – we help him or her achieve it!

Our birth culture puts a lot of pressure on partners. A pregnant parent often expects her partner to be knowledgeable – and good – at a host of new things. You may expect your partner to help you emotionally (by providing reassurance, encouragement, and confidence in you) or physically (by encouraging coping mechanisms like breathing and relaxation and providing comfort measures like massage). Lastly, you might expect your partner to fulfill other roles, like updating family and friends of your labor progress. That’s a lot of expectations for one person to handle! For many partners, this may be the first time he or she has ever set foot in a delivery room or seen labor! Add the love your partner feels for you and your discomfort to the equation, and it can be completely overwhelming!

With a birth team of both a partner and a doula, though, we share the weight of these expectations. You will have twice the emotional support and reassurance. We can alternate providing physical support so your partner is less fatigued by the labor. We stay with you if your partner needs a break for food or to update your family. This way, you are never unsupported and your partner can have peace of mind while handling these tasks. We have seen many labors and can use our experience to provide helpful suggestions for new things to try for both you and your partner.

 

Last but certainly not least, doulas provide informational support to the family.

By “informational support”, I mean explanation and discussion of practices and procedures, and assistance in acquiring any knowledge necessary to make informed decisions about your care. We help you find reputable, evidence-based information that will help you make informed decisions about your birth and your new baby’s care.

In essence, a doula doesn’t tell you how you should give birth. Instead, we share information with you so you can make informed decisions and then support you, whatever your choices.

Ok, so you definitely want a doula, but aren’t doulas expensive?

Often, yes – we are trying both to answer a calling and make a living. Although not usually covered by your insurance, some insurance companies will pay a portion or allow you to pay for your doula out of a health or flexible savings account. Contact your health insurance provider for more information about your specific situation.

DONA International’s Vision is “A doula for every woman who wants one”. With this in mind, many doulas offer some way to cut costs. I offer gift certificates so friends and family can donate to help financially (consider asking for this for baby shower presents!!). I also offer a discounted price for families on WIC. I also offer a 10% discount when you buy both birth doula and postpartum doula services. I am of course happy to answer any questions you have about my current options at info@beautiful-beginnings-doula.com or (423)384-6902.

Bottom Line: With all this information in mind, I urge you to consider carefully the benefits and options to offset the cost before you write off having a doula off as a luxury you can’t afford!

The One Year Anniversary of The Tennessee Center for Reproductive Acupuncture: Wisdom Teeth and Gratitude

Thank you, Knoxville, for a successful first year!

On March 1, 2016 the Tennessee Center for Reproductive Acupuncture finally opened it’s doors to Knoxville and the surrounding areas. We are Knoxville’s first and only acupuncture practice specializing in fertility and prenatal wellness. It was my goal to provide East Tennessee with an integrative option for the treatment of infertility and help each of our patients navigate this complex journey. We have officially been open for our patients for one year (and counting) and I wanted to touch on my thoughts for this first year in practice here. 

It was my intention to post this retrospective on the 1 year anniversary of my practice, but I spent the morning driving my husband to and from his wisdom teeth removal appointment. Luckily, all went well, and I was able to fill my afternoon seeing the patents that are truly the heart and soul of TNCRA. Minus the wisdom teeth extraction (who wants to do that!?), I wouldn’t have wanted to spend the one year anniversary of my practice in any other way.

When I think back over the past year, I am completely overwhelmed with a feeling of gratitude. I have been humbled by the reception that Knoxville has given to TNCRA. Over the past year I have met many families struggling with infertility and had a chance to help many of them achieve their dream of pregnancy. I have also met many expectant mothers and had the honor of working with them as they prepare to become mothers for the first, second, third, fourth, or fifth (and more) time. I have also met so many others whose passion for working with families during infertility and pregnancy just bleeds through their work: doctors, doulas, midwives, nurses, massage therapists, craniosacral therapists, nutritionists, chiropractors, photographers, lab technicians, yoga teachers, other acupuncturists, counselors, reproductive endocrinologists, ultrasound technicians, OB/GYN’s, and I’m sure there are few I am forgetting.

One thing I kept hearing in my first year of practice here is that it can be hard for people coming from outside of Tennessee to get a successful business going. I have found this completely and happily untrue. Knoxville has an incredibly welcoming atmosphere and a truly wonderful community to support families of all backgrounds on their journey from trying to conceive to becoming parents. I am honored to be a part of this community and look forward to many years of practice here.

So, thank you Knoxville for welcoming me with open arms. Thank you to the other practitioners who have taken time to learn about TNCRA and how we may be able to work together to help support our patients. But mostly, thank you to my patients. You have put your trust in my experience and training during the most sensitive of times and I am forever grateful to walk alongside you on this journey.

I am very excited for the years to come and hope to build upon the foundation that has been laid. I look forward to learning more each year and working with more families. Mostly, I look forward to pregnancy announcements, birth announcements, and holding space (or a hand) for those experiencing a loss or a failed cycle. These moments are truly what drives me to come to work each day. I love my job.

 

How We Use Acupuncture and Moxa to Help Turn Breech Babies

Moxa sticks, pictured above, are a useful treatment in encouraging a breech baby to turn.
Moxa sticks, pictured above, are a useful treatment in encouraging a breech baby to turn.

If you’ve been told by your midwife or OB/GYN that your baby isn’t in the best position for a vaginal birth, you know what kind of stress this can bring on! Most women facing a possible Cesarean section for breech presentation will search far and wide for things they can do to help their baby get into a better position for delivery.

If you end up consulting Dr. Google, you have probably come across others talking about using acupuncture and moxibustion (moxa) for turning breech babies, and you probably have some questions. It is true that we safely use these techniques to turn many breech babies and it can be successful much of time!

 

What to expect: At the Tennessee Center for Reproductive Acupuncture we use a combination of acupuncture and moxa to help encourage a cephalic presentation.

  • Acupuncture: We generally recommend acupuncture 1-2 times per week to help encourage baby to turn, reduce stress, and to relax any tight muscles that might be preventing an ideal presentation.
  • Moxa: You will be given moxa sticks and instruction for their use at home. Our protocol involves moxa treatment 2 times a day for 15 minutes for a course of 7 days (or until the baby turns).

After treatment, you will generally feel an increase in fetal movement, and an overall sense of relaxation and well-being. New to acupuncture? Here is what you can expect.

 

When to receive treatment: The ideal time to use acupuncture and moxibustion is between week 33 and 35 of your pregnancy.

Beyond week 35, the chances of success decreases as baby is starting to get larger, but many breech babies have turned in the last weeks of pregnancy or even as labor starts.

It’s best to call as soon as you find out you are breech and discuss your personal case with our acupuncturist. We can walk you through your options and what the best course of action is for your situation.

 

What else can I do?

  1. Swimming: any type of swimming with your stomach down in the water can take the pressures of gravity off your uterus and allow baby to move into a good position
  2. Dance: put your favorite music on and make sure to let your hips rock!
  3. Talk to your baby: Baby can hear your voice and some women have reported success with asking baby to adjust his or her position.
  4. Webster Technique: This is a chiropractic technique that is helpful in turning breech babies. Be sure to seek out someone trained in this technique.
  5. Spinning Babies: The positions on this website can help your baby settle into position and are highly recommended. We also recommend using this site throughout your pregnancy to help prevent breech presentation.
  6. Talk to your doctor about performing an external cephalic version or other medical interventions.

 

What are the chances that it will work?

In one study, where moxa and acupuncture was compared with a watch and wait approach, 75.4% of women treated with acupuncture and moxa had a cephalic presentation vs 47.7% of the control group. Both groups were offered external cephalic versions and results included the successful versions.

 

In addition to the recommendations here, we encourage all pregnant women to take advantage of Pre-Birth Acupuncture starting at week 36 to help get your body ready for labor and help support a vaginal birth. Prenatal acupuncture done in the last weeks of pregnancy can reduce the need for interventions like epidurals and emergency C-Sections.

Please give us a call at 865-315-3845 or contact us online for more information or to set up an appointment. We look forward to working with you!

 

 

Resources:

https://acupuncture.rhizome.net.nz/acupuncture/research/moxabustion-breech/

https://www.ncbi.nlm.nih.gov/pubmed/20430289

https://acupuncture.rhizome.net.nz/acupuncture/fact-sheets/evidence-base-acupuncture-and-moxibustion-breech-presintation/

https://www.ncbi.nlm.nih.gov/pubmed/15280133

http://www.cochrane.org/CD003928/PREG_cephalic-version-by-moxibustion-for-breech-presentation

http://jamanetwork.com/journals/jama/fullarticle/188144

Preventing Miscarriage with Acupuncture

Acupuncture can be helpful in preventing miscarriage from certain causes.
Acupuncture can be helpful in preventing miscarriage from certain causes.

Finally seeing those two lines on a pregnancy test is a long-awaited, and rightfully celebrated, moment for all of my patients! This joy can quickly become sadness if the pregnancy is not viable. Miscarriage is a very common occurrence with 10-25% of all pregnancies ending in miscarriage. The most common cause of miscarriage is genetic abnormalities that cause the embryo to be non-viable. Other causes of miscarriage can include:

  • Hormonal abnormalities: PCOS, low progesterone, diabetes, etc
  • Lifestyle issues: smoking, excessive alcohol use, excessive caffeine, drug use,exposure to toxic substances, etc
  • Maternal age: the prevalence of genetic abnormalities increase with age
  • Thin or low quality endometrial lining
  • Immune system issues
  • Trauma: generally only very severe trauma leads to miscarriage
  • Structural abnormalities in the uterus: adhesions, polyps, septum, etc
  • Blood clotting: anti-phospholipid syndrome

For less than 1% women, miscarriages can become recurrent. This is typically diagnosed after having 3 miscarriages. A thorough workup is done to try and find out the cause and determine what treatment is appropriate. Fortunately, many causes of recurrent miscarriage are treatable. Even in the case of genetic abnormalities, like chromosome translocation, preimplantation genetic diagnosis (PGD) can be utilized in combination with IVF to help decrease the chance of miscarriage.

 

What can I do to prevent miscarriage?

There is a lot you can do on your own to help prevent miscarriage. Much of this work involves managing chronic illness or hormonal imbalances and modifying complicating lifestyle factors. For example:

  • Quit smoking as soon as possible in your conception journey
  • Limit coffee and tea to 1-2 cups daily
  • Maintain a healthy BMI
  • Seek the help of your physician in managing diabetes, PCOS, or other health problems
  • Eat a healthy whole-foods diet high in fruits, veggies, and protein and low in sugar and processed foods
  • Limit exposure to toxic chemicals or environments
  • Avoid dangerous situations or activities where severe trauma may occur 

 

How Can Acupuncture Help?

Acupuncture can be a very useful for assisting in the prevention of miscarriage when not related to chromosomal abnormalities by treating many of the common causes of miscarriage. Acupuncture can be helpful in the following ways:

  • Increasing the thickness and quality of the endometrial lining
  • Helping regulate hormones
  • Helping to treat PCOS 
  • Reducing uterine contractions in early pregnancy
  • Improving uterine blood flow to help prevent blood clots
  • Regulating the immune system
  • Stress reduction

What does the research say?

Research on acupuncture and miscarriage is very promising. One recent study on acupuncture done along with IVF showed a 50% decrease in the miscarriage rate.

Another study suggests acupuncture may even be a potential supportive treatment for threatened or recurrent miscarriages due to its beneficial effects on serum cortisol and prolactin levels during IVF.

Acupuncture’s known effects on stress are also a possible mechanism by which miscarriage rates could be reduced. According this same study, it is possible that stress in very early pregnancy may cause overactivity of the hypothalamus-pituitary-ovarian axis leading to reduced progesterone levels. In reducing this stress, progesterone levels may stay higher.

 

When should I start acupuncture?

Acupuncture can be started at any point along your journey. Some basic recommendations are here:

  • If you are pregnant: We recommend acupuncture weekly through the first trimester to support blood flow to the uterus, reduce stress, and support progesterone levels before the placenta is fully developed.
  • If you are trying to conceive: Generally, it is recommended to begin acupuncture 3 months prior to conception for most causes of recurrent miscarriage. This allows the treatments to affect overall cycle health, hormone balance, and egg quality as it takes 90 days for an egg to prepare for ovulation. However, the effects of acupuncture are beneficial at any stage of your journey, and accumulate over time. We see many women while they are actively trying to conceive naturally or with fertility treatment. We have protocols for IVF, IUI, medicated cycles and couples trying naturally.

 

Please give our office a call to discuss your specific situation or to schedule an appointment. We are more than happy to answer any questions you may have. We wish you the best of luck!!

 

 

References:

http://www.huffingtonpost.co.uk/jacquelinehurst/acupuncture-to-support-fe_b_5958722.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342918/

http://americanpregnancy.org/pregnancy-complications/miscarriage/

http://www.acog.org/~/media/For%20Patients/faq100.pdf

http://natural-fertility-info.com/increase-egg-health

http://eastwindsacupuncture.com/acupuncture-in-ivf-linked-to-lower-miscarriage-and-ectopic-rates/

 

Pre-Birth Acupuncture: Helping Prepare Your Body for The Best Birth Possible

Here's a quick guide to Pre-Birth Acupuncture
Here’s a quick guide to Pre-Birth Acupuncture

If you’re nearing the end of your pregnancy, you’ve undoubtedly spent many hours day-dreaming about the upcoming birth of your baby. The last few weeks of pregnancy are a really exciting time! You may have even written a birth plan and discussed your wishes with your doctor or midwife. Many of you will desire to have a vaginal delivery or may even be trying to avoid using any medications during labor and trying to do everything you can to help ensure your birth goes according to plan.

In addition to keeping healthy and active during your pregnancy, there is one more thing you can do in the final weeks of your pregnancy to help encourage a healthy delivery. Pre-Birth acupuncture is helpful in preparing your body and mind for labor and delivery.

 

What is pre-birth acupuncture?

Pre-Birth Acupuncture is a series of 4-5 weekly treatments beginning at week 36 of your pregnancy that are designed to help your body go into labor on time and to labor to progress normally and without complication once it begins. It is not labor induction and will not bring on labor. The baby is in control of his or her arrival date.

Pre-birth acupuncture reduces the need for epidurals, emergency C-sections, and reduces the time you spend in active labor. Overall, vaginal birth rates increase in women who receive these treatments.

 

What does the research show:

  1. Reduces the time spent in the first stage labor (period of time between 3 cm dilated and full dilation) by an average of 2 hours
  2. Reduces the number of inductions in frist time moms by 43% and 35% in all others
  3. Reduces rate of epidural usage by 31%
  4. Reduces emergency C-section rate by 32%
  5. Increases vaginal birth rates by 9%

 

In addition to these benefits, this is a great time to address any stress or symptoms that you might be experiencing in the last few weeks. Acupuncture can be useful for swelling, back/hip pain, acid reflux, headaches, and many other common pregnancy symptoms. We can even use acupuncture to encourage breech babies to turn!

We recommend these treatments as a standard part of our prenatal acupuncture protocol, and many women choose to start prenatal acupuncture in these final weeks to help make their birth plans a reality.

Give us a call with questions or to set up your pre-birth treatments today!

 

References:

https://acupuncture.rhizome.net.nz/acupuncture/research/prebirth/

Prenatal Acupuncture: A Happy and Healthy 9 Months

Acupuncture is a safe and effective treatment for many common pregnancy symptoms.
Acupuncture is a safe and effective treatment for many common pregnancy symptoms.

First off, congrats!!! Being pregnant can be one the most exciting times of a woman’s life! It is a time filled with so many emotions, many of which you probably felt within the first few days of finding out about the little one growing inside of you! When you look ahead at the next 9 months, you know you’ll be visiting your OB’s office frequently making sure everything is on track, and you and baby are healthy. You probably also know about the myriad of symptoms that are commonly experienced throughout pregnancy: morning sickness, heartburn, fatigue, swelling… the list goes on.

 

Some of these symptoms, while not necessarily a sign that anything is wrong, can be very bothersome. It’s not like you can just put your life down while you are pregnant! We, at the Tennessee Center for Reproductive Acupuncture, use acupuncture treatment throughout pregnancy to treat and prevent these symptoms as well as help support the health of mom and baby.

 

Acupuncture works with the body to treat common pregnancy symptoms in a way that is safe for you and your developing baby. Additionally, acupuncture works without the use of medications, so you can feel better without worrying about exposing your little one to anything dangerous. As you know, the list of over-the-counter remedies that are off-limits during pregnancy is quite extensive!

 

In addition to managing symptoms, we also see patients for general wellness and stress reduction. There is evidence that chronic stress during pregnancy can lead to lower birth weight, earlier delivery, and may even affect brain development. Many women come in throughout their pregnancies to keep symptoms at bay and help control stress. We generally recommend the following treatment timeline shown below for general pregnancy wellness and to help treat and prevent common symptoms. Of course, adjustments to this protocol are made as symptoms come and go, and we see many women on an as-needed basis.

 

First Trimester: One treatment every 1-2 weeks.

For many, the first trimester is the hardest part of pregnancy. For this reason, we recommend regular, frequent treatments to keep mom feeling her best.  Morning sickness, fatigue, and a general ‘sick’ feeling that many women have are the most common symptoms we see during this time. The first trimester is also the time when the majority of miscarriages occur. Evidence suggests that acupuncture can be used to help treat some causes of miscarriage. We use points at each treatment that can help minimize risk and help support a healthy pregnancy.

 

Second Trimester: One treatment every 4-6 weeks.

Ahh, the second trimester. Most women will agree that this is their favorite part of pregnancy! Around week 10-13, morning sickness and fatigue begin to fade and you feel like yourself again. Your body will start making some big changes, your belly grows to accommodate your growing baby, and your center of gravity begins to shift. The treatments during this time are focused on helping to manage symptoms such as back pain, ligament pain, heartburn, etc. that come with your rapidly changing body.

 

Third Trimester: Treatments every 2-3 weeks from week 30-36

Treatments every 1 week from 36 weeks to delivery

You’ve finally entered the homestretch! While you’re busy preparing the nursery, your baby continues to grow and you’re probably feeling it! Heartburn, ligament pain, back pain, and feet and ankle swelling are some of the most common symptoms we see during this time. In addition to helping you feel more comfortable, we begin working to prepare your body for labor and delivery. We can help to encourage baby to turn head down if they are in a breech presentation. This is best done around weeks 32-34 as baby still has plenty of room to move, though we can still help many babies turn during the later weeks. At week 36 we begin a series of pre-birth acupuncture treatments. These treatments are specifically designed to help your body prepare for labor and delivery. They can reduce time spent in labor, the need for an epidural, and help reduce your chances of an emergency C-section.

Here’s a nice little info-graphic explaining a bit more about pre-birth acupuncture:

PreBirth Acupuncture Info DOuble

Fourth Trimester: as needed

They say that your first 12 weeks with your new baby should really be called the “fourth trimester.” Your baby is busy getting used to the world outside of your body and your body is busy returning to it’s pre-pregnancy state. You’re both getting used to breastfeeding (if you choose to breastfeed) and there can be some hiccups along the way. Acupuncture treatment can be helpful for many common fourth trimester symptoms such as post-natal depression, clogged milk ducts, night sweats, and stress reduction. Generally we see women on an as-needed basis during this time.

 

As you can see, prenatal acupuncture can be a wonderful way to encourage a healthy pregnancy! If you have any questions about your pregnancy and/or acupuncture please call or contact the clinic. We are more than happy to help! I hope you enjoy your pregnancy!