Monday, November 30, 2015

Cyber Monday Sale 2015


Cyber Monday is here and to celebrate, I'm offering up my very first Cyber Monday sale...

 

Today only, save $20 on tincture service with the purchase of a placenta encapsulation package!

 

Tincture is an excellent way to preserve the benefits of your placenta for extended use.  A small section of the raw placenta is selected and tinctured in 100 proof vodka for 6 weeks.  The solution is then strained and the remaining pure tincture can be used for years to come.  It is a great remedy  during times of stress, transition, and even for the treatment PMS symptoms when your cycle returns.  Many mothers save it for use during menopause as it is a great, all-natural way to balance hormones at any time during your life.

 

To take advantage of this sale, contact me today!

Monday, November 16, 2015

Do You NEED a Doula?

Do You Need a Doula? | www.doulabarb.com


"Do you need a doula?"


I've seen that question swirling around the internet lately.  I've seen it in my doula groups.  I've seen it in my mom groups.  I've seen it pop up on Facebook.  I've heard many, many different answers from many different women.  But I wanted to weigh in myself.

No, a woman does not NEED a doula.


We actually need very few things in this life: food, water, shelter. etc.  A doula is not on that list.

As a doula, I don't consider myself a necessary component of a woman's birth.  After all, women give birth every day, all over this planet, without a doula present.  Some women love their birth experiences, some don't.  But they managed to give birth without someone reminding them of their affirmations and doing hip squeezes for them.

 

Think about it- what are we saying about women and their abilities if we go around saying they NEED a doula?  Don't women have the inner strength to achieve the birth they desire?  I think they do.



As a doula, I support the laboring woman and her choices.  I don't save them from their hospital.  I don't save them from their doctor.  I don't save them from intervention or save them from themselves.  I support them and their decisions, whether I agree with them or not.  Because it's not my birth and I trust and respect my client enough to honor the choices she has made.

I believe women are perfectly capable of having a fantastic birth experience without me.  Now, that's not to say that I can't make a difference at a birth.  You bet I can.  I can offer wisdom, support, guidance and a mean double-hip squeeze.  But these are luxuries, not necessities.

Tuesday, October 20, 2015

Essential Oil Use During Pregnancy, Birth & Postpartum: Part 2

Part 2 of my interveiw with certified aromatherapist Shannon Dennis discusses safe use during the postpartum period and on newborns.  | doulabarb.com|




Welcome back, everyone!  I hope you enjoyed the first part of my interview with Shannon Dennis, Certified Aromatherapist.  Last week we chatted about essential oil safety during pregnancy and birth as well as how to incorporate essential oil use into a birth plan.  This week, we're going to discuss oils in the postpartum period and safe use for newborns.  Read on and enjoy!



What about common misuse during the postpartum period? What unsafe oils do you see commonly recommended during that time and what better oils would you recommend?

I'm so grateful you touched on this delicate time, too!  Postpartum is such a precious time of bonding, healing and creating a new circle of family.  For essential oil use during this period please use great caution.  I prefer to err on the side of safety to not disturb the smell bond between client and baby as well as avoid any unnecessary additional taxing on the baby's new adapting body.  While within aromatherapy there is a "spectrum of practice" (just like in western medicine you will get a variety of recommendations from different doctors) I prefer to recommend no essential oil use before 3 months.  This gives the baby's body and organs time to adapt to the world as well as a secure bond between client and baby to be established.  It also allows time for milk and supply balance if nursing.  During this 3 month period, client can use lactation safe (if she is nursing) oils for themselves in a personal inhaler, diffuser jewelry or in hydrosols.  I highly discourage use in the form of "anointing" baby or the umbilical cord after birth or diffusing in the room the baby is in.

What about oil use as a galactagogue?  I hear fennel recommended often.  What are your thoughts on that? Are there any safe oils you can recommend?

Fennel essential oil is not safe for the nursing client to use nor for a child under age 2 because of the compounds the oil contains.  The constituent estragole can interfere with hormones and neuro-activity in a small child.  The herb fennel, on the other hand, is safe so consuming a bit of fennel tea could support a healthy supply when correct hydration and nursing regimens are followed as well.  For oils during lactation or for supply supporting purposes, be sure no oils are being applied to the nipples and that any application occurs after a nursing session to avoid overwhelming baby's sensitive olfactory system.

 

What do you recommend for safe usage in newborns and infants?  Do you have a good reference for people to consult in regard to age appropriate oils?

I spoke a little earlier on the "spectrum" of practice, even within the safe use community.  Since I'm not in a direct consult with someone reading this and do not know their specific experience, medical history or that of their baby I choose in public forums to err on the conservative side with this recommendation:
  • No essential oils under 3 months
  • Begin diffusing after 3 months but starting with one oil at a time and noting any responses from baby.  Be sure to safely diffuse for 30 minutes on, 60 minutes off in a well-ventilated space, not a closed bedroom.
  • Topical application with a dilution not to exceed 0.50% after 6 months.
Here is a downloadable list of restricted oils for pregnancy/lactation and an age-restricted list for oil use under age 10:

This list breaks down safe essential oil use based on age. This list breaks down safe essential oil use during pregnancy.





















 

 

Can we talk a bit about diffusing an oil or blend?  Pros and cons?  And better times suited to it?  Why is using a diffuser at a birth not a great idea?  What is a better way for mom to receive those benefits?

I recommend diffusing MOST during labor and birth but I would agree that running a diffuser during the birth isn't something I would recommend as it can block that smell bond and overwhelm the newborn babe.  As we know, a client's tastes can change at the drop of a hat during birth so topical application of an oil is the hardest to remove from the birth space...especially if it is on the body!  A drop of oil on a wash cloth or cotton ball waved in front of the client or laid by the head can diffuse the oils into the air yet be removed in an instant if needed.  Using hydrosols to spray linens can give the necessary aroma without the prolonged lingering of an essential oil.  Using diffuser jewelry or aromasticks are bonuses, too.  I especially love the jewelry because who doesn't want to feel pretty during birth?!

 

Can you speak more about hydrosols?  What are they and how/when can they be used?  

Yes! So many reason to love all over they hydrosols.  I actually include 3 in my birth kit!

Linen and room sprays, in a bath (before the birth) or to clear unwanted clinical aromas hydrosols can fill a variety of need while being sometimes less expensive than their oil counterparts.  I very much encourage people to know the source of their hydrosols as they are easily soiled and tampered with which can produce adverse results.

What books and resources do you recommend for pregnant and nursing mothers?  What books, resources, etc. would you recommend for birth professionals?
There are very few books I recommend in general.  Both of the leading authors I've seen on the market in the area of pregnancy have published books full of unsafe and dangerous advice.  I would recommend working with an aromatherapist, honestly!

Finally, can you speak about oil quality?  How can you be sure that you are purchasing high-quality oils?  What are some things consumers can look for in a quality oil? Do you have any favorite brands? Are there any common misconceptions regarding oil quality that you would like to address?

This could be a whole other blog post as there are lots of opinions in this area, too.  I have written a blog post series on how to choose the best brand for you and your family.  It is written in three parts: Products & Testing, Labels & Pricing, and Company.  It is a series of questions to ask yourself and the company you buy from.  Quality is important for sure, but ensuring that quality and backing it up with proof of testing is crucial for me in the brands I purchase from  I also choose to purchase oils that were sustainable raised and harvested as well as organic.  These things narrow down the brands I have to pick from but also may not be important to someone else.

For misconceptions, I've always loved referring people to this article by Dr. Robert Pappas!  There is a lot in that article to chew on as far as what we see in the essential oil distribution realm but I think it is incredibly helpful.

Do you teach any aromatherapy classes or have any information you'd like to share?  Are you available to teach essential oil safety classes for groups- say doulas or midwives that might like to have a seminar on safe use?

I do teach classes locally in Cleveland, OH and hopefully soon via my website.  I have an upcoming doula/birth workers seminar (information, not training) that you can keep an eye out for here.

I also have a pregnancy, birth and postpartum product line designed with a local doula, Kathy DiVincenzo owner of Beyond the Bump birth services that provide safe, easy to use product for your clients.  Everything from a belly balm to a beautiful (non-greasy) massage oil free of essential oils to birth kits ready to go.

I'm so grateful to have been part of this blog, Barbara!  Thank you for being passionate about safe use and protecting our clients and babies during their hardest yet most glorious transition in life.  The opportunity means the world to me!


Monday, October 12, 2015

Essential Oil Use During Pregnancy, Birth & Postpartum: Part 1

An Interview with Certified Aromatherapist discussing essential oil safety during pregnancy, birth and postpartum.  | www.doulabarb.com|

I love my essential oils.  I use them for aches and pains, respiratory support, mood boosting, cleaning... the list goes on and on!  

 

It was actually during my doula training that I was first introduced to essential oil use.  Unfortunately, safety wasn't taught and soon enough I was down the rabbit hole of misinformation and unsafe use.  I attended "classes" that promised to teach me how to makeover my medicine cabinet and how to build a "first aid kit" using my oils.  The classes were fun enough (I mean, who doesn't like food and free stuff?) but I quickly noticed that it seemed these "classes" were more about selling oils than actually promoting safe use.  I began declining those invitations and searching for more reputable sources of information.  It. Was. Tough!


Luckily, I found a few Facebook groups devoted to safe use practices and slowly I began my quest for information.  I was referred to one such group, Scentsable Health, and that's where I was introduced to Shannon Dennis.  Inspired by my own personal journey, as well as by seeing constant misuse and misinformation, I decided to see if she'd be open to an interview...sure enough, she was!

 

It's a long one so I've broken our interview into two parts.  Be on the lookout for part 2 coming soon!



Tell me a little about yourself, Shannon.  How did you become interested in essential oils and aromatherapy?
Hello!  I'm Shannon Dennis.  I'm wife to my incredible husband Jeff and full-time, work-from-everywhere-mom to my three little boys.  I grew up in a very "alternative health" centered family and got a set of essential oils about 8 years ago.  That set unlocked a passion and interest in aromatherapy and I decided about 2 years ago to pursue a formal aromatherapy education.

 

What type of training did you take to obtain your certification and why is that important?

I started with the 200+ hour certification training from Aromahead Institute and quickly branched out with additional classes and mentoring.  For me, the formal education has been crucial to my career so far.  It introduced me to safe use of essential oils, connected me with my industry and above all else given me credibility in my field.  Books rarely can keep up with how quickly we are learning about the vast field of essential oils.

How many certifying organizations exist and promote safe standards and how would someone go about finding a professional to consult with?

There are a few credited associations but the area of standardized education in our industry is undergoing some changes too.  As of right now I would look to AIA (Alliance of International Aromatherapists) or NAHA (National Association for Holistic Aromatherapy) as the bodies of leadership in aromatherapy.  Many of the schools have a graduate list of people you could turn to for personalized consults.

Do you think it is possible for a doula to stay within scope and still recommend or even use oils on a laboring woman?
Great question and another tough one!  First, I believe, the client should be requesting the oils.  Can a doula use them during labor?  The biggest questions for a doula to contemplate to help answer this is, "Am I willing to accept the liability for using aromatherapy during labor and birth?  Do I have the liability insurance to be practicing aromatherapy as a doula?  Am I confident in the amount of training and education I have that I will "first do no harm" in my use of essential oils with my laboring client?  Does the doula certifying organization I am with allow me to use essential oils during labor and birth?"

Best-case scenarios I see are these:
  1. The doula is a certified aromatherapist and has liability insurance to cover her use of essential oils during labor and birth at the request of her clients.
  2. The doula is teamed with/working with/referring her clients who wish to use essential oils during pregnancy, labor and birth to an aromatherapist.  The doula then would prompt the client in the use of the essential oils during labor and birth.

Part of what prompted me to write this post is the fact that I see so much essential oil misuse, misunderstanding and downright unsafe practices at births and during that immediate postpartum period.  Can you speak a little about that?  Why do you think we see that so commonly?

Oh my, YES!  There is rampant misuse of essential oils and misinformation all over birth and beyond.  I fell for some of it with my first pregnancy and wrote about it here.  What many fail to combine in the use of essential oils is the science WITH the experimental or personal benefits.  It is important to have a sound knowledge of the chemistry of essential oils so that you can know if an oil would be acceptable and at what dilution for a pregnant client.  I think we see this so commonly because oils will do what they are intended to do... but at what cost?

I commonly see blends with wintergreen in them recommended for discomfort during pregnancy and labor.  This oil is actually on the hazardous oils list because of the constitute methyl salicylate.  Mehtyl salicylate thins the blood so in the case of childbirth, if this oil has been used frequently during labor and the client needs an emergency procedure, like a cesarean section, the client and baby are both now at an increased risk.  It is also on the NAHA list, as well as others, of oils to avoid during pregnancy.


To help prepare for this interview, I took questions from my Facebook friends and family.  They had quite a bit of questions for you, but these were the most popular:


What oils do you recommend using for managing morning sickness?  I often hear peppermint recommended- what are your thoughts on that?

I actually do not recommend oil "use" during the first trimester of pregnancy.  That period of time is too delicate and many essential oils do not have proof of safety during pregnancy.  That said, slicing a lemon (with the rind) and putting it in your drinking water or using a personal inhaler as needed with sweet orange, lemon or ginger essential oil can be helpful for nausea.  So in general, avoid topical application or room diffusing in the first trimester, and try to use fresh herbs or a very small amount of EO in an inhaler instead. 

I had someone ask me once about birthing into a tub with oils added to the water.  Why would that be an unsafe practice?

Please avoid this practice!  Here is why:
  1. It can cause issues with mom during birth as she will not be able to quickly escape the aroma.
  2. Water and oils DO NOT MIX.  There is a process of blending the essential oils with a carrier oil to properly dilute then with a dispersant like Epsom salts to carry them through the water.
  3. Failure to combine the oils in this way just creates a coating on top of the water.  As baby is born and brought up through the water their precious little body is then coated in oils possibly entering their ears and eyes as well.
  4. This oil coat can not only harm their skin, eyes, and ears but can severely damage the smell connection crucial to bonding that client and baby need just after birth.
  5. Exposure to essential oils can also cause respiratory issues and further endanger the baby if baby happens to take a breath underwater.

What about clary sage use during labor?  I've heard it recommended to help induce labor, to help augment a labor that has stalled or to induce stronger contractions.  I've even heard stories of pregnant women having their bellies lathered in it, neat no less, as part of an "induction massage".  What do birth workers need to know and be aware of when using clary sage?

Clary sage is an emmenagogue or, an oil that helps regulate menstruation.  It is not proven to start labor and I would highly recommend education around this oil and the client on an individual basis.  Generally speaking I do not recommend it past early labor as it can encourage hemorrhaging.

What are some other popular unsafe oils that you see and hear of commonly being used during labor and postpartum and what others would you recommend in their place?
Unfortunately I see a lot of blends recommended for pregnancy, labor and birth.  Blends, unless done on an individual basis for that particular person, can be touchy because many blends contain oils not safe for pregnancy or lactation.  Using oils as singles not only allows for a higher level of safe use but also can encourage blending combination that appeal to the mom in that moment.  Example: Client is afraid and unsure of their inner strength.   Diffusing neroli and spikenard or neroli and rose may help to aid in releasing these feelings while comforting and building inner strength.

I see a lot of peppermint recommended but I prefer to recommend lemon or orange for balancing the queasy tummy.  For many, an oil that may commonly be known to calm may have the reverse effect during labor solely based on everything the body is working to accomplish at that time.

If a woman would like to utilize oils during her labor, what is the best way she can prepare to do so?

Obviously, my first recommendation is that a client be seen by an aromatherapist for a consult.  Many aromatherapists take Skype or phone consults too so if one isn't referred by the doula, the doula isn't a certified aromatherapist or there isn't one locally, see if an AT is willing to do distance consults!  If the above isn't possible, a client should be as educated on the oils they want to use as possible and include them in her birth plan if she wants to use them during labor and birth.  Getting the ok from her birth facility, doula and birth team is crucial, too.  I try to encourage clients to make use of the aroma in aromatherapy by limiting topical application and focusing on inhalation or diffusion.  A dilution limit of 1% applies to birth just like during pregnancy so if the birth team is not educated on dilution it may be helpful to client to pre-dilute the oils for the team.



Be on the lookout for the conclusion of our interview next week.  Shannon shares more information about essential oil use during the postpartum period, information about using oils to boost milk supply, safe use on newborns and more!

Monday, August 31, 2015

Labor Day Sale- Free Tincture with Encapsulation Package




How about a Labor Day Sale?  Now through Labor Day (Monday, Sept. 7), get a free Placenta Tincture Upgrade (a $45 value) with purchase of a Full Service Placenta Encapsulation Package!  Enjoy the benefits during YourBest Postpartum!

 

Tincture is an excellent way to preserve the benefits of your placenta for extended use.  A small section of the raw placenta is selected and tinctured in 100 proof vodka for 6 weeks.  The solution is then strained and the remaining pure tincture can be used for years to come.  It is a great remedy  during times of stress, transition, and even for the treatment PMS symptoms when your cycle returns.  Many mothers save it for use during menopause as it is a great, all-natural way to balance hormones at any time during your life.  Tincture service is available for an additional $45 with the purchase of Placenta Encapsulation Services.


Contact me for more information!  


Please note: your signed contract and $50 retainer fee must be received by midnight on Labor Day.  A $25 travel fee will be assessed for travel beyond 60 miles from zip 76033.

Friday, June 12, 2015

Top 6 Things to Do Around Ft. Worth When You're 40+ Weeks Pregnant




This time last year I was pregnant.  I was really, really pregnant.  So pregnant, in fact, that I wanted to be un-pregnant immediately.  Most pregnant ladies experience this at some point; if not, well, good for you.


In an attempt to take my mind off of things, I made an appointment with my fabulous hair lady, Kacie Pope, and we got to talking.  She said I needed a 40+ week plan.  A wha..??  I'd never heard of this so I was intrigued.  She explained that I needed something planned for when I hit 40 weeks so I was focused on that and NOT on my due date.  I thought it was genius!  So- that's what I did.  I made a 40 week plan and it was great.  It was so great that I knew I needed to start sharing it with my clients and I figured now was a great time to share with y'all, too.


So, here it is.  My list of the Top 6 Things to do Around Ft. Worth When You're 40+ Weeks Pregnant:


6.  Get a prenatal massage!
Go see my friend, and fellow doula, Rachel Gabsi out at Aledo Power of Touch.  Rachel has been a masseuse for 13 years and is certified in prenatal, postnatal, and labor massage.  Rachel worked on me when I was suffering with recurrent migraines and she seriously has magic hands.  And, she's a doula- she get's it.  She understands what it's like (she's a mom, too) and is a great listener- schedule a massage with her and you leave feeling like buttah and like you've just caught up with an old friend.  Visit aledopoweroftouch.com to schedule and appointment or buy a gift certificate for your preggo friends (they'll love you forever).

5.  While you're there, get an adjustment!
In the same office as Rachel you'll find another dear friend of mine- Michelle Parker, D.C., owner of The Chiropractic Place for Her.





If you haven't been getting chiropractic care during your pregnancy, now is the time to start!  Studies show that women who receive regular chiropractic care during their pregnancy have shorter labor times and a reduction in the need for pain killers and intervention.  Dr. Parker is a Webster Certified chiropractor that specializes in women and children and is one of the few chiropractors located in a 250 mile radius of DFW that have received recognition from the Academy Council Chiropractic Pediatrics.  She has magic chiro hands and a special table that allows you to lay face down (for real- it's heavenly).  I'm telling you, it was the best thing ever.  She was my chiropractor during my last pregnancy and I definitely looked forward to going and seeing her each week.  I always left refreshed and feeling great, knowing I was doing everything in my power to have my best birth.  To get in on some of this action, click on over to http://www.michelleparkerdc.com







4.  How about some acupuncture, acupressure, massage, or energy healing? 
While we're on the topic of bodywork, schedule a session with Sara Brock, L.Ac, LMT at Blessed Oaks Healing Arts.  She offers acupuncture, acupressure, massage and energy healing during pregnancy, birth and postpartum to offer help with many patterns affecting body, mind, soul and spirit.

Located in Alvarado, she has a beautiful studio nestled among the oak trees.  The instant I stepped foot into her space, I was grounded and felt instantly at peace.  Her presence is incredibly calm and relaxing...it's truly a beautiful space and she's a beautiful person.  The works she does can help with things like heartburn, nausea, fatigue (and lots, lots more) and sessions with her are great for baby positioning support as well.  To schedule with Sarah, call 817-556-1764 or visit her website at http://www.blessedoaks.com/location--hours.html.



Ft. Worth Labor Braid
Rainbow Hair for a Rainbow Babe


3.  Have Kacie Pope help you look even more fabulous than you already do!
This lady has talent!  As a mom that went past her "due date" herself, she can absolutely relate!  I mean, she did come up with this idea, after all.  No matter what you choose to have done (she put a rainbow in my hair for me last year, in anticipation of our rainbow baby), you'll leave looking and feeling great.  And, she does beautiful labor braids- they last several days and it's a great way to ensure you have great hair in those birth photos!

To schedule with Kacie, give her a call at 817-914-1824. 







Ft. Worth Henna2.  Get some beautiful henna done!
Decorate that gorgeous belly with some Cardamom & Clove Henna.  Chelsea, the owner and professional henna artist, is amazing at what she does.


 "The art of henna (or mehendi) plays a pivotal role in cultures all over the world.  Once reserved for the elite, to include pharaohs of Ancient Egypt, this tradition is now widely spread in Southeast Asia, the Indian subcontinent, the Middle East and throughout North Africa.  Women across the glove share the beautiful ritual of henna application for a number of festivities, from national holidays to engagements, weddings and childbirth."

To get some beautiful artwork of your own, visit cardamomclovehenna.com or find Chelsea on Facebook.




Due Date Photos | www.doulabarb.com
A Moment in Time

1.  Get some due date photos done!

Now that you're looking and feeling fabulous, schedule a Day in the Life shoot with Kourtnie Elizabeth Documentary.  I just love Kourtnie's approach- she comes to your home and captures your day-to-day moments making for an excellent keepsake.  Your family's life is about to change in a huge way- having some photos that capture what your life was like before it all changed is priceless.


Ya know, the end of pregnancy is such a...surreal time.  You know your pregnancy is drawing to an end (you can practically hear the clock ticking).  It seems like you've been pregnant FOREVER yet, at the same time, it's gone by in a flash.  The best piece of advice I've gotten is to savor it- be present, be intentional.  As hard as it is to believe, this time will be a fleeting memory one day.  

 

Breathe it in.  Live it.  Love it as much as you can.  And SLEEP (my YourBest Childbirth Ed students should get a giggle at that)!

Saturday, May 9, 2015

Thoughts of an L&D Nurse: An In-Depth Interview

Thoughts of an L&D Nurse: An In-Depth Interview with Nurse Monica Mitchell | www.doulabarb.com
Nurse Monica: Voted Best Nurse in Johnson County in the Best of the Best Awards, 2014


In honor of National Nurses' Week, I met up with local OB nurse Monica Mitchell, RNC-OB, C-EFM for margaritas and some conversation.  We talked everything from birth plans to homeschooling but I really wanted to get her take on doulas, why she does what she does and where she sees room for improvement.  I wasn't disappointed!  I left on fire- her passion for what she does is contagious- and feeling incredibly lucky that we have such great providers in our area. 





Q: Tell me a little about yourself.

A:  Well, I always knew I wanted to do something medical.  It was in high school that I realized it was nursing that I wanted to do.  I went to Southwestern Adventist University and worked at John Peter Smith first in telemetry/cardiac nursing.  I made myself go and learn that first and get that experience.  It was ultimately the birth experience of my 3rd child that lit the fire in me to go back to school to be an OB nurse.




Q:  So, how did you make the transition to L&D?

A:  Nursing is a family profession.  My Aunt told me to go to a county hospital or to the military and nothing will ever scare me.  In training as an OB nurse, you do research and you study evidence based practice.  But, I would go out on the floor at JPS and see they were doing things much differently.  JPS is high-risk, but everyone got put on a monitor and put in bed.  I questioned the norms and I felt from the beginning that it wasn't the place for me.  I even got written up a few times for getting people up and out of bed but I stayed for 6 years.  It just so happened that I met Carla Morrow while she was at JPS working on getting her DNP.  When I found out she was down at Cleburne, I felt ready to leave JPS but it took a couple of years to make my way down there.



Q: Texas Health Harris Methodist Cleburne has been on the forefront of some excellent advances in maternity care.  Can you speak to some of the programs you've been involved in?

A:  I just presented at AWHONN on hydrotherapy.  I reviewed every single water birth we did at Cleburne- it took me nine months- and did a statistical comparison on things like lacerations, length of second stage, infection, APGAR scores.  What we discovered was that there was no statistical difference in APGAR scores, there were NO infections in any of our moms and babies- that's a big point of concern for opponents of water birth-, 2nd state of labor was much shorter- it averaged only 24 minutes- and we had a decrease in lacerations and the severity of those lacerations.

Cleburne was the first and is currently the ONLY hospital in the state offering nitrous and we're the ONLY nurse-driven nitrous option in the country.  Vanderbilt University, for example, has never quit using nitrous but the patients have to be assessed by anesthesia prior to administration.  By they time anesthesia gets to them and does the assessment, the need has usually passed, especially with repairs.  At Cleburne, we don't have access to 24-hour, in-house anesthesia and that worked in our favor as a selling point for making it nurse-driven in our hospital.  The difference is that our mixture is 50% concentration of oxygen/nitrous and needs negative pressure to deliver- it's not free flowing, and that makes it "minimal sedation" which RNs can administer.  We've found it VERY helpful for repairs- it keeps moms awake and alert for repairs as opposed to iv sedation which can knock them out for a couple hours, and they miss that critical bonding time with their baby.

Family Centered C-Sections is also something that we've worked hard to get going.  Carla Morrow started it- she had heard about it on a trip overseas- and just sort of said "this is how we're going to do it".  The biggest hurdle was getting anesthesia on board so we did a presentation of evidence with lots of literature supporting it.  The first time we did it was on a VBAC (vaginal birth after cesarean) mom that was devastated that she was going to have to have a repeat c-section.  We did it with her and it was great AND anesthesia realized that mom was much calmer with her baby with her.  Usually, mom gets anxious at the end and anesthesia ends up having to give meds to help calm her.  When they realize that doing it this way was making their job easier, they really started to get on board.

I really feel that surgical birth, when necessary, should be done in a way that parents are a part of, instead of something that is done to them.



Q:  What is something that you wish everyone knew about nursing life?

A:  I wish people knew how much of ourselves we put into it.  We go home and cry when things don't work out or we have a bad outcome, even when they don't get the birth they wanted.  I take it personally.




Q:  What is the hardest part about your job?

A:  Bad outcomes, of course.  But, trying to juggle rules and protocols and trying to make sure our patients have the outcome they want.  We have a great group of midwives and nurses there at Cleburne and we really don't take no for an answer!  We push for the change.




Q:  What is the most rewarding part of your work?

A:  Having a happy momma and happy baby.  Getting that thank you from a patient; them telling us that we made a difference for them.




Q:  What do you love/hate most about the current maternal care system?

A:  We have atrocious birth outcomes.  It's safer to deliver in Puerto Rico and it's not because of sub-standard care.  It's because 1/3 of our deliveries are sections.  It's fear driven.  It's said that it takes about 17 years for research to make it to the bedside- to see the changes happen but we need to make it happen faster!

We have a litigious atmosphere and it causes people to be scared.  You know, doctors and nurses don't do conferences together anymore and sometimes we don't even speak the same language.  We have OBs in this country that haven't taken classes since the 1970s and they literally are speaking a different language in regard to terminology.  It's also a paternalistic system and we continuously hear things like "Why are you getting induced?  Because I said so."  It needs to change.



Q:  Do you feel supported in regard to resources for continuing education?  Specifically evidence based information, since it continuously changing?

A:  YES!  100%!  I'm writing evidence based information and I'm passionate about it!  We have great management and leaders at the hospital.  We come to them with information and ideas and they hold us accountable; they expect us to do our homework and present them with the research.  We do and that's how change happens. 




Q:  How have you seen birth practices change over the course of your career and what do you think the driving force behind those changes have been?

A:  I haven't seen much change anywhere else.  In my 9 years, I've only seen the change at Cleburne.  I saw some things like delayed cord clamping at JPS, but not much.  I do think skin to skin is catching on.  People are starting to talk about gentle sections, even if they aren't in practice yet.   You know, when Medicaid stopped paying for elective sections before 39 weeks, we really started to see change.  Now the push is for 41.  Change is money driven and patients need to remember they are consumers.



Q:  As a doula, I focus on helping my clients prepare to have their best birth, whatever that may be.  What is something you wish every patient knew before having their baby, regardless of the type of birth they desire?

A:  I prefer for my patients to be educated and know what they want.  Also to know that plans can change.  This is your first experience at parenthood, realize that things can change!  I feel people sometimes think, especially with transfers, that we are the enemy but we aren't.  We really want them to get a birth that is as close to their plan as possible.  But, to get more educated parents, we need to be starting in high school.  Women need to know how birth affects their body, what is involved, educate them about breastfeeding (we need a social change to make that the norm).  I want women to know that they have options and that you don't have to just say yes to something because your doctor says so.  You can question your doctor and your nurse- it's your body!  Some people don't know the difference between good practice and bad- how much better it can be.  I also want NO shaming for their birth choices.  Care should be individualized to what they need, what they want.



Q:  What do you see patients doing to unintentionally hinder their relationship with hospital staff?

A:  People come in defensively.  I understand it and I hear their stories but it puts everyone's hackles up.  We try to explain, we acknowledge that things may not be going the way they want, but we truly do want to help them get the best birth they can.




Q:  What do you see doulas doing to unintentionally hinder the relationship with hospital staff?

A:  I think some doulas push too hard and pass judgement on their clients.  Care needs to be individualized and labor is unpredictable.  Support her when things change.  Sometimes the refuse to have a discussion.  We present them with options but we get a firm NO.  They aren't willing to entertain any.  I love working with doulas though- "ok, you rebozo and I'll doppler."  I'm in my happy place then.



Q:  What do you really think about birth plans?  

A:  Everyone should have one.  We are there to give patients a good birth experience, regardless, but they should know what they want.  If they don't have a birth plan, we help them realize their options.  We've have patients show up with no clue about their choices, only to have them get in the tub and have a baby when they didn't even realize that was an option!

I read the birth plans, no matter how long.  There isn't really an optimal length for me but make it easy to get to and easy for someone to reference.  Regardless though, I'm going to talk to the client verbally to confirm and get more information.  I'm going to go in and discuss and acknowledge their wishes and make sure we have a contingency plan- that's important.


Q:  Is there anything else you'd like to add?

A:  The nurses in Cleburne, and I've worked with great nurses, we are really passionate about what we do.  I think we need to push for change.  Patients must know their rights and advocate for themselves in order to make big, large-scale change.

Our problem now is that our birth culture needs to change.  I hear things like "well, my mom was induced so I'll probably need to be induced too."  The things that you as a doula discuss with your clients is something that everyone needs to know, dads included.  Until there is absolute demand for it, things won't change.  Some providers are pushing against the grain but we need a bigger demand.