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Paid Family Leave in Pennsylvania

April 18, 2016 by Midwifery Traditions

***Attention fellow Pennsylvanians and all who support paid family leave in the United States – There is currently a bill pending in the PA State Senate (SB 541) which would mandate 12 weeks of paid leave for workers in PA! This ground breaking legislation needs your support! Your letters, phone calls, emails, and in-person visits are needed to get this legislation passed. Let the PA State Senate hear your voices by contacting the Committee Chair (Lisa Baker) responsible for bringing this bill to a vote (please see contact information below).***

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A National Look at Paid Leave Progress in the USA

For the first time in American history paid family leave has been a focal point of discussion among the presidential candidates, citing points such as retention of women in the workforce, supporting low income and single parent households, and increasing health and quality of life for American families. While a majority of other nations around the world with highly developed economies have mandated national paid leave programs, the United States has NONE –ZERO-ZIP. Lets take a quick look at what other developed nations are doing…

A more recent source from 2015 cites the UK as offering 39 weeks and Canada 52 weeks of paid parental leave [1]. Can you even imagine? Having 52 weeks (13 months) to bond with your baby, transition with your family, and heal from childbirth/sleep deprivation before having to return to work? For many American families it seems unfathomable since many individuals in the USA return to work at 1-6 weeks postpartum, or risk loosing their livelihoods.

While the American Family and Medical Leave Act (FMLA) guarantees 12 weeks of unpaid leave for individuals who birth/adopt a baby, need to care for sick family members, or need time off for serious personal health conditions, this law only applies to individuals employed by companies with at least 50 employees, for at least 12 months, for 20 hours or more a week [2]. Even if individuals manage to meet these employment requirements, many chose to return to work sooner than 12 weeks because of the financial constraints of being unpaid.

I truly hope that federally mandated paid leave passes into law in the USA one day soon, but I would like to take a moment to focus on state mandated paid leave. Currently five states have some form of paid family leave in place, including California, Washington, New Jersey, Rhode Island, and (recently) New York. New York passed the most progressive paid leave bill yet (yay!) at the end of March, 2016, allotting 12 weeks paid leave to individuals welcoming a child or caring for an ill family member. This doubles the 6 weeks allotted in California and New Jersey and triples the 4 weeks of paid leave mandated by Rhode Island. The requirements to qualify for NY paid leave are less stringent and much more inclusive than FMLA, expanding access to more Americans from diverse backgrounds. Side note- NY also passed a bill to increase the minimum wage to $15/hr (rock on, NY, rock on)! For more information on leave requirements and plans for implementation in NY check out this article [3].

On to examining the wonderful progress in my home state of Pennsylvania! Senator Daylin Leach of Senate District 17 has proposed a bill that would offer 12 weeks of paid leave to workers in PA. Unfortunately, the bill has not gained much traction in the Labor and Industry Committee where it sits, waiting to be called to a vote. Please help push this bill through by calling, emailing, and sending letters (the most noticed form of communication) to the committee chair, Lisa Baker [R]. Click this link to electronically contact Senator Lisa Baker and send your heartfelt words of support for PA Senate Bill 541, Paid Family Leave!

Senator Lisa Baker
Senate Box 203020
Harrisburg, PA 17120-3020
Room: 362 Main Capitol(717) 787-7428
FAX: (717) 787-9242

Here are some reasons why individuals support paid family leave (all or some of which can be cited in your note to the senator)

Bonding and healing after welcoming a child
Time for partners to bond and support the drastic family transition of welcoming a child
Establishing a breastfeeding relationship, which has longterm health benefits for moms, babies, and the national healthcare system as a whole
Supporting low income families, specifically single parents, in caring for themselves and their families while still maintaining economic viablity
Allowing individuals to care for aging parents and sick family members
Because every other developed nation in the world does it!!

For more information on the benefits of paid leave for women in the workforce, check out this article. For those of you concerned about the impact of this legislation on businesses, check out this article (hint-research shows that paid leave does not harm employers).

Thank you for taking the time to engage in the political process in a meaningful way! If enough of us show our support, we could could realistically become the sixth state in the USA to join the paid leave ranks, making not only a national political stand, but also greatly increasing the quality of life for the millions of people who live in PA!

[1] http://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf

[2] http://www.dol.gov/whd/fmla/

[3] http://nymag.com/thecut/2016/03/new-york-revolutionary-family-leave-paid-time-off.html

Your Baby’s Position (and why it matters): Part 1

December 29, 2015 by Midwifery Traditions

You may have heard from your provider that you want your baby to be “vertex”, or positioned head-down in your pelvis for the delivery. However, head-down status is not the only consideration. There are, in fact, many varieties of the vertex position, and tons of factors contributing to how your labor and birth will proceed. This two-part series will explore:

varieties in fetal position
the parts of your anatomy, and how they can affect your baby’s position or the progress of your labor
healthy body mechanics for pregnancy and how to encourage optimal fetal position
techniques to correct issues

The baby’s inability to achieve optimal fetal positioning due to outside factors, such as the uterus/uterine ligaments, pelvis, and supporting musculature, is known as intrauterine constraint.

Fetal Position

Your baby’s position in the uterus is named by 1) the presenting part, or which part of your baby is entering pelvis first and 2)whether that part is facing the front, back, or side of your body.

About 96% of all babies will go vertex by 36 weeks, due to the weight of their head.

Some head down babies’ heads may be asynclitic, with their head tilted towards one shoulder, or posterior, with their spine towards the mother’s back. These positions, while not ruling out the option of a vaginal birth, are not ideal and can make for challenging labor patterns, a potentially more difficult second stage, and an increased likelihood of operative delivery.

Let’s review some essential uterine and pelvic anatomy during pregnancy.

The Bony Pelvis

The pelvis is not one bone, but four: the two innominate bones (you can feel the crests of these at the top of each hip), the sacrum, and the coccyx, or your tailbone. The symphysis pubis, the hard spot you feel at the base of your abdomen under your mons pubis, is commonly referred to as the “pubic bone” but is not actually a separate bone. It is the cartilaginous joint of the two innominate bones of the pelvis. There is a similar joint on either side of the sacrum, connecting all three of these bones together to create the pelvic bowl. These joints are called the sacroiliac (SI) joints, and are a common location for aches and pains during pregnancy when weak or misaligned. Finally, a 4^th joint attaches the coccyx to the base of the sacrum. These areas of cartilage are somewhat flexible, and the hormones of pregnancy increase this flexibility.

When the SI joints are misaligned, the shape of the pelvic bowl may be altered and can limit the baby’s ability to descend into the pelvis or rotate adequately, leading to asyncliticism or posterior lie.

The bones of the pelvis come together to create the passage through which your baby will pass during delivery. The shape of this passage varies and is classified into one of four pelvic types. 50% of Causcasian women have a Gynecoid pelvis and nearly half of African American women have an Anthropoid pelvis (a shape also associated with a higher frequency of Occiput Posterior fetal position).

“The variety of shapes, combined with the variety of fetal head presentations, plus size variations, mean that labors vary greatly.” -Spinningbabies.com

The Ligaments and Fascia

Uterine ligaments act like a sling that supports the uterus.

Round ligaments: attach to pubic bone and top of uterus

Broad ligament (not pictured): connects sides of the uterus to the walls and floor of the pelvis

Uterosacral ligaments: attach the posterior side of the cervical uterus to the sacrum.

These ligaments suspend the growing uterus in the abdomen. If any of these ligaments is tight or torqued, the uterus may be altered in shape and restrict the baby’s ability to freely move. Asymmetry of the ligaments can torque the lower uterine segment and change the alignment of the cervix, making dilation more difficult and painful.

Fascia is the membrane that wraps around all of the body’s muscles and organs and can be damaged by trauma, scar tissue development from surgery, or from poor body mechanics over time, leading to obstruction of movement.

The Muscle

Many of your muscles can contribute to your stability and well-being in pregnancy. Some of these may also affect your baby’s position.

The psoas, or ‘hip flexor,’ is a posterior abdominal muscle that helps to stabilize the pelvis. It attaches at the thoracic vertebrae and wraps around, over the pelvis, and attaches at the top of the thighs, creating support for our abdominal organs. During pregnancy, the psoas helps support the growing uterus and assist with core stability. The psoas should be stretchy and mobile, and when tight can encourage pelvic misalignments and prevent fetal descent in labor. Prolonged sitting, postural imbalances, cycling, and running may all contribute to the tightening of this muscle.

Alternately, excessively lax abdominal tone ( which may be result of previous pregnancies, see our post on diastasis recti) can lead to a pendulous abdomen, where the baby extends too far outward from the mother’s body. The result is a fetal head that is not settled directly into the pelvis and applied to the cervix, potentially impeding labor progress.

To learn more about the various pelvic types, intrauterine constraint, and optimal fetal positioning , visit spinningbabies.com or attend one of their spectacular workshops.

Stay tuned for part two of this article, where we discuss what you can do to correct these problems and encourage optimal fetal positioning for labor and birth!

Pelvic Floor Health

November 18, 2015 by Midwifery Traditions

Pelvic floor dysfunction is an issue that we rarely discuss in the United States, yet more than 50% of American women suffer from it in one way or another.[1] Pelvic floor dysfunction (PFD) can present itself in several ways ranging from urinary issues (including stress and urge incontinence, urinary retention, incomplete bladder emptying, and hesitancy), to stool incontinence, chronic constipation, painful sex, an unexplained feeling of heavy pressure or pain in the pelvis, and outright organ prolapse. Women with PFD frequently experience several of these symptoms at once, but commonly do not discuss concerns with providers.[1] Similarly, many providers do not facilitate conversations about pelvic floor health and function, which leaves a very important, core area of the body neglected and operating at a suboptimal level. I propose we start the dialogue with a little anatomy review…

The pelvic floor is a sling of muscles spanning from the pubic symphysis to the sacrum and coccyx. This group of muscles works along with the boney aspects of the pelvis to provide support to the pelvic organs. Normal contraction of the pelvic floor works to shorten the muscles, lifting the pelvic organs higher into the pelvic cavity. Normal relaxation of the muscles allows the organs to settle back into their original position. If these muscles or structures are not functioning properly, a wide array of pelvic disturbances can develop. [2]

Until recently, the cause of PFD was poorly understood. Many providers blamed weak muscles, or “low tone,” recommending a vigorous regimen of Kegels or multiple contractions of the pelvic floor muscles (squeezing the muscles as hard as you can).[3] In theory, Kegel exercises work to strengthen the maximal contraction of the pelvic floor, with the goal of creating strength and stability in the musculature. However, the most recent research indicates that PFD is in fact much more complex than the oh-so-revered one- dimensional Kegel. Many physiotherapists go as far as to say that Kegel exercises sometimes do more harm than good.[1]

One of my favorite physiotherapists (with a background in engineering) who addresses this topic is Katy Bowman. She explains that doing Kegels repetitively causes the muscles to contract and shorten, pulling the sacrum into the pelvic bowel towards the pubic arch. This continual contracting motion eventually causes shortening and tension in the muscles. Short, tense, contracted muscles cannot move through their full range of motion properly, leading to weakness and dysfunction.

(The pic on the left is of a healthy sacrum and long, taut pelvic floor. The middle pic depicts the action of the Kegel, shortening the muscles and bringing the sacrum forward. The pic on the right shows what happens to the muscles after repeatedly forcing the sacrum forward. They get slack and weak) *This image is shared from http://www.katysays.com/1234-we-like-our-pelvic-floor/)

Basically what Katy and other physiotherapists are saying is that many people’s pelvic floors are “too tight,” not too loose.[3] One of Katy’s favorite sayings is “tension does not equal strength,” which is perhaps best explained by thinking about a bicep contraction.[6] When you contract your bicep, you shorten the muscle. If you kept your bicep muscle in a constant state of contraction, you would no longer be able to generate any force or strength with it (meaning you wouldn’t be able to lift anything or have a functioning arm). What makes a muscle strong is its ability to not only contract, but to also stretch and lengthen. Without these opposing forces you are left with short, tight, dysfunctional musculature. Katy does an awesome job explaining the physiology in more detail here.

So what causes pelvic floor dysfunction anyway? Some of you may have been told that pregnancy and vaginal childbirth are to blame for all of your pelvic floor woes. While pregnancy and birth, specifically interventive births with episiotomies, forceps, or vacuum deliveries, are risk factors for pelvic floor dysfunction, it is far from the only cause.[4] Women who have never carried a pregnancy or given birth suffer from pelvic floor issues, and so do men for that matter (read sexual dysfunction and prostate disorders).[3] Lets take a look at some other risk factors contributing to tight and weak pelvic floors.

Sitting on our sacrum is perhaps the biggest threat to our pelvic floors. The constant pressure forces the sacrum inward, chronically shortening the pelvic floor muscles and restricting full range of motion.[6] Humans were not designed to sit on their butts for long periods of time, but rather meant to change positions frequently with lots of walking, bending, and variations in movement. Constant sitting at work, in the car, and at home has contributed greatly to loosing the full range of motion in our hips and legs. One way to combat this is to walk as much as possible during the day. If you work at a desk, take frequent brakes to walk and stretch (we will go over the stretching in a minute). Standing workstations are great options for people with more workplace flexibility. Here is a post from Katy about alternating sitting positions.

The way that we stand also affects pelvic floor function. Many people have a tendency to roll their pelvis forward, or tuck their tailbone under while standing. Another habit that contributes to this posture is clenching of the gluts in an effort to contain urine, feces, and flatus (in other words squeezing your butt muscles trying to hold it).[1] Both of these actions move the sacrum towards the pubic symphysis, while also disengaging the opposing force of the glute muscles.[5] When the pelvis is shifted in this way, our ligaments instead of the boney prominences of our pubic bone work to support the pelvic organs. Unfortunately, ligaments are not pliable like muscles tissue, and once stretched, they don’t recoil well. By rocking our pelvis back in a neutral spine position, our bones and muscles do the work like they are supposed to, keeping our organs well supported.[3] Check out this helpful video one pelvic range of motion and finding a neutral spine.

Another bad postural habit is chronically “sucking in our stomachs.” Sucking in the stomach causes similar issues that butt clenching does to the pelvic floor; causes tension![6] This increased abdominal tension does not improve strength, but rather causes the pelvis to tilt forward, further tucking the tailbone under. The key here is learning to relax both the core and pelvic floor muscles while also stretching them and encouraging them to lengthen.

Before we get to the stretching, we have to discuss stress. Our modern lives are plagued with chronic stress. Stress causes tension in all of our muscles, including the pelvic floor.[1] We could all benefit from a regular practice of meditation, deep breathing, and yoga to decompress and bring awareness to clenching or tension that we hold in our pelvic floor. Here is a great guided relaxation for the pelvic floor and here is a nice pelvic floor breathing exercise. Remember, muscles have to be able to relax and lengthen as well as tighten in order to function properly.[3]

So some of you may be wondering, what do we do to facilitate this taut yet supple pelvic floor? The two most important things we can do is strengthen our glute muscles and increase flexibility in our hips, knees and calves. [6] Strong glutes create opposing force on the sacrum, encouraging it to move away from the pubic bone, thereby lengthening the pelvic floor.[3] There is one wonderful movement that addresses both of these issues: The squat.

Before the advent of modern comforts (cars, chairs, sofas, toilets) humans spent a heck of a lot of time in the squatting position. Anthropologists and physiotherapists agree that this movement is biologically important to human health. Unfortunately, many of us were raised in environments where squatting was obsolete, so our bodies lost the ability to preform this range of motion properly. Our hips, calves, and groins are tight, contributing to our pelvic floor dysfunction and other elimination difficulties (including constipation).[6] If you want to see a perfect, instinctual squat, watch a toddler squat to pick up a toy. It is a movement that we intuitively do as children, only to be lost to modern conveniences.

For those of us who are not in the habit of squatting regularly, it may take some time to ease into the proper posture. This video explains how to work on proper squatting form from a seated position (this is a good place to start if you are really tight in the hips and weak in the glutes). In this blog post, Katy explains the importance of untucking the tailbone while squatting, showing step-by-step ways to slowly ease the body into proper squatting alignment. Here is Katy’s follow up post with more squatting tips. Squatting is the perfect exercises for the pelvic floor because it works in two ways. First, it works to lengthen the muscles on the way down and second it works to strengthen the glutes on the way back up. You can also vary your glute exercises with one like this. Pay attention to alignment in this exercise, keeping the thighs rolling inward and in alignment in the hips (we tend to let our legs flop out wide, which doesn’t engage the muscles in the same way).

In addition to squatting, there are other exercises that can be done to open up the hips and stretch the legs. Here are two more from Katy. One for stretching the deep hip muscles and one for tight calves. Many yoga poses can also help with hip flexibility including these ones and these ones.

Walking outdoors on an incline (read NOT** on a treadmill…the moving belt on the treadmill discourages proper use of the glutes) is great for building gluteal strength. When dealing with pelvic floor issues, specifically incontinence or prolapse, it is really important to avoid high impact activities like running. Running increases the force on the pelvic floor, causing it to strain and work harder to hold the weight of the pelvic organs. [6] Also, any abdominal exercises that increase abdominal pressure should be avoided, including crunches and sit-ups.[1] For some ideas on safe abdominal exercises check out my other post here.

As I am sure you can tell by now, I think Katy is the coolest person ever. Her work is revolutionizing pelvic floor health and the general principals of alignment and wellbeing. Here are some other posts that I highly recommend addressing high heels and their negative effects on the pelvic floor and using a squatty potty to help get those daily squats in the mix.

Incorporating these exercises and alignment strategies into your daily life will help support pelvic floor health, but they are not substitutes for working with a qualified pelvic floor physiotherapist. A physiotherapist will be able to asses your unique pelvic floor needs, including the degree of muscle weakness, muscle tightness, scar tissue, and trigger points that may be effecting muscular function.[1] Pelvic floor therapists implement many healing strategies including pelvic massage, myofascial release, trigger point therapy, scar tissue release, biofeedback, and neuromuscular electrical nerve stimulation to help restore function to the musculature.[2] They can also recommend individually tailored exercises to work on tension or strength. Many insurance companies will cover at least a few sessions of pelvic floor physical therapy, allowing patients to bring exercises home with them for continued training.

This link explains the internal work associated with pelvic floor PT and here is a video explaining some simple techniques to assess tension in your own pelvic floor. To find a therapist near you who trained with Katy, check out this link. Last but definitely not least, check out Katy’s DVD with more recommendations for pelvic floor exercises.

Well, I have officially been sitting on my sacrum for way too long writing this post, so time for me to get moving. Best wishes for your self-care endeavors!

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[1] Berzuk, K. (2014). The Pelvic Floor Muscle: the Link Between Bladder, Bowel, and… Sex? A Review of Current Pelvic Therapy Approaches for Diagnosis and Treatment of Sexual Disorders. Current Sexual Health Reports, 6(3), 192-200.

[2] Hartmann, D., & Sarton, J. (2014). Chronic pelvic floor dysfunction. Best Practice & Research Clinical Obstetrics & Gynecology, 28(7), 977-990. Research Clinical Obstetrics & Gynaecology, 28(7), 977-990.

[3] Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012, February). Recognition and management of nonrelaxing pelvic floor dysfunction. In Mayo Clinic Proceedings (Vol. 87, No. 2, pp. 187-193). Elsevier.

[4] Rogers, R. G., Leeman, L. M., Borders, N., Qualls, C., Fullilove, A. M., Teaf, D., … & Albers, L. L. (2014). Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women. BJOG: An International Journal of Obstetrics & Gynaecology, 121(9), 1145-1154.

[5] Bowman, K. (2010, May 17). 1,2,3,4 We like our Pelvic Floor! Retrieved November 17, 2015, from http://www.katysays.com/1234-we-like-our-pelvic-floor/

[6]Bowman, K. (2012, April 30). TooTightPelvicFloor 2. Retrieved November 17, 2015, from http://www.katysays.com/tootightpelvicfloor-2/

Healing Abdominal Muscles After Pregnancy

September 3, 2015 by Midwifery Traditions

One component of the six-week postpartum visit is the assessment of the rectus abdominis muscles. Separation of these muscles is normal during pregnancy as the muscles and connective tissue stretch and thin to accommodate your baby. It can take several months for these muscles to begin to heal and move closer together after giving birth. For some individuals, the separation can remain significant, a condition called diastasis recti. This condition can lead to a weak core, back pain, and a stubborn postpartum belly. Fortunately, diastasis recti can be greatly improved or healed all together with the slow implementation of certain core stabilizing exercises.

First, it is helpful to
check for the degree of muscle separation. Lying on your back, lift your head and shoulders slightly off of the floor (like doing a mini crunch) and push your fingers down into your belly button. If your fingers sink into your abdomen, you have a separation of your rectus abdominis muscles. You can then move your fingers above and below your belly button to feel the different degrees of separation in different areas. Becoming familiar with your degree of separation is helpful when beginning exercises in order to track your healing progress. Here is a demonstration on how to check for diastasis recti.

Before we talk about exercises we that should be doing to premote diastasis closure, lets quickly review what we shouldn’t be doing. Abdominal exercises like crunches, sit-ups and planks are counterproductive when dealing with diastasis recti and can, in fact, make the condition worse. Any exercises that cause the abdominal muscle to bulge away from the body (put your hand on your stomach while doing a crunch to feel it for yourself) put additional pressure on those already weak abdominal muscles. Planks force the abdominal muscles to support the internal organs, also increasing abdominal pressure and outward force. Once your diastasis is healed, these exercises can be added back into your routine, but it is important to avoid them while rebuilding your foundational core.

One of the first exercises to begin with after your 6-week postpartum visit is a simple breathing exercise that can help to isolate your core abdominal muscles. Lay on your back, knees bent, with the arch of your back pressed against the ground (you want a flat spine). Place your hand on your belly and take a deep breath, trying to expand your abdominal muscles to push your hand up and away from the floor. As you exhaled, contract your abdominal muscles and pull your belly button towards your spine. This “pulling your belly button towards the ground” action is the foundation for all of the other exercises to follow. You can do this simple exercise in repetitions of ten several times throughout the day until you feel that you have a good grasp on the technique.

Next add the “pelvic tilt” to your practice. Here, start in the same position on your back with your knees bent. This time curl your hips towards your ribcage while engaging your abs and pressing your lower back into the ground. This is a very subtle movement, which works both the core abdominal muscles and the pelvic floor muscles. Check this out for visual examples of the pelvic tilt.
As you progress in your strength and technique, you can add other exercises into your routine. Here is a great guide to 6 exercises for healing diastasis recti (some of which we already discussed above).

Lastly, here are some other gentle, beginning exercises to work with…
Ultimately, a physical therapist is going to be able to best asses your muscular weaknesses and tailor individual exercises. If you feel that you would benefit from professional physical therapy, please speak to your provider about a referral.

Here are a few physical therapy resources for the local Philadelphia, PA area (**note that we do not endorse any of these providers. This list is simply a place for you to start your own research).

Action Physical Therapy

Central Bucks Physical Therapy LLC

Select Physical Therapy

Image Property of Fit2B https://fit2b.us/how-to-check-for-diastasis-hd/

We know how busy families are with life, children, and especially new babies. I am sure that you are laughing at the idea of exercising with a 6-week-old infant at home. Fortunately, these exercises are really quick and simple and can be broken up throughout the day or even integrated into floor play with little ones. The sooner that you implement gentle core exercise (after getting the go ahead from your provider of course), the better your body will heal. Even if you had your babies many years ago, it is never too late to strengthen these important abdominal muscles!

For those of you planning on having more babies, check out this post on healthy musculature/pelvic structure and their important role in optimal fetal position for delivery.

Next time we will address pelvic floor dysfunction and how to regain strength in your pelvic floor. To kegel or not to kegel? That is the question! Best wishes for your self care endeavors!

Essential Water Birth Shopping List

August 31, 2015 by Midwifery Traditions

Many of our clients are interested in water birth and ask us to recommend products. Giving birth in the water can be an excellent pain management option for women birthing at home and a gentle transition to extrauterine life for your baby. The following list includes the necessities, as well as some of products that I have seen work best over the years.

Let’s start from the bottom:

Protecting your floors

Whether you plan to place the tub on hardwood, laminate, or carpet, a solid tarp that is larger than the circumference of your pool is a great idea. You will likely be frequently be getting in and out of tub and drips will inevitably happen. If you don’t have a very cushy, inflatable bottom (or even if you do), your knees may appreciate some extra padding under the tub. A comforter, sleeping bag, or egg crate foam under your tarp works great.

Will the floors on my second story be able to accommodate the weight of the filled pool?

I have yet to see a birth pool fall through the floor. Waterbirth International reports the weight of a filled birth tub to be equivalent to 4 adults sitting at a table, or 840 pounds. If you are still concerned, consider a part of the floor with a load bearing wall beneath. Ultimately, you will want your birth tub to be on the same floor as a bathroom and, ideally, near to the bed or other location where you will spend your first few postpartum healing days.

For carpeted floors, consider a plastic drop cloth walkway from your tub to your bed and bathroom. Some drop cloth plastics create a slippery, dangerous situation. Home Depot and other stores with painting supplies offer Self-Adhesive Carpet Protection Film, a temporary, sticky backed carpet protecting drop cloth plastic. It works great, staying in place throughout the day, even with a lot of traffic.

The Tub

You have many options at a range of prices, listed here beginning with the least expensive/most simple.

1.) “The Fishy Pool” At under $30, this pool comes at the right price. This is a simple blow-up inflatable children’s pool, without a heating mechanism, handles, cup holders, or other niceties. I have seen all sorts of pools in use, but the most frequent problem encountered is insufficient height. In order to achieve the buoyancy and weightlessness needed for the best pain management in labor, you will ideally have at least 21″ of water (The water should cover your belly while you are in a kneeling/squatting position). Look for three rings and at least 24 inches high. (Hint: You’ll know you’ve hit the jackpot if all of the top Amazon.com reviews are from home birthers!)

Intex Swim Center Ocean Reef Inflatable Pool, 75″ X 70″ X 24″, for Ages 6+

2.) La Bassine Waterbirth Pool: For the taller person, someone intending to use the tub multiple times, or someone who wants a few birth-related amenities, this birth pool might be for you. The side walls of the La Bassine have vertical inflatable pockets which create a sturdier feel. The bottom of the pool inflates to a nice cushion, which you will appreciate after several hours of kneeling, and plastic handles are fixed on the inside walls. La Bassine makes fitted liners for easier clean-up between users and covers to keep the water warm when you are not inside.

Regular Size (75″ x 54″ x 28″): $120.00, www.yourwaterbirth.com

MAXI (75″ x 65″ x 28″): $140.00, www.yourwaterbirth.com

3.) Birth Pool in A Box Eco: This popular option comes with multiple amenities. The BPIAB comes with 6 exterior handles, three adjustable height rings, an inflatable seat, and a built in cup holder. The “My Anchor” accessory birth pool strap is available for purchase. Some sites include liners, covers, and accessories in one water birth package, or they can be purchased a la carte. This sturdy pool will hold up for many uses. (Personal note: I like this pool and so do my clients, but I feel compelled to mention that I have never once seen anyone use the seat, the handles are used far less frequently than a support person’s hands, and the cup holder is awkward and the drink gets stuck in it. I wouldn’t use these factors alone in the choice of this pool over the less expensive options.)

Regular (76″ x 65″ x 30″): $210.00, www.yourwaterbirth.com

Mini (65″ x 57″ x 28″): $195.00, www.yourwaterbirth.com

Air Pumps for inflating your tub range from manual hand pumps ($5) to quick-fill electric pumps ($25) and are easily found.

4.) The Aqua Doula: This self-heating tub is a unique option for someone who does not want to worry about keeping their water at the perfect temperature. The sidewalls are made of rigid and study foam covered plastic, which some users complain is less comfy to drape themselves over. Additionally, the height is only 24″, just high enough to meet the minimum amount of water needed. At over $1,000.00 to purchase, most people interested in this tub choose to rent from someone local. Ask your midwife if she knows of anyone offering this service. Bonus: rental services typically offer liners, hoses, adapters, and pumps. Some offer set up and clean up as well.

Learn from our mistakes: Protect the integrity of your inflatable pool by keeping pets who like to scratch away!

Getting the Water In and Out

Hoses: A clean, potable hose is needed to put fresh, safe water into your birth pool. Those designed to be drinking water safe are appropriate because they are free of lead and other harmful chemicals. You will be filling your tub from either a sink faucet or shower head, so measure before you buy to get the right length.

Camco TastePURE Drinking Water Hose 25′, $9.97, www.amazon.com

Adapters: You will need a hose adapter for your shower or faucet. These are a couple of dollars and can be purchased online or in hardware stores. Every faucet is different. Please do a trial run in plenty of time to reorder if needed.

Dechlorinating filter: Occasionally, my clients are concerned about the chlorine content of their water, especially if they are getting water from the city (not well water). If this is a concern for you, dechlorinating water filters for your shower can be purchased here for around $40.00 and kept in place for chlorine-free showers.

Water pump: For removing the water from your tub after your birth, you have various options. Pumps can be external (connects to the hose outside of the pool) or submersible. External pumps are least expensive, but very loud. The EcoPlus Eco 396 Submersible Pump, $22.44, www.amazon.com, is an affordable option and comes with multiple adaptors for various hose fittings. You will need a second length of hose to go from the pump to wherever the water will be disposed.

OUR FAVORITE: The two-way siphon. These devices, designed to empty and refill aquariums, are the ultimate for home birth with an inflatable tub. These allow you to remove cool water from the tub and replace with warmer water from the faucet throughout labor. No more messy bailing with buckets and boiling pots of water on the stove. When you want to remove water from the pool, you simply flip the switch near the faucet connection and turn on the water, creating a siphon and sending water down the drain.

Python No Spill Clean and Fill Aquarium Maintenance system-25 ft, $39.99, www.amazon.com

Everything Else

Towels. So, so many towels.
Flashlight
Floating thermometer
Debris removal net. (hint: Solo or styrofoam cup with holes punched in the bottom work in a pinch)
A provider who is comfortable with water birth

You are finally ready to bring your baby into the world in this gentle, lovely way. Remember that not every person ends up delivering in the water. Your midwife may ask you to get out of the tub for some complications or you may decide in labor that you need a change of scenery. If you are planning a hospital birth, you may still like having a tub at home for labor before you go in. Happy birthing!

Herbal Sitz bath for New Mothers

August 9, 2015 by Midwifery Traditions

Postpartum herbal soaks are an excellent, natural way to soothe tender, inflamed tissue, help heal tears, reduce hemorrhoids, and otherwise pamper yourself after you have your baby. We recommend 2 baths a day for several days after your birth (or longer if you experienced tearing or significant swelling) to our clients.

Good quality, pre-packed mixes are are available for purchase from Motherlove, Earth Mama Angel Baby, Wishgarden Herbs. For those interested in formulating their own herbal soak, Aviva Romm, MD offers some favorite recipes for you to prepare on your own:

(from avivaromm.com)

The postpartum bath is a tradition that my midwifery clients have enjoyed for over 30 years, one that I enjoyed after my own babies were born, and one that I now use as my grown children have their babies. There are many herbs that can be used to soothe tender perineal tissue, heal tears and episiotomies (yes, you CAN take herb baths if you’ve had stitches!), reduce inflammation, and even shrink hemorrhoids after a vaginal birth. (Sorry – immersion in a bath is not appropriate after a cesarean – but foot soaks with any relaxing herbs, for example, lavender blossoms and rose petals are an absolutely delicious way to relax and treat yourself to something special!)

Preparing the bath is as simple as making a giant pot of tea, and the medicinal liquid can also be made into compresses and peri-rinses as directed below. The bath can be given as soon as an hour after a vaginal birth as long as long as mom is healthy and there are no signs of infection. A fresh bath can be taken once or twice daily for three to five days after birth. Baby can accompany mama into the herbal bath, which also promotes drying and healing of the umbilical cord.

When I was dispensing my own botanical products, I generally had to refill orders for postpartum bath herbs several times as women find them so soothing! So assemble enough herbs or purchase enough herb bath bags for at least 1-2 baths/day for 5 days plus some extra for use in a peri-rinse (squeeze bottle).

My 2 Fave Herb Bath Blends for New Mamas

HERBAL BATH I: POSTPARTUM DELIGHT

A blend of beautiful and fragrant blossoms that is uplifting, soothing, healing, and antiseptic.

Mix and store these herbs:

1 ounce dried comfrey leaf*
1 ounce calendula flowers
1 ounce lavender flowers
1/2 ounce dried uva ursi leaves
1/2 ounce witch hazel blossoms (if you can find them)
1/2 ounce dried sage leaf
1/2 cup sea salt

Directions: Bring 2 quarts of water to a boil. Turn off heat, and place 1 ounce (approximately 1 large handful) of the above mixed herbs (not the salt) into the pot. Steep, covered, for 30 minutes.

Strain the liquid well with a fine mesh strainer, and discard the herb material. Add 2 quarts of liquid to the tub, along with the 1/2 cup of salt.

HERBAL BATH II: DEEP HEALING BATH

Strongly antiseptic and astringent, perfect for healing trauma to the perineum, including tears and episiotomies.

Mix and store these herbs:

1 ounce dried comfrey leaf*
1 ounce yarrow blossoms
1/2 ounce myrrh powder
1 ounce dried rosemary leaf
6 cloves of fresh garlic
1/2 cup of sea salt

Directions: Peel all the garlic cloves and place them in a blender with 1 cup of water. Blend at high speed until you have a milky liquid and the garlic is completely pulverized. Strain through a fine mesh strainer. Bring 2 quarts of water to a boil and turn off heat. Add 1 ounce of the dried herb blend to the pot and steep for 30 minutes.

Strain the liquid and discard the herb material. Add 1 cup of the garlic “milk” and the herb tea to the bath, along with 1/2 cup of salt.

Do not use include the garlic milk for use in a peribottle or compress – it would be too irritating. The tea without the garlic, however, can be used directly.

Herbal Compresses and Rinses

To use the teas as herbal compresses: Simply soak a washcloth in the herbal tea and apply warm or cold to the perineum as needed to reduce tenderness and swelling.

For use in peri-rinses: Purchase a peri bottle (a plastic squeeze bottle) from any pharmacy and fill with the strained tea of your choice. Squeeze warm or at room temperature over your perineal area as you urinate. This significantly reduces inflammation and stinging.

The Sitz Bath

If you don’t feel like fully immersing, or don’t have a tub at home, try a sitz bath instead. A sitz bath is a basin that fits perfectly into your toilet seat and let’s you get a soothing soak of the important parts after a vaginal birth without having to immerse in the tub. Sitz bath basins are inexpensive and available at many pharmacies, Target, and Walmart.

Is Comfrey Safe for Use in Herbal Baths?

You may have heard rumors that comfrey root and leaf are not safe for use in herb baths. This is based on the fact that a chemical compound in comfrey leaves, Pyrrolizidine alkaloids (PA), are known to cause liver damage in rare cases when taken internally. While this compound can also be absorbed through skin abrasions and open wounds, the amount is tiny, and there is not evidence that this can cause hepatotoxicity or problems for baby through exposure in the bath. If, however, you are uncomfortable with using it, simply skip this ingredient and increase the volume of the others to make up the difference.

Where Do I Get Herbs for the Herb Bath?

Assembling your own herb baths is easy – you just purchase the amounts of each herb you need, and mix them together in a large glass jar, tupperware, or plastic bag for storage until it’s time to use them.

Bulk herbs for mixing your own baths can be purchased online from Mountain Rose Herbs.

This article was originally posted here on AvivaRomm.com, and was republished with the permission of Aviva Romm.

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