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  • The Truth About Your Due Date

    6 birth experts weigh in on the importance of your “due date.”

    Article & Photo courtesy of Well Rounded NY

    When I got my first ultrasound, my doctor measured the peanut-shaped embryo growing inside of me and managed to gift me with the sweet, sweet sound of my baby’s heartbeat. I was five weeks along, maybe six, she said. After I told her the first day of my last period, she confirmed that I was in fact six weeks pregnant. I told her my menstrual cycles were much longer than the 28-day average and wondered if that fact changed anything. But her mind was set: my baby was to be born on October 29, 2014.

    My pregnancy, as a nurse later told me, was “boring” — I was a healthy 29-year old woman; I didn’t have gestational diabetes; and my blood pressure remained steadily normal throughout the pregnancy. There was no reason to believe that I would need to fight for a chance to give birth naturally.

    Yet a week before the big day, my doctor informed me that my cervix was not thinning. I was apparently nowhere close to going into labor, and I should schedule an induction to deliver on my due date. Why the rush, I asked? My son’s predicted birth day seemed to be more of an educated guess, and a pregnancy is usually considered late at the 41-week mark. In fact, many doctors are willing to wait until the 42nd week to perform an induction. My OBGYN, on the other hand, regurgitated all the scary science she knew on stillbirths, C-sections and late labors. According to her, I was not an at-risk patient, but I could become one by holding on to the idea of a natural birth. That day (and again on my due date), I did not schedule an induction, and my son was born on November 1, 2014 — three days ‘late.’

    As it turned out, my son’s tardiness wasn’t the exception, but the rule. Only 5 percent of women deliver on their actual due date, and doctors do recognize that due dates are anything but predictable. So why was I being forced into labor a week before the big day? What did my son and I really risk by waiting it out? And if due dates offer no guarantee, what do they really stand for? To help prepare for your baby’s big debut, we’ve asked the pros to give us their views on due dates. Here’s what they said:

    The Midwife 
    Lauren Abrams, CNM, MSN — Clinical Director of Midwifery at Mount Sinai Hospital
    “One of the most important things the midwife or doctor does at the first prenatal visit is to establish the due date. Having an accurate due date is crucial, because it allows us to offer prenatal tests at the appropriate time in pregnancy, and it tells us the safest time for the woman to give birth. Many of the tests we do during pregnancy need to be done during a specific time frame, so if the due date is not correct, the results of these tests may not be accurate.

    In terms of labor, we know that a pregnancy is considered full term any time between 37 and 42 weeks after the first day of the last menstrual period, so this is the safest time period in which to give birth. For women who are having uncomplicated pregnancies, it’s always best to wait for labor to start on its own. Sometimes women ask us to induce the labor before the due date, because they are tired and uncomfortable, or wish to give birth on a certain date; however, for women who are having uncomplicated pregnancies, waiting for labor to start on its own is best, because it gives the woman the best chance of having an uncomplicated vaginal birth and a healthy baby. If labor has not started by 42 weeks, though, we will recommend induction, as we know that babies born after 42 weeks have a higher rate of complications.”

    The Doula
    Lindsey Bliss — Carriage House Birth Director & Birth Doula

    “Due dates are only based on an averages. I wish we could all call it the due month instead. Two weeks before or after the due date is still considered term. I don’t know about you but I am not average, nor have I ever fallen within an average range for anything in my life. I’m on my sixth baby & not one of them came on their due date. There is this extreme pressure from our society for women to have delivered before or on their due date. This is such an unrealistic expectation. I can’t tell you how many unnecessary inductions are performed just because women are considered “LATE” when they go past 40 weeks. In a healthy pregnancy, I truly believe that labor will start when the baby is ready. I believe in our bodies innate wisdom to give birth.”

    The OB/GYN
    Cara Dolin, MD — OB/GYN, Maternal-Fetal Medicine Fellow at NYU Langone Medical Center
    “The due date is very important. It tells me how far along my patient is, what developmental milestones I expect to see on the ultrasound, what tests to perform and how to counsel patients. Many management decisions about the pregnancy are made based on the due date, this becomes especially important as a woman’s due date comes and goes with no sign of labor. There are risks to letting a pregnancy continue beyond the 40th week, including having a very large baby, needing forceps, a vacuum or cesarean delivery and even stillbirth. Because of these risks to both mother and baby, it is recommended that labor be induced before 43 weeks. Many providers will induce labor at 41 weeks. Ultimately, the decision to be induced is made between a woman and her physician or midwife based on the specific circumstances of her pregnancy.”

    The Labor Nurse 
    Jeanne Faulkner — registered nurse and author of Common Sense Pregnancy
    “The medical community has quit putting so much emphasis on delivering by the due date. That’s because too many inductions fail to lead to vaginal births and too many women end up with c-sections. Too many babies thought to be due or near due, are being delivered just a wee bit too early and ending up in the NICU with breathing problems. We know there’s a lot of finish work to be completed before a baby is ready to leave the womb and live life independently from its mother. We shouldn’t shortchange babies by unnecessarily delivering them early. Even the American Congress of Obstetricians and Gynecologists agrees that mothers and babies know best (most of the time, anyway) about when baby should be born. Their most recent guidelines discourage doctors and mothers from scheduling inductions solely for due-date related reasons. If a healthy woman with a normal pregnancy is pressured by her doctor or midwife to have an induction or scheduled c-section, she should ask for more information. She needs to understand why her pregnancy or health falls under ACOG’s guidelines for appropriate induction. If she’s fine and her baby’s fine, then it’s probably also fine for labor to start on its own.”

    The Acupuncturist 
    Aimee Raupp — Wellness & fertility expert, acupuncturist
    “To me, due dates are approximations. They are calculated based on the first day of the last menstrual period, which is roughly two weeks before a woman ovulates and can even get pregnant. Plus, it can take from 2 to 9 days for the fertilized embryo to implant in the uterine wall. So I encourage my patients to think of their due date as a guesstimate. I remind them that babies come when they are ready: they can come early on their own, and they can come later than expected, which is often the case for first time pregnancies. If babies aren’t budging, there could be a reason that requires our patience and/or further medical intervention.

    Acupuncture can really get the labor process going, and many women who are nearing or past their due date often come to me (or are referred to me by their doctors). From my experience, acupuncture usually works within one or two visits. When it doesn’t, I believe it means that baby just isn’t ready to come out.

    Let’s not forget, too, that the very definition of a ‘full-term’ pregnancy varies from one country to the next. Here, ‘full term’ is technically 40 weeks and 6 days; in some European countries, ‘full term’ is now 41 weeks and 6 days. But I think that as long as there are no medical reasons — like high blood pressure, swelling, fever, low amniotic fluid, etc — and the woman is still comfortable, it is ok to go past the ‘full term’ mark. When and if the time comes, I rely on signs of early labor, like the baby’s low positioning and contractions, to do some treatment and encourage the progression of labor — but only once the woman hits 40 weeks, not before.”

    The Pediatrician
    Mona Amin, DO — pediatrician at Tribeca Pediatrics
    “A due date does give us a lot of information about what to expect with a baby, especially if he or she is premature (born prior to 37 weeks). We always like to know if the baby ended up needing any support at delivery (i.e. oxygen support, antibiotics, or a stay in the NICU). And when seeing a family for their baby’s initial visit, knowing gestational age, along with any complications during pregnancy, gives us, pediatricians, an idea of the baby’s transition into the world and of the health outcomes to closely follow.

    For those born post-term (after 40+ weeks), health outcomes are standard to those born term. Some findings with post-term babies include large babies (which can make vaginal deliveries more difficult and require close monitoring of sugar levels), as well as dry flaky skin from being in a water-like environment in mom for so long. The most important thing for these children is to have regular OB exams and fetal monitoring — to make sure that they continue to receive adequate nutrition and perfusion from the placenta.

    Premature babies (especially those born before 32 weeks) can have many of their vital organs affected, as they are not fully developed. So they do require much more visits to their pediatrician and coordination with specialists. They are closely monitored for their breathing, nutrition and heat regulation. We understand that if you have a premature child, you will have many questions and concerns — and rest assure your NICU doctors and pediatrician are ready and willing to walk you through what to expect.”

    This article is by Charlene Petitjean-Barkulis, courtesy of Well Rounded NY.  Conceived with love by former magazine editors Jessica Pallay and Kaity Velez, Well Rounded NY aims to be the singular pregnancy resource for city-savvy moms-to-be. Through reviews, profiles, expert Q&As, local guides and more, Well Rounded curates the New York City pregnancy and helps its readers come to terms – and term! – with pregnancy in the city.

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  • Going With Your Birth Flow – Labor Preparation Tips From Nine Naturals

    In order to have a positive birth experience, many new parents are deciding to “go with the flow,” believing that this will keep them relaxed and positive by remaining flexible. However, it’s still important to do some prep before birth! Getting educated about what happens during birth, asking questions, expressing  any lingering fears/concerns to your birth team, and discussing higher level birth preferences with your partner will make the process a lot smoother. Like all big decisions, especially for coordinating birth, it’s important to do research. Here are a few tips to make sure you remain in YOUR flow:

    Ask questions

    When it comes to birth, many successful and outspoken moms-to-be surprisingly don’t ask questions. Not asking questions is like running a marathon without being prepared. To avoid being overwhelmed in any stage and quickly agreeing to unnecessary interventions, ask questions and know your options–ask as many questions as you can before as well as during the labor.

    Consider Hiring a Doula

    Hospitals are busy and overcrowded, so hiring a doula can facilitate the birth process. The doula can help ease the pressure on the birth partner and keep them fresh for the moments closer to birth. The doula can also help with little things like paperwork and the bigger things – like decisions that come up in the delivery room. A doula helps with preparation and relaxation for both you and your partner by providing information and keeping you aware. Some studies have shown that continuous support from doulas during childbirth may be associated with decreased use of pain relief medication during labor, incidences of C-sections, length of labor, and negative childbirth experiences.

    Take a Childbirth Class

    Attending a childbirth class will help to inform and prepare you for what to expect during labor and delivery. Learn more about baby’s development, warning signs that something may be wrong, breathing and realization techniques, and pain relief options during labor. Additionally, it will help you familiarize yourself with medical terms and common hospital protocol.

    Look out for your own best interest

    One major appeal of the “go with the flow” mentality is the stress-free aspect. However, the more information you have going into your birth and the more control you have during your birth, hopefully the more relaxed you will be and the better your birth will go. For example, educate yourself on the signs of labor and your options for how you can labor while you are in the hospital (i.e. -the fact that you can move around when you want to, or that you don’t have to lie down to give birth). With more knowledge, whether it be from a doula, a class, or personal research, you will feel more empowered throughout the birth experience. Birth is an amazing experience. Take it into your own hands and go through it at your flow.

    Stephanie Heintzeler is a German educated midwife, US Doula and Certified Lactation Counselor. She owns The New York Doula Concierge with a team of 20 doulas. Find out more at www.thenewyorkdoula.com

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    • Prepping Your Body for Birth

      Train your body physically and mentally for the big day.

      Article & Photo courtesy of Well Rounded NY

      Preparing your body for pregnancy and birth is comparable to getting ready for a marathon-meets-Tough Mudder! Although every birth is unique, a healthy, fit mother has strength and flexibility to her advantage to push her baby out like a pro. The birthing experience will be taxing on your body both physically and emotionally, so the more “training” you can do beforehand, the better. Below, find 5 great tips that will help you physically and mentally prep for birth.

      Physical Prep:

      1. Squat it out. If I were to choose one exercise to perfect, it would definitely be squats because they help prepare for a natural delivery. Whether you play with a TRX squat, a yoga Malasana squat, or a weighted goblet squat, make sure you get low, and wherever the toes go, the knees should follow.
      2. Learn to Swim. Swimming takes 90% of the body weight off when you are waddling around winded during your later months of pregnancy. Learn how to swim now, and your body will thank you down the road! Spending time belly down also helps position the baby for a natural birth at 36 weeks pregnant, when you are praying your baby doesn’t flip breeched.
      3.  Untwist Asymmetries. Do you do any of the following? Turn to look at your computer screen, carry a side shoulder purse, or jut one hip out? Unbalanced movement causes a twist in the spine and pelvis. Why is it important? Two ligaments attach the uterus to the pelvis, and any twist in the pelvis will create torsion of these ligaments. If there’s a twist in the pelvis and uterus during labor, the baby will have difficulty descending and may end up facing the front of the mother leading to immense prolonged back labor. It’s important to get assessed by a chiropractor to help optimize the structure and function of your body leading up to getting pregnant.

      Mental Prep:

      1. Meditate Daily. Meditation helps us to let go of our extraneous thoughts and habits, allowing us settle into a safe and calm space. The same is true during labor; if we let go of fear and expectations, we drop into a primal, grounded space during contractions and stay present between contractions. Our patients at the Urban Wellness Clinic who meditate daily tend to deliver their babies like rock stars! Our favorite meditation guides include Headspace,  a friendly app with short 10-minute meditations under the guidance of Andy, a gentle British bloke; and Art of Meditation  with Elena Brower, an innovative and accessible online offering created by my favorite NYC yoga instructor. Find the same time of day to meditate, this helps ease in creating a new healthy habit. Just start, there’s no better way to break procrastination than sit down, close your eyes and breathe.
      2. Belly Breathe. Place your left hand on your chest and right hand on your belly, and take a breath. Where did you send the majority of your breath? If it was all in your chest, welcome to the stressed out club of NYC’s dysfunctional breathers, don’t worry there’s hope. The natural breath is mostly belly expansion as we breathe in and the belly softening to the spine as we breathe out, and the sternum (chest bone) will travel forward but not upward.

      Tips for belly breathing:

      • Place the tongue on the roof of the mouth 1 inch behind the teeth,  this helps access belly breathing.
      • Focus on the exhale. This is when we actually breathe, when there is an exchange of oxygen to the blood stream.
      • Low hum on the exhale. This engages the vocal cords and core muscles will sync up the diaphragm on the exhale.

      Get belly breathing down now. During pregnancy, the baby grows which pushes up on the diaphragm and leads to using neck muscles to breathe and reflux. Lastly, the pressure action of the diaphragm is essential in creating force for progression and pushing out your baby in second phase of delivery.

      This article is by Emily Kiberd, courtesy of Well Rounded NY.  Conceived with love by former magazine editors Jessica Pallay and Kaity Velez, Well Rounded NY aims to be the singular pregnancy resource for city-savvy moms-to-be. Through reviews, profiles, expert Q&As, local guides and more, Well Rounded curates the New York City pregnancy and helps its readers come to terms – and term! – with pregnancy in the city.

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    • Prepare For Breech Baby

      What to do when your babe is on the way out, feet first!

      Article & Photo courtesy of Well Rounded NY

      There’s nothing more exciting than those last few weeks of pregnancy, when you know your baby is on the way out. Hopefully with her head down. But it doesn’t always happen that way. According to the American College of Obstetricians and Gynecologists, 3 to 4 percent of full-term births present as breech (butt or feet down) as late as three to four weeks before the due date, often for reasons unknown.

      There’s still time for things to turn around, but it’s a good idea to know what to expect if your baby is in breech position during those last few weeks. Below, NYC OB-GYN Dr. Meredith Halpern gives us our options and preps us for the possible delivery of a breech baby.

      35 weeks: If your doctor or midwife determines that your baby is still breech at this point in your pregnancy, you may need to acknowledge a possible change in birthing plans. But, there’s still hope for a turnaround; Halpern encourages the exploration of medical alternatives that some argue may help turn your baby, from certain yoga positions to acupuncture. But it may also be the time to “wrap your head around an elective cesarean delivery,” she says, with enough time left in your pregnancy to emotionally adapt to the possibility of your new reality.

      37 weeks: Once your baby is full-term, some doctors will attempt an External Cephalic Version (ECV), a manual movement to get a breech baby into a head-down position. Performed in the safety of a hospital, an ECV can be uncomfortable, and in some cases, end in an emergency C-section if the baby shows signs of distress. “If the baby is going to turn, it will usually turn right away,” Halpern says, and that happens in more than 50 percent of ECV procedures. “But unfortunately, the baby can always turn breech again two days later.”

      39-40 weeks: If your baby remains in a head-up position as your due date draws near, most doctors will advocate for an elective C-section to reduce risks associated with breech delivery. “I always try to accommodate a patient’s wishes for her chosen birth experience, but the baby and mother’s health is the most important factor in how we get the baby out,” says Halpern. Breech delivery exceptions, she says, could be if a severely premature baby is already on its way out feet-down or if a second of twins is headed out breech.

      This article is by Jessica Pallay, courtesy of Well Rounded NY.  Conceived with love by former magazine editors Jessica Pallay and Kaity Velez, Well Rounded NY aims to be the singular pregnancy resource for city-savvy moms-to-be. Through reviews, profiles, expert Q&As, local guides and more, Well Rounded curates the New York City pregnancy and helps its readers come to terms – and term! – with pregnancy in the city.

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    • The Three Stages Of Labor

      Want to know what to expect when you go into labor? Buckle your seat belts for the three-phase breakdown.

      First Stage: The first stage of labor begins with contractions and progresses until your cervix is fully dilated.

      1. Early Labor: Your cervix gradually thins out — known as effacing — and opens. Contractions during this phase can be hard to distinguish from Braxton-Hicks, or “practice” contractions; you’ll know soon enough, however, if it’s the real thing. If you feel like moving around, taking a walk can be a nice distraction (and, some women say, method for moving labor along). If it’s the middle of the night and you feel like you can sleep between contractions, let your body rest for the hard work ahead.
      2. Active Labor (Transition): This is what birth professionals refer to as “transition;” contractions become longer, stronger and progressively closer together, and your cervix opens — or dilates — at a faster rate, preparing for your baby to pass through it. The rule of thumb is to call your midwife or doctor when contractions become regular and painful — it’ll be difficult to talk when they’re happening — and occur at a rate of five minutes apart. This is a good time to try out any pain-management techniques, such as breathing exercises, you may have learned leading up to labor.
      3. Transition is the last phase of active labor;  you may scream, vomit, moan — it’s      different for everyone. Do whatever you feel inclined to and ride the waves; your body knows what it’s doing, and it’s producing hormones to help you with the process.

      Second Stage (Pushing): The second stage of labor begins when your cervix is fully dilated, and concludes with your baby’s delivery. Some women find that pushing offers some relief during contractions. Use your moments between contractions to breathe; and try to stay directly in the present moment, rather than thinking ahead to the next contraction. The hardest part of the pushing stage is that final contraction–and final push–when your baby emerges. But as soon as it’s over, your baby will have arrived! 

      Third Stage: The third stage begins when your baby is born and ends when you deliver your placenta. Your uterus will resume contractions a few minutes after your baby is born, and your doctor or midwife will ask you to push a few times again in order to delivery the placenta. Don’t worry — this part is nothing compared to what you’ve already done, and you’ll hardly notice or care; your attention will be entirely focused on your beautiful new baby. Congratulations, mama –you did it!

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    • 9 Things To Consider Before You Give Birth: How To Create A Birth Plan

      As your due date approaches, the next critical step is start thinking about the birth. While the actual birthing process may be uncertain, it is important to become aware of what will make you most comfortable as you give birth. Creating a birth plan gives you the opportunity to become familiar with relevant terms, such as “membrane stripping” or knowing whether you’d like your placenta encapsulated. Understanding the terminology is crucial in order to avoid medical interventions you might not want later.

      Here are 9 things to consider before you give birth:

      1. What kind of birth are you hoping for? Natural, spiritual, quiet, non-invasive, epidural or a planned c-section?
      2. Who is part of your birth team? Partner, birth coach (doula), your mother, your best friend? Make sure your OB/midwife is okay with having more than one birth partner in the delivery room.
      3. What comfort measures would you like? Just to name a few: would you prefer to have music, food (make sure your OB approves of snacking during labor- most don’t), no IV fluids, massage, aromatherapy or acupuncture?
      4. When would you like to get induced (if ever)? Would you prefer a week past your due date or longer? Or are you okay when your OB wants to induce you on your due date? In addition, would you like to try natural induction methods first, such as teas, membrane stripping or acupuncture?
      5. Are you okay having your fetus monitored constantly during labor? Most moms prefer to be able to move around and have only intermittent monitoring.
      6. What position would you like for the actual delivery of your baby? Some birthing options include squatting, hands-and-knees, water-birth, and side-lying. Depending on what you are hoping for, check with your OB/midwife if they are doing non-supine positions.
      7. How would you want the placenta to be handled? Delayed cord-clamping, placenta-encapsulation or cord blood banking are options to consider.
      8. Would you like to have your newborn on your chest right away? Or are you planning on seeing the baby after it’s cleaned up.
      9. Are you okay with your baby getting medications/shots after birth? Some US states require a Hepatitis B vaccination after birth. Vitamin K shots are mandatory, while antibiotic eye-cream for your little one can usually be discussed. Make sure you know before the birth what your baby will be getting.

      Though this may feel like a daunting and extensive list, work through the questions with your birth team to craft the birthing experience that you want and are comfortable with.  Knowing what you want is the first step in creating the experience you want.

      Stephanie Heintzeler

      Stephanie Heintzeler is a German educated midwife, acupuncturist and US-educated doula. Born in New York City but raised in Germany, Stephanie found her enthusiasm for midwifery at 12 years old when her brother was born. She successfully finished her midwifery-exam in 2000 in the Black Forest of Germany. After moving back to New York in 2003, her book “New Yorker Geschichten” (“New York Stories”) was published, and she then began her own Doula business after becoming certified with DONA in 2006. For more information, visit her website: www.thenewyorkdoula.com

       

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