The hospital system has a term for describing a lack of change in cervical dilation. They label this pause in labour as "failure to progress". 

Yes! Sometimes labour stalls or full on stops, but this language is laden with value and implies that the pause is progression is somehow a failure on the birthing person's part to "do" labour. ​This is simply not true. Nothing about a stall in labour has anything to do with success or failure. 



The progression of cervical change and contraction pattern is indicated by so much, including: 

- Whether your body started labour naturally, or your labour was induced.
- The position of your baby's head on the cervix. A baby that is "sunny side up"  may result in a longer labour with more stalls. Read further to hear about positions to try to get baby to rotate! 
- Your hormone levels, cortisol levels and sense of comfort and ease.  Labour uses the right side of the brain, and when people are far into labour, they often appear to be in a sort of trance, where the left side of the brain shuts down. Their speech may slow, and they may not be able to answer practical questions.  When birthing people are stressed out, being poked and prodded at, and being interrupted out of "labourland",  the flow of the right side of the brain is interrupted and labour can stall and stop. (Source: Birthing from Within). 
- How long you have been labouring and you and your baby's exhaustion levels. Babies have a point in labour where they struggle to tolerate contractions. At this point you may choose to transition to a surgical birth, if your baby's heart rate is showing signs of distress. Also, are YOU distressed? Do you feel like you're just done? Birth is a balance and if you truly feel like you are ready to switch gears, there is no shame in doing so. 
- Your provider's schedule and the demand on the labour and delivery unit. If there is high demand on the unit, there may be more pressure for providers to "keep things moving". This is a good reason to consider an out of hospital birth or midwifery care if your pregnancy is low risk, because there is no one waiting to take the room you are in. 
- The "rest and be thankful phase". Right before your baby is born, your contractions may slow or stop altogether. This is a natural mechanism from your body to give you enough energy to push! 

So, what to do? 

The first option is just wait and see! Depending on whether you are still at home or are in your birthing setting, the cervix may change rapidly just by waiting and taking the pressure off. It's important to remember that there is no rush, and you get to call the shots of whether to shift to chemical augmentation or a surgical birth. If you have an epidural, you can go to sleep for a few hours and get into a comfortable position with the pelvis open (using a peanut ball if you wish). 

There are lots of ways to increase oxytocin that don't include medical intervention. Some examples are: 
- Sex and intimacy 
- Nipple stimulation (bring your breast pump to the hospital) 
- Dancing and playing joyful music 
- MILES circuit (www.milescircuit.com) 
- Touch from a loved one or doula 
- Change in environment 
- Use of water for comfort (bath or shower). 

​After trying positional changes and oxytocin boosting activities, you may choose to talk to your provider about augmenting your labour in some way. Your provider may agree to rupture the amniotic sac, which can pick up contractions depending on baby's position. You may also choose to use synthetic oxytocin to augment labour.  This is a medication that is given through an IV that simulates the hormones your body uses to make long and strong contractions that result in cervical change. You may also choose to get an epidural which can sometimes help the pelvic floor relax and the cervix to open. 

The reality is, nature's design is not perfect! And neither is the hospital's. It is always your choice whether to continue labouring and wait and see with position changes, or shift to a surgical birth. There is no wrong or right answer and any choice you make is the right choice for you. But, make the choice for you, not your provider. And no, you are not a failure. Your body is doing amazing things and you are giving birth to your baby no matter how and when they come! ​

The reality of our healthcare landscape often means that new parents begin their postpartum period with birth experiences that need deep processing and that include a wide range of feelings that aren't only the joy of meeting your baby. Arguably, birthing in our current medical system most of the time gives way to disappointment, anger, and frustration, and resentment of others who had a better experience. Even if there was no emergency, it's likely that you will leave your birth with a need for some amount of processing. 

Birth trauma exists on a continuum, from care providers' comments that dismiss your confidence in your inherent ability to birth, to having a baby separated at birth to go to the NICU, a "stalled" labour, instrumental delivery, disruption of the golden hour, unwanted touch of your body, or the sometimes deep disappointment that comes with an emergency or unplanned cesarean birth. 

The most important thing to remember coming out of an experience that didn't go how you wanted is that it was not your fault. You are one individual birthing in a landscape of obstetric violence. Your body and your baby's body are responding to the environment around them. And, even if that is a beautiful, patient and nurturing birth environment that supports progression, sometimes the body or the baby has a different plan. Birth going to plan has mostly to do with luck. Yes, there is a lot of preparation involved. But, doing the mental and physical preparation for delivery is one part within a landscape of a system that is used to your birth looking and going a particular, hegemonic, controlled, and disempowering way. 

After a difficult delivery, you may feel alienated from your partner, your baby, and your doctor. You may feel alienated from yourself and your body, violated, or ashamed. You might feel worse if others are making comments about how happy you should feel now that your baby is here. Please know that you don't need to be over the moon or rush to bond with your baby. There is plenty of time to bond with your baby. The most important thing after a hard birth is to tend to your needs. 

So, what might those needs be? 

Space and quiet for you and your baby to rest at the hospital immediately after birth and hands off from nurses and providers. Low or no interruptions on the postpartum unit. 

No visitors to your house, or only visitors who will understand and support that you may not feel the happiness and satisfaction that you thought you would with your new baby. 

Help from a mental health practitioner who understands the specific intricacies of birth trauma.

Support groups for new parents who had similar difficult birth experiences (see perinatal resource list) 

Nutritious meals of your favourite warm food. 

An artistic outlet. You may choose to draw a picture of how the birth experience felt, what moments felt the most difficult and violating, and rip the paper up when you are finished. You may choose to dance or listen to loud music to let the energy of anger and disappointment move through and out of your body.

Connect with nature. Take your baby for a walk, or go with a partner or a trusted friend to a park or near water. Notice what your body feels like as it is in that moment with the changes of postpartum. You might choose to say something out loud to yourself or give yourself a self-hug. 

File a complaint with the hospital or care provider. Let the hospital know that you were disappointed and upset with the care you received and exactly why. The more people who speak up about these violations, the more change will occur to disrupt obstetric violence. 

What do children do when they feel angry and disappointed? They scream, yell, cry, and stomp. I strongly believe that adults should do this more! Use sound and force to release the energy of the disappointment of anger through and out of your body. 

Have a pretend or real conversation with yourself, your provider, or your baby. Imagine what you or your baby needed to hear in the moments that felt the hardest. There is nothing wrong with my body. My body is important. My body withstood a lot. My baby withstood a lot. My instincts were violated and it wasn't fair. Other people have beautiful birth experiences and I didn't get that and it isn't fair. Say these things out loud to yourself and perhaps try a self-hug while you are saying them. 

Rest in bed for as long as you need. Cover yourself in warm blankets or a heating pad. Have a stay-cation with your baby for as many days as you need until you feel like you are ready to face the world again. 

Accept help from partners, friends, and family members or a doula who understands your feelings and isn't going to push any other feelings onto you. Let the housework, cooking, and cleaning be a village effort while you pick up the pieces. 

There is no need to bounce back from any type of birth, especially a difficult one. Taking the time to be with yourself and accept all the feelings that come with birth and postpartum is incredibly important on the road to healing. 

You will need anger, sadness, and rage to navigate parenthood just as much as you will need joy and tranquility. It is my hopes that the more we talk about birth trauma, the more we can open ourselves to these feelings as welcome visitors, and see what they can teach us about building a future of empowering births for generations to come. 

The "due date" has come (or not) and you are beginning to feel changes in your body that might indicate that your baby is preparing to meet you! 

These changes might include:
- Pre-labour contractions (previously referred to as "Braxton-Hicks" contractions)
- Low back pain and pelvic pressure (although this may not be new in late pregnancy!) 
- Release of the mucus plug
- Hind waters leaking (a slow leak of amniotic fluid) 
- Fore waters breaking (a big gush of amniotic fluid) 
- Early labour contractions: contractions that follow a clear pattern but are less than one minute long and mild to moderate in intensity. 

Especially for first time parents, the instinct when these signs begin is to gather your belongings and rush to the hospital, or call the midwife immediately to settle in for an out-of-hospital birth. But, birth may still be days or weeks away! The biggest piece of advice I give to clients at this stage in labour is to REST. Rest as much as possible until you cannot ignore the contractions, and then keep resting more. Imagine not sleeping for 2 or 3 days and running a marathon. Many many parents (and I used to struggle with this too as a new doula) get overly excited during early labour, go to the hospital sooner than needed, and exhaust all energy and tools before the really intense part of labour sets in. Then when things get ramp up towards transition and pushing, there is no energy store to draw from. Exhaustion is usually the first step in the cascade of interventions that lead to an unwanted surgical birth. Additionally, seeking clinical care earlier than needed often leads to unnecessary augmentation or so-called failure to progress. 

So, here are a few ways to spend your time in early labour: 

- Sleep or rest between contractions. You may even be able to sleep through contractions in very early labour. 
- If it is daytime, go for a long low impact walk in nature, taking in the sensory experience of a slow walk. 
- Date night or time with friends and older children and pets. 
- Immerse yourself in water. Take a long bath or shower. 
- Listen to a birth-focused meditation, practice intention setting, or pray. Get into the zone of the mountain of birth you are about to climb. Breathe deeply and notice how it feels to surrender to your body's timeline. Talk to your baby! Tell them you are excited to meet them soon and that you will take care of them as they embark on this journey of labour with you. One of my favourite birth meditations is linked here. 
- Do a short, low stakes project that is easy to abandon, like a puzzle, knitting, or low-stakes household task.
- Low impact movement, like lunges, cat-cows, and hip-openers. 
- Put your phone away! Don't record the space between contractions until they become regular and unavoidable. You may note the time that contractions began, but expect things to stay mild for a long time, especially if you this is your first pregnancy. 

And did I mention REST?! 

Have other favourite rituals for early labour? Leave a comment! 

Whether planned or due to unexpected complications arising during birth, needing a c-section can invite different type of needs from a vaginal delivery. One of the most common fears with a c-section is that the birth isn't "real" or doesn't hold the same type of gravity that giving birth vaginally does. This is simply not true. Having a baby via cesarean is still giving birth. Both types of entrance for baby can be beautiful and meaningful for you, your baby, and your family. 

It is important going in to your experience, whether it is medicalized or non medicalized (or sits outside of that binary) to know that ALL birth is inherently meaningful and sacred. Whether a through surgery, at the hospital, or at home it is possible to tap into that spiritual significance while adapting to the circumstances. No matter how baby comes to meet us, we can tap into the magic of birth when we find pathways to do so. 

This post will include a few practical ideas for highlighting the spiritual transition of birth in surgical settings. 

First of all, if you are planning a c-section it will be easy to incorporate spiritual or religious significance into your plan. This may mean playing a certain piece of music in the OR while baby is emerging (yes, this is allowed in many hospitals), or having your support person read a poem while baby comes. In the OR, you can also request delayed cord clamping and skin to skin  once baby has arrived, the same as if a vaginal birth occurred. Skin to skin can and should happen in the OR! This may look like your support person placing baby against your chest while the tissue is being repaired postpartum. You may ask for the placenta to be saved for your observation or keepsake. Once you reach the recovery area after surgery, you can continue skin to skin and baby may begin to root to try a first feed if you are planning to breast/chest feed. 

Another wonderful idea that one of my clients with a planned cesarean had was to have her friends and family all light a candle in their respective homes during the time of her scheduled surgery. This is one of the beautiful things about a planned c-section - your community and loved ones will know when it is happening and be able to send you well wishes or say a prayer or thought for you on the day. 

While recovering from a cesarean can bring its own pains and challenges, there are many resources to support in recovery and it is okay and a good thing to ask for support. One of my favourite resources that I often draw from is nurturingthemother.ca. Janelle provides many resources that support expectations and needs around cesarean birth, and has a recovery guide available on her website. 

The most important takeaway is that giving birth via c-section is still giving birth. It will still release the hormones that move through the body to promote bonding between birthing person and baby and support lactation. There are so many ways that c-sections can be made meaningful through ritual, music, poetry, and bonding and it is more than possible to leave your c-section feeling satisfied with your birth experience! 

Attention ALL pregnant people! 
Have you visited a pelvic floor physiotherapist? I cannot stress enough how much misinformation is out there about pelvic floor health for all people and how much a pelvic floor physiotherapist will help you in preparing for birth and postpartum. Below are a short list of benefits of pelvic floor physiotherapy for the pregnant and postpartum person. I won't touch in this post about pelvic floor health for non-pregnant people, though I recommend it for all. 

Education 
Dr Juan Michelle Martin, PT and doula is an advocate for skilling up in information about pelvic floor health (Listen to her speak here). She attests that unfortunately, gynecologists and doctors often do not voluntarily offer information about pelvic floor health, forcing the client to initiate questions that can feel vulnerable and uncomfortable, especially when they pertain to sex or incontinence. This creates a widespread culture of uncertainty and shame for all people around asking questions about pelvic floor dysfunction. Speaking with a pelvic floor physiotherapist, you will likely have more questions asked and issues addressed than with a doctor who does not specialize in the field. 
​
Prolapse Prevention 
Out medical system is more reactive than preventative. This is why it is prevalent for doctors to often under stress the importance of pelvic preparation for birth, because they are comfortable supporting repair and reconstruction from perineal tears and pelvic prolapse. I have spoken with birthing people who tell me that their doctors say not to worry too much about tears because "we can fix that after". But, what if we worked to prevent injury as much as we do to repair it? Your pelvic floor physiotherapist will help with strategies to stretch the pelvic tissues, to prevent common injuries that occur with a pelvic floor that is either weak or too tight during birth. In her book The Fourth Trimester, Kimberly Johnson writes that, to many of her clients' surprise, more pelvic floor muscles she works with are overly tight than they are weak. The goal not always strength, the holistic goal is to create a responsive pelvic floor to cede to let baby through. The overprescription of pelvic floor squeezes (also commonly referred to as "kegel" exercises) is a lazy, sometimes harmful lapse in care when we are aiming for RESPONSIVENESS in the pelvic muscles, not strength. 

Reducing Back Pain
Pelvic floor physiotherapists offer exercises to reduce and manage back and sacral pain during the third trimester. Additionally, physiotherapists will help with addressing back pain that can occur during breast/body feeding. This is because the musculature of the pelvic floor is closely linked to all of the lower parts of the body including the spine. 

Safe Strengthening and Recovery 
Postpartum pelvic PTs will know the level at which to work at to support a safe recovery of the core muscles. They may also be able to massage scar tissue from perineal injury or cesarean section. 

Pleasure 
Sexual pleasure and access to sexual pleasure is a basic human right. Let's throw out the idea that new parents shouldn't get to choose to have good sex when they are ready, please! Becoming a parent does NOT mean that your sex life is over, or that you will be wearing pads or feeling pain perineally for the rest of your life. Pelvic floor physiotherapy gives the postpartum body tools to strengthen and recover to feel pleasure and comfort again at the pace that the postpartum person wants and consents to. 

In summary, your pelvic floor health is not disposable and your comfort is important. So much of our medical model teaches pregnant people to see themselves as passive vessels for their baby's growth and health. There is no reason to allow for preventable injury just because it can be fixed afterwards. It is never too late in pregnancy or postpartum to visit a pelvic floor PT whether you are struggling or not, to support your comfort and well being! 

Looking for a pelvic floor physiotherapist in Toronto? Ask your care provider, or explore this​ list of providers linked here. 

This week’s blog post is all about what to expect during a membrane sweep, otherwise known as a “stretch and sweep”, a common method used by practitioners to release labour-inducing hormones. 

A stretch and sweep is different from a cervical exam. During a cervical exam, a practitioner will use their fingers to feel the cervix. This may occur before labour, to gather information about the state of cervical softness, thinness, and level of effacement. Cervical exams may also occur during labour, to estimate cervical dilation and assess your baby’s level of descent through the pelvis (also known as pelvic station).  However, during a cervical exam, a practitioner will not manipulate the tissues to induce labour. 

It is important to note that consenting to a cervical exam does not mean automatically consenting to a membrane sweep. You may choose to request a membrane sweep at OB or midwife appointments within your due window (usually 37.5 weeks onward), or it may be important to you to avoid any interventions to a spontaneous onset of labour. It is important to be clear with your provider your wishes for or against a membrane sweep or any other intervention offered. You always have a right to refuse cervical checks and interventions at all times throughout pregnancy and labour.

However if you are wanting to get labour started but are wanting to avoid induction through synthetic oxytocin, a stretch and sweep alongside other less invasive induction techniques may be a wonderful choice for you! 

What a stretch and sweep involves: 
A stretch and sweep involves your provider inserting one to two fingers into the vagina to feel the texture of the cervix. If the cervix is soft and thin, the provider may choose to use a finger to gently “sweep" the amniotic sac away from the uterine wall, in an effort to move membranes away from the wall of the womb. This action helps release hormones called prostaglandins, which, along with oxytocin, stimulate labour.  If the cervix is hard and closed, the provider may use their fingers to massage the tissue in an effort to begin cervical softening.

Is the procedure painful? 
A stretch an sweep can cause discomfort and may feel alarming, especially if the provider performs the procedure without consent. Always ensure your provider is aware of your preferences and knows you require warning should they choose to perform a membrane sweep. Lubricating jelly will help ease some of the discomfort, though you may wish to implement some pain management strategies like deep breathing or visualization during the procedure. 

What happens after a stretch and sweep? 
After a stretch and sweep, it may be common to experience bloody “show”. This show is a clear mucous plug which, when released, may continue to be produced during labour. It is normal for the mucous plug to contain a small amount of blood. You may also begin to feel cramping which comes and goes, which may be a sign of early labour contractions.

What are the benefits of the procedure? 
Studies show that membrane sweeps may improve your chance of having a spontaneous labour. Alongside other non-invasive induction techniques, it can be an effective way to avoid induction through synthetic oxytocin. It is also a zero cost intervention, and relatively non-invasive. It does not come with other interventions and can be repeated if desired. 

Does a stretch and sweep include risks? 
The risks of a stretch and sweep may include a higher chance that the membranes will rupture before labour, especially in the absence of cervical softness (read more here: https://evidencebasedbirth.com/updated-evidence-on-the-pros-and-cons-of-membrane-sweeping/). When membranes rupture before labour, there is a risk of infection to you and/or the baby and medical induction is recommended. 

For more information on membrane sweeps, talk to your provider! The bottom line is, consent for membrane sweeps needs to be verbal and informed. A membrane sweep is not a routine part of a cervical check. A membrane sweep is a relatively non-invasive and low risk intervention that may help your body naturally begin labour. 

Still have questions? Leave a comment on this post with your email, or contact me! 

Traditional Chinese Medicine teaches us that warm foods support uterine health and restore energy and balance in the body. Warm foods should be consumed both postpartum to promote healing of the uterine wound and during menstruation and ovulation. 

Cooking delicious homemade food is a wonderful way to care for a postpartum on menstruating person in your life. 

Here are some favourite warm womb foods I have made this fall and winter! 

​Pearl barley and beluga lentil soup (gf without barley, can be made vegan with vegetable broth) 
Makes 8 servings (good to freeze half for days with low cooking capacity) 

Adapted from Melissa Clark via NYT cooking 

Ingredients 
3 tablespoons EVOO 
2 sliced leeks or one diced onion 
3 carrots, diced
1 cup chopped fennel with fronds reserved 
1 bunch chopped cilantro, leaves and stems
3 cloves minced garlic 
salt to taste 
2 tablespoons tomato paste
1 tablespoon garam masala
½ teaspoon turmeric
1 cinnamon stick
4 cups chicken broth
1 cup pearled barley
1 cup beluga lentils
1 to 2 tablespoons lemon juice

Step 1
In a large Dutch oven or soup pot, heat oil over medium-high. Add leeks and cook, stirring often, until tender and beginning to brown, about 10 minutes.

Step 2
Stir in carrots, fennel, cilantro stems, garlic and salt. Cook until the garlic is fragrant, about 2 minutes. Stir in tomato paste, baharat, turmeric and cinnamon stick, and cook until the tomato paste begins to caramelize, about 2 minutes.

Step 3
Add the broth, barley and beluga lentils, and bring to a boil. Lower heat and simmer for 1 hour to 1 ½ hours, stirring occasionally, until the barley and lentils are tender. (Add some water if the pot starts to look dry; can be as thick or soupy as you like.)

Step 4
Stir in a tablespoon of lemon juice and the chopped cilantro leaves. Taste stew and add salt and lemon juice if needed. Serve with bread and cheese or butter! 

Butternut squash congee (gf, can be made vegan with vegetable broth) 
4 servings, leftovers can last in the fridge for reheating around 3-4 days 

Adapted from Hetty Lui McKinnon via NYT cooking 

2 cups leftover rice
1 tablespoon neutral oil 
1 tsp salt 
6 cups vegetable or chicken stock
4 garlic cloves, peeled and crushed
1 small butternut squash, peeled, seeded and diced in 1-inch pieces
2 scallions, finely sliced
Chile oil or chile crisp, for serving (although it may be good to avoid spicy foods to reduce cramping) 


​Step 1
Place the rice, oil and salt in a large pot and stir to combine, breaking up any clumps of rice. Add the stock, garlic, and butternut squash (if using). Bring to a boil over medium-high heat. Once it boils, reduce heat to low, cover and simmer for 30 minutes. Check frequently to avoid burning. 

Step 2
Uncover and stir. Increase heat to medium and simmer for another 5 to 10 minutes, until the rice has broken down.

Step 3
Turn off heat. Using a wooden spoon, stir to break up the rice, butternut and garlic. Some of the butternut will stay intact, while some of it will break apart. Add salt to taste.

Step 4
To serve, top with scallions, and a few drops of chile oil or crisp if using. ​

Sweet and sour soup (gf, can be made vegan with tofu instead of pork/shrimp) 
10 servings, can freeze half or save in the fridge for 4-5 days. This is a great option for leftover vegetables and meat with a broth made of ingredients likely already in the pantry. 

Original recipe inspired from the Around the World Cookbook


8 cups chicken broth or vegetable broth
Lemongrass to taste (i used one stalk cut into 4 shorter pieces) 
1/4 cup rice vinegar, or more to taste
1/4 cup soy sauce (or tamari if making gf) 
2 teaspoons ground ginger
Desired vegetables (can include snow peas, carrots, enoki mushrooms, celery, shitaake mushrooms or any other veggies on hand) 
1 can boiled bamboo shoots
1 cup shrimp, peeled if desired 
1 lb protein such as pork butt or chicken breast, sliced to bite sized pieces
1 tbsp chili oil, or more to taste 
4 green onions, thinly sliced


Step 1
Begin by making hot and sour soup base: Combine broth, rice vinegar, and soy sauce with lemongrass, ginger, and garlic. Salt broth. Bring to a boil and simmer for 20-30 minutes until desired flavour of broth has developed. 

Step 2
Add vegetables and bamboo shoots. Salt broth again to taste. Bring to boil then reduce heat and continue to simmer for 30-40 minutes. 

Step 3
While the soup is simmering, add protein to a lightly oiled pan and brown for 2-3 minutes on each side. 

Step 4
Add protein and shrimp to soup and simmer on medium low for 10-12 minutes. Drizzle with chili oil and garnish with green onions.​

​There is a trend toward hiring night doulas at the moment, and many seasoned birth professionals have taught me to feel that it is not always in the best supportive interest of a family to have frequent night support. Night support can be a great idea once or twice per week, to really offer a restful reset, especially when cluster feeding is making sleep impossible. However, postpartum doula support is about nurturing a sustainable transition into parenthood, and while night support can be an important tool for single parents, twins, and parents with other reduced capacities, I would urge new parents to consider whether the trend towards overly frequent night support is offering a nurturing transition, or a crutch to put off adjusting to the transition. There may be other ways to make nighttime work, through learning how to reduce cluster feeding, expressing breast milk to share feeds with a partner, safe co-sleeping, setting boundaries for how time is spent in the day, and adjusting your own rhythms to allow for rest when baby is resting. 

*Please note that night doulas may be necessary in reducing the risk of postpartum depression and psychosis that can come from lack of sleep. I am not discounting times when night support is a necessary mental health intervention.*

Because of the alienation of parenting from the rest of society in late capitalism, many people who are pregnant for the first time are unskilled in knowing how truly demanding postpartum recovery and adjustment is on the body. And, because of the devaluation of mothers and reproductive labour, the idea of postpartum lying in and rest is seen as modern western culture as indulgent. The reality is that a postpartum body is at its most vulnerable that it may ever be in life. The separation of the placenta from the uterine wall leaves a wound the size of a dinner plate that takes an immense amount of internal energy to heal, not to mention the calories that are drawn from a breastfeeding parent's body to produce milk, or to repair tissue damaged from tearing or cesarean delivery. Postpartum bodies need tender rest and care, and a rewiring of internal rhythms to meet the needs of the newborn. 

There is a saying within postpartum doula communities to eat when baby eats and sleep when baby sleeps. And though it seems impossible, it is so important to strive for this. This comes not from hiring a baby-sitter for every night to avoid this new rhythm, but from arranging life to adjust to this new relationship to time and sleep, creating cycles of resting, waking, and eating that shift outside of the normal (capitalist) cycle of 8 hours sleep at night and 3 meals per day. Your baby is eating 8-10 times in a 24 hour period, and taking small naps in between these feeds. Remember, a newborn baby’s stomach is the size of a walnut — the digestive system moves quickly. You will want to have many small meals and naps whenever possible, day and night. 

When you have a new baby, your life and schedule is going to change and your capacity will be automatically limited. You will need to train not only you baby’s body but your own body to sleep in the day, to be able to wake 4 or more times in the night to feed. The other need is to train the mind to not tend to any other responsibilities other than the needs of your baby and older children. Postpartum and breastfeeding parents should not be doing dishes, laundry, errands, and cooking. Postpartum parents should by no means be working. This is where the support of a doula/partner/grandparent during the day comes in, tending to the outside responsibilities so that your body can focus on milk production and uterine and/or cesarean healing. The other need is to set boundaries to advocate for this rest. Time with family and friends during the day should not be using the energy bank up ——and yes, you are allowed (and encouraged) to go take a nap while others visit your home. If you are feeling that your energy is depleted from visits, it is reasonable and fair to advocate for no or few visitors during the lying in period (first 40 days) or as long as you need to feel nourished by the presence of others.

The reality is, the way you rest and times you are able to rest will change when you have a newborn. Especially if new parents are exclusively breastfeeding, cluster feeding will happen and there will be nights where, shockingly, 30 or 60 minutes of sleep will be all a breastfeeding parent can find the time for. So, what are the other options? By all means, one night a week where a doula sleeps with baby in their room and cleans up, sterilizes pump parts, and gets you and your family a full night of sleep is invaluable. But, what are the other skills  that need to be nurtured and advocated for in order to create sustainable and manageable cycles of rest and waking for the feeding parent? How can we shift the culture of productivity towards seeing this time and new rhythm as a vital development, and mothering as hard, important work. 

There are harm reduction fixes and then there are culture shifts. And both are necessary in building a postpartum sanctuary full of rest, bonding, and care! 

Living in capitalism, we are taught to invest in things over experiences. 

You are partway through your pregnancy, and hearing friends suggest that you should hire a doula. It sounds lovely to have a support person, but you feel well supported by your partner and family and you attended childbirth classes. You're wondering whether you should save the $1000-$2000 to spend on other baby items because the expenses are racking up. 

It makes a lot of sense to be questioning whether doulas are worth the money. I am obviously biased towards doula care because, well, I am one and I have seen firsthand the impact that a doula can have on creating a positive experience in birth and postpartum. Here I will touch on the unique offerings of a doula in navigating birth in the current climate, as well as the importance of investing in your birth story as it becomes lore and ancestry. 

While some may think that continuous labour support may be the bulk of a doula's value, I would argue that the real value of doula care exists in informational and advocacy support. There may or may not be others attending your birth who are able to offer counter pressure and emotional support. However, the value of the prenatal work that a doula does to prepare for an effective and confident labour is truly unique to a doula's role. On top of that, having someone on your care team who intimately knows what is important to you and is comfortable advocating for that at your birth is also unique to the value of a doula. It is invaluable to have the support of someone who can confidently slow down the pace of decision making and politely challenge the authority of the doctor who just walked in who you've never met telling you to deliver with forceps. 

One of my doula teachers spoke during training on the particular value of doulas as support people who aren't also going through a transformation as the birth occurs. When the members of your family support you in birth, they too are going through a birth; the birth of a grandmother, of a father, sibling, and auntie is a transformation that also requires and deserves embodiment and attention. Your doula is not becoming anything new at your birth, they are simply there to hold space for your becoming. Having a calm person present who is not processing their own transformation is one of the unique magical elements of having a doula. 

The other thing that a doula offers in birth and postpartum is holding space for you, in particular. Something that I have found at births is that right when baby is born is when the birthing person often needs the most support. The care team and often family turn towards caring for the new human who has just arrived, and of course they want to, what a joy! But your doula is there to turn to you. I will not leave your side when your baby goes to the warmer. And when you are at home in the first forty days, I will be there to ask you what YOU need, not just what your baby needs. Of course your needs are entangled with your baby's needs but there are so many ways that a doula can bring you back to your own needs --- sometimes, you don't want to talk about your baby, you need a window opened, a shoulder to cry on, and a warm meal in your belly. 

We live in a culture obsessed with emergency preparedness and this often makes its way into the ways we plan for birth. I often speak with pregnant people who look for a clinical care provider based on how much experience they have dealing with the worst case scenarios; hemorrhage, shoulder dystocia, so-called "failure to progress", infant distress, and more. While it is important to be prepared for complications should they arise, pregnant people are often convinced to seek out specialist care at high risk hospitals for pregnancies that are low risk and normal. What if pregnant people searched for providers who want to give them the birth they want, rather than the birth they fear? 

Birth is a process led by hormones. Release of the "love" hormone oxytocin sends a signal to the uterus to contract, causing the cervix to dilate. Release of oxytocin occurs when the birthing person feels loved, supported and safe. Fear and anxiety can stall the progression of labour, because the flow of oxytocin is interrupted. Oxytocin release is best supported by a calming environment, a caring and attentive team, and continuous labour support. When this flow is interrupted, it is more likely that augmenting interventions such as rupture of membranes, synthetic oxytocin, vacuum and forceps will be suggested by a care provider. And, this isn't just my opinion - this is research supported!*

Yes, issues can arise even when the birthing person is prepared, healthy, and calm. But, your care team is prepared for these complications. A colleague of mine attended a home birth in the summer where a shoulder dystocia occurred that was solved by the midwives without the doula or birthing parent even knowing it was happening! I would therefore urge pregnant people to ask their care providers, how much experience do you have with the birth I WANT? How often do you induce? What kinds of stalls compel you to introduce synthetic oxytocin? What kinds of positions and movement do you encourage during labour? What is your experience with unmedicated birth? How do you care for the perineum, and do you have pelvic floor physiotherapists that you work with? Asking these questions can help you search for green flags in midwifery and OB care that encourage preparedness for the labour you want. 

Most of the time, we don't need a specialist for our pregnancy and birth! Pregnancy and birth are normal, healthy and natural parts of having a body, not problems to be solved. I hope that this post encourages you to find care providers that are prepared to support you in the birth you WANT, not the birth you are afraid of. 

*https://www.dona.org/wp-content/uploads/2020/02/DONA-Birth-Position-Paper-2022.pdf