Early Labor | What I Wish I Knew

Welcome to part three of our blog series entitled What I Wish I Knew. This series explores various topics related to pregnancy, birth, postpartum, and parenting that parents wish they would have known more about before they experienced them. You can find part one here and part two here. Our first two installments of this series addressed common postpartum issues, but today we’ll be addressing birth, more specifically early labor. When we asked our doula clients and social media followers about what they wished they would have known more about before going through labor, many parents expressed their uncertainty in knowing how to identify early labor signs, as well as what they should do when it begins.

What is Early Labor?
Early labor is the first stage in the labor process, during which your cervix begins changing. It is also sometimes referred to as pre-labor, or the latent phase. During pregnancy, a normal cervix is firm, closed, long, and pointing toward your back (posterior). In early labor, the cervix begins to soften (ripen), open (dilate), thin (efface), and move forward toward the birth canal. This begins to occur through a complex series of chemical and hormonal changes in the body. Early labor is defined as the period of time that your cervix is between 0-3 cm dilated. It is generally the longest and least physically demanding stage of labor.
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How Do I Know if I’m in Early Labor?
Oftentimes, early labor is so mild that you may not even notice it. Other times, you may experience some of the following symptoms:

• Menstrual-like cramps
• Low back ache
• Increased pressure in pelvis or vagina
• Fluid leakage from vagina
• Inconsistent contractions or contractions 10 or more minutes apart
• Increased vaginal discharge
• Bloody show
• Loss of mucous plug
• Nausea, vomiting, or diarrhea

If you think your water has broken, notice more bleeding than light spotting, experience severe pain, or a decrease in fetal movement, be sure to contact your healthcare provider.

What Should I Do in Early Labor?
Birth is often likened to a marathon. In a marathon, you want to avoid exerting all of your energy at the very beginning, so you will have the stamina to make it through until the end. The same is true for birth. If your mind and body become too fatigued early on, labor may become more difficult than necessary. So if birth is a marathon, rather than thinking of early labor as the beginning of the race, it may be helpful to think of early labor as the day or two leading up to the race. You will want to hydrate, eat well, rest as much as possible, and go about your life as usual. Don’t get caught up in the idea that you have to do anything to get active labor to begin. The time for that may come later on, but this is likely the only stage of labor that you’ll have the opportunity to rest comfortably through, so be sure to take advantage of that as much as possible. Although the thought of finally being done with the discomforts of late pregnancy and meeting your baby may be exciting, try to avoid doing too much physical activity which could exhaust you before the more strenuous work needs to be done.

In a high-risk or special circumstance pregnancy, you will want to discuss with your provider during your pregnancy what you should do in early labor. Some conditions may necessitate monitoring or intervention.

Doulas and Early Labor
If you have hired a birth doula, it may be a good idea to touch base with them during early labor. Although you likely will not need them to come to you right away, your doula can still be of importance during this time. They can help you differentiate between early and active labor, offer support and encouragement, and answer any questions for you. Communicating with your doula also allows them to begin to prepare themselves to be with you in a timely manner when you request them further along in labor.

4 Reasons Why Moana’s Grandmother is a Doula

If you’re two years behind the times, and haven’t yet seen Disney’s animated film Moana, then you may want to skip reading this post, head straight to Netflix, and watch it immediately. You’ll probably want to watch it another 10 times after that. It’s okay, we’ll wait. Otherwise, if you’re already a fan, or don’t mind spoilers, then read on.

Moana is the story of a strong and adventurous teenage girl who embarks on a dangerous journey to save her entire island of villagers and the deteriorating environment by navigating through the ocean, defeating mythical creatures, and defying the odds, with minimal help from anyone else. Yes, there’s the demi-god Maui who begrudgingly lends a hand for selfish reasons, but Moana’s grandmother, the self-proclaimed “village crazy lady”, also plays integral role in Moana’s journey to self-discovery. We’re pretty sure Gramma Tala is a doula. Here’s why:

1. She’s all about education.

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As the movie begins, you find Gramma educating toddler Moana and a group of village youngsters about their ancestors. Although many in the village may think that these stories are myths or outdated, she wants her students to be equipped for the challenges they may face ahead. Much like a doula, she provides them with the information and tools they need to make important decisions in the future.

2. She has no agenda.

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As Moana grows, everyone else in her life tries to steer her toward a particular path. While well-intentioned, they don’t trust Moana to know what’s best for herself. Her father tells her it’s dangerous to leave the island and her mother tells her it’s just not meant to be; however, Gramma gives her options and tells her to follow the voice inside her. No pressure. No agenda. Only constant, unbiased support, just like a doula.

3. She gives the best pep talks.

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As Gramma falls ill and prepares for her spirit to leave her human body, Moana begins to doubt that she’s capable of accomplishing the daunting task ahead. Gramma’s encouragement gives her the confidence boost she needs the leave the island and save her people. She even provides the affirming mantra that Moana repeats throughout her journey to help her push past her doubts and prevail. Doulas have tons of affirmations and positive words to remind you of all that you’re capable of, even when you may doubt yourself.

4. She’s consistently supportive.

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Near the end of her journey, after being defeated by the monster Te Kā and abandoned by her partner Maui, Moana decides the path she’s been on isn’t right for her anymore, despite tremendous effort. Gramma returns in spirit form to remind her she’s been with her all along and to assure her she’ll remain by her side no matter what Moana decides to do. Gramma tells Moana without judgement, “If you are ready to go home, I will be with you.” She supports her in making the decision that is right for her in that moment, and reminds her once again to trust the voice inside, even if that means a change in plans. Moana is affirmed in her abilities and sings, “You remind me that come what may, I know the way. I am Moana!” A doula supports their clients in the decisions they make in their journey, whether it be in pregnancy, birth, or parenting.

Eventually, Moana is victorious in what she set out to do, even though there were challenges to be met and revisions to her plan. In true doula fashion, Gramma was the strong, steady presence helping her along the way, but in the end, only Moana knew the best path and put in the hard work it took to restore the heart of Te Fiti.

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In birth and in parenting there are many unknowns and challenges, similar and dissimilar to what Moana faced. Despite the differences between this fictional story and your personal experience, you can be assured that with Bravo Birth DFW you will receive the same level of education, motivation, support, and non-judgment that Moana received from Gramma Tala the Doula.

*We do not own the rights to the story of Moana or the images from the film.

Endometriosis Awareness Month

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March is Endometriosis Awareness Month.

Endometriosis. It’s a disease that you’ve likely heard of but don’t know much about, and this is why the entire month of March is dedicated to raising awareness of a disease that affects so many women. In fact, 1 in 10 women have endometriosis, which is roughly 176 million women worldwide. If you menstruate then you are at risk of getting endometriosis.

Every month the lining of the uterus, the ‘endometrium’, is shed and expelled from the body as a period. It is the shedding of the lining of the uterus that causes endometriosis. Science is not exact on how endometriosis is caused, but there are two common theories.

The first theory is that during menstruation a small amount of menstrual blood is sucked up the fallopian tubes and spilled in to the pelvic cavity. This is known as ‘retrograde flow’.

The second theory relates to women who have had caesarean sections. When the uterus is cut during surgery, tissue from the uterus is accidentally introduced in to the pelvic cavity.

Once the lining has made its way in to the pelvic cavity it then attaches to various organs and begins to grow, becoming endometriosis. Because the tissue is effectively uterine lining, during the monthly cycle hormones stimulate the endometriosis, causing it to grow, break down, and bleed- as it would a period. However, this internal bleeding, unlike a period, has no way of leaving the body. This then leads to inflammation, pain, and the formation of scar tissue, known as adhesions, which act like glue and bind organs together. And because the blood from the endometriosis cannot be expelled from the body, it continues to float around, spreading the endometrium cells, and attaching to more areas of the body.

Endometriosis has been found in every organ and anatomical structure of the body including the kidneys, eyes, liver, brain, bones, heart, skin, and nasal cavity. The only place it has not been found is the spleen. For most women, however, the lower abdominal cavity, specifically the reproductive organs, is the most commonly affected area. And because of this, 30%-50% of women with endometriosis will experience some level of infertility. And that is what happened to me.

I gave birth to our first child by emergency caesarean section in December 2014. We had conceived him after only three months of trying and my pregnancy had been smooth sailing. His birth had been traumatic and I needed to wait for my both my body and mind to heal from the experience before we tried to conceive again.

That time came in March 2016. I was 30 years old. We were mentally ready for another child, our son was finally sleeping through the night, and I felt that my body could handle whatever came our way. Luck, however, was not on our side. In April 2017, after 13 months of trying to conceive, after countless tests, both non-invasive and invasive, I underwent a Hysterosalpingogram- a radiologic procedure that investigates the shape of the uterine cavity and the shape and patency of the fallopian tubes. The results were instant and conclusive. I was infertile. We were devastated.

After our initial shock wore off and we had wiped away our tears we were given two options; We could do IVF or I could undergo exploratory surgery to try and find the cause of my infertility. We wanted a baby, yes, but we also wanted answers, so we opted for the exploratory surgery.

On June 28, 2017 I was wheeled in to surgery. On June 28, 2017, I was diagnosed with extensive endometriosis of the uterus and fallopian tubes, and endometriosis of the ovaries, bladder, and bowel. The endometriosis had grown around my fallopian tubes like vines and had bent and twisted them so badly that sperm had zero chance of getting through, and this was the cause of my infertility.

I was lucky. I can say that now. Looking back, I didn’t feel lucky. I was infertile, I had been diagnosed with an incurable, chronic disease, and I was told that the endometriosis that had been removed during my surgery would likely grow back. But now, 9 months on, I know I’m one of the lucky ones. I’m lucky because my endometriosis was discovered accidentally after only 7 months of tests. In the United States it takes an average of 10 years for women to get a diagnosis from the onset of their symptoms. In the United Kingdom, it takes 7.5 years for a diagnosis. There are many reasons for this.

Symptoms vary drastically in each woman and symptoms can mimic those of other illnesses. Often women are diagnosed and treated for other illnesses before discovering that it was endometriosis all along.

Endometriosis can only be officially diagnosed visually during surgery; It does not show up on ultrasounds or x-rays. Because it needs to be sighted to be diagnosed, doctors will only operate as a last resort, meaning women can live for years with horrendous pain and life altering symptoms before their doctor will consent to surgery.

The saddest reason of all, in my opinion, is that many women simply aren’t believed. They are brushed off by their healthcare providers and are told that the pain they are experiencing is in their head and that pain during a monthly cycle is normal. It is not normal.

There is a huge lack of knowledge about endometriosis, both in the health sector and in the public arena, and because diagnosing this disease is not as simple as a blood test, it is often up to the patient to push for further testing. With knowledge comes power, and the more awareness and information people have of this disease, the more confident they will be to advocate for themselves, for their daughters, and for their friends and family.

Symptoms of Endometriosis:

• Painful periods
• Pain during intercourse
• Pain during bowel movements or urination
• Excessive bleeding during menstruation
• Bleeding between periods
• Infertility
• Chronic Fatigue
• Also, diarrhea, constipation, bloating, or nausea, expecially during menstruation.

Bravo Birth DFW would like to extend a huge thank you to guest blogger, Alex Hughes, for sharing her experience with endometriosis. Alex is a New Zealander currently living in Singapore with her husband and their three-year-old son. She’s a cinephile, bibliophile, gourmand, and traveler extraordinaire. When she’s not out having adventures and eating delicious food, you can find her organizing or doing something nice for a friend.

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Oh, Crap! | What I Wish I Knew

Constipation After Birth

Welcome to part two of our blog series entitled What I Wish I Knew. You can find part one here.

In this series we explore topics that now-experienced parents wish they would have known more about before they went through pregnancy, birth, and postpartum. When we asked this question, the most common answer we received (by a long shot) was that many mothers wish they would have known that the first bowel movement after giving birth can be quite a struggle. Although it may be an uncomfortable topic, we want you to be fully prepared to tackle this unpleasant issue.

We are so grateful for professionally trained birth doulas and postpartum doulas, but after hearing several horror stories of postpartum bathroom problems, it’s clear that what Fort Worth, Dallas, and the rest of the world really needs is postpartum constipation doulas. Someone to hold our hand and talk us through relaxation techniques on the toilet. Someone to bring us water and wipe the sweat from our brow when we need a break from pushing. Someone to wholeheartedly support our decision when we request medication to ease the process a bit. Okay, maybe we’re kidding, and we can guarantee that almost any birth doula or postpartum doula would actually do all those things for you, even while using the restroom. No extra certification for constipation support necessary.

So what causes this intimidating phenomenon?

Constipation tends to be very common during pregnancy due to several contributing factors. Your digestive system slows down considerably, prenatal vitamins often have a high iron content, physical activity tends to decrease, and your diet may be lacking adequate fiber and water. If you are struggling with hemorrhoids, another common side effect of pregnancy, this can complicate constipation issues even further.

During birth, there are additional components that may lead to constipation. You may forgo food and water longer than you normally would, resulting in dehydration. If you are breastfeeding, you may be further at risk for dehydration. Certain narcotic pain medications or anesthetics given during labor or a cesarean birth can cause your muscles to be sluggish and slow down your digestive system. After birth, your pelvic floor muscles may be weakened. Discomfort in the perineum or from the surgical site may cause you to delay using the restroom longer to avoid pain.

What can you do to avoid constipation?

All of these issues in pregnancy and birth have the potential to pave the way to an unpleasant restroom experience after birth; however, with a little mindfulness and preparation, you may be able to avoid the worst of it. Many of these tips may also help prevent hemorrhoids, as well as make for an overall healthier pregnancy.

1. Drink plenty of water during pregnancy, labor, and postpartum. Lots and lots of water.

2. Remain active during pregnancy. Resting is important to your recovery after birth, but depending on the circumstances, a little bit of walking may help to keep things moving.

3. Eat foods high in fiber, such as whole grains, legumes, fruits, and vegetables. Avoid low fiber foods made with refined white flour.

4. Seek regular prenatal chiropractic care. Not only is this great for keeping your spine and pelvis aligned for optimal health for the mother and child, it also restores function to the nervous system, which helps constipation to resolve naturally.

5. After birth, try not to hold things in. This will only makes it worse and potentially cause more pain. Try to use the restroom as early and often as you can.

6. If you are already constipated, temporarily adding prune juice or senna tea to your diet in small quantities may help to get your bowels moving. You may want to avoid drinking too much to prevent having the opposite problem of diarrhea.

7. Asking your health care provider for a stool softener after birth may be beneficial. Stool softeners increase water absorption in the stool, making it easier to pass. In more severe cases, a laxative may be necessary. Laxatives stimulate the digestive tract walls, speeding up the bowel movement process.

We hope this information makes the first trip to the toilet after birth a more positive experience. And if you need additional support, we’re confident we can doula you through it.

Postpartum Night Sweats | What I Wish I Knew

Please enjoy the first installment of a new blog series that was inspired by our Facebook followers when we recently asked what they wish they had known about pregnancy, birth, and postpartum before they had a baby. Having a child is often accompanied by many surprises, and while you can’t always plan for everything, sometimes it helps to learn from the experiences of people who have already been there.

Postpartum Night Sweats

One commenter shared, “I wish I’d been warned about the hormonal night sweats post delivery. I legitimately thought I was dying when I woke up that first night shaking and shivering, drenched in sweat. Honestly, my postpartum night sweats were horrific. I don’t miss that!” – Alex H.

This is a pretty common complaint among new mothers and while it may be alarming at first, it typically isn’t anything to worry about. Oftentimes, within the first week or two after giving birth, you may find yourself being awoken at night, not only by your newborn, but also by intense sweating, potentially alternating between shivering and hot flashes; however, the increase in sweating probably isn’t from that sweltering Dallas-Fort Worth heat. Let us explain!

During pregnancy, your body retains fluid to support you and your baby. Toward the end of pregnancy, you may even experience swelling in your hands, face, feet, and ankles from the fluid retention. Additionally, during labor you may be given supplemental IV fluids. Once you give birth and you no longer need all the fluid your body has been holding onto, your hormones rid your body of it by causing increased sweating and frequent urination. This generally normal phenomenon can happen at any time during the day, but more frequently happens at night.

Is it dangerous?

While it can be quite uncomfortable, increased sweating after birth is typically a not a cause for worry. If you notice this happening for more than a couple of weeks, you may want to discuss it with your care provider. It’s also important to report it to your doctor or midwife immediately if you experience any other symptoms such as fever, dizziness, intense pain, or difficulty breathing. These may be signs of an infection, and should always be taken seriously.

What can I do to stop sweating?

Unfortunately, you may not be able to prevent this from happening, but you can make yourself more comfortable. Consider dressing in lose fitting, breathable pajamas. Keep an extra set of pajamas within easy reach in case you need to change in the middle of the night. You may even want to make your bed with several sets of sheets, so if you happen to sweat through one layer, you can easily remove it and have another set right underneath. Sleep with a fan on and be sure to keep yourself well hydrated.

This element of the postpartum experience may be something we don’t look forward to, but thankfully it doesn’t last forever and can be a sign your body is functioning properly. Be sure to check back next week for Part 2 of the “What I Wish I Knew” blog series.