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.

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.

Endometriosis Awareness Month

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.


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.

Celebrating (Surviving) the Holidays with a New Baby

Congratulations! You had a baby this year and now you get to enjoy all the wonder and beauty of their very first holiday season. These tips from our seasoned experts will help you prepare for all the excitement the end of the year brings.

1. Stock up on Wine.

This is the first and most important step. This will set the tone for the next two months, so it’s imperative you don’t skip this one. If you don’t care for wine, that’s no problem. Eggnog, apple cider, or Irish coffee work just fine, as long as they are spiked with the alcohol of your choice. Be sure to carry your festive drink with you wherever you go.

2. Have your local pizza delivery shop on speed dial.

Let’s be honest, you don’t even like turkey the other 364 days of the year. The stuffing and pie might be tempting, but with a newborn, you won’t have time to cook a big meal from scratch. Just surrender to the fact that this year you’re saving your sanity and ordering pizza delivery. If you want some variety, chinese take-out is a good substitute.

3. Sign up for an Amazon Prime membership.

Forget the Black Friday sales. Don’t even think about stepping foot in the mall. All your baby wants is an empty cardboard box and some wrapping paper to tear up. For everyone else, there’s Amazon Prime. We live in a world where we can have anything we could possibly need delivered to our front doors with free two day shipping. This is the true holiday miracle.

4. Stay home.

Speaking of avoiding crazy parking lots and long shopping lines, just stay home altogether. Yes, holidays are meant to be spent with those you love, but it’s cold and flu season and you don’t want your baby getting sick. Use this as an excuse to stay home and avoid your drunk Uncle Al and judgmental Aunt Cheryl. If nobody buys that excuse, just tell your in-laws you’re spending time with your family this year and tell your family it’s the year to spend with your in-laws. You can sort that out next year.

5. Set your child’s expectations now.

It may be tempting to buy your baby all the popular toys and start a bunch of new traditions, but by setting the bar low early on, you’re actually setting yourself up for success when they’re older. For example, Elf on the Shelf may seem like a cute idea now, but wait until your child wakes you up at 5 a.m. crying because Elfie has been “resting” in the same spot for four days. When it comes to gift giving, tell people you’re raising your child to focus on relationships instead of material items. This will make you seem sophisticated.

6. Put your holiday decorations in storage.

Plan to keep them there for approximately 10-15 more years. Whether it’s Christmas lights and glass ornaments, a Hanukkah menorah, or a Kwanzaa kinara, they’re all basically death traps for babies. There’s no way to baby proof everything, so don’t even try. You can have nice things when your child is in middle school, or possibly in college.

7. Get a babysitter for New Year’s Eve.

This is the one holiday of the year when it’s acceptable to ditch your child and spend time with other adults without a baby screaming in your ear. You won’t get another chance at this until next year, so ignore the spit up on your cute dress and go let loose.

8. Have fun!

In all honesty, all you need is your sense of humor and a little patience. Try to take it easy. Enjoy your baby, your loved ones, and all the excitement (and food!) this time of year brings. The holidays will never be the same!

Vegan Banana Walnut Muffins

Last week was a very busy week for Bravo Birth DFW, as well as the Bravo family. I didn’t have time to grocery shop over the weekend, so I planned to do it on Monday morning. When that fell through too, I decided to use an online grocery ordering and delivery service that is relatively new to the Dallas-Fort Worth area. Ordering was a breeze, and surprisingly my groceries were delivered within two hours, giving me just enough time to put everything away before I had to pick up my older kids from school and take them to their ballet class.

The grocery delivery was a huge lifesaver, but in my hurry to place the order, I had apparently ordered five bunches of bananas, rather than five single bananas. In total, I had about 35 bananas to use before they went bad. After giving one bunch to a neighbor, and bringing some to a play date to share with friends, we managed to eat most of them before they were too ripe, until only a handful were remaining.


Everyone knows that too-ripe bananas call for banana bread, so I decided to make these banana walnut muffins as an easy, grab-and-go breakfast for us this coming week. The muffins can also be frozen in a ziplock freezer bag and then thawed and eaten at a later date. This would be a great snack to make ahead and freeze before birth to save some trouble of cooking and baking during postpartum recovery. Bonus: oats, nuts, and flaxseed are all galactagogues, meaning they may help increase breastmilk supply.

One of my children has food allergies, so I made these without dairy or eggs, but if you don’t want the vegan version, the flaxseed meal can easily be replaced with eggs. I hope you all enjoy the recipe that was born from my online grocery shopping mishap!

1 1/2 cups whole wheat or all-purpose flour
1/2 cup instant oats
1/2 cup chopped walnuts, plus more for topping
1 teaspoon baking soda
1/4 teaspoon salt
2 tablespoons flax meal
6 tablespoons water
4-5 overripe bananas
1/2 cup brown sugar
1/2 cup applesauce
1/3 cup coconut oil
1 teaspoon vanilla extract

1. Preheat oven to 350 degrees and grease muffin tin.

2. Mix the flour, oats, walnuts, baking soda, and salt in a large bowl.

3. Whisk the flax meal and water in a small bowl and allow it to thicken for 5 minutes.

4. Mash the bananas in a medium bowl. Add the flax mixture, brown sugar, applesauce, coconut oil, and vanilla extract.

5. Gradually incorporate the wet mixture in with the dry ingredients, until just mixed.

6. Divide the batter between muffin cups and sprinkle remaining walnuts over the tops.

7. Bake for 20 – 22 minutes, until a toothpick inserted into the center of the muffins comes out clean.

8. Let cool, then store in an airtight container for up to 4 days.