How a Birth Doula Can Help Make Labor a More Intimate Experience

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Chantal Traub, CD, CCCE, LCCE,

Pregnant mothers may be unsure if they want to work with a doula because they would like their labor and birth to be an intimate experience between them and their partners and wonder whether having a doula would encroach on their intimacy.

The role of the doula is to help ensure a healthier, safe and positive birth experience for the whole family. She will provide emotional support, physical comfort and the information needed to make informed decisions as they arise in labor at home or at the hospital. She will present reassurance and perspective to the birthing woman and her partner, offering various positional ideas for relaxation and labor progression and hands-on comfort measures like touch, massage, counter pressure and breathing techniques.

One may wonder how an intimate experience can be enhanced with the presence of a doula and the medical staff. Intimacy refers to the feeling of being in a close personal association and belonging together. It is the familiar and very close affective connection with a bond that is formed through knowledge and experience of the other. This intimate experience can be created by having the partner taking a role in the birthing process. The experienced doula will include the partner.

The doula’s presence offers a great sense of relief for both of you, especially for your partner who may begin to feel concerned with the responsibility of supporting you and may not know what normal is in this situation. If you’re having an intimate moment with your partner, an experienced doula will know when to step in and when to step back. She will encourage and allow you both to have that moment. In fact, she will look out for and suggest opportunities for you to be together. She will gently pull your partner back if your partner is feeling overwhelmed or feels worried seeing you in pain and give your partner the tools to help support you. If your partner needs a break or a breath of fresh air, the doula will be there, so that the partner can take care of themselves knowing the doula will take care of you.

The role your partner takes depends on the two of you. If your partner would like to roll up their sleeves and offer physical support or prefers to remain emotionally present from a distance, your doula will guide you. The doula may suggest ways for your partner to hold you or breathe with you. She can show your partner ways to massage and apply pressure while you are laboring. If a partner cannot participate physically for various reasons, they may choose to assist in other ways like getting ice and water while the doula manages the physical part, or merely remain emotionally present in the room. The intimacy is in the experience, allowing your partner to remain confident and emotionally present with you.

Whether your birth is unmedicated or medically complex, every family can benefit from the guidance and support of a doula at this often vulnerable and overwhelming time in their lives.

Chantal is originally from Cape Town and after years of working in film she began teaching yoga in 1996 and in 2003 she became a Certified Doula and has been assisting women in labor ever since. She is also a Certified International Childbirth Educator and a Certified Pre/Postnatal Yoga teacher. Her Prenatal classes are informative and educational and are designed for Labor and Delivery. Chantal has been teaching and assisting families in the New York Metro area for over 15 years and she combines her wisdom and knowledge to help families prepare for a positive birth experience

Chantal Traub, CD, LCCE, CCCE

 www.chantaldoula.com

Certified Doula (CD)

Lamaze International Certified Childbirth Educator (LCCE)

Certified Cooperative Childbirth Educator (CCCE)

Chantal Traub is a certified doula with over 15 years of experience and is a board member for the Childbirth Education Association of Metro New York. Originally from Cape Town, South Africa, Chantal received her BA of Fine Arts and after working for many years in film as an art director, she began teaching Yoga in 1996. Chantal is a White Lotus Foundation Certified Yoga Teacher, Pre/Postnatal certified Yoga teacher and Certified Traditional Ayurvedic Bodyworker. Chantal started her Birth Doula practice in 2003 after receiving her certification from A.L.A.C.E. In 2007 She became a Certified Childbirth Educator by Lamaze International and by the Childbirth Education Association of Metropolitan NY. Chantal is trained with Kate Jordan Pregnancy and Postpartum Massage Therapy and with The Julie Tupler Maternal Fitness Technique. She’s also Certified Kangaroula by Dr Nils and Jill Bergman. She lives in Brooklyn with her husband and two children, Naomi and Noah.

PH101: Improve your Birthing Experience

Fiona McMahon, PT, DPT

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Having a baby is exciting, fascinating, and nerve wracking. If you have never been through the process before, chances are you have a lot of questions and concerns about what changes your body will go through during your pregnancy, what the birthing process entails, and how your recovery will go once you’ve had your baby.

Join us  and childbirth specialist, Ashley Brichter, in our final Pelvic Health class of the year to discuss the ins and outs of having a child.

Register at pelvichealth-101.eventbrite.com  today.

Location:

110 East 42nd Street, Suite 1504

New York, NY

10017

Time: 7pm on May 4th, 2017

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Spring Pelvic Health 101 is Coming

Fiona McMahon, DPT, PT

Pelvic Health 101 is back with some old favorites like, “Something’s wrong with my what?” and “Why is pooping so difficult?” We have also added a new course on pediatric pelvic floor issues.

If you have questions, we have answers. Join us for lectures and question and answer opportunities with expert pelvic health physical therapists, childbirth educators, and nutritionists. Please reserve your spot early at pelvichealth-101.eventbrite.com. Remember spots fill up quickly. As always, light refreshments will be served.

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Sex After Pregnancy

By Fiona McMahon, DPT

Edited by Amy Stein, DPT

It’s cliché to say the arrival of a new child is one of life’s most joyful events. It certainly can be. It can also be one of life’s most stressful events. According to the Homes and Rahe Stress Scale, pregnancy is one of life’s most stressful events falling just after having an ill family member. Sexual difficulties and arrival of a new family member are ranked just after pregnancy. It is little wonder that among the joy and excitement that comes along with a new baby, there is also stress and anxiety. Childbirth can have a profound effect on a couple’s sexual intimacy. Understanding a little bit about the physical and emotional factors that can affect post pregnancy sexuality can go a long way to reducing stress and beginning to start a new sexual relationship with your partner after the arrival of your child.

The causes of sexual dysfunction postpartum can be multifactorial and varied. They can occur simply because of the sleep deprivation and lifestyle upheaval a new baby can bring to a family dynamic. They can be hormonal. They can also be caused by postpartum depression, which can have a profound effect on one’s sexual desire. There are also physical factors such as dyspareunia, the technical term for painful vaginal intercourse. Rarely one single factor is the culprit. Post pregnancy sexual dysfunction is usually caused by several factors acting in concert.

Dyspareunia or painful sexual intercourse is fairly common after the birth of a child. Between 4 and 58% of women experience painful intercourse after vaginal delivery. Painful sexual intercourse in women after the birth of their first child was examined by Chaychinda and Ungkanungedcha in a 2015 article in the Journal of Sexual Medicine. The authors of this study found no correlation between painful intercourse and the birth weight of the child, newborn head circumference, or whether or not the mother had a history of pre-pregnancy dyspareunia.

In another study by Signorello and colleagues, the relationship of sexual functioning after childbirth was compared to the degree of birth trauma experienced by the mother during delivery.  The authors of this study classified participants into groups that included, the intact group (no vaginal tearing or episiotomy), women with first degree perineal tearing (tears to the vaginal mucosa only), second degree tearing (tears extending to the perineum and perineal muscles), third degree tearing (involving the external anal sphincter), and fourth degree tearing (involving the anal sphincter and surrounding rectal mucosa). The authors of this study found that women who do not experience any tearing or episiotomy tended to be younger and heavier.  Signorello found that all women, regardless of degree of birth trauma, resumed intercourse by 6 months after the delivery of their child. Most of the women experienced pain when they resumed sexual intercourse with the degree of pain dependent on the degree of perineal tearing. Dyspareunia was found in 33% of the intact group, 48% of the second-degree group, and 68% of the third and fourth degree group. The study also found that degree of birth trauma and maternal age were independent predictors of return to sexual functioning.

Overall sexual functioning after childbirth was examined by Khajehi and colleagues in an article to appear in the Journal of Sexual Medicine this year. In this study, overall sexual functioning was examined after childbirth. Khajehi found evidence supporting the work by Signorello that most women do not return to sexual functioning until 6 months after childbirth. Factors that influence return to sexual intercourse included return of genitals to pre-childbirth state, whether or not there is prolonged lochia (bleeding after childbirth) and perineal pain.

The authors also cited research that women having their first baby are more likely to experience sexual dysfunction than those who have already had a child, with sexual dysfunction significantly higher in women who had just given birth to their first baby at 8 and 16 weeks after delivery. The authors also looked at emotional factors that can affect return to sexuality and cited research that, emotional disturbance, fear of another baby, and well-being of the newborn as well as relationship dissatisfaction are correlated with sexual dysfunction, regardless of the sexual orientation of the couple.

New moms are not to be blamed for any type of sexual dysfunction following childbirth. In our society words like “frigid” get thrown around to describe women who cannot or do not want to engage in sex. It is important to remember that your body has gone through a tremendous change and produced something truly incredible. It is okay to allow yourself some time to recover and to return to sex slowly.

The Mayo Clinic has proposed some guidelines on return to sexual function after childbirth. They advise that new mothers wait 4-6 weeks after delivery to have sex regardless of whether they delivered vaginally or by c-section. Using a personal lubricant can help reduce pain and is particularly helpful because hormonal fluctuations can leave the vagina dry and tender, especially in breastfeeding mothers.

Physical exercise can be key in managing stress, improving body image, and helping to normalize sleeping patterns, which can all contribute to sexual dysfunction after pregnancy. Try to get 150 minutes of moderate exercise in a week to improve overall health. It does not all have to be at once, but adding in short 10-minute bouts of exercise in the morning or at lunch can easily add up to the 150-minute recommendation over the course of a week.

If you are not experiencing any pain or discomfort and you have not noticed any changes in bladder and bowel function, then you can do specific exercises for your vagina to increase blood flow and pleasure during sex. Pelvic floor exercises (Kegels) are contractions of your pelvic floor muscles. You perform Kegels by squeezing and drawing up your rectum and your vagina, like you were trying to stop gas or the flow of urine. If you were sitting on a hard chair while performing a correct Kegel you can actually feel the area between your vagina and anus lift up off of the chair. The best part of Kegels is you can do them anywhere and no one knows you are actually doing them! Keep your Kegels to a contraction of about 1-2 seconds and start off slow building to 100-200 contractions broken up over the course of the day. If you feel any pain with the exercises or notice any changes in bladder or bowel health, then stop doing the Kegels. This could be an indication that certain pelvic floor muscles are in spasm or there may be scar tissue that is causing the discomfort, and it is recommended to see a pelvic floor physical therapist.

Remember to take it slow to returning to sex. Start off with kissing and light touching. If anything hurts it is perfectly okay to put it on the back burner and return to it later. Be willing to explore. You might actually come up with new activities to add to your repertoire while you are waiting to recover. If you find that you are still troubled by sexual dysfunction months after childbirth, consider seeing a pelvic floor physical therapist for guidance in your recover. A pelvic floor physical therapist will be able to loosen and free up scar tissue, and treat any tightness and/or weakness, and teach you about more gentle sexual positions and activities to help you return to full sexual function. Just like any other injury, the sooner the problem is identified and treatment begins, the better; however, most conditions can be relieved many years, or even decades, later.

Sources

Chayachinda C, Titapant V, Ungkanungedcha A. Dyspareunia and sexual dysfunction after vaginal delivery in thai primiparous women with episiotomy. J Sex Med. 2015;12:1275-82

Khajehei M, Doherty M, Tilley M et al. Prevalence and Risk Factors of Sexual Dysfucntion ln Postpartum Australian Women. J Sex Med. 2015 [Epub ahead of print]

Mayo Clinic Staff. Sex after pregnancy: set your own timeline.[accessed May 2015] http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/sex-after-pregnancy/art-20045669

Signorello L, Harlow B, Chekos Am, et al. Postpartum sexual functioning and its relationship to  perineal trauma: A retrospective cohort study of primiparous women. Am J Obstet Gynecol 2001; 184: 881-90

Can I get my pre-baby body back?

By Stephanie Stamas

Everyone around me seems to be thinking about getting pregnant or has just had a baby. There is truly something in the air! I have not caught the bug yet BUT I am very invested in keeping my friend’s bodies happy and healthy. When doing a quick Google search on how to take care of yourself during pregnancy, there is SO much information out there.  How can we know what is legitimate versus fictitious? There are also so many changes in the body – how can we know what to do to help us the most? And what should we expect from our bodies post-partum? This is the topic of our next lecture of the Pelvic Health 101 Seminar Series.

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   Image via ComedyFusion.net

If you are thinking of getting pregnant, are currently pregnant or a post-partum mother (recent or your baby is about to go to college) this lecture is for you! So much of health care is focused on the little one, and this is important, but mothers need attention too! How are mothers supposed to take care of their family, carry a stroller up two flight of stairs (NYC moms) or return to work if their abdominals haven’t come back together, their pelvic floor muscles aren’t kicking in and their post-partum posture is perpetuating weakness?

This class will address what women can do to get their strength and independence back! We will discuss diastasis recti, episiotomies, perineal tears, leaking, postural changes and most importantly – what you can do to help get your body back. Don’t miss this FREE seminar – tickets are going FAST so sign up here.

Why Do I Still Look Pregnant?!: Diastasis Recti, Part I

By Stephanie Stamas

Is it just me, or does it seem like everyone is having a baby this summer? My Facebook feed is filled with pregnant belly time lapses and newborn pictures. I’m at the age where a lot of my friends are starting families and knowing that I am a pelvic floor therapist, I have been getting a lot of phone calls. One of the top questions that I have been asked is – I’ve had my baby, so why do I still look pregnant?

Here is the scoop – When you are pregnant, your abdominal muscles expand in length by the addition of more muscle fibers (sarcomeres) to accommodate your growing belly. After birth, it typically takes 6-8 weeks for the muscles to re-organize and shrink in length to a size that best supports your abdominal contents. This is how the body is designed to adjust to the changing abdominal circumference. Some women, however, grow very quickly and the muscles are not able to expand quick enough. When this occurs, the linea alba (the vertical line of the much-desired six-pack) stretches and the abdominal muscles move away from the midline. This is a more common occurrence in women with more than one pregnancy, multiples (twins, triplets, etc) or a non-exercising lifestyle prior to pregnancy. The stretched linea alba does not typically return to its previous length in a 6-8 week time frame and can allow the abdominal contents (your organs) to bulge through the thin tendonous structure, leading to the look of being pregnant.

Having a diastasis recti may not only result in the mother continuing to look pregnant, but it can also lead to low back pain, pelvic pain, constipation and pelvic organ prolapse. I like to compare the core to a closed canister (you can think of a Coke can) – The diaphragm is on top, the pelvic floor muscles are the bottom and the abdominal musculature – specifically the transversus abdominus and multifidi – are the circumference of the can. These muscles create a tight-knit closed environment that allow for proper support of the viscera (organs), stabilization of the spine with functional activities, and normal function of the bowel, bladder and sexual systems. Having a diastasis recti is similar to having a split along the side of the coke can, and therefore can compromise all systems that rely on that closed environment.

Great, so I think I have a diastasis recti – now what do I do?
Most separations can return to normal with progressive exercises. First off – stop all crunches and abdominal exercises you are doing.  If you have a separation, doing crunches will actually contribute to the muscles being pulled away from the midline and worsen the diastasis. We need to promote approximation, not separation. Some women benefit from wearing an abdominal binder to counteract distraction forces across the linea alba with physical activity. This is helpful for active mothers who are required to use their abdominal muscles, specifically the rectus abdominus, throughout the day (lifting, carrying, etc). The abdominal binder often gives mothers immediate abdominal support, but should not take the place of strengthening. Below is a basic foundational exercise that will begin to allow the rectus abdominus muscle to return to midline.

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If the muscles are not coming together within 4-6 weeks of starting the exercises, see your local women’s health physical therapist (like us!). Sometimes abdominal scars, muscle tightness (especially internal & external oblique) and thoracolumbar fascia tightness can prevent the muscles coming together in the front because of adhesions elsewhere in the core. Also, if you are experiencing low back pain, pelvic pain or dysfunction with bowel, bladder or sexual function, then seeing a women’s health physical therapist is highly recommended.

Just found out you were pregnant or trying to get pregnant soon? Stay tuned for Part 2, where we will discuss preventative measures to prevent a diastasis recti!

Do Older Moms Live Longer?

By Riva Preil

According to NPR, a recent study published in the journal Menopause revealed that women who gave birth to their last child after the age of thirty three are twice as likely to live until the age of ninety five (or beyond!) when compared to women who birthed their last child before age twenty nine.

Thomas Perls, a geriatrician at Boston Medical Center, hypothesizes that the ability to conceive at more advanced ages is correlated with a SLOWLY AGING BODY, including the reproductive system.  Other research suggests that there may be a genetic connection between longevity and the ability to bear children later in life.

However you slice it, it would be incorrect to state that there is a direct cause and effect relationship between birthing at later ages and living longer.  After all, there is a degree of CHOICE involved with conception.  Older women may choose to use contraception even if they theoretically have the ability to conceive.

Therefore, a different and possibly more accurate factor to consider is the age of menopause.  This component accounts for the length of an individual’s reproductive ability, and it would be fascinating to explore whether or not there is a connection between this process (which is NOT in the woman’s control) and longevity.

Time will tell…let the research begin!  Until then, may ALL pregnant women have happy, healthy, and safe pregnancies and long happy lives!