Did you know that much of your baby’s blood is outside of it’s body at the moment of birth? And, that in the United States and Europe, this blood will never make it to your child?

You read that right, the umbilical cord in most births in 1st-world nations is cut before all of your baby has received all of its blood.

In fact, one third of a newborn’s blood is still in the placenta and umbilical cord for about 90 seconds longer than modern medical practice allows for. The result is that your baby is deprived of precious early-life resources that could allow your child to flourish.

If the cord is clamped too soon, before it stops pumping, your child misses out on 60% of its red blood cells, additional iron, stem cells, white blood cells and much more. These are the ingredients that support your bundle of joy developing healthy bodily functions, intelligence, resistance to infection – the list goes on.

Even more incredible is how remarkably simple it is to prevent the loss of this biological gold mine for your new baby. Watch the video below, where I talk about exactly how our generation can tackle this problem – starting today.

TICC TOCC

We’ve started a campaign to spread this message, called TICC TOCC – Transitioning Immediate Cord Clamping to Optimal Cord Clamping. To learn more about it, watch my talk at TEDxBrussels (scroll that page for video).

If you know someone who is pregnant, please share this message with them. It will make a world of difference in the life of their young ones.

In the comments below, share with us some ideas you have about how we can spread this message.

This is super powerful stuff, and the best part is it’s amazingly simple.

How can you help make optimal cord clamping a reality?

In the United States Cesarean sections are performed on about a third of women giving birth, more than in any other country. The routine practice after surgery is to separate the mother and baby which interferes with skin-to-skin contact. Even after a C-section, there are many benefits to having mom hold her baby as early as possible.

After most typical Cesareans, there is only a short introduction between newborn and mom before they are separated for up to two or more hours. Baby is taken from the mom to be weighed, examined, measured and swaddled while the mother is taken to a recovery room. The baby is then typically taken to a warmer in a nursery while the mom is recovering from the effects of anesthesia.

The World Health Organization recommends ALL newborns have skin-to-skin care, regardless of the baby’s weight, gestational age, or birth setting. In a study comparing those recovering from a Cesarean who had skin-to-skin contact in the first hour after birth vs. those who did not have very early contact, average baby temperatures during the first hour after birth were significantly better in the skin-to-skin group.

Whether a C-Section is planned or not, it is important to speak with your birthing team about the benefits and practice of skin-to-skin care, long before baby’s actual delivery.

The most classic definition of ‘Skin-to-Skin Care’ (which is the same as ‘Kangaroo Care’) refers specifically to sessions of 60 minutes of continuous touch between baby and mom in the first moments, hours and days after baby is born. First, baby is placed on mother’s chest immediately after birth, where the cascade of normal hormonal physiological benefits will occur. Baby will show nine distinct stages of bonding including relaxation, crawling (Yes! A newborn will actually wiggle towards the breast!) and rooting to suckle.

The latest research shows that while the 60 minute time frame recommended for classic Kangaroo Care is important, it touches on just a fraction of the benefits available to baby and mom from a more comprehensive understanding of skin-to-skin care. Even six seconds of skin-to-skin touch is often enough to raise the ‘love and bonding’ hormone oxytocin, which could make breastfeeding easier and reduce the symptoms of postpartum depression. Studies have shown that even brain development is enhanced in babies who had ample skin-to-skin contact in those early hours and weeks after being born. It also helps bring baby’s heart rate, temperature, and blood pressure and breathing rates back to normal after the stimulation of being born. Babies experience stress as they go through the birthing process and your baby instinctively knows that nestling into your chest is the best place she could be to rest and recuperate.

Additionally, it is within the first 48 hours after birth that baby’s skin is first colonized with the beneficial bacteria from Mom that helps keep baby’s dermal micro flora (skin surface bacteria) in protective balance.
The natural colonization of baby’s skin with the same bacteria as found on mom’s skin, plus breastfeeding, are thought to help prevent allergic reactions in baby as she ages. Skin-to-skin closeness with Mom, immediately after birth and beyond, are critical to support breastfeeding and healthy, protective skin through the proper micro flora colonization.

As baby gets older, there are plenty of opportunities for parents to share increased skin-to-skin contact time, through baby massage, giving baby a bath, taking a nap together, or just playing simple games together while touching (Peek a boo with baby in your lap and a board book!)

Becoming a birth doula was one of the best and most rewarding decisions I’ve ever made. I cannot express with words the sheer joy I have experienced at each and every one of the 50+ births I’ve attended throughout my career as a doula. Although most of my “work” as a doula at the present time is spent volunteering to help teen moms and military families, you can have a very successful and lucrative doula business if you choose.

The training and certification to become a doula is fairly inexpensive (typically $400-$600) and requires both theory and practical training. To begin with, you will typically be given a book list to read. Next you will likely attend a series of childbirth education classes prior to your actual doula training. These consist of watching videos, discussing the female anatomy, what to expect during labor, and how to work with pregnant and birthing mothers. Your doula training usually lasts from 3 full days to 2 weeks or longer, depending on what organization you certify with, or who trains you. Your training will be in depth and about all things birth related. You will learn comfort measures to use with laboring mothers, and how to advocate for them when you interact with hospital staff. You will also learn how to market your services to the public and likely create your very first network with your classmates.

To give you an idea of the income potential, the average doula charges anywhere from $500-$1,000+ per birth, depending on her experience, services offered, and additional areas of expertise (a doula who is also a massage therapist is obviously able to charge more). As a doula, you can attend about 2-4 births per month on your own, or up to 8 births per month if you’re working with a group of doulas that provide “back up” in the event that 2 or more clients go into labor at the same time.

I completed my doula training and certification through DONA International in 2002, and ALACE (now To Labor) in 2005. While DONA is probably the most well-known, widely respected doula training organization, there are many options available. Furthermore, while any reputable doula should receive quality training, certification is not required to practice as a doula.  Anyone can work as a doula regardless of whether or not they have been certified to do so. However, many clients will only work with certified doulas, and if you are serious about pursuing a career as a doula, it’s definitely worth getting certified with a reputable organization.

If you’re interested in becoming a doula, I recommend registering for a birth doula training with one of the following reputable organizations:

DONA International
To Labor (Formerly ALACE)
CAPPA
ICEA
Birthing From Within- Love them!

When it comes to dads and doulas couples can have a myriad of concerns, but the truth is both play a very important role.  As a doula and mother who knows firsthand how important dads and doulas can be, I’d like to address some of the most common concerns – because dads and doulas make a great team!

Concern: If I have my partner, why do I need a doula?

Truth: The dad-to-be is in an unfamiliar environment, and trying to become familiar with the process and language of birth, understand medical procedures, and advocate for his partner is often extremely stressful. A doula can eliminate this stress by explaining what to expect, providing the information needed to help parents make appropriate decisions, and facilitate communication between the couple and medical team.

Additionally, it’s hard for a father to understand a woman’s instinctive behavior during birth and he may react anxiously to what a doula knows to be the normal process of birth. Seeing his partner in pain may cause the father to become distressed. A doula can skillfully help the mother to cope with labor pain in her own unique way, offer reassurance to both the mother and father, and encourage the father to participate at his own comfort level.

Concern: What if the doula takes over, displacing the father-to-be and interfering with the intimate birthing experience?

Truth: The doula can actually bring the couple closer, making sure the partner’s needs are met (food, drink, and reassurance) so the woman and partner can work more closely together. When the dad-to-be chooses to be the main source of support, the doula can help him be more successful by using her expertise to make suggestions for comfort measures, keep him informed about what’s going on, and offer words of encouragement and reassurance. During a long tiring labor, the doula can also offer the father a break or brief rest, without him feeling guilty about leaving his partner alone.

For the father who is shy, uncertain, or unversed in his role, the doula can suggest simple but truly useful tasks such as timing contractions, holding the woman, supporting her in a particular position, or showing him how to apply counter pressure to her back.

While the doula probably knows more about birth, hospitals, and maternity care, the partner certainly knows more about the woman’s personality, likes and dislikes, and needs. Moreover, he loves the woman more than anyone else there. The combined contributions of the father and doula, along with a competent, and caring medical team give the mother everything she needs to have the best birthing experience possible!

Concern: The doula has her own belief about how the birth should go, and imposes it on the woman and couple.

Truth: The doula’s number one goal is to help ensure the woman’s or couples birth plan is acknowledged and followed as best as possible. If the doula is thoroughly familiar with the couple’s wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes when the birth plan is not followed, the couple later looks back with regret or disappointment- especially if it was a result of the choices they made.

The doula never makes decisions for the couple, but instead asks questions that will ensure the right information is provided so the couple can make an informed decision of their own.  She may also suggest alternatives (like waiting a while) for the couple to consider their options.

In summary, the doula helps make the birth experience as rewarding and satisfying as possible. As one father said “I heaved a big sigh of relief when the doula walked in. I hadn’t realized how much pressure I’d been feeling. She not only calmed my wife, she calmed me down too.”

The father’s presence and loving support in birth is comforting and reassuring. The love he shares with the mother and his child and his need to nurture and protect his family are priceless gifts that only he can provide. With her partner and a doula at birth, a mother can have the best of both worlds – her partner’s loving care and attention and the doula’s expertise and guidance in birth.

Many women and couples are now choosing to hire a professional birth doula to support them during their birthing journey. If you’re considering hiring a doula, here are some tips on where to find one, and what you should ask her before you seal the deal.

If you are looking for a birth doula, I recommend using the Doula Locater at www.DONA.org. Other options include asking your midwife or childbirth educator for a referral, or doing a Google search for birth doulas or doula groups in your area. Many doulas and doula groups have their own individual websites. Here in San Diego, we have www.beautifulbeginnings.org as well as several others.

I also recommend interviewing several birth doulas before deciding on one that’s best for you. Here are some points you may want to consider, and questions you may want to ask when you interview a doula…

• What kind of training does she have? Is she certified? How experienced is she? Has she given birth herself? Has she worked with your OB or midwife, at your birthplace? Can she provide references? What is her fee? Does she accept monthly payments or require one lump sum?
• What services does she provide? Does she have training in any other areas such as aromatherapy or massage? Will she come to your home in early labor? Can she offer suggestions for comfort and facilitating labor?
• What is her availability around your due date? How will you get in touch with her? Does she offer 24 hour phone support? Does she have a backup doula in case she is not available? Can you meet her? How many clients does she accept each month? How often will you meet prenatally and postpartum?
• What are her philosophies on childbirth? Do they “feel right” to you?
• How do you get along with her? How about your partner? Beware- personality conflicts can bring negative energies to a birth. You should feel confident and positive with her.
• Discuss your partner’s role at birth. She should be enthusiastic about support for both of you- offering her skills while supporting and enhancing your partner’s role.
• What does she expect from you in terms of preparation for birth and assuming responsibility? Although doulas act as advocates, remember that you and your partner are the parents of this baby, it is your birth, and you are the ones who must ultimately assume responsibility for decisions that are made. The doula can provide information and point out alternatives, but she cannot make decisions for you!

If you would like to have a doula, but are worried you can’t afford one there are several options available! Many doulas love their work so much they are willing to offer it on a volunteer basis, I know, because I am one of those doulas. I am not sure of the best way to find a trained/certified volunteer doula, but you could try searching your local Craig’s List, posting a wanted ad on Craig’s List, doing a Google search for volunteer doulas in your area, or simply try asking around. There are some hospitals that offer volunteer doulas to all patients, such as UCSD Medical Center in San Diego- if your hospital offers these services by all means take advantage! If you are a military family, there is an organization called Operation Special Delivery with doulas that volunteer their services to active duty military families. Another way to find a low or no cost doula is by contacting the organizations that train/certify doulas such as www.DONA.org (others listed below) and ask for a list of doulas who have recently completed their training, but are still working towards certification (you may have to get the name of your local doula trainer and contact her for the list of doulas she recently trained). Most doulas have to attend a certain number of births before they can get certified, and these doulas are often eager to volunteer at births in exchange for the experience they will gain.

National Birth Doula Organizations:
www.CAPPA.net
www.DONA.org
www.ChildbirthInternational.com
www.BirthingFromWithin.com
www.ICEA.org
www.ACBE.com
www.ALACE.org

Tick tock. Tick tock. TICC TOCC.

At the moment of birth, only about 2/3 of the baby’s blood is in the baby. The remaining third is still in the umbilical cord and placenta. During the third stage of labor, which lasts from the delivery of the baby to the delivery of the placenta, the cord actively pumps iron-rich, oxygen-rich, stem-cell-rich blood into the baby.

Unless the cord is clamped too quickly.

Immediately clamping the umbilical cord was popularized in 1913 as one of three pillars of active management of the third stage of labor. While this intervention began in the West, we exported this technique to developing nations around the world. Today, in some low-income countries as many as 95 percent of delivery clinicians surveyed practice immediate cord clamping.

Immediate cord clamping results in up to 10x the risk of developing iron deficiency anemia.

Anemia hinders a quarter of the global population, and is disproportionately concentrated in low-income groups. Iron deficiency is the leading cause of anemia – but with iron deficiency, anemia is just the tip of the iceberg. Even when iron deficiency is not severe enough to cause anemia, it has been linked to lasting damage to the developing brain. Infancy is thus both one of the most important as well as most common life cycle windows for iron deficiency.

What can we do? It’s simple – improve the health of billions by spreading an idea.

Wait 90 seconds – until the cord stops actively pumping fetal blood into the baby, unless there is a strong reason otherwise. This has been studied all over the world and has been shown to be both safe and effective at significantly reducing the risk of iron deficiency. Other benefits may include reducing birth asphyxia (inadequate oxygen to the brain) and cerebral palsy. The health benefits from receiving the cord’s pluripotent stem cells may be the most significant impact, but has yet to be understood.

It’s time for TICC TOCC (Transitioning Immediate Cord Clamping to Optimal Cord Clamping).

Spreading an idea that makes intuitive sense, is cost effective and a simple first step to addressing a major global health problem.

Not only have people around the world traditionally waited for the cord to stop pulsing until the 20th century innovation, every other mammal studied instinctively waits for the cord to stop pulsing as well. More than a quarter million babies will be born today.

The clock is ticking.

Get Yourself a Doula.

Trained labor support is worth its weight in gold, especially through a VBAC.  If your previous birth ended in a cesarean after a long, hard labor – or, if you never got to labor at all – you may need an experienced support person present through your VBAC to help keep you strong, and to help you understand what’s normal. 

My recommendations for finding a doula that’s right for you:

• DONA
• DoulaMatch.net

And on the topic of support people – make sure the people you are allowing into your birth space are wholly supportive of your needs, and understanding of your desire to have a VBAC.  When dealing with family or friends who may not support your choice, keep the discussion about your birth to a minimum.  Provide them with good information about VBAC during your pregnancy if they’re interested, but keep in mind their opinions have no place in your birth.  It is your body, your baby. Do what is right for you, and ignore any negativity.

If you need more support — join your local ICAN chapter, and/or get on the national listserve.

Finally, relax.

Now that you have prepared yourself to have a better VBAC, that is probably exactly what you’ll have.  Visualize your beautiful birth.  Will your beautiful birth into existence.  Even if life throws you a curve ball, or if your baby does truly need to be born by cesarean for some reason, the steps you have taken to empower yourself can help the experience remain as satisfying, beautiful, and safe as possible.

What did you do to prepare yourself, and/or your family, for a Vaginal Birth After Cesarean?

Before you even get pregnant, start searching out a supportive VBAC provider.

Simply asking your provider if they support VBAC may not be enough.  The answer may be flatly no, but it could also be “Yes, but…”  Ask any potential provider about his or her VBAC rate, what types of restrictive policies they place on VBAC moms, and what his or her overall philosophy is on normal, natural birth.  If you are not comfortable with the answers you get, keep searching.  A little work on the front end could save you a lot of stress, and possibly a surgical birth, on the back end.

Get Informed about Normal, Healthy Births.

Birth itself is a normal, biological event, where mother and baby usually fare better without (often unnecessary) drugs and procedures.  While learning about natural birth, you will see that women possess a powerful, innate wisdom about how to birth their own babies.  Through your studies, you will learn to believe in yourself, no matter what may have sabotaged your previous birth.  You may find your previous cesarean could have been avoided by avoiding certain practices and procedures.

My recommendations for the two essential natural birth books:

• Ina May’s Guide to Childbirth
• Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation

Learn About Interventions, and about VBAC itself.

Being an informed consumer is one of the single most important steps in preparing for any birth, especially a VBAC.  No matter if you are laboring in a hospital, birth center, or right at home, you need to have a basic understanding of the machines that go “Ping!”  The more informed you are, the better equipped you are to make the choices that you are comfortable with — even in a pinch.

My recommendations for learning about commonly used birth interventions and VBAC:

• The Thinking Woman’s Guide to a Better Birth
• Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First
• The VBAC Companion: The Expectant Mother’s Guide to Vaginal Birth After Cesarean

What did you do to prepare yourself, and/or your family, for another baby in the family? Do you have a birth plan?

In the nearly two years since my VBAC (Vaginal Birth After Cesarean), I have had the pleasure of bearing witness to a plethora of other VBAC stories through my connection to the birth community. Many mothers know they want a VBAC, but they may not be clear on what steps to take to get there. Over the next few days I want to share some tips on how you can have your own beautiful VBAC story, but first I want to share my story.

My labor began just moments after I arrived for my last scheduled day of work before maternity leave.  I felt a hard contraction, then my mucous plug came, and intense, steady surges followed.  Things seemed to be moving quickly, so as soon as my husband got into work, we turned around and headed for labor and delivery.  I wanted to labor at home because I felt that it would increase my chances of having an intervention-free birth.  However, since we took the train to work, I would have had to labor on the train to get home.  The hospital was just a cab ride away.

We were checked into labor and delivery where we met out doula.  I hired her at 37 weeks pregnant after it became clear that my doctor was no longer being as supportive of my VBAC plans as he had been originally.  There was no medical indication for his shift, he simply did not like my birth plan.  I wanted someone at my birth to help support my informed choice to avoid interventions unless medically indicated.   Though I handed out bound copies of my birth plan to everyone I came into contact with at the hospital, the staff was not honoring my wishes to labor in the birth tub.  I tried sitting in the shower, but the hot water was broken in my room.  I had planned to go natural, but requested the epidural when I felt my pain relief options were being limited to that.

Just as it had the first time, the epidural slowed my labor. My first son’s birth ended in a cesarean after my obstetrician chose to induce me for being 5 days past my due date. My body was not ready, and I only made it to five centimeters in that birth.  I started to get worried the same thing would happen again.

At the end of the workday, the doctor said he wanted to go home and told me I needed a cesarean. He said it was a “failure to progress” and I told him it was a “failure to wait.”  I sent him home and kept laboring.  By the next morning I made more progress, but it did not satisfy him.  He then told me I had no choice to but consent to surgery, and I told him I was not consenting until I felt like it was the only option.  He spent the next few hours trying to coerce me into it; telling me my uterus “just might not work” and that I was asking for my baby to be born with “cerebral palsy”.  My baby’s heart tones were fine, there was no sign of infection, and my only major issue was the stress the staff was putting me under.  The doctor did not see it that way, however.

After hours of fighting, my husband finally took my doctor into the hall and explained that I would not be consenting to unnecessary surgery.  My doula showed us a trick to get my labor moving again, which included shutting off the epidural.  By the time the sun set on the second day of my labor, I was finally in transition.  At 10:01 pm, 38 hours after my labor began at work, my son Jules was born vaginally after only five pushes.  He weighed 9 pounds, 10 ounces and was as healthy as any baby could be.

What’s your birth story? Are you facing a birth after an earlier cesarean? I’d love to hear from you.