I recently had the opportunity to be part of a training for a local hospital's BFHI process. I wanted a tactile way for people to feel the differences in palate shapes. Needing the models to be comparable to a newborn's mouth-size, I had the idea of using plastic spoons. 

1. I used an air-drying clay and I formed different shapes onto the spoons. They dried overnight without shrinking, which was great since I hadn't put much thought into my supplies. ​I then used a cement glue to adhere the forms to the plastic spoons. This was all pretty easy stuff. Originally I planned to make lower gums as well, hence the spoons with just the gum-lines. I imagined putting the spoons together with palate-spoon facing the gum-spoon, and adding a tongue in between (balloon with Play-Doh in it so it was flexible). I didn't end up following through with the complete mouth as it wasn't crucial to the skills I was teaching.

2. Up until now this was all pretty simple stuff. But I wanted a coating over the forms, so I decided to use balloons, and this is where it got tricky. I used water balloons, and I had to not only stretch them over the spoons and forms without them breaking, I also had to use the cement glue to ensure the balloons were tightly applied to the forms' odd shapes. The bubble-palate balloon kept pulling away. I had to go through a few balloons because they kept tearing, and then I had to keep my thumb in the bubble for a few minutes to allow for the glue to really grab hold of the balloon. ​Also the glue is messy, and it will get all over your fingers and your project -- try to wipe it off the spoons ASAP because it is hard to get off the latex later.

4. This is how I had participants engage with the spoons -- in a similar fashion as when they are engaging with a real baby's palate, from underneath. The feedback from folks was excellent. The nurses appreciated the variations present, right next to each other, so they had immediate comparisons. Most admitted they never felt a baby's palate except to rule out a cleft, and they could see how this information would be helpful when encountering babies who are struggling with feeding. 

This is Max, my amazing demo doll I bought from Magic Cabin Dolls. His tongue sticks out, he is intact, and anatomically correct. These sweet dolls come in different colors, genders, and are machine-washable as well. 

​If you have questions, or you make your own, let me know! I'd love to see what you come up with.

I love Sharon and her creativity, and what an idea machine she is! She is great to brainstorm with -- I lay out all my half-baked imaginings, and Sharon helps plug the holes into a complete activity, or she offers an additional use of something I came up with. When I asked her to share in this year's 31 Days, I had a vague idea I tried to (poorly) convey: "...something about motivating yourself to write when it's the last thing you want to do. How do you come up with creative content, over and over and over?" Well Sharon has figured it out. She took that seed of an idea and grew this amazing, inspiring post, sure to help any new or blocked-blogger out there. 

There is such emphasis on what to bring to the hospital -- you can find a hundred lists on Pinterest and other places. While we try to anticipate what a laboring person will need, inevitably, something may be forgotten. Here's a handy list of things you may already have access to simply because you are in the hospital.

​Every doula learns her own tricks according to the laboring person's needs, the hospital's set up, and the nurses' suggestions. It's always a good idea to ask before you go searching in drawers and cupboards. But I have found, if you have a need or an idea, the staff is supportive of out-of-the-box ways to comfort someone in labor. What has worked for you?

Recently for the Bakersfield BirthNetwork, I was presenting on comfort measures for birth. Expectant families, as well as doulas, come to these gatherings, and I love being able to offer information that is not only helpful to parents, but also information other professionals can take to their clients! As a Lamaze-certified Childbirth Educator, I am always putting together ideas in an unusual way to help make learning about birth fun!

The inspiration for this started when I had a few ideas I wanted to squish together into an activity:
1. Update the stages of labor to reflect an additional pre-labor phase at the onset of the first stage
2. Scaffold the stages/phases of labor by choosing and practicing supports meant to intertwine with the key emotional and physical events occurring
3. Provide a handout which not only helps visualize the opening of first stage, but also serves as a cheat sheet to labor happenings, timing, and ways to cope

What I came up with, I call the "Spinning Circles of Womb." Just kidding, I don't. But I think it works, and it's pretty simple, and that's all that counts -- no frilly title needed. Basically, here are the supplies: 

• items/ideas that comfort
• items that encourage art
• non-negotiable for this activity are 4 circles measuring 3cm, 6cm, 8cm, and 10cm, tacked together with a metal fastener 

I can't remember a time when I sat participants at a table, but for this activity we did, indeed, sit at a table. Surrounded by Mr. Sketch Markers, paper circles, and stickers, I began to share the stages of labor by tacking three sheets of (laminated) paper onto the wall. There is relief when an expectant parent realizes there are only three stages of labor (I did have a dad once who suggested there were 14, but that was his lucky number, and I asked him to take a guess!).

Three. That's not hard to remember, right?

​Then I tack up two more papers, which you can see below, right. I share how some genius decided to break the first stage of labor up into phases, which is another word for, let's just insert more stages into this stage and call it good. 

On the front of the circles we write things like average length of that phase, approximate cervical dilation achieved, contraction action, and more (note: I don't show all of that in the picture). The pinnacle of this is affixing the face sticker to the appropriate phase​, as a handy visual reminder of what a laboring person might be feeling in that moment. 

While we are moving through the phases with markers and stickers, we are also brainstorming what comfort measures might be beneficial at what time, and those are added to the back of that circle. We practice these comfort measures as we go. If we expect people to feel comfortable with different physical ways to counter the strong sensations of labor, we can't expect them to get there from a picture alone! Would you step into a ballroom, ready to dance in front of judges, simply from pictures you saw in a book? We need to actually show families what these positions and movements look like, how they feel, and when they help -- or they are of no help at all.

​At the close of this activity, families walk away with their concentric circles of information, a piece of pool noodle, and an information sheet which shows about 20 different physical positions of a laboring person and partner working together.

Not a bad way to merge my three goals! A handy takeaway that can be utilized easily during birth.

I'm a doula. I love what I do, and I am really good at it. It is always an honor to help a family through birth by offering physical, informational, and emotional support unique to their situation. And I also recognize, as a certified Lamaze educator teaching families in the Bakersfield and Visalia areas, there are many reasons why a family might choose NOT to employ the services of a doula. These reasons might range from cost, to comfort, to hospital rules. In this situation, I want pregnant people to know how to shape their partner or other birth supporters into a doula. 

What are the advantages of a doula? How is she different than a partner, BFF, mom, etc.? She has no agenda or investment in this birth experience except to help a laboring person feel supported and know their options. 

What are the advantages of the partner, BFF, mom, etc.? You know this person better than anyone in the room. You know the likes and dislikes, the history and beliefs of this person, and you will be around after the baby is born.

I often open this topic by asking each person to tell me something he or she knows about the person they have come with. I like this activity because it shows there will be professionals surrounding this birthing family, and while the professionals will know all the medical "stuff," the partners will know the pregnant person better than anyone in the hospital. Labor support is not rocket science. When you know what a pregnant person likes and dislikes, when you know what care this person would appreciate when sick or stressed, when you know what relaxes and what tenses -- this puts you in a prime position as a supporter, and suddenly you have something just as important as the professionals around you. By sharing things they know about each other ("She loves rocky road ice cream," "He hates his head touched") they see already they are armed and ready to doula their loved one. 

​I make goodie bags for all the families. They are filled with objects that symbolize a trait, activity, or way to support someone in labor. 

• Ladybug Straw: stay hydrated; bugs remind us of germs and the need to wash our hands, put a towel on the birth ball, put shoes on when walking, etc.
• Tissue with Yoda on one side, R2D2 and C-3PO on the other: Yoda's "Do or do not, there is no try," for encouraging words, peace through The Force, learning from the master (who's the master???); the droids represent friendship/partnership, C-3PO interprets what R2D2 says like a partner can interpret what a laboring person needs
• Plastic Frog: all fours position for labor or pushing, staying active and changing positions,  change/metamorphism (if it's not working, change it up)
• Sucker: be sweet as you offer support, it's wrapped up like a baby in a pregnant belly, it can provide pressure to a receptor spot on the roof of the mouth which released endorphins, and a reminder to eat while in labor
• Ring Squirter: use of hydrotherapy -- shower, tub, ice
• Gold Medal: treat laboring person as a champion with lots of verbal reminders, and be a cheerleader
• Gum: it smells good (reminder to use comfort scents), partner is not allowed to have bad breath, it "sticks together" like partner and pregnant person
• Watch: of course we time contractions to help us know where in labor we might be, reminder to "watch" the pregnant person and not the machines or the clock
• Head Band: this can bring comfort for unruly hair, it can also remind us this is an athletic event
• Whistle: blow stress away, there may be loud noises, and as a support person, "don't blow it!" 
• The Princess bags: If there ever was a day a person should be treated like royalty, it's the day you birth your baby!

When you love doulas, believe in their benefits, and are a professional doula yourself, it can be hard for class participants to feel you are unbiased on the subject (even if you are a professional childbirth educator, as well). I feel by offering an activity like this, you can show there are many different ways to create a birth support team -- and with anticipatory expectations of what a laboring person's needs are -- that doesn't have to include a doula.

I have lots of fun goodies I use as an educator and doula. Sometimes these look like toys, and sometimes they are purchased in the toy section, but I promise, they are not toys, they are props.

What's the difference? How do Hot Wheels track pieces change from toy to prop once absconded from my kid's room and placed in my childbirth ed supplies? What changes a kitchen utensil to an educational model? Dollar Tree junk to demonstration delight? 

One word:

Here is a sampling of toys, and how I use them!

One thing's for certain, it isn't going into the toybox at home! I let my little guy (21 months old) play with it, heavily supervised, for about 30 minutes, before I packed it up and put it back in its box.  I know, I've got problems, you say -- it is, after all, a kid's puzzle! I own my issues. Just like we encourage when it comes to precious personal objects:  it's my special toy and I don't want to share it.

I added links to similar posts...

As I compose this, my washer is going full-steam-ahead with a vomit-covered, king-size comforter in it, my 8 year old lies on a well-protected couch (his bowl on the towel-covered ottoman), and Kipper -- a long ago forgotten, feel-good kid show -- streams on the TV. 

My little guy is sick. 

Standing vigil with him last night, I was reminded we can make our pain worse or we can make it better, and a lot of that power lies in our brains. Like many of us, he doesn't enjoy being sick. He tried to rest, but when his stomach started to rumble, he grew restless, rocking his legs back and forth with anxiety and anticipation. Not wanting to wash any more linens, I encouraged him to move to the bathroom, where he would pace back and forth in front of the toilet in his attempts to avoid the inevitable. 

"I don't like to throw up," he said, tears sliding off his cheeks. 

"I know." I gently rubbed his back. I wasn't sure how much of his pain was from his stomach, and how much was from his brain. Sure, he was coping, yet he was also masterfully avoiding his body's natural impulses to move through this illness. Fear -- he was scared.

"When you worry so much about being sick, it can make your body feel worse. I think if you can take deeper breaths and try to let your arms and legs be lazy and heavy, then you can really hear what your stomach is saying." We both sat on the edge of the bathtub as I mirrored the deeper breathing and lazy legs while continuing with my fingers on his back. 

We repeated this ritual many times in the night, and a shift occurred: knowing he could calm parts of his body and mind led him to feel more secure in what was actually happening in his tummy. He was able to better feel the illness, as it would come and then go, and this helped him rest in-between.

See any similarities to labor here? 

Really what this describes is the fear-tension-pain cycle. In my classes we demonstrate this with a very long piece of elastic tied in a knot -- like a very, very long piece (10 yards?). I offer it to three different participants, so when held, it makes a giant triangle in the middle of our classroom. I then assign each of the three to be either "fear," "tension," or "pain," and have them relax their arms so the elastic falls to the ground, and we read over a few situations. As one trigger point becomes activated, that person pulls back on his or her piece of the triangle, then the next trigger is activated, and we see the result when the third person has to hold his elastic tightly to prevent it slipping from his hands. As we get to the problem-solving part, that person relaxes his or her part of the triangle, until it is loose and dragging the floor again. 

What's going on here? And how can we short-circuit the fear-tension-pain cycle? The biggest difference is, Mary's coping strategy has changed -- she is no longer upright and mobile, being comforted by her partner's hands. Now she is sitting, strapped into the car, and on her way to the hospital. 

A change in the level of PAIN, brought TENSION to her body, and FEAR about the future. Mary's partner can help her through this verbally -- reminders to relax and release tension, seatbelt caused hindered mobility,  labor not necessarily picking up but changing sensation from changing position, etc. Relaxing can reduce the TENSION, while knowing this information can speak to the FEAR, thus helping to change the intensity of the PAIN, interrupting the cycle.

Let's look at another situation (without the pictures -- as a side, I am currently reading Unfolding the Napkin, and I decided to follow the author's advice about processing visual information and creating my own pictures :)). Mary is now in the hospital. She is coping well by sitting on a birth ball and rocking through her contractions. She hears a scream down the hall and suddenly she has a FEAR response; consequently, she TENSES, and her PAIN increases. What can help here? 

Address the FEAR with words. Remind the woman, just as she has a birth team taking care of her, the lady down the hall also has professionals aware of her situation. The screaming might not actually have anything to do with a level of pain or danger -- it may just be how that lady chooses to cope, maybe she is just a screamer? Hands-on touch can offer physical reminders to relieve TENSION in areas of her body, and her PAIN level can go back to where it was before her scare.

My little one is on the mend, the laundry is done, and I got a nap this afternoon. Watching him struggle was intense as a mom, just as it is when we are with laboring moms. It was an amazing tool to offer him, navigating through his own experience of the F-T-P cycle, by helping him recognize ways to make himself feel better in his body, by simply using his head. 

The Cascade of Interventions is a typical topic covered in childbirth classes. I don't want to say it's like the Domino Theory of Communism,a logical fallacy known as "slippery slope," but it...it kind of is. As moms, doulas, educators, and birth workers, we often can recall someone's "cascade of interventions" story. The important thing when it comes to teaching is to help students understand that the use of an intervention doesn't mean a woman is fated to the "next" likely step -- with education and awareness, she and her partner can be work to avoid the common pitfalls a specific intervention might bring. Basics:

• I like to use story-telling in many childbirth education activities. Roger C. Shank, a cognitive scientist, said: "Humans are not ideally set up to understand logic; they are ideally set up to understand stories." I feel this is an effective way to help participants relate and remember bits of information, versus throwing factoids at them. 
• I have a set of 12 boxes, that when stacked reach over my head (and I am 5'5"). I bought them at Costco about 7 years ago with this activity in mind.
• I have a 12-step story with each step written on its own slip of paper. The first part of the story is in the smallest box. Step two is in the next size up box, etc. I put these under students' chairs before class.
• Parents offer their boxes as size/story dictates, read their part of the story, then stack their box. In reverse-size order we see how even though the small box was no big deal, as the stack increases, it starts to teeter, and it might even fall. I ask a partner to be in charge of holding the stack up while we finish the activity.
• This story starts with the tiniest box in my nesting collection, and it is a benign "intervention," one we might not even consider when looking for offenders: external fetal monitoring. The story ends with breastfeeding being interrupted -- of course the worst thing we generally think of within the context of normal birth situations is cesarean birth; I felt that was an obvious choice. When it comes to cesarean birth, I feel it can be easy for participants to think, "That won't be me," whereas breastfeeding interference seems an idea we can open our ears to.
  

The story I use:

1. EFM: Jamie arrives at the hospital at 3 cm woth contractions about 5 minutes apart. Jamie's coping method is bouncing/swaying on the ball. Once in her room the nurse wants to get a reading on her baby and requests 30 minutes of EFM to get a 'baseline" on baby.
2. limited mobility; increased pain/anxiety Jamie's limited mobility means she is no longer able to sit on the ball through her contractions. Her contractions become more intense, and this starts the F/T/P cycle.
3. pain medication request (Stadol) Jamie is scared about how she can cope with labor if it is going to get worse. She decides she wants to try an analgesic pain medication, which can be given as a shot.
4. labor stalls Jamie finds although the medication takes away some of the pain, her labor has stalled.
5. pitocin to speed things up; IV Jamie now needs pitocin to get into an active labor pattern. This means she will have an IV as well.
6. epidural request As the pitocin increases the strength of her contractions, she experiences F/T/P cycle again. She requests an epidural.
7. blood pressure drops Jamie's blood pressure drops in response to the epidural.  
8. medication for blood pressure Jamie gets meds to counter low blood pressure.
9. maternal fever Jamie has a fever, which could be from the epidural.
10. OFP affected; baby born via vacuum Since Jamie was not able to be more active, her baby has not had help moving and rotating into an optimal position and needs the vacuum to be born.
11. baby has fever; sent for observation, possible septic work-up Baby has a fever at birth and needs to be taken to the nursery for observation and possible tests. Jamie and her baby are separated for 6 hours.
12. separation/breastfeeding affected Breastfeeding is affected.

The bolded statements are being recorded on a large sheet of paper as we read along. After the activity with the boxes, we go through the list and discuss what can be done to avoid or minimize the effects from a specific intervention. This is also the time I hand out basic info sheets about common interventions. 

I hope I included everything? If you have questions, ask! And please "like" my Facebook page to stay up-to-date on the teaching tips I share.

In celebration of getting my DONA recertification in the mail, I decided to challenge myself to see if I could make this creatively and frugally. 

This morning I went to Wal-Mart to peruse the Halloween decorations, thinking there had to be a usable pelvis from a skeleton I could use. I found one I thought would work -- and only one, really, out of all the decorations. I live in a small town, and Wal-Mart is just about all we have; I would have checked other places if I lived with more options, because although this one worked, I would have liked to see more samples. That was the only thing I purchased -- everything else I had around the house.


Materials List:
skeleton with a pelvis
embroidery floss
orthodontic rubber band
needle/thread
fabric
baggie
tape
baby that fits the pelvis
baby sock for uterus

I would use something else for the amnion, but I was grabbing things I had in my house -- nylons might work? Also I would use a newborn's sock, not an 18 months old's sock, for the uterus...you could also knit one. 

If you have questions, let me know! It took me about an hour from start to finish! And it could save you 70+ dollars! Sorry the order is off -- putting them in order this way on the computer makes the mobile version easier to view.

I'm an educator that calls pain "pain." I think that is how most people perceive it. I used to feel the "p" word was bad, and I used all manner of euphemisms to avoid saying it. When you teach almost 2000 hours a year, you hear back from a lot of families. When more than one former student came back asking me why I didn't just call it "pain," I decided to adjust my viewpoint.

I do have an activity where I "break down the pain" into sensations, involving a bucket and water. The intent is to dissect each sensation, that when clustered together, we call "pain." I find it makes the physical sensations we experience more recognizable and less scary. But I digress!

I begin this activity before class, really, when I bring out the Hot Wheels track pieces absconded from my sons. When the first couple arrives, I ask them to put the track pieces together. Once finished, they are laid on the ground, the starting line by me, the finish line at the back of the classroom. 

You would be surprised how happy it makes people feel to see Hot Wheels tracks and cars on the floor of the classroom where they are learning about how to have baby! This is generally class 3 of our 6, when we discuss pain theories and comfort measures. This is how I share the Gate Theory of Pain, essentially, that we can make pain worse (turn it on) or make it less (tune it down) by what we think, feel, and do.

To start, I lift up the end of the track near me, the starting line, and I let a few cars loose. Unobstructed, they zip down the track like greased lightning (hello, Grease fans!). Then I ask, "What have you heard about, in books or from your friends or family, that helps with labor pain?" People start shouting things out. "Water!" Okay, get your Post-It notes out and write "water" down on one. Choose a partner to come and place his or her shoe under the track, and stick the note on the shoe. 

Ask again. "Massage!" Same thing. Have a partner come, place his or her shoe under the track at a different point, and slap that Post-It note on the shoe. How many people you have here depends on how long your track is. Pretty soon you have something that looks like this the top image, above (except I have them continue to stand while we do the next part -- I was home alone when I made the pictures here and I opted for empty shoes). 

Now repeat the exercise with the cars. Start sending them down (I use 5-6 cars). Some will make it all the way to the end, some will slow, and some will get knocked off the track. What you will see, though, is that the undulations made by the shoes (interference, right? Comfort measures) will compete with the "sensation's" ability to get to the end (the brain). We can make sure the road is clear for those sensations to fly straight up and tell us we are in pain, thereby triggering the fear-tension-pain cycle, or we can "congest" those nerve pathways by throwing in other sensations to confuse our brains about what we are really feeling...enter comfort measures and emotional support! Voila.