Rhode Island Birth Network: RIBN Guide & FAQs

The RIBN Guide & FAQs

for Conception, Pregnancy, Birth and Postpartum

RIBN is providing you with the means to successfully and effectively navigate your entire birth experience from start to life as a new family. This guide will provide you with information and tools to help you make the most of your pregnancy, birth and beginnings as a new family.

Education and knowledge generates confidence and effective communication.

1. Ready to start your family

Take inventory of what you need to lay the groundwork and get your body ready. Start taking prenatal vitamins. Consider supplements such as DHA, vitamin D3 and discuss with your care provider. Keep in mind that every woman’s body is different and has a different cycle so give ovulation a span of 14 to 20 days. Exercise, nutrition, reducing stress all will contribute to proper preparation. Consider specialties that aid in fertility such as acupuncture and Bowenwork as well.
Become excited at the prospect and start to become educated about all aspects of pregnancy and birth.

Recommended reading: Taking Charge of your Fertility by Toni Weschler, MPH

2. Congratulations on your pregnancy!

Much the same as when you were preparing to become pregnant. Be sure to take prenatal vitamins — folic acid is very important for baby’s health. Well-balanced meals and exercise help keep mom in shape on every level. If you are noticing heartburn, nausea or reflux, simple remedies can help such as ginger, apples and almonds for relief. While starting to "nest", keep the air that you breath in mind as well. Consider green products to clean your home such as white vinegar and hydrogen peroxide. Aromatherapy oils can be used more safely as room deodorizers than the standard fare purchases. Steer clear of cigarette smoke.

3. Meet your baby on the inside

Your baby is aware of you and your environment from very early on in the womb - they are connecting with you and those around you - listening, reacting, taking everything in. Designing the ideal "room" starts well before they are born - what is it like for them while they are in the womb? Consider how relaxed you are, the food you are eating, the noises around you, the time you take to connect with your baby every day, just as you will do when they are born. When you bond with your baby and treat them as a person well before meeting them face-to-face, you start to consider what it will be like for them while pregnant and when you give birth. Set time aside for mom, partner and baby while listening to music, rubbing mom’s belly, reading baby books, etc.

Prenatal bonding handouts and links - Karen Strange
Prenatal bonding activities — FirstSounds, Drumming Circles

4. What is going into your Body?

Your nutrition has a definite impact on your baby’s development. Folic Acid is very important for your baby’s growth and development. For meals, eat balanced, smaller meals several times a day with water intake being a big priority. Taking such measures such as increasing your protein intake throughout your pregnancy and following the Brewer Diet can help you to avoid high-blood pressure and pre-eclampsia. Be aware of your nutrition facts regarding fish, heartburn, nausea and reflux, swollen hands, swollen feet and ankles and other conditions associated with pregnancy.

5. The Mind-Body Connection — doing what is best for you

Remember that your baby’s emotional balance is a direct reflection of your own. When you are relaxed and happy, your baby is relaxed and happy. Conversely, when you are stressed, your baby becomes stressed. This can have a profound effect on the baby's development and your pregnancy.

Sharpen your instincts and intuition by reducing stress and "mind clutter." This will help you to better identify your wants and needs during your pregnancy, birth and postpartum. Exercise, yoga, massage, hypnosis and relaxation can help to alleviate stress substantially, along with diet and proper sleep. What needs to change in your lifestyle to provide you and your baby with a well-balanced environment?

Specifics to watch:
Genetic Testing/Screening - especially for first-time mothers, be informed of your options for prenatal testing, the process and results. Being educated and informed on this topic can remove undue stress during your pregnancy.

See Sarah Buckley’s book Gentle Birth, Gentle Mothering speaks to testing, ultrasound, etc.
http://www.sarahjbuckley.com/html/about.htm

6. Don’t forget your partner!

Partners can sometimes tend to get swept aside or lost along the way during pregnancy and at the birth. They can have a difficult time figuring out their role — they aren’t carrying the baby! How are they feeling? Moms should be aware that partners may be feeling helpless or confused. Are they going to medical visits with moms? How involved are partners? There is no limit! Please see our store for specific recommendations, including the Fathers-To-Be Handbook, A Roadmap for the Transition to Fatherhood. Also, Being Dad is a great DVD to put it all in perspective.

Articles:
Go Ahead... Use the F word!
Breast is Best... for Dads too!

Check out the RIBN Store for more books and DVDs for Dads and Partners.

7. Get educated — take a class best for mom and partner / getting the info you need

The more educated and informed you become about prenatal bonding, the birthing process, all of your options for natural as well as medical births, support from medical providers, and integrative providers, the more you become invested in the birth experience. There are several different types of Childbirth Education classes and workshops available in Rhode Island, whether they are offered privately, in a group setting or through the hospital. Research the course that is most aligned with your philosophy and approach to birth. The tools you and your partner learn can serve to make your pregnancy and birthing experience the best possible, even in the face of unexpected challenges.

8. Designing your BIRTH - the nursery can wait!

Birth can tend to be viewed as a medical procedure to be endured rather than the momentous occasion for a mother, baby and partner to experience as a family. It is a time worth investing all of the options that lay in front of you. Would you jump into buying a house or a car without careful investigation of services, prices, options? Would you settle because it seemed like too big a task? Think about your baby’s birth in the same way. Your baby is born one time — seems like it is worth investigating how the hospital will support the mom and baby, understanding the differences between OBs, Midwives, Family Practitioners. What options are best for mom and baby? How can the partner be involved? What is best for you as a family unit? Keep in mind that you are paying for all of these services. Isn’t it worth taking the time to ensure that your birthing experience is respected and supported in the best manner possible? For a complete list of options for unmedicated, medicated and planned cesarean birth, we have provided you with a list of birth preferences that make accommodations for all birth designs.

Recommended Resource: The Business of Being Born

9. Where to give birth — Which hospital? At home?

Your first question should be "Where do I go to give birth?" as opposed to "Who do I go to?". Which hospitals are more like birth centers and which ones seem to have babies on conveyer belts? Have you considered home birth? We have every resource available within RI. It is your choice depending on how you see your birth for you and your baby.

Hospital Options

Mother-Friendly designation— the participating family practitioners, OBGYNS, midwives and nurses are supportive of birth plans and of wishes of the family. These providers are respectful of the birth experience as a special time for all involved. See Memorial Hospital and the Alternative Birthing Center at Women and Infants Hospital as examples.

Baby Friendly Designation— The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for lactation. The BFHI assists hospitals in giving breastfeeding mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies and gives special recognition to hospitals that have done so. We have four facilities in RI who are approved as Baby-Friendly.

Home Birth

For some mothers, the prospect of being at home in familiar surroundings provides tremendous comfort and reassurance.

10. Choosing your doctor or midwife — the differences.

You are looking for a medical provider who is a perfect fit for your expectations for pregnancy and birth, not one who demands compromises. You will find that there can be striking differences among doctors and midwives. Keep in mind this is a service for which you are paying. The effort you invest in your birth experience should be comparable to shopping for a car or any big-ticket purchase.

What is most important to you when making a once-in-a lifetime purchase?

Making the best purchase for your family and shopping around for the best package
Going with "what everyone else does" without considering your options
Not making an exchange because you don’t want to hurt someone’s feelings

Midwives

The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures.

Midwifery Group — These practices endorse the Midwifery Model of Care to varying degrees, in some cases, it can depend on the hospital association. Be sure to ask questions and determine your comfort with the level of care and attention.

Home Birth Midwife — Now legal and supported in the state of RI. For some mothers, the prospect of being at home in familiar surroundings provides tremendous comfort and reassurance. Others may feel uneasy that more technical medical assistance isn't at hand. With a skilled midwife and a non-meddlesome approach, homebirth is safer. (Excerpt from http://www.midwiferytoday.com/articles/homebirthchoice.asp)

Doctors

Family Practitioner — a practicing physician who specializes in treating the general medical needs of the whole family. Some Family Practitioners specialize in OBGYN care and attend births.

Doctor of Osteopathy —Osteopathic medicine is dedicated to treating and healing the entire patient as a whole, rather than focusing on one system or body part. An osteopathic physician will often use a treatment method called manipulation -- a hands-on approach to assure that the body is moving freely.

Obstetrician (OBGYN)

"An obstetrician manages labor; the midwife supports labor. The obstetrician makes things happen; the midwife lets things happen. The doctor trusts technology and is wary of nature. The midwife trusts nature and is cautious of technology. The obstetrician fears a birth may go wrong. The midwife expects the birth will go right." William Sears, MD

OBGYN Groups — Typically work within a medically managed standard. You may see one particular doctor within the group, but on the day of your birth, you may end up with a different doctor in the group or with a doctor from a partner group whom you have never met. Your birth preferences may be challenged since the doctors tend to share different views on the meaning of the birth experience.

OBGYN Group that includes Midwifes— Midwives in these groups offer more time devoted to the mother and partner for questions, review, etc. The midwives, however, are typically only available for the standard office hours, not to attend deliveries. If you determine that you prefer the care of a midwife to an OBGYN, you should consider moving to a formal midwifery practice.

OBGYN Private —will see mothers for visits through pregnancy and attend their birth as well. Typically work within the medical model of care. In some cases, if your OBGYN is not available for your birth, you will be seen by an OB from a partnering group instead. Be aware of the policy and the supportive level of the partnering group.

OBGYN / Midwife Private Practice — Please determine through questions whether the practice philosophy is based in medical or midwifery model. It varies from practice to practice.

11. How to change to a new doctor or midwife.

Do you feel completely satisfied with your doctor or midwife or are you feeling like you have to make compromises for your birth? Are you at the right hospital? If you have a little nagging feeling, don’t dismiss it as hormones or being pregnant. That is your gut instinct letting you know it’s time to consider other options. Don’t feel intimidated by changing! You can do it any time, up to the time you give birth if you feel it would benefit you and your baby. Changing providers is far easier than feeling like you are swimming upstream during your labor and birth.

Three Easy Steps:

Schedule a consultation with a new doctor or midwife. Let the consulting office know that you may be changing physicians and your due date.
Choose your new medical provider.
Your new office typically transfers your medical records with one phone call.

End result: Peace of mind, confidence and a birth experience of your design.

Potential reasons for changing providers

Feeling like a number within a group practice.
Your questions are unanswered or ignored during appointments.
Your birth preferences are not acceptable to your doctor or midwife
Knowing you may have a doctor who you never met attend your birth
You know you could have a better experience than what you are being offered
Saying to others, "For my next baby I’ll go there or do that instead."
Red flags: Hearing any of the following…
"I believe mothers should give birth on their back"
"If the baby gets too big, we’ll have to do a C-section"
"I give you a 10% chance of that kind of birth…" or
"I’ll give you a chance to have that birth up to a certain point and then…"
"Don’t worry your husband and I will take care of you" (disregard mother’s role)
The baby’s "safety" is achieved with medical procedures instead of other alternatives

12. Supportive Providers — what is Mom in need of? Conditions

Moms need to determine what they need to feel confident, physically comfortable and happy during their pregnancy. Some of the target issues are listed below with targeted provider groups. There are additional conditions identified on our index. RIBN representatives can help you select a provider to serve a specific condition as well.

Anxiety / Fear — Childbirth Education, Hypnosis, Maternal Mental Health, Yoga
Breech turn — Chiropractors, Acupuncture, Hypnosis
Back pain — Acupuncture, Acupressure, Bowenwork, Chiropractors, Physical Therapist
Pelvic discomfort — Bowenwork, Chiropractor, Physical Therapist

13. Do I need a doula? They don’t take the place of the husband!

A birth doula serves as additional support for mothers and partners during the birth itself and postpartum doulas serve mothers after the baby is born.

Birth doulas may be used in various capacities, some more hands-on than others, depending on the desires of the couple. Couples are encouraged to interview a number of doulas to determine who is best aligned with their birth vision and philosophy. Doulas are available to couples to give continuous physical, emotional and informational support to the mother before, during and just after birth. Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.

Suggested sites:
CAPPA
Doulas of North America

14. What else do I need or need to know?

Don’t become set on your due date! The due date is very subjective and assumes that every woman is the same body type, on the same cycle, etc. Please give your baby the time it needs to finish its development and allow for at least up to 42 weeks. Imagine coming out of an egg too soon…
That you feel completely supported by your doctor or midwife
Finish your birth preference sheet
Practice being relaxed, and gather all of your tools — hone your skills and tools so they are second nature by your big day.
Placental Encapsulation — Placentas have the potential to be a powerful aid in your postpartum recovery and avoiding PPD. Strongly suggested for those who may be prone to PPD.
Sibling preparation — book selection
RI New Mom’s —"Breaking the Silence…"

See Key Resources
Henci Goer

15. Get into position!

Consider how you would feel if you had to urinate or poop on command or have someone dictate how you need to do it? These processes are dictated by sphincter muscles — when they sense stress and agitation, they stop working in mid-flow. Nothing progresses. Keep in mind that your birth is affected in the same way — the baby is the product travelling down a sphincter. The more you can remain in tune with your body and your baby without interruptions, the easier time it is for your body to work as it knows to. Keep the environment quiet, dim, comfortable, just as you would if you were having a romantic evening with music, soft lights and pleasurable surroundings. Would you want to have everything bright and impersonal, being unable to move with strangers coming in asking you questions in loud voices and performing checks in your most private physical places?

Set the stage for your baby’s arrival with care. Will you be able to move freely? The more you can move, the more relaxed you remain, and your body is able to open up more quickly and easily. See RIBN website http://www.mattmasi.com/ribn/encaps-2.3.16/ for position options. Even if you receive medication, you still have options for birthing positions. Getting off of your back can help progression significantly with or without medication and can prevent tearing. Please be informed as to all of your tools for this day.

16. Hello Baby

Be aware of hospital protocols that remove your baby from you after giving birth as a standard. Your baby is craving you for bonding time and nourishment. If necessary, advocate to have your baby rooming in with you at all times.
Are you feeling challenged with breastfeeding? Be sure to solicit the help of a lactation consultant in and out of the hospital. Once you are home, there are lactation consultants and counselors (note differences — must adjust definition in provider directory and link here) who are available to assist in any way necessary.
Remember that sleep, water intake and proper nutrition is essential for breastfeeding and preventing stress. Nap with baby when possible.
Circumcision — a personal decision, but please make with baby’s comfort in mind as well. You do not have to have your baby circumcised in the hospital by an OB — research the hospital procedure thoroughly. You may have the procedure done under a pediatrician’s care or other professional.
Is your pet ready to welcome your baby? Be aware your pet will need a chance to acclimate to the new arrival.

17. New Family

Don’t rush the guest list. Take time for yourselves as a new family.
Baby takes precedence over emails, thank you notes and to do lists.
Getting enough sleep? Be sure to work together to establish a balance so everyone is not exhausted at once.
Be sure the lines of communication between mother and partner are open. This can be a confusing time for partners and mothers to figure out their new roles and become comfortable. Check in with each other to be sure no one is feeling left out.
Families First provides mentors to pregnant and new mothers. There are resources available for any mom feeling overwhelmed or depressed.
Postpartum doulas — can help with housework while mother cares for baby
Moms groups — can provide a safe forum for discussion and answer questions

18. Checking in with Mom and Partner — How are you feeling? What do you need? Selecting providers postpartum Conditions

Breastfeeding issues — Healthy Babies Happy Moms, La Leche League, South County Hospital Lactation Services
Fear/Trauma/Grief — Maternal Mental Health, Acupuncture
Postpartum Anxiety/Depression — can be treated by Maternal mental health, Women & Infants Day Hospital, Mother-Child Bonding, placental encapsulation, infant massage, postnatal massage, acupuncture / herbs, hypnosis, homeopathy
Tearing / Episiotomy / Pelvic Floor Dysfunction - Use a physical therapist specializing in pelvic floor for any issues leading from tearing, episiotomy, pushing or medically assisted births.

19. Baby’s Health - selecting providers for baby condition

Is your baby experiencing symptoms that are not resolved by prescribed medication? Consider integrative care that steps out of the medical standard of care for newborns, infants and children. Consider the effects of mediation in birth, cesarean delivery, vacuum assisted deliveries, oxygen deprivation, traumatic labor and delivery for causes of certain health conditions. See our Provider Directory for providers throughout the state.

Health conditions addressed by specialized health providers

Asthma-like issues — B, CP, CST, H, IP B Bowenwork

Colic - B, CP, CST, H, IP CP Chiropractors

Constipation — B, CP, H, IM CST Craniosacral Therapy

Crying — B, CP, CST, H, IM, IP H Homeopathy

Gas - B, CP, H, IM, IP IM Infant Massage

Reflux - B, CP, CST, H, IP IP Integrative Pediatricians

Sleep Issues — sleep consultant LC Lactation Counselors