Sunday, January 24, 2016

Understanding Your Newborn: The 6 Different States of Consciousness

Good morning! Today, I will talk about the different states of consciousness of the newborn (also called behavioral states), as classified by Dr. Peter Wolff and Pr. Heinz Prechtl. What use is it? By learning to identify the different states of consciousness of your newborn, you will learn faster to know her rythm, which will allow you to answer her needs better and help you feel more confident as a new parent. These six states of consciousness are : quiet awake, active awake, crying, quiet sleep, active sleep, and somnolence.

All of these behaviors have their reason to be, and have different needs associated with them. But I shall start with the most interesting one to me: Quiet alert state

Baby in quiet alert state
Quiet alert state is very close to the attitude a grown-up has when listening attentively to someone. The baby is calm, awake, aware of her surroundings, and taking in new information. Newborns (especially those born without drugs) almost all have a long quiet alert period right after birth, lasting from 30 minutes to one hour. It is the longest time a baby will stay awake for the next few weeks, and it is an important moment to get to know each other, as much for the baby as for the mother. It is one of the many, many reasons why separating a newborn from her mother right after birth can greatly affect bonding. During the first week of life, the baby only spends about 10% of her time in quiet alert state, most of it being during feeding time.

In quiet alert state, the baby is receptive to what surrounds her, and is looking to learn new things about the world, especially about her parents. The newborn is born near-sighted, but she can see at a 25-30cm distance (which incidentally is the distance between the breast and her mother's face). The baby also has a particular preference for human faces. Even this small, they are able to recognize the different facial expressions and try to reproduce them. This can actually become a fun game for parent and child to do together, one that many mothers do instinctively. When baby is in this receptive state,  put her face-to face with you, and make a facial expression, repeating it after a few seconds. Open your mouth, or stick out your tongue, or make a big ''O'' with your mouth. Very often, you will be surprized to find your newborn imitating you! The baby can also follow a red object with her eyes, or turn her head to the side to see where a new sound has come from. But be careful of overstimulating! Stop the game when your baby seems to lose interest or is getting tired. The attention span of such a small baby is very short.

The active alert state : In that state, the baby is moving her limbs and body vigorously, is looking around, and sometimes makes sounds. The baby won't necessarily move continuously, but in a particular rythm, every one or two minutes. This state means in general that it is time to eat, or that something is bothering her, and, if nothing is done, the baby will start crying.

Crying: It is important to know that a newborn baby will never cry for no reason. Crying is a mean of communication. Cries can mean many different things: she is hungry, she is tired, she needs to be changed, she needs to be reassured, she is not feeling well, she is feeling left alone, etc. With time, parents eventually learn to recognize that baby's cries change depending on what she is trying to communicate, and can respond more accurately to her needs. If the baby is crying because she is hungry, it is always better to calm her first, then offer her the nipple. One really efficient way to calm a crying baby is to take her in your arms and/or hold her upright against your shoulder, and walk around with her. When a parent responds to a baby when she is crying instead of ignoring her, it teaches the baby that the world isn't hostile and that her parents are there for her. That helps the baby to feel more secure and loved.

Drowsyness is more of a in-between state, happening as the baby is waking up or as she is falling asleep. The baby has falling eyelids and tired, eyes with an absent look.

During quiet sleep, the baby's face is relaxed, her eyelids are closed and still. She has little of no movement, except for occasional somersaults or mouth movements. Breathing is regular, with the occasional long sigh.

In active sleep, the baby is in the REM (Rapid Eye Movement) cycle of sleep. This is the sleeping state associated with dreaming. The baby's eyes are closed, sometimes half-closed, and we can see the eyes moving under the eyelids. During this sleeping phase, breathing is not regular, and the baby is moving her arms, legs and whole body, or/and makes various facial expression, grimaces and mouth movements. Usually a baby will wake up coming out of an active sleep cycle.  A baby's sleep is almost evenly distributed between active sleep and quiet sleep cycles, changing every 30 mins approximately. Sleep cycles of babies are very short, which explains why they wake up so often.

I hope this article will help you to understand your newborn baby better.

Have a nice day!

Note* I am using the femininine  to talk about the baby, simply to avoid having to put him\her every time. I try to alternate from one article to the other.

Tuesday, December 22, 2015

The Performance: Comparing Sex and Birth

Giving birth is a sexual act. Even though the medical establishment has tried to make us believe otherwise for generations. When we start to compare having sex with having a baby, there are countless similarities. The same hormones are in play, and they need the same conditions to work properly: intimacy, respect, safety, dimmed lights, etc. When these conditions are broken, the hormones are not released as they should, and this can cause a longer labor, or even a stalled labor,  often referred to as ''failure to progress''. Just think: how many women have experiences a slowing or even stopping of contractions as they entered the hospital? Stress and disruption are the main factors that block the hormones of labor (and sex) because they make us release adrenalin, which blocks the hormone of love and sex: Oxytocin.

And what is having sex and conceiving were treated like a medical event, just like giving birth? It's a comparison I use often when trying to explain the hormones of birth to future parents.

One example I use a lot: imagine you are having sex. And then a nurse comes in, turns on the light, and starts to measure the man's penis to evaluate if things are progressing well. That would cut the impulse, right?

It is in the same perspective and to explain that concept that a group of Italian birth activists (Freedom for Birth Rome Action Group)  produced this very funny video that imagined what it would be like if conceiving was treated like birth in a hospital. What would happen if we disrupted sex like we disturb the birth process?  Here is the link: The Performance: Sex like Birth

Upcoming Film: In Utero


During the APPPAH congress I had the chance to see the premiere of a new upcoming documentary feature called In Utero. 

This film, made by the director as she was expecting her first child, explores the various implications and impacts of prenatal live on human beings. How does stress, violence, emotions, war, and even everyday life impact the developing foetus? An eye-opener for anyone interested in the future of humanity.

Since this film deals with a lot if intense subjects, in can be difficult to watch for some people, and even trigger some difficult memories, but sometimes that's what is necessary to bring change. Thankfully, the film ends in a more positive and optimistic note on love and healing.

According the the person who came to show us the film, this feature should come out in a couple of months, and will also be on Netflix.

I leave you with the trailer of this film:

At the APPPAH congress!

I'm afraid I have neglected this blog a little bit in the past months. I will try to write more this year.

A few weeks ago I attended the International APPPAH (Association of Pre and Perinatal Psychology And Health) Congress in Berkeley, CA. The same assiociation through which I recently completed my certification as a Pre and Perinatal Psychology Educator.

It was an amazing congress, full of interesting conferences, all geared towards the same goal of improving our understanding of the various implications of pregnancy, birth and the postnatal period on the development of human beings.  We talked of epigenetics, bonding, education, skin-to-skin, evolution, rituals, assisted reproduction, new research, conscious conception and much more!

I bring back lots of new knowledge and tools to continue my work in perinatal education.

I am also bringing lots of new topics that I will write about on this blog, hopefully within reasonable delays of one another.

Have a nice day!

For more information on APPPAH:

Monday, August 31, 2015

Time to change our Newborn Model of Care

Hi! Today, I am sharing with something that has been disturbing me for a while.

A little while ago, I was with a doula client* in a hospital. The baby required some medical attention. This baby was healthy, except for a few things that showed up in his blood test, and a traumatic birth. Now, I am not a doctor. This baby may have really needed that we intervened, and I am not able to pose a diagnosis or an opinion on that subject. But one thing is certain, the way things were done could have been different, and it would have made a huge difference for that baby and his mother.

My studies in pre-and-perinatal psychology have taught me that most modern newborn hospital protocols have been created under the belief that babies' brains at birth are too immature to realize what is happening to them, to remember it, and that they are not able to feel pain (physical or emotional).  Of course this belief has since been proved entirely wrong, as babies are sentient beings who are conscious of what is happening to then, have a wide range of emotions, and who feel pain even more strongly than adults do. That out-dated belief, combined with a total ignorance of the immense benefits of skin-to-skin, and a bad understanding of the workings of breastfeeding and of the absolute necessity never to separate a newborn from his mother, except in extreme cases, is often still what drives medical protocols on newborn care.

Now this baby, very close to term, who seems healthy, was breathing and pink, and was a champion breastfeeder, was separated from his mother to go under observation. They isolated him in a plastic box. All day long, he had to undergo physical exams, blood draws on every available veins on his little body (including on the scalp), and surveillance by a machine that beeps loudly if something is a little out of the normal (or more often, when the sensor moves). They put him on an IV. They even refused to bring him back to his mother who could not get up, because there wasn't enough nurses on staff to be able to go with him. So they told the mother to pump her colostrum so that we could give it to the baby with a cup.

Never was the baby in a critical state. He did not need assistance to breathe, was not premature, and was not sick. And even if the care he received was necessary, the IV and all, ALL of these interventions could have been done in the room with the mother. An IV? A saturometer? A machine that goes beep to count his heartbeat and breathing? Why can't it all be dont in the room with the mother? Instead of a plastic box, this baby could have been kept warm by being skin-to-skin with his mother, which incidentally also regulates the breathing and heart rate. That way he would also have had the nipple available to eat when he wanted to keep his blood sugar at a good level.  This mother could have been able to get to know and bond with her baby better, and feel more competent in taking care of him and seeing how he was doing. The blood tests could have been done while the baby was breastfeeding, as suckling on the nipple helps reduce pain, instead of being put on a table under a neon with a gloved finger in his mouth.

Of course it is easier to put all the babies in the same room to watch them all at the same time. It saves staff, and makes it faster for all the check-ups. I know the nurses and medical staff do the best they can with the tools that were given to them. But I think it is time to change. It is time to put the discoveries of the last 30 years into work for an entirely new, modern and gentle way to care about babies.

Why is it still acceptable to separate babies from their mothers? Why, with all the microchip techonologies we have now can't we come up with a device that gives a full blood test with a single drop? Or even better still, through the skin? Why do we still make the mothers feel incompetent when it comes to caring for their own offspring? Why do we rely more on the machines than on our eyes to assess the state of a newborn? So many questions and so few answers...

Stories like this one, there are dozens, and a lot of them have undergone even more painful procedures, like a spinal tap for example. And very often, the parents don't have a doula with them to keep the baby company and reassure him until they are able to come take over. As I was keeping this baby company, I looked at all the other babies in the nursery, most often they were left alone for longs periods of time. I thought I was in the 50's. A nurse even said, nodding to a screaming and distressed baby, something like « his brain is too immature to know what is happening, he doesn't know what he want». In the eyes of the babies, you could read incomprehension, sadness, questioning: Where is my mom? What am I doing here?

I got out of this birth shocked, sad, and angry. Angry at the ''modern'' medical system who wasn't able to welcome and protect this baby as it ought to have done. I also got out with my heart full of love and compassion for this mother and her baby, who had a more than trying day. I hope I was able to help a little bit to dim the negative impact of the hospital protocols on that baby. I hope some day things will change, that we will treat the babies as we ought to, and without separating them from their mothers. As a matter of fact, I had a few ideas to improve neonatal care, but this will be the subject of a future post. 

* I have the permission of my client to relate this story

CHAMBERLAIN, David, Windows to the Womb, 2013, North Atlantic Books, California, 225 p.
ODENT, Michel, The Baby is a Mammal, 2007

VERNY, Thomas, with KELLY, John, The Secret Life of the Unborn Child, 1981, Dell Publishing, New York, 253 p.
What Babies Want, film by Debby Takikawa Dc., 2004

Early skin-to-skin contact for mothers and their healthy newborn infants
The importance of Skin-to-Skin contact

Have a nice day!


Thursday, April 16, 2015

About VBAC

Not so very long ago, we used to say ''once a c-section, always a c-section''. This isn't true anymore. Having a VBAC, or a Vaginal Birth after Cesarean is an entirely possible option for women who have had a previous cesarean section and who wish to give birth naturally.

When a woman decides to have a VBAC, some things will be checked in order to evaluate if she is a good candidate. They will look at the reason for the prior cesarean, the length of time that has passed between the pregnancies (ideally at least 18 months), the type of incision that was made, the state of the uterine scar, the woman's motivation to give birth naturally, etc. All these notions will be taken into account and explained to the pregnant woman in order to help her make an informed choice. Having had a prior cesarean section does not count to classify a woman as a high risk pregnancy, which means that in Quebec, VBAC candidates have access to the services of a midwife.

Of course, there will always be talk of risks. The most talked about risk for VBAC, and which incidentally is a very much used argument to scare women, is uterine rupture, which happens in 0.2 to 0.6% of cases (about one to three women out of 500). Uterine rupture means the opening of the uterus during labor, usually on the site of the scar, that can happen to various degrees. But if we put things in perspective, this percentage of risk is comparable to the risk of losing the baby during an amniocentesis, a procedure that health professionals do not hesitate to recommend to women to screen for genetical problems in the baby. It is also interesting to know that the perinatal death rate for babies in VBAC is the same as for women giving birth for the same time.

We also often forget to mention all the risks associated with undergoing a repeat caesarean section. It is important to remember that a c-section is a major abdominal surgery that not only poses risks to mother and baby, but that especially implies a much longer and harder recovery time than with natural childbirth. Actually, one of the most often heard remarks from women who had VBACs is their astonishment at their speed of recovery with a vaginal birth compared with their surgical experience.

There is another medical attitude towards VBAC that I don't like. It is that in medical terms, when a woman wants a VBAC,  they won't say she's going for a VBAC, they'll say she's going for a TOLAC (Trial of labor after cesarean). If she succeeds, then they'll say she had a successful VBAC. It's like saying "We don't really believe you can do it, but we'll let you try and they we'll see".

I could carry on talking about the pros and cons of VBAC, the interventions to avoid, and the choices that are available to women. But there are already numerous books which do that very well. As a matter of fact, I highly recommend to you the book: Birthing Normally After a Cesarean or Two- A Guide for Pregnant Women, by Hélène Vadeboncoeur.
I would actually like to look at the side of VBAC that I consider the most important: the psychological side. Having a VBAC starts in your head. Do not let others discourage you with their fears. Once you have made your choice, believe in it. Also do the exercice of dealing with the trauma of your cesarean experience, and trying to make peace with it. There are many many different approaches, from traditional to spiritual to help you through that journey.

When we listen to women who have had a VBAC they all radiate this wonderful feeling of empowerment. This makes me think of one of them in particular whom I saw recently. She had her VBAC a few weeks ago. This usually shy young woman had a completely different vibe about her. You could feel how proud of herself she was, how healing that birth was for her. She was glowing. I thought she was so beautiful, just sitting there holding her baby, and completely in love. And this proud, empowering moment where she welcomed that baby into the world, this beautiful episode of deep healing of her previous birth experience, she, like so many other women , will be able to revisit it in times of doubt or hardship. What a wonderful gift from life!

So, here is some advice to put all the chances on your side for your VBAC (This advice is also good for any birth, come to think of it):
- Believe in yourself
- Hire a doula
- Go for a follow-up with a midwife, of carefully choose your hospital to make sure they are pro-VBAC
- Read and listen to positive stories of women who had a VBAC
- Make sure you know all your options
- Keep in mind that no one can force a woman to undergo a cesarean section without a medical reason.

Sometimes, life can also be unpredictable. So if, even following all the advice and being as ready as you can, another cesarean is required for reasons out of anyone's control, you will have the feeling to have tried everything and will hopefully be more in peace with the situation.

I also highly suggest you watch this new documentary called Trial of Labor. It just came out and follows the journey of a couple of women going for a VBAC. They all have different stories and different outcomes, but it is a really beautiful movie to watch, and very well filmed too!

There is also ICAN, the International Cesarean Awareness Network. It has a lot of information on cesareans, VBACs and anything related to that subject.

Have a nice day!

BUCKLEY, Sarah J., Gentle Birth, Gentle Mothering, Celestial Arts, USA, 2009, 348 p. 
GASKIN, Ina May, Ina May's Guide to Childbirth, Bantam Books, USA, 2003, 348 p. 
VADEBONCOEUR, Hélène, Une autre césarienne ou un AVAC?: S'informer pour mieux décider, Éditions FIDES, Québec, 2012, 380 p.

Wednesday, February 25, 2015

Aren't you afraid of giving birth?

Often, when I am talking with friends or new acquaintances, the subject of the conversation often turns toward birth (who would have thought, eh?). Almost every time, I am asked the following question: Aren't you afraid of giving birth?

FEAR... This word appears so often when it is question of childbirth and maternity. Not only from childless friends who haven't really thought of the question yet, but almost everywhere, and especially coming from mothers about to give birth...

Fear of pain, fear of tearing, fear of bleeding, fear that the baby won't be healthy, fear to die, fear that labor will be long, fear of not being a good mother, fear of not being able to breastfeed, fear that our vagina won't come back the way it was, fear that out breasts will be affected breastfeeding, fear of the c-section, fear of not being able to lose the extra pregnancy weight, fear of the responsibilities of maternity, etc, etc, etc.

Fear is a birthing mother's worst enemy. When we are afraid, we release adrenalin, a powerful hormone that can mess up the fragile balance of the hormonal cocktail making birth possible. This can create a stalled labor, bring interventions and create complications. When we are confident instead of being afraid, we are putting chance on our side for everything to go well.

To succeed in this, the best thing to do is to start early to identify and eliminate our fears one by one. Ideally, do this even before getting pregnant. Don't wait until the last weeks of pregnancy to deal with your fears, but better late than never.

But where do all these fears come from? They are mostly generated by our cultural environment, medias, and even religion, who are creating and projecting exaggerated visions of childbirth. For a dramatic or comical effect? For control? I am still waiting for mainstream TV shows and films showing a beautiful vision of childbirth. We are surrounded by horror birth stories. We talk about all the worst things that can happen, but we omit all the beautiful stories. Is it because they are not entertaining enough? Because we don't want to hurt the feelings of the mothers who did not have an idyllic birth experience?

Yes, it is true that complications can arise, and that there are women who have traumatic births. But when we are focusing on these stories, we feed fear and forget everything that can go right, and all the wonderful births that happen too.

It is important to remember that a lot of complications arise from wounds and traumas that have been left undealt with. They can concern your own birth, your sexuality, your self-esteem, or a previous birth. One of the worst mistakes to make is to brush away these fears and pretend that you're over them, because they have a tendency to catch up with us during our most vulnerable moments... during labor, for example. Yes, it is hard to dig into our past traumas, it can be painful. But once we free ourselves from our past wounds and traumas, the fears associated with them cease to exist.

The first thing to do is to talk about our fears. Sometimes it is all that it takes. The simple fact of naming our fear makes it smaller. There are also a multitude of tools to help us free ourselves from our fears. Start early. Even before getting pregnant (if possible), look around and within yourself to find the tools to deal with your wounds and fears. Early in pregnancy, try to obtain a follow-up with a midwife, or hire a doula. They can help you unwind your fears one by one, and orient you towards various tools if you wish to go further. Look for positive birth stories, the ones that give you confidence instead of creating anxiety. The tools are there, you just have to reach for them. It is also very important that the future father also address his fears, as they can influence the mother and affect the process of birth. Fear is contagious.

There are also alternative therapies for those who wish to try them out: hypnosis, energy treatments, rebirth. These are only a few examples of ressources available to help us go to the bottom of our wounds and fears.

No, I am not afraid of birth. In the birthing center where I work, beautiful births are the norm, not the exception. Yes, I have seen a few emergencies, but I have never doubted the skills of the midwives to deal with the situation. I have also been working on myself for the past few years, to make peace with my own birth, heal my wounds and dig into my own fears, allowing me to be more confident with life and connected to my intuition. I surround myself with positive stories, and I do not watch sensationalist birth TV shows.  Now, it's all up to you!

Have a nice day!