Hybrid Midwifery by Hannah Weiss

View fullsize

Hannah Weiss, LM, CPM in her roll as Hybrid Midwife

HYBRID MIDWIFERY

In planning a hospital birth, you're encouraged to stay at home until labor is well under way before transitioning to the hospital for birth. How do you feel about that? Will you know when that time has come? Can you determine how far along you are in labor? Even the timing of contractions can be misleading. Doulas provide crucial support and guidance during these intense hours, and midwives take it to the next level with the ability to check dilation and the baby's heart beat. It's next-level birth support.

Hybrid Midwifery was born from a desire to provide one-to-one continuity of care to women planning a hospital birth. Not every woman wants to birth in her home, but every woman should have access to the personalized prenatal and postpartum services of a midwife. Many of you are familiar with a doula’s role, but most need clarification between a doula and a midwife.  A doula provides advocacy, education and emotional support in your home and in the hospital. A midwife is clinically trained and licensed by the state medical board to provide maternity care to women during the prenatal, birth and postnatal period. A Hybrid Midwife can give you care alongside and in cooperation with your obstetric care, giving you 24/7 support in your home up to and after you have your baby in the hospital.  

Why are women drawn to Hybrid Midwifery in conjunction with standard medical care?

Some women simply want more maternity care; they want more information, they want more support and they want it to be holistic, incorporating all aspects of the human experience in pregnancy and birth. This includes emotional support as well as physical, nutritional and medical support.

An increasing body of research has unveiled the emotional and physiological benefits of being previously familiar with a medical practitioner who attends your birth. Simply having the continuous support of a doula can reduce labor time, the likelihood of a c-section and preterm labor. In case you’re interested, it also reduces the odds that you’ll need an epidural.   These statistics alone have helped doulas and midwives increase in popularity. 

Doulas are tremendously valuable practitioners, they offer physical and emotional support for you and your partner as well as vast knowledge about the birth process and hospital system. Different from a doula, a Hybrid Midwife has medical authority to administer healthcare prenatally, postpartum and at home in the early stages of labor before transitioning to the hospital for birth.  

Holistic Prenatal Care

Your midwife will be your touchstone throughout your pregnancy and birth process. She will monitor your health status as you move through the medical system and support you as a familiar and trusted guide.  The schedule for midwifery prenatal visits mirrors your OB visits, allowing for tandem care.

During these in-home hour-long visits, you’ll discuss topics that complement your obstetric care, like nutrition, exercise and ways to prepare your body and mind for birth. Perhaps most significantly, you’ll have time to discuss any fears or concerns that may be arising around pregnancy or birth. Your midwife will medically screen you by checking vitals, listening to the baby’s heart beat and discussing testing options such as genetic, gestational diabetes and Group B Strep, to name a few. 

As you grow closer to delivery, your midwife will help you create a Birth Plan that may include desires around pain management, IV use, and what types of procedures you would like performed on your baby. You're able to discuss the pros and cons of each option with the midwife, so you have a basic understanding of the medical process. 

Home to Hospital Midwifery Support

Laboring at home with your midwife decreases the likelihood that you’ll receive medical interventions, sometimes a bi-product of arriving at the hospital too early. Different from a doula, your midwife continuously checks the health of both you and your baby during labor. She is constantly making sure it's safe to remain in the comfort of your own home for as long as possible. As your labor progresses, your midwife will help determine when it’s time to go to the hospital by checking cervical dilation, assessing your contraction pattern and the positioning of your baby. 

At the hospital your midwife transitions into the role of an advocate, providing continuous comfort measures, breathing and meditation techniques and overall guidance for your needs and desires. After the birth of your babe, she remains by your side for an hour or more to help with breastfeeding. Your midwife will capture family photos and help transport the placenta should you choose to save it.

Postpartum Magic 

Maybe you remember those early days postpartum or you’ve heard stories about how physically and psychologically fragile the beginning of parenthood can be. Intense hormones and learning how to feed your newborn can be maddening, not to mention the complete physical recovery from a vaginal birth or C-Section. With this in mind, it’s no surprise that 24/7 access to a trusted healthcare provider is not only comforting, it’s clinically significant in decreasing postpartum depression and helping the entire family unit adjust. Unfortunately, in the common medical system, mothers won’t see a practitioner to assess their health and recovery for six weeks after discharge from the hospital.  Enter your Hybrid Midwife.

When you’re all settled back home, your midwife schedules six full weeks of postnatal care for you and your baby. She will usually visit five or more times in these postpartum weeks, starting twenty-four hours after you arrive home. Your midwife’s long list of medical support topics will include lactation, normal newborn behaviors, umbilical cord care and vaginal healing. She will check your postpartum bleeding and vitals, to make sure you don’t need further medical care. She weighs the baby, assesses normal growth patterns, listens to your baby's heart and lungs and is consistently making sure your newborn is thriving. 

A lot of questions come up in the first few weeks of welcoming your new baby into the world and it's truly wonderful to have a medically qualified and compassionate midwife by your side. Your midwife will carefully assess your overall emotional health, allowing you the time and space to learn what is “normal” and what is worrisome.

Aside from her vast knowledge, your midwife is also deeply connected to the wider community. Should you need referrals to support groups, lactation consultants, overnight doulas or massage therapists, your midwife is connected to this vibrant network.

Hybrid Midwifery is the best-kept secret out there!  In the interest of perpetuating the health and vitality of early parenthood, spread the word! 

DOES YOUR MEDICAL INSURANCE COVER HYBRID MIDWIFERY? 

Verify your insurance benefits here using Hannah Weiss’s provider details, (note that it’s a $20 verification process): 

City: Oakland
State: CA
Zip Code: 94611
Phone number: 510-685-6703

---

MEET Hannah Weiss, LM, CPM 

Hannah Weiss is a Licensed Midwife under the Medical Board of California and a Certified Professional Midwife under the North American Registry of Midwives (NARM).  Her formal education consisted of a three year accredited midwifery school and two clinical home birth apprenticeships in California and Utah. Hannah regularly attends Peer Review and is an active member of the California Association of Midwives (CAM). She  held the lead doula position at  Glow Massage and Birth Support for 2 years before starting her midwifery practice.  Hannah is certified in Neonatal Resuscitation (NRP), CPR and First Aid.   

When Hannah is off-call she travels home to Kaua'i where she grew up surrounded by an abundance of nature and the rhythms of the ocean.  She currently lives in Montclair, Oakland with her husband Martin, head chef for Maiden Voyage Meals, it's a family affair!   

Toddler, Much? An interview with Dr. Jill Sulka, PsyD

Jill, as a mother of two and a psychologist specializing in 0 to 8 years old, you are uniquely qualified to give your opinion on toddler matters. In your personal and professional experience, what is the most difficult aspect of parenting a toddler?

Perhaps the most difficult part of toddler parenting is keeping your own emotions in check. It’s so easy to become frustrated with a toddler who wants to do more and say more than they are capable of developmentally, and losing your cool will only fuel a tantrum.

Toddlers are coming into a newfound sense of themselves as differentiated from their parents. In this crucial phase of development, toddlers are navigating their emerging autonomy while needing the security of their relationship with their parents. When toddlers come up against their own limits and the limits of their parents, frustration and disappointment can be overwhelming and seem very out of proportion to the situation.  While this sometimes intense phase can feel like a train gone off the rails, your toddler is tackling essential and normal developmental tasks. 

As a mother of twins, I have certainly fallen into the traps of a frustrated parent. One of my twins has the temperament of what we commonly call an “easy baby”, and even as a toddler this child’s feelings didn't lead to an extended loss of control.   He easily accepted the comfort and assistance I offered, the ups and the downs weren’t so extreme, and all of my professional and personal parenting strategies worked. These interactions were gratifying and rewarding.

With my other twin, the same strategies  didn’t result in the same outcomes. This twin, constitutionally, came into the world much more fiery and intense. It gave me the opportunity to feel the humility of learning to navigate that relationship and our fit.

All children bring their different and unique selves, and self-blame is such an easy trap to fall into as a parent. When you compare yourself to others, it's impossible to win. As a professional, observing the number of children I have in my career, I can assure you that there is so much variation in what babies and toddlers bring to the relationship. It’s about meeting your children where they’re at and knowing that they’re all going to be different, and what you need to do to meet the specific needs of your child and your relationship with them may look different than how another parent learns to be best respond to their unique child.

Ah yes, parental judgment, my favorite aspect of the job. That’s such a brutal one, because you can be judged by others, sure, but the judgment you place on yourself follows you home.

Exactly! I believe so strongly in compassion for ourselves. We are all going to be thrown by what our children present us, so it’s about having compassion when we fail over and over again. "Success" is weathering the storm as you show up in the best way that you can. It’s about striving towards how we want to be in our best selves as a parent, to each unique child.  That doesn’t mean you wouldn’t want to reach out for help to learn more effective ways to parent and to manage your own triggers that come up, but be easy on yourself in your self-judgment as you strive to learn more about your child and yourself as a parent.

The act of parenting is your opportunity to learn who you are in this evolving role and even to revisit your earlier history from a different perspective.   Your worth as a parent is not  dependent on what others think; know that kids are different, and it’s very easy for others to judge what they haven’t personally experienced.

Remember that your role as a toddler’s parent is to do your best to assist your child to calm down, to manage their big, irrational feelings and eventually those experiences of help in managing their feelings will result in the child developing the capacity to soothe themselves. As a part of healthy development, toddlers do need to push their emotions and your limits to the very edge sometimes, and just being present to help them calm down is doing the necessary work.

When dealing with a tantrumming  child, remember that the tantrum will end, and that your value as a parent is not determined by whether or not your child throws a tantrum and for how long.  You can neither reason with your child toddler about their upset, nor force the tantrum to end. No matter how “perfect” you are as a parent, your toddler will still have tantrums; stopping them isn’t the goal, staying emotionally connected with them  through their ups and downs, while calming yourself, is. In fact, tantrums are normal and important work for toddlers.

Important life lessons about emotions and relationships come out of a tantrum:

• Big feelings are survivable;

• Feelings shift and change;

• Their parent is still there, a real separate person who didn’t fall apart or retaliate.

• Relationships can recover from hardship, their parent still loves them.

Know that after the toddler years, your child will have more capacity for reason, for being rational and for being socially and emotionally available in a different way. This phase does not last forever.

We all make “mistakes,” we all overreact at one time or another. Always remember that there is power in repairing the relationship with your child when you haven’t succeeded the first time (or the 10th time);  it teaches your child that big emotions are survivable and that the love remains intact even when we have a disruption in our connection. 
 

Acknowledging that every family is unique, what are some common ways you observe parents contributing to the sometimes brutal frustration of toddlerdom?

Trying to control the toddler’s behavior in order to manage your own emotions.

When your emotional state is dependent on how the child is behaving, that is often how power struggles begin. If you feel the emotional pressure building inside of you because of what your toddler is doing, it’s easy to become more insistent and controlling of your toddler in an effort to shift your own feelings and reactivity. When you are feeling upset, frustrated, saddened or angry, notice your reaction, take care of it separately, independent of what the toddler does. 

Taking responsibility to manage your own feelings and not take your child’s oppositionality personally is a primary part of parenting during this period, especially because toddlers have embraced the experience of saying the word “no” as a way to experience their newly emerging personhood, as an individual separate from other people, testing out how their world and relationships work and hoping to find it predictable.   While it may be greatly frustrating for you, your toddler is doing something utterly necessary for their growth as a human being, and it has nothing to do with good or bad behavior. And it has nothing to do with disrespect.

In the December 2015 newsletter you explained that “time-out” is counterproductive for most children. Can you please explain briefly what time-out does to the child mind at 18 months to 4 years of age?
 

Thinking of your child as behaving badly disposes you to think of punishment as the answer. Alternatively, thinking of your child as struggling to manage something difficult encourages you to help them through their distress.
Even if we were to consider the merits of time-out  as a productive form of discipline, it would not ever be valuable for a child younger than 3.5 because the parts of their brain that are necessary to make any use of something like that are not yet developed. A toddler is not yet able to go sit and think about what they did, that is not part of their capability  and is not be part of the experience of being a toddler.

In general, connection with their important adults is the primary thing that helps toddlers calm down. Being forced to separate from their parents and to be alone can have the opposite effect, children become even more distressed and dysregulated.

So, in addition to whatever the original disappointment or frustration was, they now have to manage the disruption in the emotional relationship with the parent. Consequently, they can become so overwhelmed with that disruption in the relationship, that the likelihood of learning from the experience decreases dramatically. Now they are distressed by being isolated, but they are not aware of the cause.
 

Are you saying that toddlers are not yet capable of understanding consequence? 

Often parents will designate consequences that have no relationship to what was going on with the child. The closer the consequences are to what actually happened, what we might call “natural” consequences, the more likely a child will make a connection between the consequence and the behavior. Then, the child doesn’t view the consequence as punishment, but part of a natural sequence of events spurred by the problematic behavior. The child then learns that there are rules, and that they can expect that the rules will be upheld, as opposed to learning that they are “bad”.

For example, your child is throwing a shoe in the house, and this is against your house rules. Firstly, say a few times,  “We don’t throw shoes in the house because they are hard and can break something.” Then offer the toddler an acceptable object to throw (i.e. a little foam ball or a small stuffed animal), and simply say, “The shoe is going away”, and take the shoe away. Do not allow the shoe to be part of the equation any longer, as opposed to saying, “Now go on timeout!” or “No dessert tonight!” which is entirely unrelated in time and in associative connection to what actually happened. The timeout or the withheld dessert are independent of throwing the shoe, and this type of punishment undermines the learning of why the shoe was taken away because the consequence is not meaningful to the toddler mind. 

Your child’s job is to be a scientist in the world--they need to push limits in order to understand the boundaries of the world. They will test the hypothesis that things will or won’t respond as they expect over and over again and this includes testing their social relationships. This is how the child learns that they are secure, that their relationships are lasting and strong. They are going to push and push and push against the limit in order to understand what the world is, and that it won’t be destroyed, and that they won’t be destroyed, . They will actually feel safer after pushing a limit and having it enforced in a way that is meaningful to the toddler mind.

It would be tremendously helpful to have some toddler parenting guidelines both for self-management and for child-management, please give us a shortlist of parenting tips.
 

I know it’s popular to publish clear “Do’s and Don’ts” on parenting, but I so strongly believe in compassion for ourselves, that I have a problem with this style of education. Here are some basic guidelines to help you through the toddler years; let’s call them “Try to’s” and “Try not to’s:”

---

Try to…

• Find your calm. Your own managing of your own feelings in the moment is the number one thing that is going to be helpful. When you have stress hormones coursing through you, it has an effect on the stress hormones coursing through your child. Remember, you are needed as the secure base that anchors your child’s world, and if you collapse or get angry or hurtful back, your child’s anxiety—even devastation--about the rupture between you intensifies their distress and out of control behavior.

• Validate your child’s feelings. Even when we’re ignoring the behavior, we don’t ignore the child. We speak to the distress, “You really wanted the purple cup, and it’s not here, it’s so disappointing.”

• Give your child the words to express what they’re feeling. “I think you’re feeling really mad and you can say ‘I’m mad.’” That’s how they are going to learn to express themselves through words instead of through their bodies.

• Give your child reasonable choices. “The purple spoon isn’t here, so would you like the red spoon or the yellow spoon?”

• Offer physical comfort. The child may not be able to verbally express that they need comfort in the form of affection.

• Express reassurance. After the tantrum, reassure your child that you love them, that the relationship will be ok.

Try not to…

• Think of your toddler’s tantrum as misbehavior or disrespect.

• Reason or argue with your toddler. Logic will not work, a toddler is not capable of logical reasoning, even if they are verbal, so we often forget this and then feel manipulated, or compelled to negotiate.

• Give your child false choices: “Would you like to use the red spoon or go buy the purple spoon”, if you don’t intend to fulfill the promise.

• Punish your toddler for their out of control feelings. Try not to yell, scream or scold the child. Don’t put them by themselves and expect them to manage their distress on their own. Try to remain connected to your toddler through the tantrum: they are needing your support while they navigate their own intense feelings.
  **Exception: If your own stress leads you to feel like you are no longer effective in the interaction with your child, if you aren’t able to calm down by remaining with your child or if you feel you might harm your child, put your child in a safe place, tell your child that you are going to calm down and that you’re going to come back,, then go take of yourself so you can come back and be more helpful to your child.

• Don’t collapse or retaliate. Don’t be so scared of the toddler’s feelings or behavior that you are willing to do anything to appease them, that shows the child that their feelings are more powerful than anything else, more powerful than you are. Don’t retaliate by getting angry and returning their aggressive or destructive behavior. For example, by hitting them if they hit you, or an older children will often say “I don’t love you” or “I hate you” and it is only destructive to say it back to them.

---

MEET JILL SULKA

Jill Sulka, Psy.D. is a licensed psychologist who specializes in infant and early childhood mental health. She provides parent consultation, infant-parent and child-parent psychotherapy, and child play therapy in her office and at home, depending on the needs of the family. Dr. Sulka has been providing psychological services for 20 years, and has directed several programs for parents and their children birth to 8 years old. She believes that every child and parent deserve the opportunity to develop a relationship together that best supports that child’s potential to grow well and love well. Jill regularly contributes to the Glow newsletter and her articles can be found in the Parenting section of our Resources page. She can be reached at (510) 326-2002 and jillsulka@gmail.com.

Your Heart is Depleted.

My lovely baby girl is 18-months-old today.

Around her first birthday, I started managing crippling abdominal pain. The pain stops me in my tracks and wakes me in the middle of the night. Causes me to double over, grimacing and sweating while I wait in line at the grocery store; somehow still managing to dangle something – anything -- in front of my daughter’s face to keep her content for Just. Five. More. Minutes. Yet another attempt to stave off the piercing scream that marked her entry into this world and continues to sound out throughout each day to signal hunger, sleepiness, boredom, displeasure, disapproval…

My soul was not prepared to withstand the overwhelming amount of adoration and responsibility that accompanied my daughter's birth. I remain unstable. Many days I’m convinced that I will feel this way for the rest of my life. I often marvel at the fact that we are only at the very beginning of this journey together. Down the road remains teaching her how to ride a bike, helping her with math homework (ahem, learning how to do math), and holding her close when someone breaks her heart. Once you enter motherhood you can’t turn back. We are forced to evolve at someone else’s pace and keep up, keep up, keep up.

And I want to be the best. Mostly because I want her to be the happiest, healthiest person that ever was. Also, selfishly, I want her to love me as much as I love her.

But I digress -- back to the stomach pain. For months I’ve endured this pain. Most days I thought it would go away on its own. Some days I thought it was a sign of a heart attack. At some point, I think I just accepted that living with chronic pain was my new reality.

The truth is that between keeping a relatively new job, keeping a relatively neat home, keeping my husband relatively happy, toddler giggles, first steps, “Goodnight Moon,” changing diapers, changing clothes, filling bottles, cleaning the cat litter, feeding the dog, “Twinkle, Twinkle,” Doc McStuffins, breakfast, lunch, dinner, and “MOMMY!,”I just didn’t have time to figure out what was happening to me. There were never enough hours in the day to genuinely check “Take care of me” off of my to-do list.

My body showed evidence of this, too. Post the initial breastfeeding weight loss, I’d put on some weight. I ate whatever was nearby without thinking. My grad school days of eating only raw food, cognizant of the intentionality of food consumption as fuel for my body, soul, and mind, were long gone.

Then one day I sat in a meeting, pain searing through my stomach to my back and radiating down both sides of my ribcage. The room was fuzzy. I couldn’t focus on my colleague’s words. I could only focus on taking shallow breaths and contorting my body in just the right way to make it through this flare-up. I was finally fed up. I made my first appointment with my doctor.

As of today, I’ve had several appointments with specialists, including the one where they stick a camera down your throat. Nothing has been named. No plan for healing identified. No relief in sight. The ‘diagnosis’ does not ring true with my experience. I called my gastroenterologist the day after that procedure, failing to hide my lack of faith in his opinion, “This is not acid reflux. I was pregnant about a year ago. I know acid reflux intimately.”  

A month ago, I started seeing a Chinese Medicine practitioner. She is convinced that the pain is related to food sensitivities and digestive disturbances, and I’m inclined to believe her. After some changes in my diet and the addition of some digestive herbs, I feel better. I’m not 100%, or even 85%, but I feel better. 

During our second meeting, she did fire work over my body as she walked me through a guided meditation. This was the start of the shift to less pain. I felt at peace. As she closed the session, she shared what she’d learned about me that day. Four words rolled off of her tongue that will stick with me for the rest of my life, “Your heart is depleted”.

Having met the love of my life just a year or so prior, I could not fathom that this was true. My heart had never felt more full. The rewards of motherhood outweighed the pains every day -- not every moment, but definitely every day. She continued to tell me that I needed to find time to connect with other grown-ups – to laugh, to dance, to escape the to-do list.

I’d been so wrapped-up in giving all of me to my family, to my daughter, that I’d opted to endure a life full of pain just to keep doing it for her. My healer went on to explain that in the end, that choice would only be hurting my little girl as she would get a lesser version of her mother. I’m certain I’d heard this once or twice before, but it's so easy to get sucked in without even realizing it.

This time the light bulb went off. To help create the happiest, healthiest person ever, and even to achieve the impossible of having her love me as much as I love her, I have to make time for self-care. And, every once in a while, I have to attempt to define my health and happiness as separate from hers. I imagine this will be something I will have to remind myself of often.

The spa day is scheduled. I’ll keep you posted.

RESOURCES 

Get yourself some bliss:

ACUPUNCTURE | Cara Brockbank’s Temescal practice combines classic acupuncture with divine aromatherapy, set in a charming craftsman cottage.

TAROT | Are you having trouble tapping into your gut feelings? This is your remedy. Laura Zuspan’s tarot readings are just the dose of reality you need, with a sprinkle of magic on top. Laura pulls from her beloved tarot deck and offers grounded, pertinent observations without judgment.

INDIAN SPRINGS | Located in Calistoga, this resort and spa is the perfect day trip to fit between daycare drop-off and pick-up. Our favorite treat is the mud bath and mineral pool combo.

GLOW POSTPARTUM DOULA CARE | Email us to find out more about our postpartum doula services which include a suite of wellness therapies tailored for your experience. 

---

MEET IMAN MILLS GORDON

Iman is an independent consultant living in Oakland, CA with her husband and their daughter, Lena. With the support of her family, Iman continues to actively pursue her ultimate balance.

Diastasis Recti with Mary McQueen from Baby Bootcamp Oakland

Let’s get right into the Diastasis Recti struggle- firstly, how do we pronounce this word?

Haha, tomayto, tomahto. I have heard people say it both ways - "di-uh-stay-sis" with a long second a and emphasis on the third syllable (which is how I pronounce it), or "di-aa-st-uh-sis" with the emphasis on the second syllable. The Greek prefix Dia- means “through” or “going through” and -stasis means permanent. So, in effect, going through and separating, and then staying that way. Luckily, there are many techniques to modify DR.   

Now that we can discuss Diastasis Recti (DR) like we know what we’re talking about, tell us what it is.

Diastasis recti (DR) is a separation of the connective tissue (linea alba) of our “6-pack” ab muscles (rectus abdominis). If you draw a line from the center of your ribs, down to your pubic bone, directly through your belly button, you are tracing the linea alba. This fibrous band connects all of your abdominal muscles like a corset: your obliques (abs at the sides of your waist, above the hips) and transverse abdominal muscles (our deepest layer of abs, wrapping like a corset).

DR is NOT life-threatening - it is a natural part of pregnancy, delivery, and birth recovery, that is often ignored by the American medical community. Left untreated, DR can seriously impact your quality of life. A severe separation of your abdominal muscles results in a weak pelvic floor, uterine prolapse, inadequate support for your internal organs, and may possibly result in back pain and tight hamstrings. 

How did you learn about DR in the first place?

A couple of years ago, a friend and former Baby Bootcamp instructor got certified in the Tupler Technique. Tupler is another program that works on repairing DRs without surgery. She asked if she could speak to my Baby Boot Camp moms about it and do DR checks for my clients. She checked me, and lo and behold, I had a 3+ finger separation at my belly button, which explains (at least partly), my chronic low back pain! Since then, I have become licensed in Baby Boot Camp’s Core 9 Birth Recovery and Diastasis Recovery programs in an attempt to bring this education to mamas that really need it. 

How can we find out if we have DR and what are the symptoms prenatally, postpartum or even years after birth?

It is easiest if someone else checks you (I check all of the moms that attend my Baby Boot Camp classes), but you can certainly check yourself: 

Lie on your back with your knees bent and feet flat on the ground, one hand behind your head. With the other hand, place your index and middle fingers inside your belly button with your palm facing you. Inhale with your head resting in your hand and then as you exhale, lift your head and shoulders an inch or two off the ground, like the beginning of a mini-crunch.

With your head up, you should feel the rectus abdominis muscles harden around your fingers. You then see how many fingers you can fit between those muscles. You will want to measure at your belly button (if you have a DR, it is usually largest at your belly button). Additionally, measure a couple of inches above your belly button, and a couple of inches below.

When I check moms at Baby Boot Camp, I also look for how far down I can push my fingers. Some moms have very shallow separations, which are not as concerning as deeper DRs. Moms that have a 1-2 finger separation can do most exercises; I modify significantly for 3-finger separations. If you have a separation of 4 or more fingers, you are still able to workout and come to class, but you should also see a physical therapist.

If you find that you have a separation, your goal is to strengthen and correctly engage your transverse abdominis muscles (TVA), which will start to bring the rectus abdominis back together. Do not do work that engages your Rectus Abdominus, or 6-pack muscle, it will only further the separation.

Is there any way to avoid DR during pregnancy?

Stay active during your pregnancy and learn how to engage your Transverse Abdominal muscles (TA).

Never sit straight up from a reclining or flat position. Roll to your left side and then press up to seated with your hand every time you get up from bed or mat-based exercises. This way, you avoid putting additional pressure on your abdominal muscles and connective tissue.

We recommend signing up for our Core9 Birth Recovery program a minimum of six weeks prior to your due date. Core9 Birth Recovery provides specialized support specific to where you are at in your postpartum recovery. It begins with essential movements that you can do at home immediately after delivery.  

There are some specific exercises and movements to avoid if you have a DR. You should not do any twisting movements (for example: Russian twist and bicycle) but you can work your obliques by doing a modified side plank instead. 

Avoid a full plank position until you bring your DR down to at least a 2 finger separation, and this includes push-ups. These should be done with your upper body elevated or with your knees on the floor, and possibly not at all, depending on the severity of your DR. And NO sit-ups!!! Please!

If you take one thing away from this interview, mamas, no more sit-ups, no more crunches, no more roll-downs! I never do any of these in Baby Boot Camp classes - they can make your DR worse. We are socially conditioned to do crunches and sit-ups when we hear it is time for “mat work” or “ab work.” Not only is this not the most effective way to work your core, but it can make your DR worse, and all of that flexion and extension can be really harmful for your back. Did you hear that the US Army is phasing out sit-ups because of spine injuries?! 

There’s so much pressure on mamas to get “back into shape” within a couple months of giving birth - how does this impact your clients’ health?  

Sara, I see this all the time, and I completely understand - most of us have a very limited amount of time off of work with our newborns, and our goal is to LOSE THE BABY WEIGHT! I get it! But things take time. Through Baby Boot Camp, I’m really trying to shift the focus more towards long-term health, safety, and longevity. Boot camps can be really great, but there is a danger in throwing yourself back into exercise and not listening to your body’s signals to pull back.

A physical therapist that specializes in pelvic floor issues spoke at the last Baby Boot Camp conference and she said that because of the relaxin still in your body (a joint loosening hormone), you should not run until you have stopped nursing! Now, I understand that sounds a bit extreme, and there would probably be a mutiny if I told my mamas that, so we have compromised and instituted the 6-16 week rule - moms can come to my classes 6 weeks after a vaginal birth and 8 weeks after a c-section, but from 6-16 weeks, we HIGHLY encourage moms to take the low-impact modifications and to power walk instead of run. You will still get a great workout, trust me!

You might feel really great after having your baby (and I hope you do!); but, use me as an example: I felt great and wanted to get back in shape and went back to teaching way too early, and I’m dealing with issues that I can trace back to my compromised core strength almost four years after I had my last baby!

How would you recommend that a new mama ease her way back into health, what’s your ideal plan from birth to 12 weeks?

I love this question!

About a year ago, we created a program called Core9 Birth Recovery. The program involves weekly supportive emails, movements and stretches you can start doing from week one postpartum, easy and nutritious recipes, and in-person Diastasis Recti checks for 0-9 weeks postpartum.  

I would recommend using a postpartum belly binder during exercise and movements. Walking is great if you’re ready for more movement, and the no-impact core movements that are outlined in Core9 Birth Recovery are great for general core strength, but also to aid in repairing a DR.

I also highly recommend coming to Baby Boot Camp classes once you are cleared by your doctor and either 6 weeks postpartum (vaginal birth) or 8 weeks postpartum (c-section). You will get a great workout taught by nationally certified instructors, that are also well-versed in the appropriate postpartum modifications.

Read this great article by one of my colleagues that outlines safe exercises for newly postpartum moms, as well as what to avoid.

Do you have any other resources mamas should know about? 

Indeed! Baby Boot Camp classes are taught by nationally certified fitness professionals. You will get a fantastic one-hour workout that is safe for newly postpartum mamas, all in a fun and supportive environment.

I am also licensed and certified in Core9 Birth Recovery and Core9 Diastasis Repair. Core9 Birth Recovery is for moms 0-9 weeks postpartum and is NOT an in-person program. It consists of weekly emails with safe and effective movements and videos that moms can do at home in the early postpartum weeks, plus two in-person DR checks.

Core9 Diastasis Repair, on the other hand, is an intensive in-person four-week workshop. I run 3-4 workshops per year, and have one coming up in June. We work on repairing DRs through safe and effective movements, while also improving posture and strengthening the pelvic floor.

The Fitness Center on the Baby Boot Camp website also has some great articles on DR, birth recovery, and postpartum exercise, in general.

Here are a couple articles that are particularly relevant to our conversation:

Early Postpartum Birth Recovery
Birth Recovery and Diastasis Recti
Birth Recovery and Running

---

MEET MARY MCQUEEN

Mary is mom to Liam (5/07), Sinead (6/10), and Jameson (7/12), and has owned Baby Boot Camp Oakland since April 2009. She has a B.A. in English and French Literature from U.C. San Diego, is an ACSM-certified personal trainer, and certified in Group TRX Suspension Training. You can reach Mary by email or phone at 510-418-8599.

Lean Sideways with Mary McQueen from Baby Bootcamp Oakland

What inspired you to start Baby Boot Camp in Oakland?

I was actually about 35-40 pounds overweight before I got pregnant with my first son, Liam, and then I put on an additional 50 pounds during that pregnancy; so, all told, I had about 90 pounds to lose.

Having a baby really awakened me to my need to get healthy. My father passed away suddenly from a heart attack when he was 49 years old (I was 20) and his father passed away from a heart attack when he was only 38 (my dad was 17)! So my family history of heart disease is so strong, and I realized that I did not want to follow that same sad path and not be around to see my children grow up.

After I had Liam, I thought I could make these changes on my own, so I started doing some light cardio - run/walking around Lake Merritt, pushing Liam in the stroller. I realized about 9 months in, though, that making these big changes on your own can be quite challenging. I was yearning for a support system. It was my younger sister, actually, who found out about Baby Boot Camp - she does not have children, but she did have her personal training certification, and she answered an ad for an instructor on Craigslist.

So I started going with her as her “plus one,” and I instantly fell in love. I loved the workouts, I loved that I could bring my (sometimes screaming and cranky) baby along, and I especially loved the camaraderie with the other moms. I lost the rest of the weight as a participant of Baby Boot Camp, and I thought, “Hey, I did it. I can show and encourage other people to do what I did.”  

The previous owner of Baby Boot Camp was going on maternity leave and needed another instructor, so I got my certification and taught for her for about 6 months, and then she asked me if I was interested in buying the business. I jumped at the opportunity - I saw such potential in the program, and I wanted to help people make positive changes in their lives. I had no interest in returning to my previous job - I went on maternity leave and then just never went back! So, I was definitely looking for the next step in my life, and this just sort of fell into my lap! 

How did you find the courage to bring your life into its current state and what have been the rewards of that investment?

Ha! Talk about taking a risk - I bought the franchise when the classes were very small, in April of 2009 when the economy tanked; and the same month that I bought the business, my husband, a carpenter, lost his job! I knew it was all a little crazy, but I have always dreamed of owning my own business- I was drawn to having time freedom, being my own boss, and, above all, hopefully making a difference in people’s lives. I saw the potential and I knew that what Baby Boot Camp had been for me, could be for someone else that really needed it - whether it be the need to lose weight, the need for companionship, or the need to help combat the “baby blues.”

When I bought the business, I had also taken on some part-time work as an Administrative Assistant for a wonderful network of psychologists in Oakland that do really meaningful and important work for children in the Richmond school system and the juvenile “justice” system in Oakland. So I didn’t make a complete and clean break with regards to my career change - I most certainly eased into it. The CEO and COO of that company were awesome, and, by this time, I had just given birth to my daughter, and they let me bring her into the office with me, nurse at the office, work from home with her...And I really supported and believed in the work that they were doing.

But there came a time when I needed to focus on my own business if I wanted to be able to reach more moms and families, so I gave my notice. I was really nervous about my decision, but it has absolutely been worth it. I think that if you are passionate enough about something and if you have a really authentic experience with that vision and passion, you can find a way to make it work!  
And I see this more and more with the moms that I teach in Baby Boot Camp. There are definitely a lot of moms that go back to full-time work, but there are also a significant number that do things a little differently - working part-time, working from home, freelancing. It is less “lean in” and more “lean sideways” - we are navigating new territory in this way, I think.

What is the simplest, most fundamental way a woman can take care of herself postpartum?

Move your body (even if it’s just for a walk around the block) and make connections with other moms. Honestly, I was really in denial about how isolating being a new mom can be. There is no easy segue into motherhood, no course on how to do this - you really are just thrown into it; and that is true for each baby, at least in my experience. Being a first-time mom is so different from being a second-time mom, which is different from being a third-time mom. And it can all hit you like a brick sometimes.  

When I had my first son, I was only 25, which is rare for the Bay Area. None of my friends were even close to having children yet. I had already made the decision that I wasn’t going to go back to my previous job, and I had also decided that I wanted to get back into shape, but I thought I could be a mother and make these life changes on my own. It took me several months to realize that not only does it “take a village” to raise a child, but it takes a village to raise a mom and to help support her with these big life changes. I did start losing weight and getting healthier on my own, but, to be honest with you, I was pretty miserable, and I felt really alone.

I joined Baby Boot Camp when my son was about 9 months old, and everything changed. I found a community of women I could really talk to and who knew exactly what I was going through, it got my babies and me out of the house, and as my children have grown up as “Baby Boot Camp kids” it has helped set a healthy example for my children, whether they see me exercising, participate in the class themselves (which they love to do during the summer when they are off from school), or tear it up on their bikes and scooters and skateboards while I’m teaching.

So my advice would be to find your tribe - whether that be through a mom support group, Baby Boot Camp, a music class you enroll your children in, whatever! Just find a group that is going to help support you in this transition.

Why is it so important that a woman who is tired, potentially nauseas and physically uncomfortable consider her own fitness during pregnancy?

There are a couple of things going on here. First, it is so important to consider YOU. When we are pregnant, so much of the focus is on our bellies and that little baby growing inside of us, and we forget to put ourselves as a priority (and things only get more extreme after that baby is on the outside). It is certainly easier said than done, but it is so important to put time and energy and care into ourselves in order to support all of the caring that we do for other people. So move your body in a way that feels really great - take a dance class, take a yoga class, go for a walk or hike. Your body and your baby will thank you for taking that time for yourself!

Second, I was so much more active and my nutrition was so much better with my second and third pregnancies, and I think it made a huge difference in my deliveries and recoveries. And I’m not the only one - I have spoken to many of my Baby Boot Camp mamas that say the same thing. They took Baby Boot Camp classes after they had their first baby, got pregnant a year or two in, and they felt so much stronger in their second pregnancies and deliveries.  

You’ve recently widened your focus to diastasis recti prevention and repair. Why is it important to find out about your DR status and how common is it?

Oh my goodness, it is SO common! Over the years, the VAST majority of moms that have come through Baby Boot Camp have a diastasis recti (DR) and did not know it. It is very important to know that this is NOT a life-threatening condition, and it can absolutely be healed without surgery! 
DR occurs during pregnancy when our bellies are growing - it is the natural separation of the rectus abdominis (our “six pack” abs, so to speak). A lot of women think that because they had a c-section they wouldn’t then have a DR; but the DR starts happening at pregnancy. Our abs separate during pregnancy, the tissue between the two sides of the rectus abdominis called the linea alba gets stretched thin, and in an ideal world, everything comes back together after we have our babies.

This does not typically happen, however, and after we have given birth, our rectus abdominis does not come back together. This can lead to lower back pain, incontinence, and in extreme cases, can contribute to uterine prolapse.
I measure all new moms that come to class for a DR - we measure finger width at the belly button, above the belly button, and below the belly button. Moms with a 1-2 finger separation at the belly button are good to go in class (it probably won’t close beyond a 1); for moms with a 3+ finger separation, I make a lot of modifications for them during class, and I also recommend that they attend my 4-week intensive Core9 Diastasis Repair Workshop (I have another workshop scheduled for June).

In general, it is so important for ALL women - not just recently postpartum and not just those of us with a DR - to strengthen the transverse abdominis (the deepest layer of abs muscles) and the pelvic floor with pelvic floor lifts (use it or lose it - yikes!).

Please join us next month to talk about diastastis repair in more detail! We’re just scratching the surface here.

I will be more than happy to join you for more DR talk - it is one of my favorite topics, and it is such a important and overlooked part of postpartum care!

---

MEET MARY MCQUEEN

Mary is mom to Liam (5/07), Sinead (6/10), and Jameson (7/12), and has owned Baby Boot Camp Oakland since April 2009. She has a B.A. in English and French Literature from U.C. San Diego, is an ACSM-certified personal trainer, and certified in Group TRX Suspension Training. 
You can reach Mary by email or phone at 510-418-8599.

Stacking Up Your Spine to Discover Your Core

Did you know that your abdominal muscles may not be strong even if you are performing core exercises?

Poor body mechanics and poor posture can greatly contribute to pre and postnatal discomfort and core dysfunction. For a balanced body throughout your pregnancy and throughout your life, various muscles should work in harmony for your pelvic floor to function well. Performing a bunch of Kegel exercises may only help you from holding in that “sneeze pee” temporarily. 

Imagine standing with a posterior pelvic tilt (your buttocks tucked under).

This woman likely has tight pelvic floor muscles, muscles that when inflexible are not functional muscles. During labor, these muscles need to relax, and after labor, they need to fire properly for various practical reasons. This is the muscle group that helps you to control your urine. This is also the muscle group that, when functioning well, makes sexual intercourse more enjoyable. 

Travel up the torso, and this woman’s ribs aren’t stacked over her pelvis. In-between the imbalanced pelvis and ribs is the abdominal core. Because of misalignment, the abdominal muscles are both pulled and shortened, leading to dysfunction. 
Stacking the joints is a great first step to a healthier core—a healthier you. Imagine it’s you starting with a clean slate. From a stance of proper alignment, you then can move with the ability to employ the correct muscles. Pilates uses a lot of imagery.

I tell my clients to imagine that they are a hanging fruit basket, the head the first, the ribcage the second, the stomach the third, and the pelvis the fourth basket. If properly stacked, all of the baskets will balance
with ease. 

I have worked with a number of postpartum clients who experienced “sneeze pee” after giving birth. They came to me because they’d been instructed to perform Kegel exercises yet weren’t getting better. With hip strengthening, such as gluteal work (squat, squat, squat!) and postural work, their bodies responded well. The pelvic floor consists of two types of fibers, slow twitch and fast twitch. Therefore, it’s good to practice both the quick “flicking” contraction and the slow contraction, like the rise of an elevator. 

The Kegel work was performed in conjunction with other muscles in various exercises, resulting in a stronger and more functional core from the pelvis up through the trunk. The harmony of muscles engaging together is like listening to a well-tuned orchestra. You deserve to feel like your best, well-tuned self.

---

MEET SANDRA SPRINGER

Sandra is a Pilates Master Trainer and Rehabilitation Specialist. Beyond her Pilates rehabilitation and fitness certifications, Sandra studied prenatal Pilates extensively and Pilates for diastasis recti. Sandra works with spinal injuries and repetitive strain injuries, as well as clients in stages from pre- to post-surgery, including Cesarean.
Sandra focuses on inefficient patterns of movement and imbalances so that clients can not only gain awareness about their bodies, but also integrate the lessons into their daily lives.

In her prenatal Pilates courses, she tailor exercises to each client’s needs as the group classes are small—only three per class. The classes were developed to safely move you through each trimester. You will be exercising with other moms-to-be while both relaxing and strengthening your body during incredible, life-changing time!

Beyond pilates, Sandra is a lauded writer, earning a Fulbright Scholarship and the Joseph Henry Jackson Award. 

The Four Chambered Heart | Meditation or Journaling

This exercise can be done in pure meditation or as a journaling exercise in which you answer all of the questions and more.

Begin seated comfortably or resting on your back with one hand on your belly and one had on your heart. Feel your breath come and go until you find a gentle relaxed rhythm.

Picture your heart, four beating chambers, this muscles giving you life with every pulse. Now imagine the chambers more closely, figuratively dividing the heart into four equal parts:

• The Full Heart

• The Open Heart

• The Clear Heart

• The Strong Heart

The Full Heart, the left upper chamber, beats in abundance, giving freely and receiving freely, without limit. Let your heart swell, fill to the brim and overflow with compassion and appreciation for yourself, your children, your loved ones, your work, your world. Where do you find constriction? Where do you find ease? What can you share and what do you keep? Now ask your Full Heart what it needs from you and from the world. What does it need to create and receive? The Full Heart knows no limits; what would you do with boundless love?

Shift your focus now to the Open Heart, taking a deep, cleansing breath in and then out completely.

The Open Heart, the left lower chamber, pulses to learn, to see the world afresh. The Open Heart beats without judgment and anticipates only love. The trusting Open Heart is deeply wounded by rejection or disappointment. How much joy can you accept? What do you reject for fear of disappointment? The Open Heart can also be the Black Heart; what divisive tools do you use to protect yourself? What hurt have you suffered? Courageously, how open can your heart be? Can you forgive yourself to trusting too much? This is your vessel, let it be strong and let it be buoyant.

Let all of your air out with an audible exhalation, "Haaaaaaa", then breathe in deeply to your belly, expanding your chest until it feels as though it will burst and let your heart be as open as the dawn, then exhale entirely. On your next inhalation, shift your focus to the Clear Heart.

The Clear Heart, the right upper chamber of your heart, the heart that knows all before thoughts arrive. If you’re able to let the water of your thoughts still, the Clear Heart is your spiritual compass. The Clear Heart says, “Trust me, I know. Trust me, I’m always here. Even when hell has arrived, I am here. Even when the most difficult decision must be made, I am here.” The Clear Heart only speaks truth, without fear. When you are connected to your Clear Heart, you fearlessly speak your truth. Quiet your mind. What do you feel? Can you forgive yourself for the times when you’ve been too loud to hear your heart? When your heart has turned cloudy, what has circled in your head: fear or greed or need? You can take time to get clear, to return to this pure center where you know your truth, and you’re taking that step right now.

Take a deep breath in and blow it out powerfully, as if you are blowing away insecurity, and then breathe in grounded courage as you turn your focus to the Strong Heart. Breathe in until your chest is puffed out, and you are the lion, letting that breathe go with a roar.

Finally, the right lower chamber, The Strong Heart, houses your dreams, your power and your abilities. You are able to face the world, no matter the resistance, to pursue your truth. You can bring love in for fuel and give love out without pain. You can stand down a thousand armies and pursue your rightful place. You can risk your career for a vision. You can laugh about your shortcomings without self-consciousness, because you know your strength. What do you want? What can’t you abide? Draw your line in the sand- what’s on your side and what’s on the other? What does your Strong Heart need from you now?

Place both hands on your heart and take a final, full-body breath in, as if from the soles of your feet, all the way to the top of your crown, and then let it go with sigh. As you breathe in again, feel yourself at the center of these four chambers: The Full Heart, abundantly beating; The Open Heart, fresh to the world; The Clear Heart, wise as the Universe and The Strong Heart, driven with clarity. You are all four of these elements and it’s your right to know every aspect of your heart. Spend some time with your heart regularly to reconnect and remind yourself that your heart is both supple and strong, even through upset, your heart beats again.

Move Your Body with Yoga

Yoga is a tried and true conduit to mental clarity. Bend your body into the following positions to loosen your joints, invite fresh blood to your limbs and physically open your constricted chest and shoulders.

And BREATHE.

If these look too cray, click on each pose and find variations to suit your comfort level.

Dancer or Natarajasana

This pose lifts you up and forward through your heart and your head. Nataraja is another term for Shiva, The Auspicious One, whose cosmic dance clears the weary and makes way for creation. Bring it on.

Camel Pose or Ustrasana

The mother of all heart openers- my typical crying pose: Camel Pose pulls your heart open, bares your sensitive throat and leaves you as vulnerable as any human can be. Let your heart be free and see what comes in.

For more: Yoga Journal's awesome interactive piece on Heart Openers

Mark the Moment | Smudge with Palo Santo

In an effort to bring yourself back to your heart, to soften what may have hardened over the years of surviving here on earth, why don’t you take 30 minutes or an afternoon to address the issue. Set aside time to try some or all of the following elements of a heart opening ritual to bring in light and let go of some weight.

When was the last time you had a good smudging? Some of us are probably saying “a couple days ago” and others haven’t smudged for a long, long time, if ever. It only sounds dirty; in truth, it’s an ancient cleansing ritual practiced by various cultures worldwide. It’s a classic and wonderful way to commence any chosen moment, ceremony or ritual. It creates a sensory threshold that will queue you: “BE PRESENT, THIS IS SPECIAL”.

You may have experienced the smudging practice with sage but Palo Santo has a sweeter, woodier smell that I much prefer. It evokes a deep rootedness and brings you to your center. Use a lit candle flame or a lighter to ignite the end of the wood stick until it’s smoldering, an ember is all you need. If you do light the wood on fire, blow it out quickly so the ember remains. Then let the ember smoke; sometimes you need to blow on it gently.

Use the stick like a wand to encircle yourself: around the body, around your head, in all four directions- North, South, East and West, and then towards the sky and down towards the earth. If you’re feeling really frisky, you can smudge your doorways and the rooms of your home to clear stale, old energy and invite fresh vibes in. Then let the smoking stick burn itself out on a specially chosen plate or other non-flammable surface.

Buy Palo Santo on Amazon.

Sleep: It's No Joke!

Sleep deprivation is not a laughing matter, nothing to be casually bandied about like it’s a cheeky right of passage. It’s not a badge of honor. It’s torture. And it sucks. Bad.

What are we living on if we haven’t slept for days on end? If we’re postpartum, we get a healthy super-mama dose of oxytocin to help us through those zombie days, so we can drive a car and be trusted with another human’s life. But that’s not enough. 

Our wise, desperate bodies release adrenaline to carry the tired load. And then we drink caffeine, which only increases the amount of adrenaline our adrenal glands pump into the bloodstream. So, now you’re flitting about the new-mama world of mothers groups, work, and grocery runs fueled by adrenaline and caffeine. Oops. This can’t be physiologically healthy, never mind psychologically. 

So, let’s review what happens when your body is operating like this. Adrenaline is designed to trigger your fight or flight response (thank you, evolution). There are three major muscles programmed to contract with adrenaline- any guesses what they are?

1. Your shoulder muscles, the ones between the shoulders and the ears- yeah, those. They tighten to protect your brainstem as if a grizzly bear is approaching.

2. Your jaw tightens in preparation for direct combat - those teeth are serious weapons, am I right early teethers?

3. Finally, the psoas, a deep abdominal muscle, tightens along the lower back and this muscle helps us run away. Fast. But it also provides significant lower back discomfort when chronically contracted from adrenaline and poor posture (read: stress and sitting- hmmm sounds an awful lot like the early days of breastfeeding. And every single day in the car or an office.

It’s a feedback loop: the tighter these muscles become, the more adrenaline they trigger in your tired, baby-obsessed brain. But this is good news! You can address this exhaustion, this overwhelming abundance of adrenaline, from two different angles: physical and lifestyle. Reduce your physical tension in your shoulders, your jaw, and your psoas and you will reduce your anxiety, your stress, and your general feeling of “what’s happened to my life?!" (thumbs up!).

Stretch!

• Stand with your feet wide, look straight ahead, clasp your hands behind your back and bend forward, letting your hands slowly drift towards the floor

• Open your jaw slowly just to the point that you feel a gentle relieving stretch. Then close your jaw lightly so your teeth are barely touching, relax your tongue in your mouth and massage the jaw muscles

• Place one foot on the ground and the other knee on the ground with both knees initially bent at 90 degrees. Support yourself with both hands on the ground at your sides. Slowly inch the front foot forward so that you begin to feel a gentle stretch at the front of the body with the bent knee.

• Once you feel a gentle stretch, place both hands on your upper knee and lift your chest to stretch the psoas

Decaf!

Yeah, yeah, I know, embarrassing to order, but give it a whirl. And notice how your breastfeeding baby responds- maybe they’ll chill out too since they drink what you drink. It may take you both a few days to notice the positive benefits. Trust that it’ll be worth it when you don’t want to go all “Red Wedding” on your partner come the end of the day.

Ask For and Offer Help!

It may only be 90 minutes that you crucially need, or an hour: ask someone to come to your house and hang out with your baby or, better yet, take the baby on a long walk around the ‘hood while you put earplugs in and slumber. Ask a mom in your mothers group if you two can do a sleep/playdate swap. Call your friend who wants to be called ‘Aunty’ and let her know that this is the test. Ask a tolerable and relatively responsible family member to help. People will be honored, I kid you not. And, most importantly, don’t let this opportunity pass you by: discipline yourself to get in bed, plug those ears, and close your eyes.

Please, Share a Night Feeding!

Share this article with your partner and then arrange for them to take at least one of the feedings at the beginning or end of the night so that you can go to bed early or wake up later and get a “proper” stretch of sleep (4 hours!? YAAASSSSSS!!).

If you’re breastfeeding, you will have to consider your boobs’ schedule but it’s worth the logistical analysis. If you encounter pushback, reference the “Red Wedding” allusion above.

Massage!

Did you know that Glow treats women at any age and stage of life? We’re not just prenatal specialists! Massage relieves anxiety by relaxing your tired muscles, reducing adrenaline, reducing blood pressure and increasing our happy hormones like oxytocin and serotonin (yum). Glow’s massage therapists will come to your house if that’s what suits you logistically or you can escape to our perfectly controlled environment at 4901 Lawton Avenue. 

Postpartum Doula!

Hire a Glow postpartum doula to come to your house for a four-hour spell so you can take a load off, watch a backlogged episode of The Affair, and zzzzzzzzzzzzz. If a postpartum doula is too costly with all baby accoutrement accounted for, ask your friends and family for an early birthday gift. Better yet, pregnant mamas, ask for postpartum doula care in lieu of baby gifts! Email us to explore more postpartum doula options at glow@gloweastbay.com and check out our offerings.

Mini Vacay!

Once you’ve mastered breast milk storage or trained your partner/friend/family member to mix formula, GET OUT OF THE HOUSE! Book yourself a hotel room; it doesn’t have to be posh, because your eyes will be shut, god willing. Bring ear plugs, bring some basic food items, and SLEEP, MAMA, SLEEP! Even if you have to pump in the middle of the night, it’s not the same as waiting to hear the cry for a feeding. Worth every penny you will save on couples counseling, do this for the team.

Toddlers and Time-Out

Many parents grapple with the challenging behaviors of their babies, toddlers, and preschool-aged children and wonder: Can a young child manipulate or be naughty? What does child discipline look like for babies and young children?

These are important questions, as the meanings that we attribute to our children’s behavior affects how we feel and respond. Seeing our children’s behavior as manipulative or bad sets us up to respond in harsh or punitive ways that worsen rather than calm the situation. It’s essential that parents’ expectations for their young children, and the interpretations they make of their children’s motivations, be informed by an understanding of what is normal for each age and developmental stage. Interactions that seem driven by purposeful mal-intent are often creative strategies central to your child’s developmental milestones. When my son was almost one, he started to drop his food off his high chair, watching what would happen to the food and also closely observing my response. While it would have been easy to interpret what he was doing as manipulative or naughty, I came to understand that he, like all young children, was investigating cause and effect. In this situation, he was discovering gravity and he was also fascinated to see how his actions impacted me, whether it led to my frustration at his refusal to stop or to my delight in the game he was inviting me to play by picking up the food he dropped.

We come into the world as little scientists. From infancy, children are driven to explore and investigate all facets of their world, including exploring the full range of emotions in themselves and in others, the most compelling of which are those of their parents, or other primary caregivers. An astonishing number of neural (nerve cell) connections in your baby’s brain are made each minute in response to their interactions with you, and from numerous, similar, repeated experiences over time, those connections are laid down as established neural pathways. As I discussed in the October and November newsletters, your baby’s relationship with you will be the central thing that organizes their experience of their world for the first six years of their life.

Young children are driven by emotion, not logic. They have very little self-control and are dependent on you to help them learn to manage their intense emotions and communicate in acceptable ways. These skills take years to evolve, so don’t blame yourself or your child when you find yourself helping your child manage their great disappointment for the thousandth time in response to a limit. 

Time In vs. Time Out

The purpose of child discipline is to assist children to regulate their emotions, increase their control over their behavior, and learn acceptable ways of communicating over time within a developmentally meaningful framework.

Limits make children feel safe and secure. When your child tests the limits, your kind, firm and consistent responses help provide a predictable world where your child knows what they can expect.

Children between birth and age three are not developmentally capable of making use of “time out” as a discipline strategy. Even after age 3, time out is of questionable usefulness before age six, and even then is not ideal as a primary strategy for changing problematic behavior. Young children need physical proximity and emotional connection in order to calm down after dysregulation and to learn new ways of interacting. If a young child is overwhelmed or distressed, physical and emotional separation in the form of time out will increase the child’s anxiety and fear and escalate the situation. The best use of time outs is when parents themselves need some time to get calm enough to reconnect with their child. Instead of time outs, try a “time-in”. “Time-ins” involve a break in the current situation, usually by removing the child in order to manage feelings and calming down with parent/caregiver assistance. When calm enough, the parent addresses the issue and assists the child in a reparative act if relevant. Time-ins build capacities for emotion regulation and self-control, both vital lifelong skills. This alternative to a “time-out” can allow your child to make use of your help calming down, and when calm enough, to address what happened in order to learn new ways of being.

BASIC TIPS

• Manage your own feelings so that you are calm enough to help your child. Strive to maintain control over your response to your child’s actions.

• Set the limit and keep it short and sweet: “We don’t throw plates. It’s not safe.”

• With empathy, validate your child’s feeling: “I see you’re really disappointed that your sister is using the yellow plate."

• Provide simple choices: “Would you like to us the red plate or the purple plate?”

Every parent deserves the support and help they need to have the best possible relationship with their child. For some, consulting with a therapist specifically trained in infant mental health or early childhood mental health can be of great benefit.

---

MEET JILL SULKA

Jill Sulka, Psy.D. is a licensed psychologist who specializes in infant and early childhood mental health. She provides parent consultation, infant-parent and child-parent psychotherapy, and child play therapy in her office and at home, depending on the needs of the family. Dr. Sulka has been providing psychological services for 20 years, and has directed several programs for parents and their children birth to 8 years old.She believes that every child and parent deserve the opportunity to develop a relationship together that best supports that child’s potential to grow well and love well. She can be reached at (510) 326-2002 and jillsulka@gmail.com.

“Prenatal” Vitamins Help Every Woman Every Day

Are you exhausted?  Try taking some of your prenatal vitamins like Floridix Florivital!

Floridix Florivital provides ample doses of iron, Vitamin C and B Vitamins. Iron supports your immune system, boosts red blood cell generation thereby supporting your heart, your liver and your digestive system. Vitamin C works synergistically to boost iron absorption, and support your immune system. Florivital’s B1, B2, B6 and B12 vitamins keep the body functioning optimally. You’ll notice increased energy and healthier hair, skin and nails.

Floridix is safe for pregnancy and breastfeeding but, as usual, check with your healthcare provider if you have health concerns that may preclude you from taking Floridix Florivital.

Buy Floridix

Infant Mental Health

From birth to age 6, your child’s relationship with you is the central organizing experience of their life. From the beginning, your baby is a person with feelings, thoughts, and a meaningful inner life who is developing a sense of themselves, others, and the world through their relationship with you.

Babies are extremely attentive and sensitive to the feelings, facial expressions, and mental state of the adults to whom they’re close, and they depend on back and forth responsive communication to feel calm and secure.

Understanding the mind of your baby or child, and the meaning of their signals and behavior as they seek to understand yours, is a key part of the parenting experience. However, it is not uncommon for parents to find it challenging to attune to their baby or young child, especially with babies that have difficult temperaments.

When stressful things happen in your child’s life, it’s their relationship with you as their attachment figure that will help them manage their feelings and make sense of their world.

The more safe and secure your young child feels in their relationship with you, the more they will turn to you for help when in trouble when they’re older. With this foundational security, they will have a higher sense of self-worth, know that most problems have an answer, solve problems on their own, know how to be kind, and trust that good things will come their way.

Be aware that memories of our own early relationships and childhood experiences—both benevolent and problematic—return to us when we become parents. As children go through different developmental phases, unresolved past experiences and feelings can emerge in one’s present relationship with their child.Sometimes this causes difficulty with parents’ relationships with their children, but it also offers new opportunities for growth and transformation

Did you know?

Every baby and child is different. What it takes to be a good-enough parent to one child can be very different from what it takes to be a good-enough parent to another.

Separating from your baby? Make sure to say goodbye! All children feel more secure when they know they can count on you to let them know when you are leaving. Otherwise, children learn that that the people closest to them unpredictably disappear, and can become more clingy and anxious in general since they don’t know when you will suddenly be gone.

Everyday routine activities like diapering, bathing, dressing and feeding are not mundane activities for your young child; from the start, these are learning experiences through which your baby is developing a relationship to their body and their needs, and discovering what they can expect in connections with other people. 

RESOURCES

Zero To Three: National Center for Infants, Toddlers, and Families

The Emotional Life of the Toddler, by Alicia F. Lieberman, Ph.D.

Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive,
by Daniel J. Siegel, M.D. and Mary Hartzell, M.Ed.

---

MEET JILL SULKA

Jill Sulka, Psy.D. is a licensed psychologist who specializes in infant and early childhood mental health. She provides parent consultation, infant-parent and child-parent psychotherapy, and child play therapy in her office and at home, depending on the needs of the family. Dr. Sulka has been providing psychological services for 20 years, and has directed several programs for parents and their children birth to 8 years old.She believes that every child and parent deserve the opportunity to develop a relationship together that best supports that child’s potential to grow well and love well. She can be reached at (510) 326-2002 and jillsulka@gmail.com.

Babymoon Breakfast Cookies

Makes 5 dozen cookies - an excellent make-ahead food to prepare for while waiting for baby. Freeze 2/3 of the cookies in ziplock baggies, and they are there to grab whenever you are desperate for a meal, whether it's breakfast, a missed dinner, or middle of the night breastfeeding munchies. These cookies are delicious, and full of nutrients your body needs to heal and feed a growing baby!        

xo Sarah Vine, Glow Doula

Ingredients

• 2 c oats

• 1 1/4 c whole wheat flour

• 1 c high fiber cereal (any sort! I used this Trader Joe's kind last)

• 1/2 c wheat germ

• 1/2 c oat bran

• 2 teaspoons baking soda

• 1/4 c seeds - can be sesame, hemp, pumpkin, sunflower, flax, chia

• 1 c butter, room temperature (or coconut oil)

• 1 c applesauce

• 2 eggs

• 2/3 c brown sugar

• 1 tablespoon vanilla

• 1 c chopped almonds and walnuts

• 1 c rasins or cranberries,

• 1 c chopped dates

• 1 c dark chocolate chunks

Method

• Preheat oven to 350. Line cookie pans with baking paper. Combine all dry ingredients.

• Cream together butter and sugar. Add eggs and vanilla, beat well.

• Add dry ingredients a bit at a time, until mixed.

• Stir in nuts, rasins or cranberries, dates and chocolate bits.

• Form golf ball sized cookies, flatten onto cookie sheets 1 inch apart. Bake 13/15 minutes, cool, enjoy!

Benefits

• Oats and oat bran - iron, also known to increase lactation

• Wheat germ - vitamin E, zinc, B vitamin folate

• High fiber bran cereal - good digestion regulation

• Seeds and nuts - good sources of essential DHA fats important for infant (and mother) brain development

• Walnuts - omega 3, calcium, iron, vitamin B6

• Almonds - increase milk production

• Dates, raisins and cranberries - iron, carbohydrates, potassium, help regulate the gut.

• Dark chocolate - makes you happy! And that is always a good thing.

CMV and Your Family

There are a million things that cause anxiety during pregnancy; this doesn’t need to be one of them. The following information is powerful and significant because this virus is preventable. Please ask your doctors about the risk of CMV infection during pregnancy.

Did you know?

50-80% of the population will be infected with Cytomegalovirus (CMV) by the time they are 40 years old yet. Coming into contact with the CMV virus is a common occurrence and is generally harmless for healthy kids or adults, but it can present critical problems for babies who are infected with CMV before birth, referred to as congenital CMV

Approximately 30,000 children are born with congenital CMV infection each year in the U.S. and 5,000+ will develop permanent health problems such as hearing or vision loss, cognitive or developmental disabilities, cerebral palsy or seizures

More children will have disabilities due to congenital CMV than other well-known infections and syndromes, including Downs Syndrome, Fetal Alcohol Syndrome, Spina Bifida and Pediatric HIV/AIDS

CMV is preventable! Only 13% of surveyed women of childbearing age know about CMV prevention tactics

There are simple and effective prevention measures you and your loved ones can take to mitigate the risk of CMV transmission during pregnancy. Please join Glow and the National CMV Foundation on October 8th to learn more.

The National CMV Foundation is a non-profit organization dedicated to promoting awareness, providing access to resources and sharing prevention information to eliminate congenital CMV. With your support, we intend to empower women, facilitate communication, generate social outreach, and ultimately drive behavioral change.

Learn More

The National CMV Foundation is a non-profit organization dedicated to promoting awareness, providing access to resources and sharing prevention information to eliminate congenital CMV. With your support, we intend to facilitate communication, generate social outreach, and ultimately drive behavioral change. Please visit the CDC.

Postpartum Belly Binding

Growing a baby necessarily forces your organs to the sides of your abdomen. Your tummy muscles, connective tissue and skin stretch to accommodate your growing baby. After birthing, you are left with an abdominal void, an empty space where the baby once grew. Your body gives you about 6 weeks to acutely impact the healing of your abdominal and pelvic tissue. Depending on our breastfeeding tenure, you have about 6 months to recover from birth before your beneficial postpartum hormones dwindle and you’ll then start fighting an uphill battle to bring our organs and abdominal tissue back into alignment. The first 6 weeks postpartum are imperative to our lifelong urinary and sexual health.

In the Bay Area we have access to a wealth of prenatal education but we rarely learn about postpartum rehabilitation. Recently, the tradition of postpartum corseting or “belly binding” has gained popularity. Lauded for its superficial impact on Hollywood starlets (Jessica Alba’s abs immediately postpartum, anyone?) the practice’s exposure has us buzzing. More important than fitting into your pre-baby jeans, the practice of belly binding can protect you from a secretly common ailment that we previously discussed in our June newsletter: Uterine prolapse.

Prolapse occurs when the uterus falls through the weakened pelvic floor and into or even out of the vagina. Painful, scary and embarrassing, prolapse is mostly preventable if postpartum care is taken seriously. Postpartum corseting draws the abdomen back to the spine and brings your abs together in the case of diastasis recti.

A postpartum corset retrains the tissue to support your lower back and organs as the postpartum hormones reset your posture. Combined with the pelvic floor exercises from our June newsletter, you are giving your torso the kindest support possible.

RESOURCES

Glow has sourced the best postpartum corsets available in America. Unlike the bulky Velcro versions developed in the U.S., or the time consuming woven binders, we offer South American eye-hooked corsets with flexible boning so the fabric stays put at your hips and around your upper torso. Our postpartum wellness specialist will visit you immediately postpartum to take your measurements and fit you for the appropriate sizing. Contact us at glow@gloweastbay.com for more information on corset fitting and more postpartum services to care for your body.

Parental Leave

As parents and soon-to-be parents, you likely know about the federal Family and Medical Leave Act, which provides just 12 weeks of (unpaid!) job protected leave for pregnant mamas and new parents. We’re lucky in California because working parents are entitled to additional protections and benefits. These additional protections and benefits mean that a pregnant woman in California can take a longer leave from work and some of it is even paid! 

The downside to having all these laws, is that it’s confusing to figure out which ones actually apply to your situation and as a result, employees may not take advantage of all the leave that they are entitled to. Because of this, it’s incredibly important to be informed so that you can maximize your time at home with your new baby.

When Should I Start?

Start the research process early (during your second trimester)

What Are My Leave Rights?

• Determine your eligibility to take leave under each of the three relevant laws: the California Family Rights Act, the federal Family and Medical Leave Act, and California’s Pregnancy Disability Leave law. Your eligibility is likely to dictate how much leave you are entitled to take.

• Educate yourself about your company’s policies and procedures regarding pregnancy/parental leave and other leaves of absence (most likely in your Employee Handbook).

Will I Get Paid While I’m on Leave?

• Confirm you are eligible for 10-12 weeks of State Disability Leave and 6 weeks of Paid Family Leave.

• Review your company’s policies regarding paid leave and use of accrued leave during maternity leave.

What Should I Say to My Employer?

• Once you’ve done your research and you know your options, develop a plan for your pregnancy and maternity leave before presenting it to your employer.

• This is also a good time to discuss any pumping accommodations you may need after you return to work.

---

Resources

• Care.com’s Avra Siegel outlines the issues *California provides additional protections to those outlined in this article

• 11 Questions Pregnant Employees Worry About *California provides additional protections to those outlined in this article

• FMLA Fact Sheet

• FAQ for California Family Rights Act and Pregnancy Disability Leave

• California Disability Insurance

• California Paid Family Leave

MEET Rachel

Rachel Gardunio is an attorney with more than six years of employment law experience, and she currently works in-house for a governmental agency. As a working mother of two, she was inspired to begin a practice focusing on working families. 

Rachel provides private and group education to soon-to-be and new parents. She can help you decipher the various laws and policies and assist in developing a plan to bring to your employer so that you can maximize your leave options. She provides a flat-fee consultation in-person in the Bay Area or via telephone throughout California. 

Rachel can be contacted at rgardunio@gmail.com .

Pelvic Floor Health for All Women

(And Maybe a Flat Tummy Too...)

The French medical system devotes an entire 10-20 professionally-guided sessions to la rééducation périnéale or postpartum vagina education. Following this course of therapy, abdominal reeducation begins with a further 10-20 sessions. This program successfully reduces incontinence, postpartum depression, sexual dysfunction and organ prolapse (look it up!).

In contrast, our American system eschews rehabilitation, instead focusing on a return to normal physical activity. With no guidance in between, many of us exercise to get our outermost layers smokin’ hot and yet we’re unable to jog around the block without a maxi pad. So what’s the skinny?

Warning Signs

You may have pelvic floor dysfunction if you experience the following...

• Incontinence: Urinary or fecal (with cough, sneeze, running, laughing)

• Urgency: Having to rush and not quite make it to the bathroom

• Frequency: Going more than every 2-4 hours

• Pain with sex, pain with orgasm or inability to orgasm

• Pelvic, hip, lower back and/or SI joint pain

Resources

WATCH | A succinct five-minute video of the perfect abdominal workout appropriate for all women: prenatal, postpartum or non-natal. Do it 3-5 times per week.

VISIT | Back to Life Physical Therapy in San Francisco and Oakland. Kaiser patients are covered by referral at this practice.

VISIT | Pelvic Health & Rehabilitation Center in Berkeley.

READ | Postpartum Strong, from the inside out. Real talk about your pelvic floor and all the fun organs it supports.

READ | A hilarious Slate article about the French postpartum care system.

Probiotics Every Day for Every Woman

Did you know that probiotics like lactobacillus and bifidobacteria are good for your mental health?

Studies are finding that daily probiotic ingestion increases our ability to cope with stress, reducing both depression and anxiety.

The neurochemical composition of your brain is impacted by what you’re eating and how it’s populating your intestines. Furthermore, a healthy gut will reduce your cortisol levels, elevating your mood and balancing your hormones. As women, our gut flora impacts the chemical environment of the entire body, impacting the flora in our reproductive systems as well. Fighting candida (yeast) and promoting regular bowel movements, probiotics are a girl’s best friend.

Probiotics and Pregnancy 

From a Chinese Medicine perspective pregnancy increases damp heat, making us susceptible to swelling, increased blood pressure and yeast growth. Probiotics populate your body with good microflora, fighting the growth of pathogenic flora like candida or yeast. Probiotics are an easy way to promote a healthy amniotic environment for your baby’s growth.

Probiotics and Postpartum

Candida growth can impact uterus healing and breastfeeding. Thrush is a yeast infection that can plague your nipples, your baby’s mouth, your own healing uterus and your vagina. Help your healing body by taking various strains of probiotic. Your breast milk will benefit from probiotic use, giving you and your baby a boost of beneficial bacteria.

Purchasing Probiotics

Pharmaca sells a home-brand probiotic line produced by Natural Factors. The 12 billion count capsules will provide ample probiotic support at any age and stage of life. If you aren’t close to a Pharmaca, you can find Natural Factors Acidophilus & Bifidus Double Strength Capsules at your local health food store.