Articles

Fertility Charting

 Posted by on May 27, 2016
May 272016
 

As our practice is evolving, Jenni and I are helping more people learn how to chart their menstrual cycle. This is a skill I think everyone who has a uterus and ovaries should learn how to do. It can help you know when is the best time to conceive a baby if you are trying to, and, conversely, not conceive if you are trying not to. Fertility charting has many names: cycle monitoring, natural family planning, and menstrual tracking, just to name a few. I have a fantasy that every middle school kid learns this skill to help them know their bodies better and feel like they have some control before and as they start to experience their sexuality.

 

A normal menstrual cycle length is 21-35 days, with 28 days being the average. It is measured from the first day of bleeding (cycle day 1) to the first day of the next bleeding. The menstrual cycle is regulated by hormones produced in the brain and in the ovaries. These hormones fluctuate throughout the cycle causing many signs for us to notice; signs that can tell us if our cycles are healthy and when we are most likely to conceive a pregnancy during ovulation. There are several different things to pay attention to during the cycle to help interpret the signs of ovulation. We encourage people to pay close attention to their basal body temperature upon waking first thing in the morning, their cervical mucous consistency and the look and feel of their cervix (yes, it changes!), and the rise in the luteinizing hormone (LH) in their urine (often referred to as ovulation predictor kits, or OPKs). We have been using these three clues to help people figure out when the best time to conceive by insemination or intercourse might be.

 

There are many great books about cycle monitoring that give thorough explanations of all the signs to watch for while cycle tracking, please see descriptions in resource list below. These books have charts showing how to read temperature variations throughout the cycle and share some of the other physical and emotional changes to notice during ovulation. The Beautiful Cervix project online has great pictures to compare with if you are viewing your cervix using a speculum, as some people choose to do.

 

To help people track their cycles, Jenni and I created a chart for our clients to use. Please feel free to download and use this chart for yourself. MB Fertility Chart

 

Other Resources

Period Repair Manual by Lara Briden, ND

A new book I just discovered. The author does an amazing job describing the hormones and their functions in the reproductive and endocrine systems and outlines specific ways to “fix” your cycle if it has strayed from normal.

 

A New View of a Woman’s Body by the Federation of Feminist Women’s Health Centers

This older (1995) book is a fabulously detailed yet accessible book to have. Very do-it-yourself, and the illustrations and pictures are really good.

 

Taking Charge of your Fertility by Toni Weschler, MPH

This is an extremely thorough delve into cycle monitoring, get to learn so much that you didn’t know you didn’t know about your fertility cycle. Their website has lots of information as well.

 

Honoring Our Cycles by Katie Singer

I love this very simply explained way to watch for fertility signs; this is a great book with lots of pictures and charts.

 

A Cooperative Method of Natural Birth Control by Margaret Nofziger

An old classic, first published in 1976. This was the book I first used to learn about natural family planning when I was younger; it was the only book I could find on the topic!

 

The Moon Mysteries book by Nao Sims and Nikiah Seeds, and their Moon Cycle Chart downloadable chart http://www.moonmysteries.com/moon-cycle-chart

 

Many of the above books are written with heterosexual people in mind as the target audience. They are filled with great information, but if you would prefer less hetero-normative or gendered language, check out the fertility sections in these books and the following online resources:

 

The New Essential Guide to Lesbian Conception, Pregnancy & Birth by Stephanie Brill

 

The Ultimate Guide to Pregnancy for Lesbians: How to Stay Sane and Care for Yourself from Pre-conception through Birth, 2nd Edition by Rachel Pepper

 

My Period and Me: A Trans Guy’s Guide to Menstruation by Wiley Reading http://everydayfeminism.com/2014/11/trans-guys-guide-menstruation/

 

La Loca Loba has a 5week online course on RADICALLY AND CONSCIOUSLY MOONING: http://www.lalobaloca.com/radically-and-consciously-mooning-an-online-knowledge-share.html

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Oct 312015
 

Recently I was perusing Facebook (not one of my favorite pastimes but sometimes it has to be done) and I came across this interesting article about breastmilk and breastfeeding.  One of the tag-lines says, “Not nearly enough people know about this mind-blowing characteristic of breast milk: It changes daily based on signals from the baby.”  But what are those signals?  And how can the mother’s body respond?  Read here to find out:

The More I Learn About Breast Milk, the More Amazed I Am by Angela Garbes found online in The Stranger

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May 272015
 

Karen Rayne, PhD, sexuality educator, is publishing her first book!

Karen-Book-Mockup-2

Rayne2sm

Breaking the Hush Factor: Ten Rules for Talking with Teenagers About Sex! will be released on June 14th. Karen has been teaching sex education with all ages for several years and is a great resource for helping parents work through our own thoughts, beliefs, and feelings around sex and relationships.

A few days ago, Karen come over to our house to chat about her book, we also fed her some delicious baked pears…it’s always nice to feed someone when you really want them to talk! The following is a paraphrased retelling of our conversation….

Jenni: Is the book an accumulation of teaching classes for middle school or is it more related to the individual counseling you do?

Karen: This book is not content oriented at all, it is really about helping parents become familiar with their own feelings around sex so that they can be open to discussions with their teens in an authentic way. I discovered there is much less information out there in the literature about practically addressing your (parents’) own issues.

Christy: My sense is that a parent’s ability to talk to their children and/or teens about sexuality depends mostly on relationship building throughout parenting. It is a gradual process of becoming more and more comfortable discussing things that feel very intimate.

Karen: The context of the relationship is really important and coming to the conversation without any of your own baggage around what is going to happen in the context of that conversation is very important. There are kids who actively come to a conversation about sex and want to engage with their parents and there are some kids who absolutely do not want to talk with their parents about sex. But the ways that the parent should approach each of these kids is within the same framework of honoring and trusting your kid to bring you what they need. They may bring you the need for lots of discussion about sex or none at all; the important thing is to remain open to the dialogue however much or little that is.

Christy: I have been amazed over the years when I didn’t think my kids were listening, I later learned they were taking everything in and remembering it!

Karen: That’s something I do talk about it in the book a lot, about how much your kids do listen to you and how well they do know you. By the time they are teenagers, they really know you AND your reactions very well. Now it is your time, as the parent, to listen and get to know them really well. It’s important to spend a lot of your time listening and really hearing what they are saying, being a sounding board for them to process and assess where they are, thus helping them move forward in beautiful ways.

Christy: What came to me listening to you just now is that we can and should give our kids credit for knowing more and being capable of figuring things out more than we might think.

Karen: It’s a transition, right. When our kids were three, we clearly knew more things about their bodies and how they work and what their needs might be, but as they get older it’s a process of them learning and knowing their own needs; the adolescent years are when this self knowing and transfer of power happens most dramatically. In many ways our culture sees it as a lack of innocence if you know about sex, and even if you don’t buy into that it can be a little bit shocking when your kids start to talk about sex.  Cards Against Humanity is a really interesting point of discussion around this. Most of my high school students have played it and some of my middle school students have.

Christy: I feel like middle school age is a little inappropriate for playing Cards Against Humanity but I actually think it would have been a great game for me to play in high school. I was so naïve and broadening my world would have been helpful, I think; shocking and a little embarrassing, but helpful. So I have not tried to stop my high schooler from playing it, but I have encouraged my middle schooler to wait till she gets a little older.

Brief digression here but moving on….

Karen: Kids do generally think their parents are stricter than they are. And I think this comes from a place of kids really, really caring what their parents think. Especially with something like sex, kids may think their parents are particularly less open-minded than they are. Take my classes for example, some of my students say, “my parents would never be OK with me talking about this.” And I say, “well, your parents know the entire curriculum for this class and they pay me a lot of money to discuss this stuff with you!”  And they say, “ooo….”

It’s like an impulse or reflex that the students respond this way to some of the things we talk about in class.  So what I am trying to do with the book is to help parents help their kids get out of that reactionary place by suggesting that they [the parents] stay interested in what their kids are saying and engaged with their kids at whatever level the kids are bringing the conversation to. This will help the kids understand that their parents really want to be there with them, listening to their thoughts, emotions, and feelings, considerations and worries, instead of the parent leading the conversation. It’s a definite conversation power shift that helps kids discover their own sexual paths.

Jenni: That speaks to the individuality of sexuality, that we are all dramatically different from each other, so that makes a lot of sense to me.

Karen: I think there is an element of kids needing to separate from their parents in some way, and sometimes they tell the parent and sometimes they don’t. Every kid in my class talks about their parents. It’s like their parents are over their shoulder, there with them. Sometimes the kids are arguing with them, sometimes agreeing, sometimes trying to figure their parents out, but they are always there, figuratively present with the kid.  It’s about how as a parent to be supportive of their kids finding their own identity, whether this matches what the parents want or expect.

Jenni: Even when you may not have figured it out for yourself… (laughter)

Karen: Yes, and that’s what the first four chapters in the book are about, the parent figuring themselves out enough to be present in the conversation about sex with their kids.

Please check out Karen’s indiegogo campaign and think about buying her book,

especially if you have teenagers 1200x900-testimonial-book-gina

Seeing as we are midwives who get lots of questions about sexuality and relationships, our discussion with Karen moved along to sex during pregnancy and the postpartum months. She facilitated one of our group prenatal sessions last year, and talking about that experience is where this conversation picks up again…and then organically moves back to talking with kids, very cyclical….

Christy: People expect their sexuality and sex drive to remain the same in pregnancy and postpartum and most often it does not. That change can be pretty sudden and can catch both partners off guard.

Jenni: And then there is this notion that when people become pregnant they have to put aside their sexuality and/or some people have trouble figuring out how to be a parent and a sexual being at the same time.

Christy: Yes, when one has a lot of different hats to wear it’s hard switching back and forth between them quickly.

Karen: What’s normal? What’s right? I think that is where people’s questions really are. People have a fear of cross-mingling sex and babies/children.

Christy: I also think one thing pregnant people are really surprised by is how low their libido is in pregnancy and/or the postpartum months. Some people worry, I think it’s a common fear, that they will never feel like having sex again in the way they did before having a baby. I think it is totally normal and it’s a helpful thing to point out that they may not have sex for a very long time but that the desire will come back. Of course, some people have a very high libido in pregnancy and enjoy it very much! I want to help people understand that libido is very fluid over a life span; sex drive varies greatly at different times in people’s lives. That’s something I don’t remember hearing about or talking about when I was pregnant or just postpartum: that sexual desire is so up and down over one’s lifespan.

Karen: I think that is one thing that is really missing in abstinence-only sex education. So when we are talking about abstinence in my classes with young people, I always say to them that there are times over their entire lifespan that they will be deciding not to have sex, for a variety of reasons — maybe they don’t have an appropriate partner, they or their partner may have some kind of STI, they may have other physical health concerns, maybe they’ve just given birth to a baby, there are lots of reasons, they may be on a spiritual journey where refraining from sexual contact is what seems best at the moment… During their life, whether they’re married or not, whether they have a partner or not, there will be times in their life when they will choose to refrain from having sex… Really honoring the space that abstinence provides is something not just for teenagers; because, firstly, I think that teenagers can hear it more easily if it’s something for everyone, and also they are then able to carry that into their future lives where they are able to respect a decision or feeling inside themselves to refrain from sexual activity. It’s important for people to know that choosing abstinence at all different times in their life is a respectable decision and a respectful decision as part of the life process.

Christy: I think that the common approach to abstinence only birth control does teenagers a big disservice.  This description you give providers a more holistic view of what abstinence can look like in an empowering way.

Karen: When coming to a conversation with your kids about sex, the key is to identify your own issues so that even if you don’t resolve them, you at least know what they are, and if your kid starts to mention something [difficult for you], you know where the trigger is coming from. This will help you know when to take a break in the conversation, because you’re having a reaction that’s about you and not about them. But part of that process is ideally learning to just sit with where you are sexually at any given moment. It may be a time of a lot of arousal, and a lot of desire, and a lot of sexual activity, and a lot of orgasms, or it may be just a place of a lot of desire, but not a lot of arousal or sexual activity. There are a lot of variables at play here, and I think that just letting your body whisper to you where you are and following it and respecting it, and not feeling the need for it to be different is a huge gift to yourself and for your kids. The painful parts of sexuality are when you end up with sexual activity and even orgasm, without the arousal or the desire. That’s what we really want to avoid.

Jenni: And that can be tricky if you are partnered, with all the potential discrepancies between partners. And often, as a parent, I imagine you are trying to figure out where you are at, and that’s influenced by your current relationship or non-relationship. So then it’s influenced by your partner’s desire or interest in sex.

Christy: So, it could be that the sexual desire of both partners could go for long periods of time never matching up; that kind-of stinks. And then they have to navigate that within the relationship.

Jenni: I can imagine that affects the conversation with your kids; trying to figure out what to say to them when you are figuring out your own relationship makes it much more complicated.

Karen: So much more complicated! And if you have all these emotional reactions to sex because of what’s going on in your relationship right now, then talking to your kids about it, without having any of your own emotional reaction around the topic influencing the conversation, is really, really hard.

[Pause in conversation, which is unusual for us]

Karen: That’s how it can be talking to kids. It is a process of trying to negotiate your response, because in some ways that is a public face, rather than a private face. Your private sexual life is not about your child and they don’t need to have any part of it or know anything about it, in terms of concrete details for sure. But how do you negotiate your public face in those conversations while still being authentic, because if you’re lying your kids are going to pick up on it.  You have to be honest to a degree, saying things such as “You know this conversation is really hard for me right now, but I know it’s important so we’re going to have it anyways.” Owning up to that weirdness is important. One of the things that I cover in my book is that [as a mature adult] you use the other adults in your life to talk with about sex or other issues before you talk to your kids. Work through some of your own stuff with your peers, or a therapist, or whomever is appropriate for you.

Christy: I think that’s a good place to end it, especially since our kids are such great mirrors of ourselves, helping ourselves ultimately helps them.

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Group Prenatal this Week

 Posted by on April 17, 2015
Apr 172015
 

Yesterday we had a great discussion at group prenatal. Jenni and I wanted to pass along more information related to the topics we discussed.

We talked about the importance of helping the pelvic floor stay strong, especially after birth. My favorite information about pelvic floor health, complete with excellent pictures, great descriptions, and helpful exercises, comes from Blandine Calais-Germain. She has two books that I highly recommend, though The Female Pelvis is geared more towards pregnant clients.

pelvic floor bookpelvic floor book 2

Found here on Amazon                    Found here on Amazon

This article, 5 Myths Surrounding Your Pelvic Floor in Pregnancy by Ann Wendel, is helpful as well.

We also talked about things to do to be nice to ourselves in pregnancy, ways to get out of the hustle and bustle and really connect to baby and self.  This blog post from Pam England (Birthing From Within) and meditaion from Aviva Romm came to mind so we are passing them along:

Information Frenzy Vs. Awareness Moment, Pam England

The Safe Space Body Awareness meditation, from Aviva Romm, is an exercise from her article on sexual health generally as well as in pregnancy.
“Close your eyes.
Imagine that there is a soft, pink, warm bubble around us, the size of a comfortable room. In this space you are warm and protected. Everything that is said here is confidential and sacred.
Now, take a few deeps breaths. Make your mind and your belly soft. Breathe deeply and slowly, inhaling to the count of 4, imagining your breath bringing a warm, glowing, pink light all the way down into your sacred woman parts. Imagine this soft light bathing your pelvis, all the way down to your pelvic floor. Feel warmth spreading through your lower abdomen. Notice any areas where you feel tight, tense, blocked and use this light to massage them free. Then exhale to the count of 6, letting go of all the tension in your body. Quiet your mind and focus only on the rhythm of your breath and the feeling of your breath moving deeply through your body. Repeat this 8 times. There. Now open your eyes.”
Some people talked about how being pregnant just isn’t what we thought it would be, it’s hard and makes us not feel like ourselves. Again Aviva Romm’s insights to the rescue: read about Depression in Pregnancy to help stay connected to the process of becoming a mother.
Aviva’s pregnancy book has other great information, exercises, and meditations as well.Aviva Romm

Found here on Amazon

 Group prenatal appointments generally happen the first and third Thursdays of each month from 10 to noon. Let us know if you want to attend in place of your individual appointment time. You can attend a group on a week by week basis; topics are determined according to a rotating schedule and the interests and questions of whomever is attending on a given day.

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Human Rights in Childbirth

 Posted by on January 23, 2015
Jan 232015
 

I have been working with the international organization Human Rights in Childbirth for about six months, getting to know the founders and feeling my way around the organizational structure.  Recently, I was asked to be on the newly expanded HRiC board of directors, which I gladly accepted.  HRiC’s mission and values align perfectly with my beliefs that people always have the choice to make the decisions about their care, regardless if  those choices fall inside or outside the standard of care.  Often what is practiced in medicine, particularly in obstetrics, is not evidenced-based or even compassionate, but rather based on efficiency, provider opinion, and “that’s just how it is done.” HRiC’s goal is to amplify the voices of people in their own communities, to network, and to share legal tools to help create change in maternity systems.

Hermine Hayes- Klein, founder of HRiC, joined with other attorneys representing Birth Rights Bar Association, Improving Birth, and International Cesarean Awareness Network, in writing an amicus curiae brief to highlight the rights of people to refuse care/interventions in the US maternity care system.  An amicus brief is a legal opinion or testimony not solicited by any parties in a legal suit.  In this case, these organizations wanted to bring attention to the considerable informed consent and refusal negligence seen in maternity care today, which is an under-identified violation of rights in this country. See links below for full text.

Women’s Voices Amicus Curiae Brief: Informed Consent and Refusal, USA, Part 1

Full Amicus Brief and Appendix

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Jan 172015
 

Childbirth Connections has done it again!  They have put together an evidence-based, very readable and user friendly tool explaining the importance of physiologic birth and the role hormones play when the body is allowed to gestate, labor, birth and breast feed without interventions.  This report highlights the significant negative effect that stress (physical, emotional, financial, racial, etc) can have on people in all cultures who are pregnant and birthing their babies when they do not feel supported or nurtured.  The Childbirth Connections website is full of useful information for both families and providers, please see the links below for some of the most pertinent documents.

Hormonal Physiology of Childbearing 

Abstract and Topline Recommendations

“Pathway to a Healthy Birth” Booklet  

Core Hormonal Physiology of Childbearing Principles

Physiologic (Spontaneous) Onset of Labor versus Scheduled Birth

Physiologic Birth versus Cesarean Section

Pathway to a Healthy Birth Infographic

 

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Every Body is Enough

 Posted by on September 5, 2014
Sep 052014
 

Our teenage neighbor Alyza Moore is doing her high school senior project about body image. She has a video coming out soon and started a kickstarter campaign to create a book. I think her idea has taken on a life far beyond her expectations due to the positive support and accolades she is receiving. Here is a blog she wrote that was picked up by the elephant journal, it’s beautiful…

“I don’t wake up every day loving myself.

I am not in awe of my intrinsic value and beauty every time I look in the mirror. Some days I wake up and I want out.

I want out of my skin, I want out out of my body, I want out of this particular life.

Some days I curse my sensitivity. Sometimes I hate that I am so easily broken, so easily hurt and so easily shaken.

I have fallen down more times than I can count.

And you know something? That’s okay. [Read on HERE]

 

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Apr 252014
 

Recently Rebecca Dekker, PhD, RN, APRN, of Evidence Based Birth fame wrote an exhaustive, research-based blog article about the Vitamin K injection.  The full article can be read HERE , to help parents make an informed decision about whether or not to give their babies Vitamin K.

 

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NEW MANA Stats Homebirth Study Press Release

 Posted by on January 31, 2014
Jan 312014
 
Today marks the long-anticipated publication of two articles on the outcomes of the Midwives Alliance of North America Statistics Registry (MANA Stats).

We are very excited to share with you the findings – and how you can help spread the word. But first, the findings:

Key findings of the study

This is the largest ever look at planned home births in the U.S., examining nearly 17,000 births.

This study joins a growing body of research that shows that, for low-risk women, home birth with a skilled midwife is a safe option that has health benefits for mothers and babies.

The study has implications far beyond home birth, because it shows the benefits of normal physiologic birth, which can be supported in any setting.

Today’s study – unlike recent anti-home birth research that relies on birth certificate data – is based on the MANA Stats registry. The MANA Stats registry contains high-quality data that uses the gold standard – the medical record – instead of birth certificate data, which is notoriously unreliable for studying intended place of birth and newborn outcomes.

More detailed findings

For planned home births with a midwife in attendance, key outcomes include:

  • Over 93% women had a normal physiologic birth
  • A cesarean rate of 5%
  • Only 2.5% of babies admitted to the NICU in the first six weeks of life
  • 87% of women with previous cesareans had their babies vaginally
  • Of the 10.9% of women who transferred from home to hospital during labor, the majority moved for non-emergent reasons, like a slow, non-progressing labor, or maternal exhaustion
  • At six weeks postpartum, nearly all babies were breastfed

While we can’t make a direct comparison to hospital outcomes (because they include women with different risk factors), we are happy to see such low intervention rates and high breastfeeding rates without increasing risk to mother and baby.

Rates of fetal and newborn death were very low for babies without congenital anomalies: the risk of death to the fetus or newborn (including during labor, in the first week of life, or the first 28 days of life) was about 2 per 1,000.

The risk of fetal and newborn death are even lower when women in higher-risk categories were excluded. When breech, previous cesarean, multiples, preeclampsia, and gestational diabetes were removed, the risk of death was about 1.6 per 1000. These rates are in line with other well-designed studies that look at home birth. In particular, babies born in the breech position appear to have the highest risk.

At the conclusion of midwifery care, 98% of babies were being breastfed; 86% were exclusively breastfed.  Nationally, only 77% of babies even begin breastfeeding, and we know how important this is to the lifelong health of babies and their mothers.

We need your help to spread this good news!

We’ve all read about the poorly designed research or data releases that suggest home birth isn’t safe. Opponents of a woman’s right to choose her place of birth have made sure those numbers have been widely spread. But together, we can ensure that women receive the accurate information they need to make well-informed decisions about their health care.

Here’s how you can help

First, you can learn more by reading our summary of findings here on the MANA blog. While you are there, please stop by the comments section and leave a note.

Next, share the blog post widely on your Facebook page, on listservs, and with your community.

While you are on Facebook, please consider stopping by the MANA page and sharing some of the visuals we designed to help educate consumers about the research. Please leave a comment too; every comment you leave means more people will learn about the positive outcomes of midwifery.

You can also find a link to a fact sheet about the research to share with consumers over at the Citizens for Midwifery site.

Please join us in gratitude

Please join us in thanking the many, many people who have made this possible, including the homebirth midwives who have diligently contributed to the MANA Stats database.

We also thank the members of the MANA Division of Research who created the system, continually improved it over the years, and have put quality assurance processes in place to make sure the data are sound.

We are very grateful to the Foundation for the Advancement of Midwifery for providing ongoing financial support for the MANA Statistic Project.

And finally, we thank the researchers who validated and analyzed the data and shepherded these articles down the long road to publication.

Sincerely,

Jeanette McCulloch, MANA Communication Director and
The MANA Board of Directors

Copyright © 2014 Midwives Alliance of North America, All rights reserved.
You received this email because of your relationship with MANA.
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