Adjusting to life as a new mom can be a tricky proposition. The transition of becoming a mother is a challenge, to say the least. Most, if not all, mothers I have met describe the change as overwhelming. And, it is.

During the first week or two postpartum, you may feel like nesting and spending a bit of alone time with your baby. But, when the day arrives that you are craving adult interaction, here are a few great options for you to consider. Being able to commiserate with other moms can help you to smile through struggles and, most of all, remind you that you are not alone.

The first four suggestions listed below are usually free-of-charge while the remaining may generally require a fee. Programs and fees may vary.

The story time program at your local library is a great place to start. Many have programs from birth to preschool age. It’s a truly low-pressure way for you to get out of the house and interact with other moms. The exposure to all the books and new activities will have obvious benefits for baby and will hopefully spark a life-long love of reading and learning.

If you have a religious affiliation, inquire about a mother’s group in your congregation. Many religious groups provide support for mothers within the organization. Ask your minister, priest or rabbi if there is support group for moms in your religious community and when they meet regularly.

Attend a meeting of your local chapter of the La Leche League. You’ll get down-to-earth, informed support for breastfeeding. You’ll also find that the group is a great place to meet other moms. My experience is that the LLL sometimes gets a bad rep for being aggressive or militant about their opinions. I haven’t found this to be the case . Quite the opposite, these women generally feel that the social bias is against their favor. Breastfeeding is still very much in the minority of mothering preferences. It’s critical to have this encouraging place to go when you’re first starting out.

Scan the bulletin boards of local community center, coffee shop, library, internet for ads listing local moms groups/playgroups. This can be a bit like a blind date as it’s likely you won’t have a direct affiliation with playgroup members. Still, it’s worth a look. Many moms (and kids) make lasting friendships through playgroups. Examples of the nationally recognized groups that can be found online are MOPS, MOMS, Mothers and more (each of these have local chapters throughout the U.S.)

The hospital or birth center where you delivered may hold meetings for new moms and babies. Many hospitals and centers develop seasonal calendars with group meetings and classes for new moms and babies. Options may include informal play dates or classes for a fee such a infant massage, newborn care, breastfeeding, infant CPR and the like.

Groups such as gymboree, kindermusik, baby and me, etc. offer lots of activity. This can be fun simply because all of the activity is set by the teacher/leader of the group. You don’t have to think or plan. Just show up and enjoy.

Contact your local children’s museums, zoos, parks, as well as indoor creative play centers. Many of these centers offer activity days for moms and tots as well as resources to partnerships with other organizations who do the same.

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During my first childbirth class, we watched a video of a newborn who, after being placed on his mother’s belly directly following birth, wriggled and squirmed until he reached her breast and immediately began to suckle. It was, to put it mildly, quite a feat. While I understood that the childbirth educator was trying to inspire a little bit of “awe in nature’s magic” motivation, I just sat there wondering how my experience would measure up. Would I be a successful breastfeeder? Would I be able to stick with it if nature didn’t take it’s proposed course? Oh, the pressure. And, it hadn’t even begun yet.

In the beginning, we might expect the baby to automatically latch on and commence with the nursing immediately following birth. And, why not? Women are lead to believe that breastfeeding should be an innate function of motherhood that just comes naturally. Effortless breastfeeding? It just doesn’t happen that way.

That doesn’t mean, however, that it’s not worth pursuing. It also doesn’t mean that we should ignore the challenges or withhold compassion for the struggling new mom. What it does mean is that women shouldn’t be set up for failure.

Yet, the true-to-life experience of breastfeeding is rarely acknowledged in the public forum. The reality of the difficult, frustrating first weeks postpartum that has driven many mothers to tears is scarcely offered for consideration or comfort. If more women knew that these first few weeks would drastically improve once mom and baby work out the kinks, more moms might stick with it.

And, so I say it here: Breastfeeding is tough— plain and simple. To say the least, it’s a challenging physical maneuver. A mother has to be aware of letdown and latch-on. And, who knew that positioning the baby in the crux of your forearm like a football can sometimes be the most comfortable and effective for both parties involved?!

The whole process can oftentimes feel like an intricate tightrope act during which mom and baby attempt to embrace without disrupting balance, without losing patience. In many cases, one or both end up in tears. I guarantee it’s not for lack of trying.

Then, of course, there’s the psychological facet of breastfeeding. The emotional changes that occur postpartum will hopefully lead to the acceptance of a new identity—primarily that of nurturer and nourisher. It’s a normal human reaction to experience a bit of anxiety during this challenging transition from woman to mother. The test of character involved in making this passage cannot be understated.

What makes breastfeeding work is will. And, you also have to relax a little. And, have patience. At the risk of sounding glib, the relationship really just takes time to grow. With persistence, the cracked nipples, the weak latches and the uncomfortable positioning will all blossom into a peaceful, precious exchange. Say what you will about the ease of bottle-feeding, but there is nothing like the skin-on-skin closeness of nursing.

Truly, there is a beauty in the act that can’t be denied. Enduring all of the hassle and heartache to nurture one’s child is incredibly fulfilling, not to mention the advantages of the mutual health benefits. The knowledge that mothers alone have the gift to do this is particularly empowering. The return on investment is pretty great.

Still, so many women decide not to breastfeed their babies. Not even for the first few critical weeks, much less months. I proffer that women could use a little more support from both society-at-large and moms in the trenches. If any progress is to be made, we first have to address the dizzying amount of misconceptions about breastfeeding and motherhood.

I hereby propose that there is a dirty underbelly of mothering that should be celebrated; that should be explicitly and openly discussed as normal. As any real-live mom will tell you, mothering is a beautiful experience but, by no means, is it always pretty.

To that end, I offer this suggestion:
New mothers should have the opportunity to share their experiences as soon as possible. Hospitals should offer group breastfeeding tutorials to new moms before being discharged postpartum. Yes, the private in-room instruction by a lactation consultant is valuable. But, let’s go one further. Let the LC address a group of moms as a whole. Imagine a roomful of women being given advice and support, together. Imagine a forum in which nervous, postpartum moms could SEE firsthand that every other mom is going through similar experiences and has the similar questions, problems, concerns. Imagine a group of women laughing (and crying) through the learning process together, instead of being isolated in a stark, sterile hospital room. I’d be willing to wager that there would be a lot less tension, a lot more widespread confidence and a stronger mothering community. There would also be alot more breastfeed babies. Then, again, I always have been one to hope for the possible.

If you’re looking for resources on breastfeeding, these are three good ones:

Kellymom.com
La Leche League
Breastfedbabies.org (includes helpful photos of positioning)

I highly recommend going to a La Leche League meeting rather then calling them for advice. It’s the best place I know of where a new mom can meet other non-judgmental moms who are in the same boat. It’s the closest thing you’ll find to my group-breastfeeding suggestion described above as all meetings are lead by an educated, registered League Leader.

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The newborn baby has only three demands: warmth in the arms of this mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.

–Dr. Grantly Dick-Read

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1. Select your family doctor, Ob/Gyn or midwife wisely.
   Choosing a person or team that you trust will make all the difference in the world. Find someone that you know will respect your wishes. Base your choice of health care practitioner on a few key factors: What is their rate of episiotomy use? Yes, you can ask this question and expect a truthful answer. It is public record, so it is your right to know. Choose a practitioner that has a low rate (you want less than 10%) and doesn’t practice routine use (emergency use only). Make it clear that you do not consent to an episiotomy.
   Other questions to ask: Does she promote childbirth as a natural process that a woman’s body is capable and built to do? Will she suggest techniques to prepare you for the physical event in the months and weeks before birth? During how much of the labor will she be present? Will she be a positive supportive influence during birth and advise you when pushing the baby to allow your skin to adjust and stretch?
   Knowing the answers to these questions, you will be more confident in your practitioner’s decision-making process. The comfort of trust will help to buoy your confidence and stave off tension.
2. Kegels and Perineal massage are invaluable.
   These two exercises can make a huge difference in how your perineum prepares for birth. And, both are really easy to incorporate into your daily routine. Many women do kegels while performing everyday tasks like driving, sitting at a desk or cooking.

   To do Kegels:

   • Remember to breathe normally.
   • To find the correct muscles, practice stopping the flow of urine when urinating. This is called contracting the pelvic floor muscles.
   • Hold for 10 seconds, then relax. Try not to contract legs, buttocks, or abdominal muscles.
   • You can do a series of “short holds” (5-10 seconds) then a series of “long holds” (10-20 seconds),repeating 10-20 times for a full session of Kegels.
   • It’s recommended to do a session two-to-three times a day.

   Perineal massage can be added to your bedtime ritual and is a wonderful way to get your partner involved. Go to childbirth.org’s step-by-step guide to get started.

3. Remain active during your pregnancy and labor.
   Your perineum is a collection of intricately woven muscles. So, according to what your doctor, midwife or practitioner recommends, be active and exercise. It will strengthen the perineal area just as it would any other muscle group. Walking and squatting do well to keep the area flexible. As squatting is an ideal position for birth, practicing the position will help you to find a comfort zone and be ready for when you want to use it during labor. When in labor, stay as active as possible. This help to keep labor progressing and the laws of gravity will help baby descend.
4. Use visualization. Stay calm. Be relaxed.
   It sounds new-agey, yes, but many women have utilized this technique while in labor. The idea of imagining or visualizing yourself opening up for baby can actually cause your body to physically do it. Some women imagine a melon, basketball or even a hula hoop while focusing on their round, open qualities. Try this as you exhale through a contraction; imagine the sphere widening. You’ll be amazed at the results and distraction from contractions is a bonus.
5. Breathe slowly and deeply.
   Many childbirth preparation classes teach us how to breathe effectively during labor. The key here is to continue through the birth. It’s especially important to breathe during the crowning, stop pushing and let your skin adjust to the stretching. Try to stay calm and wait until your doctor/midwife says it’s OK to breathe and push. By allowing for adjustment, you prevent a tear or drastically reduce the severity of a natural tear. Natural tears heal quicker, easier and with much less pain than episiotomies.

All of the above steps can help to avoid having an episiotomy during birth. More importantly, they can make an impact on your overall experience by keeping you confident, positive and calm. As always, we recommend that you never start a new activity without consulting with your doctor. Discuss the suggestions listed above with your practitioner, and follow her direction as per your individual medical health and history.

See Episiotomy Part One: The real story your doctor isn’t telling you

See Episiotomy Part Two: A Call for Awareness and Change

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The American College of Obstetricians and Gynecologists (ACOG) considers an episiotomy to be minor surgery. Despite this designation, many obstetricians routinely use this medical intervention in healthy, normal births. In April of 2006, the ACOG published a statement acknowledging that “women who have an episiotomy do not have significantly improved labor, delivery, and recovery compared with those who do not have one. The best available data does not support the liberal or routine use of episiotomy.” So why the discrepancy between real life use and researched need?

Not surprisingly, there is no set criteria which a doctor must follow when making the decision to perform an episiotomy. As such, a doctor has full license to perform the surgery without consent whether or not it’s needed. Further, there is no current disciplinary action or accountability to penalize doctors who grossly overuse it or cause permanent damage. And, as a result, at least half of women who have given birth in the U.S. live with the consequences.

In comparison, there is a drastic difference in episiotomy use among MD’s than that of Certified Nurse Midwives. Across the board, midwives report radically lower percentages of use with some rates in the 1 or 2% range. Some midwife practices report well below one or even zero percent—a stark contrast to those condoned by the ACOG. This irrefutable evidence proves that episiotomies in as much as 75% of laboring women is unnecessary and, as some have suggested, obvious abuse.

Yet, the ACOG shows no signs of discouraging rampant cutting of a woman’s perineum during labor. On the contrary, the organization just released a new 2007 teaching aid for new doctors confirming that indeed “episiotomy is the most common operative procedure that most obstetricians will perform in their lifetime. Because it is so common, teaching students or interns the principles and techniques usually is left to the most junior of residents.” With the procedure being taught during childbirth in the delivery room by junior level doctors, it begs the questions: who is monitoring how it’s really being taught and when is it advisable? Issuing a pocket-sized booklet is a far cry from implementing rules of conduct and liability.

Still, it’s pure speculation as to why doctors choose the procedure so often. Perhaps, it is lack of accountability. Perhaps, it’s impatience. Perhaps, it’s because antiquated practices die hard. Instead of making any rush judgments, it is my hope to work toward educating mothers and doctors. Public awareness and activism can force the ACOG to set the standards and accountability that are far overdue. Until then, the only recourse is to spread the word; to educate women about how to choose a responsible practitioner and what questions to ask her maternity team. It’s a mother’s choice to make informed decisions about healthcare, the people who attend births and labor preparation techniques. Mothers do have the option to take a proactive stance, to embrace our ability to birth naturally, and to change the common misconception that a healthy normal labor would need to be medicalized in any way.
See Episiotomy Part One: What your doctor isn’t telling you

See Five things you can do to prevent an episiotomy
Resources:
americanpregnancy.org
acog.org
childbirthconnection.org
bmj.com
jwatch.org
midwiferytoday.com
A Wise Birth: Bringing Together the Best of Natural Birth with Modern Medicine by Penny Armstrong and Sheryl Feldman
Ina May’s Guide to Childbirth by Ina May Gaskin

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There is one specific event that was the impetus for writing this article. Recently, friends of ours were expecting their first child. When she went into labor, the couple drove to the hospital where she was “drugged, cut and, after a while, out popped the baby.” Disturbed by their story, my husband asked them, “did she consent to the episiotomy or pain medication?” A little confused by the question our friend matter-of-factly replied, “well, no. we didn’t know it was an option.” Later that night, my husband warmly confided that he was so glad that I chose to have a midwife. He couldn’t imagine the alternative of having what the majority of women have: a doctor-controlled birth. It is this all too common scenario that has inspired me to present the following information for anyone who is or knows someone who is pregnant.

Did you know that episiotomies are the most common surgical procedure that obstetricians will perform in their lifetime? Theoretically, it’s intended to facilitate birth in an emergency during labor. But recently, especially in the United States, it has become the subject of much debate due to increased routine use. Resources show that the rates of episiotomy in the U.S. rank among the highest when compared to other industrialized nations. Statistics vary stating that it’s performed during at least 50% (in many cases as much as 75%) of all doctor-attended U.S. births. In contrast, midwife-attended births demonstrate rates of episiotomy that are radically lower, if at all.

I sought to uncover the real story behind episiotomy use, how it is performed and the differences in recovery experiences of those who’ve had it versus those who haven’t. What I discovered is that the current practices are in dire need of change. I learned the shocking reality of the permanent damage inflicted by episiotomies and the alarming lack of concern in the Obstetric community.

An episiotomy is a surgical incision made to widen the vaginal opening. The incision is made through the perineal muscle (perineum) between the vagina and the rectum. In general, there are two approaches. The midline incision cuts straight toward the rectum. The sideline or mediolateral cuts at a 45 degree angle. The more commonly used midline can likely tear straight to the rectum (called a third or forth degree tear) causing severe damage. In contrast, the sideline doesn’t usually tear further, but it causes greater blood loss, does not heal well and can be much more uncomfortable in the long-run. Both types of incision must be sutured directly following birth and are highly susceptible to infection before the mother is even discharged from the hospital postpartum.

The recovery period after having an episiotomy is approximately three to four weeks (in some cases months.) Until fully healed, the repair remains susceptible to infection. Recovery is described by many as being very painful wherein most mothers find it difficult to even walk.

In the recent past, episiotomy allegedly prevented postpartum incontinence or pelvic floor relaxation — a condition which hinders sexual pleasure and perineal muscle control. Research now suggests episiotomy does not prevent but rather causes these afflictions when the muscle is severed. Some women report that their experience of incontinence is far worse than they would’ve imagined. Some young women report having to wear adult diapers or pads because they experience so many “accidents.”

Women who underwent episiotomy were also more likely to report that they were still experiencing pain more than six months postpartum, especially during sexual activity. One of the most explicit long-term effects from the incision is permanent deformity of the vaginal area—a consequence some outspoken activists have compared to female mutilation.

When episiotomy is not performed, women either don’t tear at all or if a tear does occur it can be repaired much easier than a surgical incision. Research proves natural tears heal quicker with much less pain and discomfort initially and long-term. Repaired tears usually heal within a week or so. Likewise, when allowed to proceed without incisions, women were able to quickly resume daily activity (ie: walking) immediately postpartum. Normal functions of continence, physical activity and sexual intercourse resume within three to six weeks postpartum.

Curiously, there is no set criteria for making an episiotomy. Ideally, the procedure is intended to intervene in complications of labor when mother or baby is in immediate danger. However, emergency is rarely a factor in real life hospital delivery rooms. Many resources point to the reality that most doctors simply don’t want to wait for nature to take it’s course. Below are events that most frequently prompt use—the majority of which are doctor-inflicted circumstance rather than naturally occurring emergencies.

• the mother or baby’s heart rate becomes extremely high or low
• rapid progression of labor most often caused by over-medication of the mother; the baby enters the vaginal opening too quickly for the area to adjust and stretch causing potential for an extreme tear.
• though uncommon, sometimes a baby turns into a breech position (laying sideways or “shoulder first”) during labor.
• the doctor decides that baby is too big to fit through the mother’s pelvic canal and cuts a wider opening. *Statistics show a baby is almost never too big to fit through a mother’s pelvis.
• the laboring woman has been over-medicated, barely conscious and can not push; the Ob chooses to use forceps or vacuum to pull the baby out; an incision is made to widen the area.

*Forceps and vacuum are dangerous instruments that have been extensively reported to cause serious damage to both infant and mother.

See Part Two: A Call for Awareness and Change

See Five things you can do to prevent an episiotomy

Resources:
americanpregnancy.org
acog.org
childbirthconnection.org
bmj.com
jwatch.org
midwiferytoday.com
A Wise Birth: Bringing Together the Best of Natural Birth with Modern Medicine by Penny Armstrong and Sheryl Feldman
Ina May’s Guide to Childbirth by Ina May Gaskin

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