The 3rd trimester doc.

Invite the magic. Get Ready. Embrace your birth story.

3rd Trimester Notes:
Congratulations ! You have made it to the last leg of your pregnancy! Now is a great time to zone in your nutrition, prep for baby and take in all the information that will help you in pregnancy, birth and postpartum.
As your doula I do do not make decisions for you, but will pass along a lot of information so that you can make the best informed decisions for you and your family.

Reflections :

Give yourself the permission to experience the birth of your dreams. Reflect on what this looks like for you:
- What does your dream birth look like?
- Where do you want to meet your baby?
- Who specializes in this birth?
- Do you need to switch providers to experience the birth you are desiring? See local resources page for top providers
- What did you like and not like from previous births? What can be different about this birth?
- As you journal your birth desires and preferences, write yourself a letter that you or someone on your birth team can read to you when you are in a moment of needing encouragement. Or, save it and you can read you this letter to yourself after your birth...when you are on the other side and soaking it all in: Yep, you did that!

“Is this Labor?” When to call your Doula:
Call or text me! 925-768-2100

I have you on bypass at night and will respond ASAP. Group text is great, individual messages are welcome too. Call if you prefer! I will answer if we can and call back ASAP if for some reason I can’t. No question is too much. No concern is silly. This is my job and I love it.
I WANT to hear from you! Yes, even if it’s 3am. Im used to it. I promise you!

  • EARLY/PRODROMAL LABOR
    - Contractions come and go. You notice them, but can easily talk through them.
    - Most labor contractions feel like period cramps or a consistent backache at the beginning. If it’s day+me, rest. If it’s nigh\me, go back to sleep. It’s normal to be really excited and wonder if this is the real thing. If you go to sleep and they wake you up, it probably is!
    - Keep in mind that prodromal labor can last for days or weeks, which is why it’s important to preserve your energy, priori+ze sleep and stay well hydrated. The work is coming! Prodromal labor contrac+ons can feel like the real thing, the difference is that they don’t get stronger or closer together.
    - Every surge has a purpose. They may be toning your uterine muscles, moving your cervix down toward the birth canal, supporting effacement or working toward dilation. Your body knows just what to do. Trust this process, hydrate yourself well with coconut water, and rest up if you can.
    "When the waves pull you out of bed, and you need to be on your feet, turn on soft music and move to the beat.” (Baby loves movement in labor)
    - Connect with your Partner. Use this time to take it easy and take it slow. Give your birth team a heads up. You are strong, brave and ready for this transformation. You can do this. We know how to birth. Invite you spouse to support you and lean into them. Allow this part to reconfirm your love for each other.
    - When you are in labor together, I want you to feel connected to your partner. I want you to look at each other and feel a loving presence. I never want to take away from your partners involvement; only fill in any gaps, offer support, guidance and give them rest and direction if needed. I will head over upon your call and invitation.
    I DO NOT COME TO YOUR HOME UNANNOUNCED & UNINVITED IN LABOR.

  • MUCUS PLUG / BLOODY SHOW
    The mucus plug is a cervical stopper that protects baby, the bag of waters and you from the outside world.
    - Some women lose their plug in pieces and hardly notice it. For some, it comes out all at once. This is generally an indication of effacement, meaning your cervix is softening and shortening -- that’s a third of the work! However, this isn’t a sign that labor is imminent. It could be days or weeks, but take comfort in knowing your body is working.
    - If you lose your plug and it’s with a streak blood, do a little dance, drink some water and get some rest because baby is on the way! We typically see labor begin within 24-48 hours of the bloody show.
    - Some women don’t have either of these signs prior to the onset of labor, so don’t discount those sensations if you’re having them. The plug is just one piece of this beautiful puzzle!

  • PREMATURE RUPTURE OF THE MEMBRANES (PROM)
    Water breaks prior to the onset of labor contractions/surges.
    - This occurs in around 1 in 13 pregnancies, though we are seeing an increase in prevalence in the last several years. Approximately 79 percent of women go into labor within 12 hours and 95% go into labor in 24 hours. These timeframes can be longer for first-time mothers.
    - PROM doesn’t always look like it does in Hollywood. Fluid can leak slowly. You may think you are accidentally peeing your pants. If you cannot control the flow as you would urine, it’s likely amniotic fluid.
    - Some questions to note: Is the fluid clear? Is it odorless? Do you feel feverish or ill? (Your doulas and midwives will ask!)
    - When your water breaks, baby is coming! Be sure to rest, eat and stay well hydrated. Follow what feels best, if a walk outside in the sunshine sounds doable…go grab your shoes and walk a mile. To get contractions started I recommend movement, pumping (10 min on, 20 min off, for 1 hour) and a chiropractic adjustment
    -With the waters broke, your chances of infection increases. Do NOT insert anything into the vagina: No tampons, no sex, limit cervical exams.
    Put on a big pad with the depends absorbent underwear.
    -Keep your Midwives and/or OB in the loop on any updates. Sometimes Moms will need to check in at the hospital for a small drip of Pitocin in the IV to encourage contractions, if things do not happen organically.

  • MOVING INTO ACTIVE LABOR
    Contractions have a consistent pattern with increasing intensity.
    - You may not be sure this is the real thing. It can be hard to tell! If you’ve rested, bathed, eaten, hydrated and the surges are still happening regularly, you’re likely in labor. Yay! Get excited, you’re about to meet your baby!
    - If you can no longer stay still during surges and find yourself swaying or rocking to cope, you’re in labor.
    - If the surges grab your focus to the point that you cannot watch TV or talk during them, you’re in labor.
    - If you find yourself vocalizing to cope with the surges, you are in active labor and your team definitely needs to know! Call me and your provider!

  • When to head to the Hospital or Birthing Center:
    - Your contractions are 4-5 minutes apart, lasting for 1 minute and sustained for more than an hour.
    - You are vocalizing and swaying through contractions. They require extreme focus.
    - Your intuition tells you it’s time.
    - You and/or your partner feel you need the support of your birth team.

  • IF YOU’RE FEELING PUSHY
    Consider whether you want to deliver your baby in the car, or stay home. If you are involuntarily pushing, baby’s birth is imminent. Please Call your provider! (Hopefully I am with you so I can help and communicate to your provider/EMS.

What’s an Emergency?

  • BRIGHT RED SPOTTING: Take a picture and call your midwives/Provider as soon as possible. There could be several reasons for this, some concerning, some not. If this is accompanied by your mucus plug, it’s likely bloody show.

  • CORD PROLAPSE: Get on your elbows & knees, butt high in the air. Do not pull cord or attempt to push it back in. Call 911 immediately. This is a legitimate medical emergency that requires OB care.

  • HEMORRHAGE: You begin leaking bright red blood, enough to fill a maxi pad. Call 911 immediately. Lay down, feet raised. Cover with a blanket. This is a medical emergency that requires OB care.

  • BODILY TRAUMA: Car crash, a forceful fall, any injury that puts extra force on your body would be cause for an assessment. Depending on the severity, call your midwives, OB or 911 immediately.

Nutrition:

The pregnant body requires over 120 grams of protein every day. This helps your body create cells for your baby, muscle recovery for you (so much stretching going on) and grow this beautiful human to 7, 8, 9+ pounds. Try to eat a source of protein with every snack and meal: Steak, Chicken, Eggs, Greek Yogurt, Cottage Cheese, peanut butter and Mixed Nuts. “To make the healthiest babies, we need the healthiest ingredients.”

> Give yourself 1 day a week for a cheat meal and dessert of your choice. Limited refined sugars and sweets.
> Stay hydrated, too! Drink over 90 ounces of filtered water a day, at minimum.
Sodas, Juice, energy drinks, fast foods, donuts and sugars should be limited to once a month, at most.

> Read ingredients: stay away from all Food Dye’s, diet soda, fake sweeteners, refined sugars, and “pre workout” drinks and powders.

Highly recommend this book on pregnancy nutrition: Buy Here

This one, too!

37 Week Protocol:

  • chiropractor adjustments 2 times a week

  • start eating 6+ dates a day, its not to encourage labor but to help prime your cervix and shorten labor duration

  • drink red raspberry leaf tea: steep 4-5 bags overnight and drink throughout the day (this is a uterus toner and helps prevent postpartum hemorrhage)

  • Gentle Birth Tincture Daily

  • do NOT insert any evening primrose oil: I know this is a common suggestion, however I am no longer recommending vaginal insert as it is starting to produce a correlation to PROM (premature rupture of membranes) for those with a cervix already dilated beyond 2/3 cm.

  • Acupuncture for labor encouragement after 40 weeks.

  • Highly recommend getting Pelvic Floor work to prep for vaginal birth

  • Cervical Exams: Some OB’s will offer a cervical exam to see how dilated you are. First and foremost, do YOU want one? They are not mandatory. Some Moms find them to be unnecessary stress as they cannot predict when labor will occur. Continuous checks can cause PROM and derail ones desired birthing plans.
    Being dilated ..or not.. is no prediction of labor. I have witnessed a few local OB’s do a cervix exam, do a sweep, and “accidentally” break the water. The more sweeps a Mom gets, the more chances of PROM.

Chiropractic Adjustments:

If you have not started receiving chiropractic care, now is the time to begin weekly sessions until you deliver. Chiropractic care has vast physical benefits and improvements to Mom’s and baby’s nervous system. I have noticed over the last 22+ years of attending births is the Moms who were regularly adjusted had significant reduction in labor duration, shorter pushing, far less chances of shoulder dystocia and breech presentation. I recommend these providers:

Books to Read:

Vitamins to take in Pregnancy:

Childbirth Education Information:

______________________________________
In person or Virtual Childbirth Education Options:

* I highly recommend Couples to take Childbirth Education classes, regardless of where you plan to deliver.

Having a Boy? Lets talk about Circumcision:

Now is the time to research Circumcision. I know this can be a very touchy subject and I don’t mean to be judgmental or shame anyone for their decisions.
I recommend a few points of research:

  1. Look up how the procedure is performed. YouTube has videos, notice how you feel while watching this…do you want your baby to experience that?

  2. Why was Circumcision in America started?

  3. Who is Harvey Kellogg and his influence on American Circumcision?

  4. What happens to the baby brain during and after a circumcision? Research the MRI study.

  5. How does circumcision impact breastfeeding?
    Having the answers to these questions and accumulating the research when I was writing my thesis in college on Maternal/Baby bonding:
    I don’t recommend circumcision at all.

  6. Do Father and Son really need to match? Does a Mother need to match her daughter? What happens if it’s botched? Or “buried”?

    With the research and studies available, along with the noted benefits of not circumcising, many parents are opting to keep their baby boy intact.

Postpartum Notes & Product Recommendations:

Resting after birth would include the first 15 days of bed rest, to allow for best healing and reduce chances of infection along with helping milk supply come in (and we are going to maximize your supply!) The only time you’ll get out of bed is to shower, use the restroom- no heavy lifting, cooking, entertaining family, shopping trips or caring for the dog. A few nursing sessions on the back patio every day for vitamin D and fresh air. Lots of skin to skin with your baby, in bed.

This resting period of 15 days is very important because the placenta leaves a wound inside your uterus the size of a dinner plate. That is a big wound! For the best healing and easiest “bounce back” the studies are showing us that the first 15 days of rest (keeping the legs together) are important and the first 40 days with your newborn sets the path for your whole postpartum journey, including pelvic floor recovery. Adjusting to life with a new baby takes about 120 days/4months. “The 4th trimester”.

If you had a C Section, resting for 25 days is the minimum. Please take it easy!

Safe Co Sleeping guidelines:

Is it safe?

Many Moms have found that sleeping close to their baby helped them get more sleep. Researchers found that breastfeeding Mothers who slept next to their baby and nursed throughout the night got an extra 1 hr and 43 minutes of sleep in a 8 hr night.
To your baby, sleeping in a bassinet by your bed is too far from you. Every time you place them in the bassinet- they wake up and you start the process all over again. That can drive you crazy!
With so much fear mongering about sleeping with your baby I recommend following The Safe Sleep 7
* DO NOT BED SHARE WITH PETS. NO DOGS OR CATS IN THE BED WITH YOU & BABY.

What is not recommended: sleep training: “Happiest Baby on the Block”, baby wise, Ferber and Cry it Out methods.
I don’t recommend these practices because they have shown to cause stress on mom and baby, compromise breastfeeding, raise cortisol levels, change brain chemistry and lower milk supply- causing weight gain concerns in baby. With such rapid brain development, inability to regulate blood sugars, babies need consistent food and nurturing - and these books promote the opposite of the biological norm of what newborns require.
I do have a lending library with an array of breastfeeding, parenting and baby books- you are welcome to borrow anything I have in stock.

Postpartum Depression & Anxiety

  • Postpartum Depression: I tell this to every Mom- Postpartum Depression is more common than we are told. The days your milk increases in volume and switches from colostrum to mature milk “Your milk coming in”, your hormones take a huge dip. You cry a lot, you get annoyed easily and minor tasks can be so overwhelming. Its normal. But if this lasts longer than 10+ days ... let’s get you in with a therapist. Asking for help is never weakness, but a sign of strength. Your care team is here to support you and help get you back to feeling like yourself again.
    Her Hope Therapy
    The Motherhood Space

- If you are someone who had depression and anxiety pre pregnancy, I have seen great results with Placenta Encapsulation. This is a process of taking your placenta, dehydrating it, grinding it up and then turning it into pills. You take 3 pills a day and the vitamins from your placenta put back a lot of hormones you’ve lost in delivery- including iron. Feedback from Moms has been pretty great! One huge benefit is that the pills reduce the chances of postpartum depression...and tons of milk supply. If you’re interested, put it in your birth plan to save the placenta and you grab it before discharge. Keep it cold in the fridge and I’ll get it encapsulated for you. I don't do it, but I have 2 fellow doulas who do. Both are VERY OCD with cleaning and keeping everything safe.

Birth Plans and Newborn Procedures :

You will be asked to create a birth plan, together we will write one at our final prenatal together. I love the easy format of Mama Natural Birth Plan (check your spam folder)
Things we will go over together:
-Vitamin K: pros/cons/ do you need it
-Hep B: Vaccine: pros/cons/do you need it
- Eye Ointment: pros/cons/do you need it
- Delay the bath for 7 days, benefits
- Epidurals: pros/cons, best time to get one, effects on breastfeeding, ideal positions to avoid baby “getting stuck” and reduce pushing time.
- Iv Fluids: pro/cons, is it needed? what are your options and alternatives?
-”Cascade of Interventions”

We will also discuss your birth plan in the situations of Plan A, Plan B, and Plan C. Regardless of how birth unfolds I will reference my doula book, your birth plan and what we discussed to ensure your birth desires are followed and all options are explored with informed consent.

Hospital Packing List :

“Yikes my baby is breech… NOW WHAT?!?!” :

First, take deep breath. Its going to be ok. You DO have options and nope, a C Section isn’t always the path to meeting your baby.
Things to do now:
- Chiropractor adjustments, STAT! The ones listed on Local Resources page are all trained in adjustments to release your ligaments to allow more space for baby to flip head down.
- Spinning Babies, do forward leaning versions 3-4 times a day.
- Many babies will flip head down upon the natural onset of labor. Talk to your baby, try everything and see what transpires.
- Head Stands in a pool ...the water and flipping of your body makes baby flip.
- ECV: Manually moving the baby into head down position. This happens in the hospital at 37 weeks and can be effective. It does come with risks and we can go over the risks/benefits with your provider and you can chose the best route for yourself and baby.
- You CAN birth a baby breech...and fun fact: I was born breech, too! A unmedicated, vaginal breech birth with zero complications. There is a Midwife in South Florida that will deliver breech babies. The Farm Midwifery Center in Summertown Tennessee has been catching Breech babies since 1972 with much success. Explore your options.

Breastfeeding Info :
Save this link and reference if you have questions: Timeline of the breastfed baby

If my clients want to take a Breastfeeding 101 class, this is complementary and included in your Doula fee. Sign up here

  1. “Early & Often”

  2. Getting started

  3. Watch for hunger cues: babies will latch better and nurse more efficiently if they are offered the boob before the crying stage. Look for licking lips, turning head towards the breast, rooting, putting hands to the mouth. These are signs baby is looking for the breast and wants to nurse.
    Even if you just nursed again- “When in doubt, whip it out.” Sometimes babies need a 8 course meal and 2 boobfulls of milk to be satisfied.
    Please reach out with any questions and concerns.

  4. Benefits of Breastfeeding

  5. Health Benefits of Breastfeeding

  6. Immunity Benefits of Breastmilk

  7. One of the benefits of breastfeeding I experienced first hand was when my oldest daughter was 3 months old and I was meeting up with my husband on the east coast as he had a conference out there. I was flying from San Francisco to Philly when suddenly our 7am flight was diverted to Scottsdale due to high winds. Once we landed the flight crew noticed a mechanical issue and we needed a new plane. Every hour our flight was given an update that a new plane was 1-2 hours away so stay close to our gate. They repeated this update until 7pm that night! And our terminal was being remodeled and had no air conditioning. It was November in Scottsdale and still very hot. I could not leave the airport to buy formula and airports don’t sell formula …But Ella Grace was happy as can be- nursing, sleeping in the baby carrier, being walked around in the stroller. I was so thankful to have been breastfeeding during this unforeseen travel situation! We finally landed in Philly at 10pm that night.

  8. Breastpump recommendations:
    Spectra is best for daily use (check your insurance provider, a free breast pump will be included)
    MommyCozy S12 is best for “taking the edge off”. Wearable breast pumps dont have the suction to extract all the milk available and can cause low supply with frequent use. You can use this on the other breast while nursing to catch extra milk and offer some relief when that initial engorgement hits.

Product Recommendations:

Labor is like a firework show. It starts off slow and gentle, with some “Ohhhh” …. “ahhhh’s”
the waves get stronger, the intensity increases and then you get a grand finale.
At the end, the dust settles, and the smokes clears… and you are left with a beautiful baby in your arms.

You did it.

There is nothing like that moment when your sweet baby lays upon your chest and you feel the warmth of his breath on your skin… it’s truly the best feeling in this world! And I cannot wait for you to experience this. “Welcome to the bliss”

Families have the option of purchasing additional photography packages at a discount, if their doula package does not include them.
If you would like to purchase a maternity session or in home Newborn session, please text me. Each session is discounted to $250, via venmo.