Monday, February 18, 2013

What's In The Bag?

A lot of folks ask me what I carry in my birth bag, so I thought I'd share this image from today as I was packing up for my upcoming birth.
 Now I'm not the kind of doula that spends the entire labor pulling tools and tricks out of my bag, but because labor can be so unpredictable, I find it's important to carry a lot of this stuff with me just in case. What I have includes (in no particular order):
  • Massage tools: Nukkles, an Omni ball, several sizes of balls inside of socks, heated "stones", a foot roller, and a hollow rolling pin.  
  • Bath pillow, fully sterilizable.
  • Stress ball and comb for accupressure/hand rolling
  • Covered kneeler pad (also washable)
  • Flip flops and a change of clothes for me (just in case)
  • Microwavable brley pack - both scented and unscented depending on client's preference
  • Massage oil, lotion, peppermint spritz, and several essential oils for light aromatherapy
  • A compact fan (a client favorite for transition and second stage)
  • Hair clips/pins and ponytail elastics
  • 5 Hour Energy (disgusting but effective)
  • Battery-lit LED candles
  • Extra lip balm for mama or me
  • Sustenance for me (I never want to look at a granola bar after a birth)
  • Extra toiletries for me
  • Birth ball (not pictured) and air pump
  • A "pull toy" for 2nd stage... this was an idea given to me by another doula several years ago
  • Medical gloves in case of roadside delivery (hasn't happened so far)
  • The Labor Progress Handbook (aka, cheat sheet)
  • Client file and numbers for me to call if I need to reschedule appointments
Again, I don't use 90% of this stuff during a single labor, but you never know!

....and it all fits into one bag!!

Saturday, February 16, 2013

To Encapsulate or Not To Encapsulate?

Placenta encapsulation has become increasingly popular in the natural birth community. Claims of lower postpartum depression, the replenishment of vital nutrients, even increased milk production permeate discussions in both mainstream and "crunchy" circles alike.

Placentophagia (the eating of one's placenta) is found in many mammalian species, though interestingly has not been recorded in human history and is only occasionally observed in the reproductive behaviors of our closest cousins. Anthropologists have failed to nail down the specific drive behind placentophagia, however, the hypotheses have become the mantras of today's placental encapsulation enthusiasts.

I'll say this: I'm a huge supporter of the practice. Not only do I believe it can potentially replenish your body's nutrients, I also believe in every person's right to do what they will with their bodies whether or not they're giving birth. If you have spent the better part of 40 weeks growing the organ that sustained your child in utero, it is understandable that you wouldn't want it to just be hauled off to the incinerator. Many families opt to take it home, bury it, save it in a freezer, or have it encapsulated. Encapsulating parents take the capsules like vitamins, and indeed the placenta is home to a number of beneficial nutrients that may aid postpartum recovery.

On just about every placenta encapsulator's website, you can find the following claims:
It is believed that consuming your placenta can:

  • Help to balance your hormones
  • Replenish depleted iron levels
  • Assist the uterus to return to its pre-pregnancy state
  • Reduce post-natal bleeding
  • Increase milk production – this has been proven in a study
  • Make for a happier, more enjoyable post-natal period
  • Increase your energy levels

Sounds pretty good, doesn't it?

As much as I hate to be a buzzkill, I must interject here that there is absolutely no methodologically sound research to back many of these claims (or demonstrate how consuming one's placenta would, say replenish iron levels better than a diet rich in heme iron). I wish there was such research, but unfortunately, the evidence of any of the above benefits remains largely anecdotal.

Deena Blumenfield at Shining Light Prenatal Education breaks down the issues with some of the commonly-held beliefs about placentophagia, noting specifically the questionable claims surrounding oxytocin and postpartum bleeding:
Yes, oxytocin is present in the placenta… but how much of it is destroyed during the cooking or dehydrating process.  No one knows because there are no studies on this.  How much of any of the hormones or nutrients are destroyed during cooking or dehydrating?  Again, no one knows.
Placenta is also used to control postpartum hemorrhage ... by cutting off a small piece of placenta and asking mom to suck on it, or eat it, as her care provider is trying to control the bleeding.  However, this is used in conjunction with other techniques, such as uterine massage, to control bleeding.  So where is the bleeding control coming from?
As a lactation consultant, I wish to specifically address the commonly-held belief that consuming your placenta can combat low milk supply because of its high levels of prolactin. It's shocking to see a number of people citing "a study" on placentophagia and prolactin levels when in reality no such study exists.  Let me rephrase... no such methodologically sound study exists.

The "study" put forth by most supporters of placentophagia is Soykova-Pachnerova et. al, Placenta as Lactagagon. The first thing I noticed about this study is that you can't find it anywhere... I sifted through page after page of placenta enthusiasts citing it, but couldn't locate a primary source at all.

The second thing I noticed about this study, once I found a reliable source with more details about it, is that it was conducted in 1954. It had an extremely small sample size, it was not performed with any kind of single- or double-blind method (in other words, participants knew whether they were being fed placenta or the placebo), and it did not control for outside factors (first gestation vs. subsequent, overlying health issues, etc). It has yet to be replicated. From those issues alone I am prepared to dismiss this research as bunk. Moreover, I am concerned with the number of folks claiming increased lactation from placentophagia has been "proven in a study."

Still, I find that the rationale deserves a closer look. While it is true that placenta contains lactogens (human placental lactogen, or hPL), hPL is slightly different from the prolactin (PRL) responsible for milk production. In fact - to totally nerd out on endocrinology for a moment -  it appears that the similar hPL molecules, along with progesterone, keeps the body's prolactin levels at bay until the placenta is delivered.[1]

Which brings me to my next point: even with lactogens present in placenta, can taking them orally cause one's prolactin levels to increase? For this to happen, lactogens (prolactin, etc) would need to have some sort of oral absorption capabilities.  Do they?

Unfortunately, the evidence seems to suggest they do not. While the body of research on this topic is also lean (and decades old), a well-controlled experiment conducted in 1979 found that the serum prolactin levels of lab rats were not effectively raised by the oral administration of prolactin. This study has also not been replicated, however, the conclusive nature of the results may contradict the need for further study.

Lastly, anecdotal evidence of better breastfeeding success and lower PPD is suspect in that it leaves many socioeconomic factors out of the equation. Consider location alone: the provider listings at show that most placenta encapsulation specialists are localized to metropolitan areas, areas where there are also likely to be lactation consultants, peer support groups, friends close by, etc.

Now consider the economic factor. To my knowledge, placenta encapsulation is not covered by any insurance company (and definitely not Medicaid), with out-of-pocket costs ranging from $200 and up. If someone has the ability to pay that fee (especially after having a baby), they probably also have the ability to pay for a lactation consultant, a doula, a therapist, etc. They are more likely to be partnered and have well-paying jobs (which would denote higher education levels). These factors play major roles in breastfeeding success and postpartum depression risk alike; therefore, without research on placentophagia that controls for these factors, there is truly no way of knowing whether the placenta - not socioeconomic status - is what's lending these great results.

Regardless of all the suspicions I have about placentophagia being a "miracle cure," my opinion is that there are probably many benefits (mostly nutritional), and it is likely not harmful. There has been some concern over the 2011 study that found heavy metals present in placenta and cord blood, but those levels are likely a reflection of what the body has been exposed to anyway. I am not clear on whether or not re-consuming those metals will do any more damage, however, I would encourage you to speak with your midwife or doctor if that is a concern.

But unfortunately, the claims involving lower PPD and better milk supply seem to be anecdotal. I'll echo Blumenfield that I would love to see actual research. As someone who works with new parents as both a doula and lactation consultant, it would be great to find out that placentophagia does in fact have these miracle properties. In other words, I would love to be proven wrong.

Lauren Guy

[1]Jan Riordan, and Karen Wambach, Breastfeeding and Human Lactation Forth Edition, (Sudsbury, Massachusetts: Jones and Bartlett Publishers, 2010), 88-90.

Wednesday, February 13, 2013

Hiring a Doula: A Doula's "Stats"

This is Part Three of a series on choosing the best doula for you and your family. Are there other topics you'd like to see addressed in this area? Email me at, or visit my Contact Form.

I always encourage my clients and friends alike to research their care provider's stats. As in, how often do they induce, what is their cesarean rate, etc? (This is also helpful to learn about their place for birth, which has fortunately become easy to find out.) 

In the past year or so, I have been asked more and more about my rates as a doula. As in, what percentage of my clients have epidurals? What percent have cesarean births? And so on.

There's really nothing wrong with this question, and I happily answer as I keep decent records of the births I attend. But what you may not realize is that these "stats" don't necessarily tell you anything about the person you're interviewing. It may give you limited information about the kinds of births the doula has attended, but seeing how medical decisions are 100% out of our hands, you may be surprised to learn that stats don't dictate how effective a doula will be for you.

Now granted, if a doula has attended 10 births and 8 have been cesareans, I would want to know a few more details as there are many factors that may influence this kind of rate: does she regularly assist in higher risk labors? Does she get a lot of referrals from care providers with high c-section rates themselves? Did she just have a string of strange outcomes that required the surgery? Regardless, are you comfortable with her limited experience with vaginal birth?

I would be less inclined, however, to inquire about her epidural rate, as this really tells you nothing at all about how "good" a doula is. The vast majority of women giving birth today plan on having an epidural at some point during their labor, and while a person hiring a doula is less likely to plan for that option, families hire doulas for many different reasons. In other words, there is no reason to assume that a doula with a 70% epidural rate is a "bad doula." You may, however, have questions about her lack of experience supporting folks through natural births, which is a legitimate concern.

One thing to remember when hiring a doula is that no topic is taboo. It's your birth, and you deserve to find a doula that you are comfortable with! But keep in mind what questions tell you and what they might not, and if you want additional detail, just ask!  We're always happy to offer some insight, even when you haven't hired us yet.

Speaking of sharing... in the interest of transparency, my stats:

(As of 2/13/13)
In the births I have attended:
  • 58.8% were first time mamas
  • 33.3% opted to have epidurals
  • 25% were induced
  • 8.3% were cesarean births 
  • 16.6% were born in water
  • Shortest gestation was 38w 0d
  • Longest was 42w 2d
  • Shortest labor was 2.5 hours from start to finish (45 minutes with doula in attendance)
  • Longest was 30+ hours (27 hours with doula in attendance)
  • Smallest baby was 5lb 14oz
  • Largest was 8lb 15oz
  • All babies healthy
  • All mamas an inspiration