Post of the week

Posted November 17th, 2014 in Birth Doula in Fresno, doula, fresno, Fresno birth, Fresno Birth Doula by Kathryn DiPalma

You must be the change you wish to see in the world.

Mahatma Gandhi

ACOG suggests getting a doula!

Posted February 20th, 2014 in Uncategorized by Kathryn DiPalma

ACOG suggests getting a what? Yup, a doula!

February 19th, 2014 the ACOG released guidelines to encourage physicians in lowering the nations cesarean rate and improving birth outcomes. You may be quiet surprised to learn how:

The ACOG(American College of Obstetrics and Gynecology)  released a document entitled,  Safe Prevention of the Primary Cesarean Delivery. This document discusses the different reasons for primary(first time) cesarean births so that it can than suggest ways to lower the cesarean rates.

They made a few different recommendations /guidelines on how to lower the cesarean rate.  But the one I want to highlight is  continuous labor support. Directly from the report:

“Continuous Labor and Delivery Support

Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized.”
OBGYNs are being urged to utilize the support of a birth doula.
Read the full text here:
So folks, your hearing it from the most highly respected group of obstetricians in the world:                        Get a doula!!

Newborn Photography Special

Posted January 15th, 2014 in Uncategorized by Kathryn DiPalma

A former client of mine is a wonderful photographer.  Her newborn pictures are just beautiful!!  She is running a great special and I would encourage you to check her out.

Having a baby in 2014? Register for your newborn session today and I will send you 50 cards to include in your shower invitations telling your friends and family how to purchase you a gift you will treasure for a lifetime and your family will treasure for generations. They are only this little once.

Hello and Congrats!!!

I am so excited to offer the newborn session registry for mom-to-be!

If you are expecting and would like to register to have your friends and family help purchase your newborn session/package please email me at [email protected]

I will send you cards to add to your invites with instructions for your family.

To visit the registry site and see where your guests see the more info tab on the left of the page, certificates are available in $20,$50,$100 and $150 increments. I must add your name to the store before your guests can purchase under your name, so please email me before sending anyone.

If you are trying to purchase a Gift Certificate please see the ‘Newborn Registry’ tab on the left of the page.

Please remember that Gift Certificates can not be redeemed for cash value.

Don’t Wash That Baby! Why Many Believe Newborn Baths Should Be Postponed

Posted June 8th, 2013 in birth, Birth Doula in Fresno, Fresno birth, Fresno Birth Doula, Newborns by Kathryn DiPalma


Newborn baths are essentially standard operating procedure in a hospital delivery. Yet, there’s many significant reasons to postpone that newborn bath. It might seem gross to many Americans. You may be thinking about the white coating, called vernix, and how that should be cleaned off.

Essentially, a newborn is bathed in a hospital, which is the home of the strongest and most drug-resistant microorganisms. This bath washes the natural protective coating from the newborn’s skin. This protective barrier is rich with natural flora, emollients, proteins, and antimicrobials… but we wash it off. In washing it off, we leave the newborn’s skin open to colonization from the hospital’s microorganisms. We allow the skin to dry out, and we in turn, apply manufactured, less adequate moisturizers to compensate. We also, no matter how well we attempt to dry a wet baby off, leave the skin damp at a time when temperature regulation is vital. To compensate, we bundle and cap the baby. This compensation eliminates important skin-to-skin contact that is important in proper flora building and crucial olfactory (scent) bonding.

As if these medical reasons weren’t enough of a case for delaying that first bath, an article in the Lancet suggested that interrupting the initial bonding process with a wash down can cause significant damage to successful breastfeeding. When a baby is placed on a mother directly, after about a twenty minute acclimation period, the infants in their study began to make crawling movements towards the breast. This was followed promptly by the rooting reflex. Before long, most of these infants were breastfeeding. Remarkably (or not so remarkably, perhaps) more infants in the group that were allowed this bonding period demonstrated correct “suckling technique” than than in the group that was separated from their mothers. (24 out of 38 in the contact group, as opposed to only seven out of 34 in the separation group.)

Tell me, is vernix really SO gross looking, that we are willing to wash away something so amazing and interrupt such a crucial period of bonding ?

Five Ways to Prepare Your Body for Pregnancy By Marianne Ryan

Posted May 20th, 2013 in Fresno birth, Fresno Birth Doula, Fresno VBAC by Kathryn DiPalma

Great article by Marianne Ryan.

Whether having children is in your 10-year plan or you’ve decided now is the time to start trying, it’s never too early to begin preparing your body for pregnancy. Ensure your body is ready to carry a baby by addressing before pregnancy any pain or problems associated with posture or weakness. Unfortunately, these issues can worsen during pregnancy and cause pain and dysfunction. The good news is a physical therapist can evaluate, diagnose, and treat pre-pregnancy musculoskeletal issues and continue to help you during pregnancy and post-childbirth.

Tips to Help Prepare Your Body for Pregnancy

1. Strengthen your pelvic muscles. To strengthen your muscles, use pelvic floor contractions (commonly referred to as Kegels), which involve gently squeezing the sphincter muscles (rather than the buttocks and thighs). These tightening exercises help prevent leakage when a woman sneezes, coughs, etc, and also can help reduce pelvic pain during pregnancy. However, many women do Kegels incorrectly (perhaps because muscles are too tight and need to be relaxed before strengthening). Physical therapists who specialize in women’s health can instruct women in how to perform these exercises safely and correctly.

2. Prepare for “baby belly” by focusing on your core. Core exercises can help prevent diastasis recti —abdominal muscle separation. As your belly grows, the abdominal muscles that run vertically along either side of the belly button can be forced apart, like a zipper opening. If these abdominal muscles separate from each other too much, the result can be low back pain, pelvic pain, or other injuries as your body tries to compensate for its weaker core. This also can result in the post-pregnancy “pooch” many women find undesirable. But beware, some exercises, such as sit-ups, increase the likelihood of developing diastasis recti.

3. Take a breath! Learning proper breathing and relaxation techniques from your physical therapist will help prepare your body and mind for a healthy pregnancy. It is important to learn to properly exhale before performing any exercise. With proper technique, your core and pelvic floor muscles will contract automatically, and this will lead to optimal stability and injury protection.

4. Begin a regular fitness routine. Exercise will help reduce the amount of cortisol (stress hormone) in your body and will boost your muscle and cardiovascular strength—strength you’ll need to carry that extra baby weight. Once you become pregnant, consider engaging in relatively low-impact activities such as swimming, walking on even surfaces, biking, or using an elliptical machine. Runners should be aware that loosening of their ligaments may make them more susceptible to knee and ankle injuries. Also, when the muscles and ligaments that support a woman’s pelvic organs weaken, the repetitive jarring of running can cause these organs to descend. This is known as pelvic organ prolapse. Physical therapists strongly recommend that, to prevent this condition, women wear undergarments that offer pelvic floor support, or compression shorts that support the pelvic floor both during and after pregnancy.

5. Practice good posture. Poor posture can have a major effect on every part of your body, particularly with regard to pain during pregnancy. A physical therapist can evaluate your posture and suggest muscle-strengthening exercises and lifestyle education (such as not sitting at a desk for long periods, and carrying your grocery bags properly). Establishing healthy posture habits—pre-baby — will better prepare your body for the extra weight of pregnancy and lessen your chances of low back and pelvic pain.

So, in the midst of all the planning and excitement, don’t forget to focus on yourself, the mom-to-be. You have a big job coming up. Take time to prepare your body for the rewarding challenges ahead.

A Baby’s View of Birth By Beth Kephart

Posted May 16th, 2013 in birth, Birth Doula in Fresno, fresno, Fresno birth, Fresno Birth Doula by Kathryn DiPalma
A Baby’s View of Birth

By Beth Kephart

Her voice comes to him like a stream of music, particles of sound from a  world outside his own. He has awakened from a sleep and from a dream he  won’t remember, and feels swaddled by sound — not just the voice, which pleases him, but the decisive beating of his mother’s heart, the  grumble of her intestines, the murmur of her lungs as they balloon and  then deflate. The light is dim inside the womb. Blood gurgles as it  washes by. He feels the weight of his mother’s hand pressing in, toward  his knee, and he presses his knee out toward it, as if to say, Yes, I am here.

Thirty-eight weeks ago he was nothing but one cell. One cell that then divided into  the stuff of tissues, organs, bones, and hormones, each cell finding its place in the growing cluster by heeding the instructions inscribed in  its genes. Some cells sloughed off and others settled in for life —  folding and migrating until, for instance, a miniature tube became his  pumping, robust heart. Now, transparent nails cap the tips of his  fingers and his toes. Billions of neurons are bundled in his brain.  There are creases on the bottoms of his feet, and on the sides of his  head are the fleshy blooms of his ears.

Now that he has a mouth and hand, he sucks his thumb. He squints toward the placenta through the amniotic fluid in which he floats. Attached to the back wall of his mother’s uterus, the placenta utterly encircles him,  anchoring him in with the ropy umbilical cord. The placenta is the only  organ he’ll discard upon his birth. An ingenious collaboration, composed partly of his cells and partly of his mother’s, it has served him these last many months as lungs, liver, kidney, endocrine glands, commissary, and telephone. How has he been getting his oxygen and blood? Through  the placenta. Where has he been sending his waste? Back to the placenta. From where have his glucose, amino acids, water, fats, mineral ions,  and vitamins come? The placenta. By what means has he already initiated  the processes of his own birth? By sending a squirt of hormone to the  placenta, of course.

For indeed the time has come. There’s enough fat on his body now to help  him make the transition to what will be a far cooler, drier environment. Enough neural pathways have been established between his sense organs  and his brain. He has shed his lanugo (the fine hairs that have covered  his body for many weeks) as well as his vernix caseosa (the waxy white  coating that has protectively sheathed his skin during his long  incubation), and then swallowed both; they’ll ooze away from him after  birth, with his first bowel movement. His bloodstream has been fortified with his mother’s immunoglobin proteins. And he’s ingesting the salty,  growth factor-enriched amniotic fluid that he floats in — thereby  helping the maturation of his digestive system.

For weeks now, he has been practicing breathing — exercising the muscle  fibers of his diaphragm, strengthening the nerve connections between his respiratory center and his brain, ensuring that his lungs will have the stuff it takes to expand and ventilate when they finally meet air. And, just to ensure that all systems will indeed be go, he has lately given  himself over to the stuff of sleep, napping as much as 95 percent of the time. He’s been spending much of that naptime in rapid eye movement  (REM) sleep, which has increased his heart rate, fluttered his eyes,  quickened his pulse, sparked the release and receipt of electromagnetic  pulses. This has been integral to the development of his brain —  pushing the mass of bundled nerves, cells, and connections to sort  themselves out in time for life outside the womb.

Now the fetus hears a low-frequency sound — the voice of his father. Soon  thereafter, the voice of his mother wafts in. He feels his body swaying, and senses that his own oxygen level has started to decline, for his  mother is pacing again, exerting herself and, therefore, him. His body  responds as it always does at times like these — channeling the  oxygen-rich blood to his brain and other critical organs, protecting  them above all else.

Upside down and snug in his mother’s womb, the fetus is aware that his  mother’s abdomen is tightening around him. Small, painless contractions  that are a mere precursor of what’s soon to come. “The baby comes when  the baby’s ready” may be folk wisdom, but it is also a fact, and this  fetus — fully developed, with no more space to stretch and grow — is  definitely ready for life outside.

Life On the Outside

A few days ago, his brain’s hypothalamus sent a message to his pituitary  gland. His pituitary, in turn, sent a signal (a small dose of the  chemical adrenocorticotropin, or ACTH) to his adrenal glands, which  subsequently played their part by releasing a stress hormone, called  cortisol, through the umbilical cord to the placenta. There, it has  begun to promote the production of estrogen, suppressing the manufacture of progesterone and, at the same time, releasing enzymes that are  capable of converting progesterone into estrogen. Thus, without raising  the suspicions of his mother, the fetus — as seemingly helpless as he  is — has triggered the processes of his birth.

All throughout her pregnancy, his mother’s abdominal muscles have been held in stasis by the predominance of progesterone over estrogen. Enough  progesterone has kept her body from rejecting the foreign object of her  fetus; the right amount of estrogen, on the other hand, has made mild  contractions possible, keeping the abdominal muscle toned.

Now that contractions are required to bring the pregnancy to a close, the  hormonal ratio must begin to shift in favor of estrogen. The softening  and dilation of the cervix is reliant on estrogen, as is the production  of proteins that encourage contractions. The ability of the mother’s  blood to coagulate during the birthing process depends on estrogen; so  does the production of prostaglandin and oxytocin receptors. Without  these, vaginal childbirth would be impossible, for it’s only after  estrogen makes the mother’s uterus more suspectible to oxytocin — and  oxytocin and prostaglandin then stimulate the contractions of smooth  muscles in the uterine wall — that the whole choreography of labor can  genuinely begin.

To get the contractions moving at some meaningful tempo, what’s needed is a dose of oxytocin, whose production is a collaborative effort: it’s  released by the pituitary glands of both the mother and the fetus. The  release of the oxytocin promotes further hormonal releases from the  adrenal and pituitary glands of the fetus. Mother and child have  officially entered the first stage of labor.

Contractions will start coming every 15 to 20 minutes or so now, each lasting 30 to  60 seconds. For the mother, there’s pressure and pain. For the fetus,  there’s the sensation of being squeezed. He hears voices outside  himself, feels the rock and walk of his mother’s pelvis. As labor  progresses and the cervix starts dilating, contractions come more  forcefully, more quickly, bring more pain to the mother. With his own  head, the fetus helps the process along — stretching his mother’s  cervix until it initiates a new cascade of nerve impulses that travel up the mother’s spine to her pituitary gland, which answers with the  release of more oxytocin. This further stimulates the contractions.  Inside, the fetus feels the squeeze and release of the muscular chamber  that’s housed him these many months.

With every contraction, the uterus shortens and closes, inching the fetus  farther down. With every contraction, the cervix widens. If things  seemed tight before, they’re nothing short of crowded now. The  contractions are coming far more often, and the fetus is dimly aware of  an array of new sounds outside the womb. He hears the groan of his  mother, the soothing voice of his father. Now he is squeezed tightly;  it’s not pain he feels, but pressure. The uterine muscles clamp down on  his head with such persuasion that he begins to release the thyroid  hormones and adrenaline that his body instinctively knows it will need  to adjust to the cooler temperatures in the outside world.

The pressure from the contractions, as well as the rising concentration of  prostaglandins, also protect him from a serious danger: the temptation  to breathe. Breathing before his head is completely free of the birth  canal would mean taking in fluids and risking pneumonia, so the fetus  obeys the blueprint in his genomes that instruct him to wait until the  world can hear him cry. It might sound easy, but his oxygen supply is  getting thin. His umbilical cord, with its many vessels supplying  oxygen-rich blood, is stretching. His mother’s blood vessels are  squeezed. The placenta is starting to tear away from the anchor of her  uterus. But he mustn’t yet breathe.

All of a sudden something breaks. he feels the amniotic fluid trickle, then rush past him. Just below his head, the cervix is at last fully  dilated. He feels his head push through a narrow channel, caught in the  vice of a contraction. With the cervix fully dilated, he can now push  through the birth canal, but it’s not a journey even this world-ready  fetus could make were it not for his own soft skull, which deforms in  the narrow passage. Still, no pain for the fetus. Just pressure.

It seems to go on for an eternity. The umbilical cord is stretched thin.  There’s hardly any oxygen in his blood. The amniotic fluid is being  squeezed from his lungs. His body fights fatigue.

Suddenly, there it is: A cold, bright, shouting light — dry air! Sound turned up to a whole new level. Slippery hands upon his head. A clamp on his  umbilical cord. He wails. Instinctively, he turns 90 degrees in the  birth canal, and trusts the hands in this new world to pull his naked  body free.

The fetus’ holler is that very first breath he’s practiced for. His lungs  draw in the air and its air sacs open. The oxygen relaxes the walls of  his lungs’ blood vessels, causing them to dilate. Whereas in the womb  the fetus’ blood bypassed his own lungs and was shunted off to be  oxygenated by his mother’s, now the shunts close forever, and his blood  begins to find its way into his lungs. There, it is oxygenated, and  rushed into his arteries via his heart.

The world the baby has entered is strange and new. There’s five times more  oxygen available now than there was ever before, and the rush of its  life-giving molecules stimulates his nerve cells. He still has a lot to  master, for his umbilical cord has been cut and his placenta —  surrogate lung, kidney, protectorate — is no longer a part of his life. Now his nutrients must come from milk. Now his kidneys must take charge of balancing his bodily fluids. But before he’s given much of a chance  to grasp the skills he’ll need, he’s given (and isn’t this just like  real life?) an exam — an Apgar test — which assesses his heart rate,  respiratory effort, color, muscle tone, and reflexes. Then he’s carried  beneath the harsh lights, through the dry air, toward a new destination.

A sweet voice he recognizes speaks to him, and a second voice whispers in his ear — his father. Who knows what the proud, encouraging sound  waves mean, but they play like music to his ears. He nuzzles close in  his mother’s arms.

Beth Kephart’s A Slant of Sun: One Child’s Courage was a 1998 National Book Award finalist.

What is your calling?

Posted April 28th, 2013 in Fresno birth, Fresno Birth Doula by Kathryn DiPalma

I believe that the…most important thing you can do for mothers, babies, fathers and society is to keep walking forward in your calling. Changing our birth ways will take all of us doing what we are called to do.

Jan Tritten

25 Reasons to Use a Birth Ball During Labor

Posted April 27th, 2013 in birth, Fresno birth, Fresno Birth Doula by Kathryn DiPalma

Have you ever wondered why a doula encourages you to use a birth ball while you are pregnant, or during birth?  Below are 25 reasons why using a birth ball during labor can help!

*    Its use facilitates physiologic positions for labor

•     It encourages fetal descent

•     It assists in rotation of the baby in the posterior position

•     It encourages pelvic relaxation

•     It allows for pelvic rocking and body movements

•     It encourages rhythmic movement

•     It helps relieve back pain

•     It can be used with both external and internal electronic fetal monitoring

•     It encourages pelvic mobility

•     It provides perineal support without undue pressure

•     It takes advantage of gravity during and between contractions

•     There is less strain on wrists and hands when in the hands-and-knees position

•     It helps when a back rub or back pressure is needed

•     The ball may enhance rotation and descent in a diffcult birth

•     The ball can be used as support while squatting

•     Its use helps widen the pelvic outlet to its maximum dimension while used during the second stage while squatting

•     It eliminates hard external pressure of a bed, chair or rocker when sitting

•     It allows freedom to shift weight for comfort

•     It helps take the pressure off hemorrhoids

•     It encourages good physiologic resting positions

•     It may speed labor

•     It helps contractions to be less painful and more productive

•     It is benefcial with techniques for failure to progress

•     In shoulder dystocia, it can support the mother who needs to be on hands and knees to facilitate rotation of the posterior shoulder.

by Paulina Perez, RN, BSN, FACCE, CD.  Posted with permission from ICEA.