Postpartum Intimacy: Are You OK Down There?

In anticipation of Valentine’s Day this week, we thought we’d cover one of the big fears that women have about life after baby: sex. Many women wonder if it will ever feel the same, how much it will hurt, and what their sex life will be like once baby comes into the picture. Below, some of the experts at FitPregnancy give the scoop on sex after birth. 


By Tamekia Reece, a writer in Houston who specializes in parenting, sexual health and relationship issues.

Will intercourse hurt when we start having it again? Will my vagina be loose? Will my partner still enjoy sex with me? More pregnant women and new moms than you might think fret about issues like these. To put your mind at ease about your after-baby body, here’s the scoop on the biggest sex-related worries women have.

Worry No. 1 > >  Sex will be painful.
Real deal: Having a baby causes the ligaments that support the uterus to stretch, making it lower slightly, says Mark Chag, M.D., an OB-GYN at Harbour Women’s Health in Portsmouth, N.H. While discomfort caused by the penis hitting the uterus during intercourse is normal (and easily remedied by switching positions), pain is not. As long as you wait until you’re given the green light by your doctor (usually six weeks), sex should be painless, Chag says. If it isn’t, talk with your doctor, especially if you had an episiotomy; you could have another tear or an infection. But even when you’re physically ready for sex, you may not feel like having it. Blame fatigue, hormonal factors or the possibility that it’s just nature’s way of making sure you don’t get pregnant again too soon.

Worry No. 2 > >  My vagina will be stretched out.
Real deal:  Nikki Perry, of Salem, Ohio, is worried that her vagina will get “stretched out” during her second delivery. “It’s 10 years later and I’m 10 years older, so I’m concerned,” she says. Although the vagina obviously expands during childbirth, “it is very elastic and returns to its normal contour afterward,” says Jennifer Berman, M.D., director of female urology and sexual medicine at Rodeo Drive Women’s Health Center in Beverly Hills, Calif. If you’re concerned about tightness, do Kegel exercises or other pelvic-muscle-strengthening moves. To do Kegels, repeatedly squeeze and hold the same muscles that control urine flow several times throughout the day. Doing the same during intercourse can help keep your partner happy.

Worry No. 3 > >  Nursing will make my vagina dry.
Real deal:  “Because of low estrogen levels, lack of vaginal lubrication is common after delivery, especially for nursing mothers,” Chag says. However, he adds, most women find the problem corrects itself once they stop breastfeeding. In the meantime, use a vaginal lubricant like K-Y Jelly. If you use a lubricant insert such as Lubrin, your partner won’t even know the difference. If this doesn’t help or if dryness persists for longer than two months after you give birth or stop breastfeeding, talk with your OB-GYN.

Worry No. 4 > >  I’ll look funny “down there.”
Real deal: After a traumatic delivery that resulted in fourth-degree tears, Rachel T., of Newport News, Va., wouldn’t have sex with her husband for weeks after being cleared by her doctor. “I felt like a vaginal Frankenstein,” she says. While your vaginal area may be swollen and discolored after you give birth, it returns to its normal appearance within four to six weeks. “The vagina is like a rubber band,” Berman says. “It’ll bounce back.” And so, probably, will your love life.

Postpartum pointers
Ease into intercourse: You might want to devote more time than normal to hugging, kissing, mutual masturbation or oral sex.

Be prepared: Have plenty of lubricant on hand.

Use protection: Remember, breastfeeding is not a reliable form of birth control, and you can become pregnant again before your menstrual periods resume.


Breastfeeding & Parenting: One Family’s Experience

By Lauralee Moss

Creative Commons photo by Raphael GoetterColds and the flu always surrounded my poor babies. Before I stayed home with them, I taught high school language arts. My students gave their nasty germs to me, and even though I nursed my children, they still got “lighter” versions of my illnesses. Seeing sick babies is always difficult for me, but it’s even more tough with a nursling who struggles to latch with a stuffed nose.

My husband and I created a routine to make nursing a sick baby easier: I showered and dressed before work, and then he showered. Only about five minutes into his time, I handed him a small towel and an infant. The warm water and steam rinsed off goopy eyes and cleared stuffy noses. Daddy finished showering, and I nursed a relaxed and latch-able baby.

I no longer teach, but my older two children are in school and bring home germs to the baby. We continue our routine, as he still volunteers to shower the baby if the tiny nose stuffs up again.

This seemingly small task makes my nursing life easier, as does all of my husband’s help. Nursing is an important, but fractional part of our larger parenting work. I may do the actual, physical feeding, but their father provides indispensable support as I nurse.

I’ve heard friends make the argument that by formula-feeding, they are not the only ones responsible for feeding — that the father will bond with the baby and will do “just as much work” as the mom.

In our family, we have found ways, apart from feeding, for my husband to bond with our babies. Showering tiny sick ones is just one of those ways. He lifted our babies’ tiny arms to wake them when they fell asleep at the breast. He carefully positioned them around my cesarean section incision for more comfortable nursing. He remembered advice from the lactation consultants and pediatrician as I sat in a new-mom daze. He helped me cover myself with a blanket as I ventured out as a new mother. As I grew in my confidence, he stood beside me as I publicly breastfed without a cover. He has listened to me discuss my breastfeeding theories and observations and defended me when family members questioned why I was still feeding our baby “on the boob.” When others question why I didn’t start feeding our first baby solids at four months, he quoted the American Academy of Pediatrics and World Health Organization statements about breastfeeding for six months.

Now that I nurse our third child, he provides healthy answers for our older two children when they ask: “How does the milk come out? Where does the milk go? Why does Cara not drink from a bottle? I want to see the MILK!” Most importantly, when my impressionable son asked why I nurse the baby, my husband said, “Because that is how it is supposed to be.”

Normalizing the process for the next generation — acting as a role model for a son — is important work. My husband has defended, physically helped, and mentally supported my breastfeeding. He does it all, not because he came to our parenting relationship as an outspoken breastfeeding advocate, but because we parent the best way we know how, and we do that together.

We have always seen breastfeeding as a part of parenting — and we parent together. I supply the food for a tiny fraction of our children’s lives. He has at least seventeen years to feed our babies.  I have breasts for food — he has big bear shoulders for the kids to ride around the house. Together, we provide both the physical and mental nourishment for our children.


Lauralee Moss lives in Illinois with her husband, three children, and crazy dog. She writes at

Postpartum Fitness: Stretching with Your Stroller

In continuing our discussion on fitness in the new year, we present a step-by-step piece on how to stretch your body while out and about with your baby. Christine Krauth, a pre- and postnatal Pilates instructor, shows us how to achieve an all-over body stretch using simple movements.


By Christine Krauth

I recently taught a “Pilates and Running” workshop to some members of Moms Run This Town: a very cool group of gals who run. A lot. With strollers. I am also a stroller runner and I think that if you run with a stroller you are a) a rock star and b) should be given extra mileage credit: like, 3 miles with a stroller is the equivalent of 4.3 miles without.

So, with that figured out let’s learn some cool stretches you can do WITH your stroller at anytime: before, during, or after your run or walk.

Lower Back and Shoulders Stretch

This first one is great for a tight lower back (lumbar spine) and tense shoulders ( ’cause you know as you are pushing that thing up a hill you are using your shoulders, girl):

  1. Stand with your arms long out on the stroller handle bar, your feet in a parallel position, hip width apart and in line with your knees.
  2. Gently lower your chin and engage your abdominal muscles (think belly button to spine!), keep your shoulders down and round over your hips extending your torso out from your hips. Try and keep your hips over your ankles.
  3. Get a nice lengthening in your spine by sinking your weight into the stroller bar and reaching your arms as long as you can.
  4. Round your spine (imagine you are a Halloween cat!) and roll up one vertebrae at a time back to your starting position.
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Hips and Lower Back Stretch

The second part of the Stroller Stretches is specifically for your hips but also feels good if you feel tight in your lower back. Honestly, it feels good regardless! If you feel a little pain in your hips while you run or walk, take a moment and try this stretch:

  1. Stand with your feet hip width apart, hands on the stroller, feet parallel.
  2. Lift your right leg off the ground and cross it over your left leg (like a man would sit in a chair). Make sure your right leg crosses above the knee on top of your left quad.
  3. Bend your left leg watching the alignment of your knee and foot. Do not let your knee pass your ankle!
  4. You will feel a stretch in your gluteals and hip on the right side. Try and keep your right leg as open as possible. Count to 10 as you breath deep (slowly. sometimes it’s hard to count slow if you are in the middle of a run).
  5. Repeat on the left side.
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Calf and Hip Flexor Stretch

The third installment is a calf and hip flexor stretch. Your calf muscles induce foot flexion AND help stabilize your ankles. Your hip flexors are a group of muscles whose primary action is to lift the upper part of the leg to the body. If you are walking or running, you use your hip flexors and your calves.

  1. Stand with your feet parallel, hip width apart.
  2. Lunge your right leg forward. Remember: your knee should be directly on top of your right foot and your foot should still be parallel.
  3. You will feel a stretch in the hip flexors on your left leg at this point. If you want more of a stretch, try pulling your left hip forward a little. Be subtle; it won’t take much.
  4. Lift your left heel and press into the ball of your foot.
  5. Lower your left heel slowly, pressing the heel into the ground. This is your calf stretch.
  6. Switch sides by bringing your right leg back and lunging out with your left leg.
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Christine teaches Classical, Prenatal and Post Natal Pilates at ProHealth, a Physical Therapy and Pilates Studio. Christine practiced Pilates throughout the pregnancy and after the birth of her first child in 2009. She found that Pilates helped her body tremendously to adapt, support and facilitate the work of carrying and birthing her child. This revelation motivated Christine to empower other women through Pilates during their pregnancies.

Easing Back Into a Fitness Routine After Birth

With the start of the new year, many women look to begin a new or revived exercise regimen. After all, ’tis the season for gym membership deals! If you’re entering the new year as a new mom, you might also be eager to return to your pre-baby workout habits. Finding time postpartum to focus on exercise can do wonders for your energy and emotional state (but don’t worry if you DON’T feel ready to be active again — take your time and do what feels best). Debra Flashenberg, a doula, Lamaze Certified Childbirth Educator, and prenatal yoga instructor, offers tips on how to ease back into fitness after the birth of your baby.


By Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 and Director of the Prenatal Yoga Center

I remember chatting with a friend about a month before I was due with my son about my po

st-baby gym routine. At that time, I was an avid morning gym goer — 6:30 am spin classes — things one can do before baby! I was under the great delusion that I would miss a couple of weeks and then be right back into my fitness regimen.

Reality struck me rather quickly after giving birth that it would take more time to ease back into physical shape than I had estimated. My pelvic floor needed work, I was hopelessly looking for any sign that I still had core muscles and I was downright tired and delirious from sleep deprivation. Many of the mothers I talked with experienced a similar awakening. We all had been somewhat surprised by the postpartum body compared to that of pregnancy. (Full disclosure: these women had been steady prenatal yoga students and were in very good shape during pregnancy.) The shared experience was atrophied muscles, bad posture, achy body and general fatigue. Given that was the physical state postpartum, it would take a mindful approach to returning to a fitness routine.

The first thing to take into consideration when easing back into a fitness routine is to be realistic and patient. It took around 40 weeks to form the pregnant body and it could take nearly as long to fully return to your pre-pregnancy physical self. Birth is a transforming event. I remember very clearly my midwife announcing to me, “the landscape of your pelvis will never be the same.” No matter if your labor is quick, long or surgical, the body undergoes a huge transformation to expel a baby.

Starting Back Slowly
As a general rule, I recommend that women do not return to postnatal or mommy and me yoga until their bleeding has stopped. If a woman gave birth via cesarean section, she needs to wait 6 weeks before rejoining class. If you push yourself too hard in the beginning, then you can actually be setting yourself back from real recovery. That of course does not mean you need to be held hostage in your house for 6 weeks. A walk can be considered a good start to your road back!

Watch for Your Bleeding to Stop
Once you do embark on some heavier activities, pay attention to signs from your body. Some women find that their bleeding that had tapered down starts to get heavier again, which is a sign that the body needs more time to heal.

How Is Your Pelvic Floor?
Also, if the pelvic floor is weak, putting intra-abdominal pressure (like crunches, pilates or general ab work) can put too much pressure on the pelvic floor and inhibit healing or even lead to a chance of organ prolapse. One of the first forms of exercise you can start to incorporate daily can be a kegel routine, restrengthening or even re-familiarizing yourself with your pelvic floor muscles.

Repairing Diastasis
It is very common that women experience a separation of the abdominal muscles, specifically the rectus abdominals — aka the six-pack muscles. Your care provider can check this for you when you return for your six week check up. If it is severe enough, you may need to work with a physical therapist to help draw the muscles back together. So, when easing back to an abdominal workout, be mindful not to overdo it. In postnatal and mommy and me yoga, we focus more on plank pose and variations of plank instead of old fashion crunches. It is also advised not to do extremely deep twisting poses which can also inhibit the muscles from repair.

Wiggly, Wobbly Joints
Relaxin, the hormone that is responsible for softening the ligaments and joints during pregnancy and childbirth, can stay in the body for up to six months postpartum. This can lead to wobbly, unstable joints and a loose pelvis. Again, just be mindful that the activity your choose is not too jerky in movement.

Find All Sorts of Exercise!
You do not need to attend a scheduled class to start to return to a general fitness routine. As I mentioned earlier, walking is a great place to start: don’t discount walking as a gentle cardiovascular exercise! At one point, I was told to avoid higher impact cardio since I was healing from some pretty severe pelvic floor issues and was instructed to try swimming. Fortunately, I have been an avid swimmer for years, so it felt like a nice welcome back to exercise and rediscovering my body. The nice thing about swimming is that it is gentle on the joints and pelvic floor, and is great for strengthening the core and back muscles.

Once you do start to ease back into your routine, please remember to hydrate well, especially if you are breastfeeding. If you are out for a stroll with your baby, put your water bottle in the cup holder as a reminder to drink often.

At the end of every postnatal or mommy and me yoga class we incorporate a few restorative yoga poses and then savasana (corpse pose). Even though many new moms hear the old saying, sleep when your baby sleeps, very few (I believe) adhere to these wise words. So, including a few moments to simply relax post-workout can really help replenish you. If you are feeling rested and restored, you will have so much more to offer to those that need you.

I hope that these ideas of how to ease back into a fitness routine post-baby have been helpful. Enjoy your baby and your new life!

How did you ease back into a fitness routine post-baby? What tips can you offer to other new moms?

Pregnancy, Birth & Postpartum Resolutions

New Year’s resolutions may take on more meaning if you’re preparing for the birth of a child in 2013. This year, perhaps for the first time, “join the gym and lose 10 pounds” isn’t on the list. At the same time, many of the resolutions you make for a healthy pregnancy look a lot like those you would make for a healthy lifestyle, pregnant or not. For example:

  • eat fruit and vegetables daily
  • get 8 hours of sleep
  • exercise 30 minutes a day
  • carve out time for yourself
  • ask for help when you need it

For a healthy pregnancy, birth, and postpartum period, we’ve compiled a few significant resolutions for you to consider adding to your list this year.



Listen to your body. If it’s telling you to slow down, do all that you can to make it happen. Cereal for dinner? Why not. Nap at 6 p.m.? Yep. On the other hand, if you’re feeling great, don’t let pregnancy slow you down — continue your exercise regimen, meet up with friends for dinner, enjoy life!

Learn about evidence-based maternity care. You can’t always count on your care provider to give you the best, most up-t0-date care. How will you know if you’re not receiving the best care? Learn how to navigate the maternity care system and how you can get the best care.


Labor & Birth

Plan for the best support. Who will attend your birth? Do they support your wishes? Will they provide positive energy? Think carefully about your birth support team. Look into hiring a doula. Share your birth plan with everyone well before labor begins.

Take labor one step at a time. Humans seem to be hardwired to think about what’s going to happen next. With labor, it helps to only think about what’s happening now. If you can take each contraction, each stage, each moment as it’s happening, you’ll be better able to put complete focus on the task at hand instead of worrying about what’s to come.



Speak up. It’s wonderful to have friends and family ooo and ahh at your new little joy. But a house full of visitors can be overwhelming during a time when you’re trying to understand a brand new world. Feel free to ask for some time and space alone with your baby. Post visiting hours on your front door or update your Facebook status to let friends know when you’re accepting visitors.

Know the signs of postpartum depression/disorders. Postpartum mood disorders (anxiety, depression, OCD, psychosis) affect hundreds of thousands of women every year. With knowledge of the warning signs and access to resources, women who suffer from postpartum mood disorders can and do recover.

Maternal Mental Health: Pre-Existing Risk Factors for PTSD and Childbirth

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.



This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Heidi Koss, MA, LMHC

Health care providers aren’t exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Your inherited mental health risks, such as an increased risk of anxiety and depression
  • Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
  • The inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

  • Being female — women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD and depression
  • History of abuse (such as childhood abuse, sexual abuse, rape)
  • Combat exposure
  • Physical attack
  • Being threatened with a weapon
  • Car accident, plane or train crash
  • Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

  • Flashbacks of the event — vivid and sudden memories
  • Nightmares
  • Insomnia
  • Fears of recurrence
  • Emotional numbing
  • Panic attacks
  • Inability to recall important aspects of the event — psychogenic amnesia
  • Exaggerated startle response, hyper-arousal, always on guard
  • Hyper-vigilance, constantly looking around for trouble or stressors
  • Avoidance of reminders of the traumatic event
  • Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it’s hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Recommended Books:

  • Postpartum Mood and Anxiety Disorders, A Clinician’s Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
  • Beyond the Birth, A Family’s Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.




PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.


Bonding with Baby Now

By Phyllis Klaus, MFT, CSW

As with pregnancy, bonding with baby develops over time. It, too, is a process that, with your care and attention, will deepen and progress with each passing day. Do you remember when you learned you were pregnant? Surely it was a deeply emotional moment. A second before, you were responsible for yourself and a second after you were forever linked to a new being growing inside you. The bond you feel with your baby isn’t as instantaneous; it will grow slowly yet steadily over these months of pregnancy until the day you meet your child and begin life as a family.

“Bonding” refers to the feelings of love and empathy that parents develop for their children. During pregnancy, sometimes that love is manifested in the form of dreams and fears about your baby and future as a mother. Positive, loving dreams can help you connect with your little one, but fearful ones can diminish your confidence about your baby’s health or your own capabilities. Let your health-care provider worry about your baby’s health. Then give yourself space to deal with your other fears in a way that works for you. Write in a journal or draw pictures of what’s going through your head. Share your concerns with your partner, as well as with your girlfriends, pregnant or not. Expressing your thoughts will help you deal with them and accept your child into your life.

Another way to begin bonding with baby is to send him loving messages. During a quite moment, put your hands on your abdomen and send happy thoughts and energy to the baby: how excited you are to meet him, what you plan to do when he arrives, how you can’t wait to have him as part of your family. Many women say this activity makes them less anxious and worried about their pregnancy.

The Power Of Your Partner

Your partner is a major factor in how you feel about your baby. If your partner is excited about your pregnancy, watches over you, protects you and takes care of you, you will likely feel closer to your child. But if your partner is unhappy or hesitant, then you may have doubts and worries too.

Your partner may be nervous about being a dad because he’s unhappy with how he was parented or his own childhood. That’s why now is a good time to talk to him about how each of you grew up, both the good and the bad. Discuss what kind of relationship you had with your parents. You don’t just have to start a conversation out of the blue; wait until a situation presents itself. Your friends might tell you they don’t have a set bedtime for their toddler, or you may see a couple in the supermarket letting their child select a sugary cereal. Use these incidents as starting points for conversations; discuss how your parents handled such issues and what you would do with your own child. By talking about your upbringing, you can establish a unified front on how you will raise your kids and address any fears that your partner may have about being a parent.

You should also discuss your feelings about the baby, how he has and will alter your life. When you and your partner can talk freely about the many changes that a baby will bring to your relationship, finances and lifestyle, you can continue to support each other and see the baby as enhancing your life instead of disrupting it.

If your partner feels removed from your pregnancy, help him with this simple exercise. Have him put his hand on your abdomen, and when he feels movement or when you tell him you sense the baby, have him say, “Hello, baby.” If he does this a few times a day for a week or two, he’ll feel more connected to both of you. Pretty soon, the baby may even kick his hand at the sound of your partner’s voice.

Your child was conceived out of deep love. That’s why bonding with baby doesn’t have to wait until she’s born: It really starts the moment that you find out you are pregnant, and it continues throughout your pregnancy. Not only is it a way for you to get closer to your child, it will also help you grow closer to your partner. And becoming an even more solid couple will help prepare you for your newly bestowed title: parents.

Lamaze Care Practices: What They Are & How They Can Help

Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible. But don’t take our word for it — click through to watch each of the short clips to learn more about safe & healthy birth and how best to achieve it, no matter where you give birth.

Introduction: Safe and Healthy Birth Practice - Download PDF

#1: Let Labor Begin on Its Own - Download PDF

#2: Walk, Move & Change Positions - Download PDF

#3: Have Continuous Support - Download PDF

#4: Avoid Unnecessary Interventions - Download PDF

#5: Get Upright & Follow Urges to Push - Download PDF

#6: Keep Your Baby With You - Download PDF

Download the complete booklet here.

Lamaze International partnered with InJoy Productions and their new Mother’s Advocate program to provide you with this free, evidence-based educational material.

A Voice of Strength I Didn’t Know I Possessed: Part II of An Interview with Ivy Shih Leung

A Voice of Strength I Didn’t Know I Possessed: An Interview with Ivy Shih Leung, author of “One Mom’s Journey to Motherhood: Infertility, Childbirth Complications, and Postpartum Depression, Oh My!”


In this second part of my interview with Ivy, she shares insight into her Chinese culture and pregnancy and postpartum. Secondly, she delves into her experience with infertility and complications during pregnancy. Finally, Ivy shares wonderful thoughts as to how writing, blogging, and communication can help to end stigma about PPD and create the causes for healing. You can read the first part of our interview here.


How has culture affected your writing about your experience?

I don’t feel that my culture really affected my writing about my PPD experience.  Though, I have to say that I am one of the few Asian bloggers I’m aware of.  Unlike most of my Asian friends and acquaintances, I am very outspoken and opinionated.  The Chinese tend to keep their emotions bottled up and thoughts and experiences to themselves.  In general, they are a very proud people.  Everything is pretty much about “saving face,” which means not putting oneself out there when it comes to personal experiences, especially if there is anything in the least bit negative.  As we know from the Western culture, pregnancy and motherhood are supposed to be blissful experiences.  I, on the other hand, have a book that shares ALL my thoughts and experiences while suffering from PPD.  It’s a fairly big deal for any woman to share her PPD story, let alone publish a book about it.  It’s an even bigger deal for a Chinese woman to do either.  


What would you like mainstream culture to know about your culture regarding pregnancy and postpartum?

Although I am Chinese and even speak Mandarin fluently, I was born and raised here in the U.S.  As a result, I am very Westernized and do not observe many of the traditions my parents and the generations before them may have observed.  Actually, my mother gave birth here and was not privy to the custom of Zou Yue.  She gave birth in a foreign country with no loved ones around her.  She received less help with taking care of me when I was a newborn than I had when I had my own daughter.  At least when I had my daughter, my husband helped, and my mother and mother-in-law each stayed a week to help. 

Zou Yue is like some of the other mother-nurturing customs observed by other cultures (la cuarentena in Mexico, sarantisma in Greece, Jaappa in India) in terms of observing a 30 or 40 day period of taking care of the mother, so she can take care of her baby and get adequate sleep to recover from childbirth.  Forty seems to be a magical number, a number that has survived through the centuries and therefore has special significance….no doubt it has something to do with the fact that 40 days is the average length of time for a new mother’s body to recover from childbirth and return to a pre-pregnant state.  It’s also why an OB/GYN will tell the new mother, once she’s given birth, that he will see her in 6 weeks.  Each of these traditions involves female family members and friends of the new mother providing her and her baby with care, so that the new mother’s only focus is on getting rest and bonding with/feeding her baby.  They also help around the house and prepare meals.  Certain rituals are observed in which food is prepared a certain way to help keep her body/system warm. She is protected from feeling overwhelmed; hence, visitors are kept away (or kept at a very minimum) during this time. She is told to avoid bathing for fear of catching cold.  All these rituals have the mother’s well-being in mind.  In terms of breastfeeding, female family members are on hand to teach her how to do it. In these other cultures, there is no expectation that the new mother know how to breastfeed instinctively and easily.  There is a reason behind the phrase “it takes a village.”

I have blogged about the importance of social support and how, through the years, we seem to have lost perspective on things when it comes to the community coming together to help a new mother who has just had a baby.   Getting adequate social support—comprised of both emotional support (e.g., shoulder to cry on, listening non-judgmentally) and practical support (e.g., help with breastfeeding, cleaning, errands, laundry, taking care of the baby for a few hours so mom can take a nap or shower) is critical for new moms. Having enough support during the first 4-6 weeks—until a new mom’s body recovers from childbirth and her hormone levels return to their pre-pregnancy state—can help keep anxiety levels down, help her get the rest she needs from all the changes her body has gone through with childbirth.


When you were pregnant, how was your culture addressed by care providers in ways that were helpful? And what about during your recovery from PPD?

I don’t remember if my OB/GYN and hospital staff asked me any questions, either orally or via a written questionnaire, as to whether I had any cultural preferences that needed to be taken into consideration during or after childbirth.  There definitely was no attempt on the part of my OB/GYN to ask me if I had any preferences for the duration of my pregnancy.  Fortunately, I didn’t have any preferences, anyway.  I just wanted to be treated with respect and care, both of which my doctor ended up failing at. Now, in terms of the GP who treated me during my PPD, he was the ultimate example of a doctor with extremely poor bedside manner.  The way I was treated by him and my OB/GYN angered me so much that I wrote them both letters during my recovery from PPD, telling them that their treatment of me aggravated my already extremely painful experience, they should get with the program when it comes to PPD, and I was dropping them and moving on to doctors who didn’t lack bedside manner the way they did.


Infertility and Complications

Can you share a little about your experiences with both?

Without getting into the details as covered in my book about my infertility experience and childbirth complications, I’ll just say that, like more and more women these days, I got married late (at age 36 ), had a dermoid cyst removed a year later to increase the likelihood of getting pregnant and not having it get in the way of a developing fetus, tried to conceive naturally for over a year before being referred to an IVF center where we failed our first cycle (it was such less than optimal experience mostly because the staff and environmental overall were cold and disorganized), and got pregnant successfully via my 2nd IVF cycle at a different center.  What started off as 2 fetuses became only one after a car accident I had about 2 months into the pregnancy.  Other than nausea that lasted my entire pregnancy, some spotting, and overall anxiety that I would carry to term, my pregnancy went well.  I delivered vaginally (with an epidural and episiotomy), but ended up having my uterus removed 3 days afterwards due to placenta accreta.  During my entire 7-day stay, I was constantly woken up for blood work and extremely exhausted as a result.  On top of that, I was starved for nearly the whole time I was there.  Due to my surgical procedure, I was kept in an entirely different wing from my daughter for over a day, and whenever I called for a nurse, no one came.  Some nurses were not nice to me at all.  It was like a living hell for me most of the time I was in the hospital.  To get the full details of my infertility, childbirth complications, and PPD experiences, you can read my book. 


How can your experience help the readers of Giving Birth with Confidence?

My hope is that those who read about my experience in my book—which covers a lot, including key statistics and information on the biopsychosocial factors behind PPD (infertility and childbirth complications are risk factors)—will become more knowledgeable about perinatal mood disorders.  I hope that they will also read the growing numbers of blogs of mothers who are speaking up about their struggles with perinatal mood disorders.  Why?  Well, knowledge is power.  With more knowledge, there would be less ignorance and stigma, and motherhood myths will have less of a negative impact on mothers than they do today. I want to see fewer mothers being caught off guard and not knowing what is happening to them, should PPD strike.  Being ignorant and unprepared for it causes unnecessary fear, anxiety, guilt, and inability to appreciate one’s baby. For example, insomnia after the third week postpartum is a common first symptom of PPD. 

My blog is hit numerous times each day via Google and other search engines using words like “postpartum insomnia,” “new mom insomnia,” “insomnia four weeks after childbirth,” “can’t sleep when the baby sleeps,” “can’t sleep six weeks postpartum,” and so on, which means that there are many moms out there who are going through what I went through, in terms of insomnia as a symptom of PPD, beginning at around 40 days.  That’s right, there’s that magical number again!  Had I known about PPD before my daughter was born, I would not have been as scared as I was as to why I had insomnia and couldn’t sleep even though I was exhausted beyond words and even during the times she slept. My fear would not have escalated to full-blown anxiety attacks. I would’ve recognized other symptoms like loss of appetite (I lost so much weight so fast that within a couple of weeks I weighed less than I did before I got pregnant!). As soon as I started to have insomnia, instead of merely taking the Ambien prescribed to me by my OB/GYN, I would’ve immediately known to question it as a sign of PPD and gotten the right treatment then.  As they say, hindsight is 20/20….


I would like to thank Ivy for her wonderful work and sharing her experiences and knowledge with Giving Birth with Confidence. To learn more about Ivy, visit her blog at

Circumcision Decision

By Deena H. Blumenfeld, RYT, RPYT, LCCE


Adapted from the original article at Science & Sensibility, “Parental Autonomy in Decision Making: A Follow-Up to the AAP’s Newborn Male Circumcision Policy Statement”


As parents, we face many decisions regarding how we raise our children.  It’s everything from what to name them; which car seat to purchase; choosing a pediatrician; what school to send them to; and so on.  If you are having a boy, you may be wrestling with the choice of whether to circumcise your son, or to leave his penis intact.  It’s not an easy choice to make for some families; others have no doubt about what they will do when their son is born.  Hopefully, this article will assist you in feeling confident in your decision regarding circumcision.


On August 27, 2012 the American Academy of Pediatrics (AAP) released their new Policy Statement on Male Circumcision. It caused somewhat of a stir in the online parenting communities and in the media. Ok, so maybe it caused a big stir…  In much of the coverage I’ve read online, I found much vitriol, anger and self-defensiveness, as well as overly aggressive behavior and dismissive or patronizing attitudes. This is entirely unsurprising. Circumcision has been a “hot button” issue for many years. This reaction comes not only from the mainstream media and individuals, but from the anti-circumcision organizations as well.


I’d like to explore the issue in a more objective and compassionate manner. Looking at the rationale behind circumcising (or not), we find multiple reasons, falling into two main categories: social and medical.


Social reasons regarding circumcision:

  • Religious beliefs
  • Perceived sense of what’s normal with regards to how his penis should look.
    • Wanting the baby to look like his dad.
    • Fear of the child being the only one in the locker room who doesn’t look like his friends.
  • Ethical belief that:
    • Circumcision is genital mutilation.
    • The child has autonomy.


Medical reasons regarding circumcision (cited from the AAP’s policy statement):

  • Reduction in rates of:
    • Urinary tract infections
    • Penile cancer
    • Transmission of some sexually transmitted infections, including HIV
  • Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.


From the new policy statement, the AAP concludes:


“Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.”


So, as a parent of a baby boy, how do you make this decision?  It is a multifaceted issue and no one person can tell you what the “right” choice is.  For some parents, the medical reasons carry greater weight than do the social or religious reasons.  For other parents, the social or religious reasons carry greater weight over the medical reasons.


On the medical side, just as we do with prenatal testing, medications or procedures during labor, vaccines for our children, etc., we look at the benefits of the treatment and the risks. We compare these to our own risk tolerance levels and then decide “Is this treatment / medication / procedure right for me?”


On the softer, but no less valid side, are our belief systems. We use our religion, our upbringing, and our societal norms to help us determine the right course of action.


How does the AAP feel regarding the social and religious influences on circumcision decision making?


“Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.”


“Parents and physicians each have an ethical duty to the child to attempt to secure the child’s best interest and well-being. Reasonable people may disagree; however, as to what is in the best interest of any individual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other. This situation is further complicated by the fact that there are social, cultural, religious, and familial benefits and harms to be considered as well. It is reasonable to take these nonmedical benefits and harms for an individual into consideration when making a decision about circumcision.”


This theme of parental choice is written throughout the document, overshadowing the medical evidence presented.


Trends and statistics in the United States:

Right now the circumcision rate in this country stands at about 50-60%, depending which survey you look at.  (All of the surveys are in regards to hospital circumcision.)  The rates of circumcision in the U.S. are declining, overall. 


Coming full circle: When you, as a parent, are trying to decide whether it makes sense to circumcise your baby boy, or to leave him intact, understand that the decision lies solely in your hands and that there is no “right” choice. Circumcision should be discussed by your obstetrician or midwife.  It should be discussed by your childbirth educator. Your pediatrician will offer guidance. Your family and friends will have their own opinions and the online universe will work diligently to try to convince you one way or the other.


Take a deep breath. Understand, as the AAP does, that you are the only one who knows what’s best for your baby, and whatever choice you make will be the right one for him.


How is this approached in your childbirth education class?  Every instructor will have her own approach.  However, she should be fair, compassionate and keep the environment of her classroom well balanced and safe for all students.


What should be covered in your childbirth class?

  • The medical and social reasons to circumcise (or not)
  • Addressing circumcision in your birth plan
  • How the procedure is done
    • Including risks and benefits
  • Your options, should you choose to circumcise
    • Shortly after birth, in hospital
    • A few days or weeks after birth in your pediatrician’s or family practice doctor’s office
    • At home, with a religious ceremony, such as a Bris
  • Care of the circumcised penis
    • Including warning signs for infection, etc.
  • Care of the intact penis 
    • Including what is normal, bathing, etc.
  • She may provide a handout with additions resources to which you may refer later.

Deena is a Certified Khalsa Way™ Prenatal Yoga Teacher and Lamaze® Certified Childbirth Educator. She has been practicing yoga for more than 15 years. She became a certified Yoga instructor through 3rd Street Yoga in December 2008. She completed her 60 hour Prenatal Yoga training in February 2009 in Los Angeles at Golden Bridge Yoga with Gurmukh.

Her Lamaze certification was completed in October 2010, through Magee Women’s Hospital and Lamaze International. She is an advocate of empowered birth for women. Through the teaching of Prenatal Yoga and Childbirth Education classes, she helps women become more confident in their choices regarding pregnancy, birth and parenthood. Deena has also studied yoga with Doug Keller, Max Strom, KK Ledford and Shakta Kaur Khalsa. Her ongoing professional development as a Childbirth Educator has been with Ina May Gaskin, Penny Simkin, Gail Tully of Spinning Babies and other childbirth professionals.

Deena is also a mom of two – a son, born via c-section in April 2005, and a daughter in March 2009, a VBAC. She is an active member of the local ICAN chapter and a member of the Coalition for Improving Maternity Services.