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Cervical Exams: The Good, the Bad, and the Ugly, by Julie Brill, CCCE, CLD, CAPPA Faculty

By Julie Brill | February 20, 2013 | Comments Off on Cervical Exams: The Good, the Bad, and the Ugly, by Julie Brill, CCCE, CLD, CAPPA Faculty

“Is this something I have to do?” is a question about vaginal exams frequently asked by my childbirth students. The short answer is no. Especially in teaching hospitals, women are often examined frequently, without even knowing why. The most important question to ask when considering an exam, like any other test, is “What will we do with this information?” A woman’s preferences regarding cervical exams can be discussed with her provider prenatally and included in her birth plan.
The good news about exams is they can be helpful if a laboring woman is deciding whether to stay in the hospital and be admitted or go home, or if this is a good time for her to get pain medication. They can provide encouraging news to women if they show increased dilation in labor. In the absence of increased dilation, they can still be encouraging, if the mom is able to get positive news about increased effacement (thinning) of the cervix or station of the baby.
The bad news about exams is that they increase the risk of infection, especially when they are done after the release or artificial rupture of membranes. In a hospital setting, they are usually done in bed, which is often uncomfortable during labor. Sometimes a woman is laboring successfully in out of bed positions, but after getting in bed for an exam she stays in bed, which can slow labor and increase pain. If an exam does not yield information about increased progress it can be discouraging. VBAC women especially may wish to avoid exams during their labor until they are quite confident they have progressed past the farthest dilation of their last labors.
We all come from a long line of women stretching back to the beginning of time who have successfully birthed babies. When students ask me if exams are something they have to do, I like to think of those grandmothers laboring without exams, pushing when they had the urge to do so. The energy of birth is down and out, and having an exam can often feel like energy flowing in the wrong direction in labor. For women with a history of sexual abuse, probably about one third of laboring women, exams can be triggers. It’s also important to remember that exams are subjective, what feels like six centimeters to one provider, might be seven to another. In precipitous labors, women will often have transition like contractions before their cervixes catch up to that dilation, and being in transition with a cervix that seems to have only begun to dilate can be quite discouraging.
And what about prenatal cervical exams? While these can be encouraging or discouraging, depending on the information they yield, they don’t necessarily indicate how close a women is to starting labor. I recently emailed with a woman considering a VBAC who was told by her provider after she had difficulty with a prenatal cervical exam that this was an indicator that she would have difficulty VBACing. Again as with all tests, a great question when considering a prenatal cervical exam is “what will we do with this information?”

Julie Brill, CCCE, CLD owns and manages WellPregnancy in Bedford, Massachusetts. She has been teaching childbirth classes and attending births since 1992, and mentoring new birth professionals as a member of the CAPPA Faculty since 2003. She is also certified to present Peggy Huddleston’s Prepare for Surgery, Heal Faster workshops. Her website is

A Holistic Approach to Your Prenatal Care

By Julie Brill | February 15, 2013 | Comments Off on A Holistic Approach to Your Prenatal Care

By Guest Blogger, Webster Certified Prenatal & Family Chiropractor and WellPregnancy trained, CAPPA childbirth educator Dr. Jessica L. Caruso

Many of my patients ask “Is it safe for me to continue chiropractic care during my pregnancy?” The answer is a resounding “YES!” In fact, not only is it safe; but chiropractic care is highly recommended as it can help with lower back pain, sciatica, nausea, heartburn and many more of the common symptoms associated with pregnancy. Chiropractic care during pregnancy is vitally important in supporting the body’s innate ability to adapt and function the way it is designed to for both the mother and baby. Prenatal chiropractic care can give you a flexible, balanced spine, hips & pelvis; and help your internal organs stay free from postural and nervous system stress, which is essential for a healthy pregnancy and delivery.

Another reason to be under chiropractic care during pregnancy is…it’s drugless! Over the counter medications for relief of the common symptoms associated with new postural strains can be decreased — even avoided. There is no such thing as a safe drug. Most prenatal and family chiropractors will speak to their patients about proper and safe nutrition & supplementation during pregnancy and lactation.

When expecting, finding a chiropractor who is Webster Technique Certified through the ICPA is recommended.  This chiropractic technique helps to correct sacral and pubic bone misalignment, and balance pelvic muscles and ligaments, which in turn removes torsion to the woman’s uterus, its resulting constraint to the baby’s growing cranium and spine, and allows the baby to get into the best possible position for birth. (

To find a Webster Certified Chiropractor near you visit

Webster Technique Chiropractic Care During Pregnancy:

  • In expectant mothers presenting breech, there has been a high reported success rate of the baby turning to the normal vertex position.
  • Prepares the woman’s pelvis for an easier pregnancy and birth by creating a balance in the bones, muscles and ligaments which allows the baby the room to develop without restrictions to its developing cranium or spine.
  • Removes tension on the ligaments that support the uterus, such as the round ligaments- giving the baby the room to move into the best possible position for birth.
  • Reduces interference to the mother’s nervous system which controls and coordinates all of her organ systems and functions; such as the reproductive system for better baby development.
  • With proper baby positioning, there is a significant decrease in dystocia (resistance to normal function in birth) and the resulting birth trauma caused by intervention.
  • Allows for a safer, easier birth for mother and baby by decreasing the potential for interventions such as augmentation, c-section, vacuum and forceps extraction, etc.
  • Research has shown  chiropractic care throughout t pregnancy to significantly reduce labor time. (Joan Fallon, MD study)

Pregnancy and birth are special times in a woman’s life that she should enjoy and treasure, not something to just “get through.” I recommend finding a Webster-certified chiropractor who is committed to helping you have the best possible childbearing experience through holistic prenatal care.

About the Author:

Dr. Jessica Caruso is a Webster Certified prenatal & family chiropractor, CAPPA childbirth educator and the owner of Healing Hands Chiropractic in Londonderry, NH and Healing Hands Community Chiropractic in Portsmouth, NH. To learn more about Dr. Jessica Caruso and Healing Hands Chiropractic -Londonderry please visit: or call (603)434-3456  for Londonderry or 603-512-3191 for Portsmouth


*Derived from the notes of Jeanne Ohm, D.C., F.I.C.P.A., Perinatal Care,

Top Ten Pieces of Baby Advice to Ignore by Julie Brill, CCCE, CLD, CAPPA Faculty

By Julie Brill | February 9, 2013 | Comments Off on Top Ten Pieces of Baby Advice to Ignore by Julie Brill, CCCE, CLD, CAPPA Faculty

1.Put that baby down before you spoil it. How exactly can you spoil a baby? They’re supposed to be dependent. The great thing about front packs and slings is that your baby can be exactly where she’s supposed to be and you still have your hands free.

2.Get that baby out of your bed. Unless you like staggering around in the middle of the night, your bed is the handiest place to keep your nursing baby. Unless you’re on something, you won’t roll onto them. And co-sleeping prevents against Sudden Infant Death Syndrome (SIDS). Most of the world sleeps with their babies. And you’ll save on the cost of the crib.

3.Your baby has diarrhea. If your mother-in-law has only ever seen formula fed baby poop, she’ll probably think your breastfed baby has diarrhea. That’s because formula is constipating. Breastfed poop is usually runny and can be brown or green. And yes, it’s true, it doesn’t smell until your baby starts eating solids.

4.Buy one of those plastic tubs to bathe your baby in. Why don’t you just take them into the bathtub with you? Enough said.

5.Have some formula on hand just in case. The reason formula companies send out free formula is because they’re trying to get you hooked. They know the more you use their product, the less milk your body will make. The best way to increase your milk supply is to nurse more frequently. By the way, sending out free formula is in direct violation of the World Health Organization Baby Friendly Code. Call the formula companies on their 800 numbers and tell them what you think of their formula.

6.If you can’t pump milk, your breasts must be empty. Your baby is the best pump. He or she can get milk when your pump can’t. If your newborn is wetting 8-10 diapers a day, pooping every day, nursing every 2-3 hours and growing you’ve got plenty of milk.

7.Put your baby to sleep on his stomach. That’s what the nurses told your mom when you were born but research shows that back sleeping prevents SIDS. This is especially important if your baby doesn’t sleep with you. As she or he gets a little older give her or him some awake tummy time to help develop the muscles needed to crawl.

8.You need to buy a lot of baby stuff. Yeah they want you to believe you really need the diaper genie, the swing, the walker, the stroller that converts into a car seat so you never have to actually touch your baby, and the toys that squeak, bong, beep, and talk. But even if you could afford it where would you put it all? Older babies love to play with pots and pans and plastic water bottles filled with unpopped popcorn. They love to splash in water, play with your keys, and look at themselves in the mirror.

9.It’s ok to vaccinate your baby today – it’s just a little cold. Well, actually, no it’s not. Vaccines are controversial, but if you are going to vaccinate, only do it when your child is totally healthy, even if it means bringing them back in to the doctor’s office. The risk of vaccine reactions goes way up when a sick child is vaccinated. You should not have to pay an insurance copay for a vaccination only visit [but check your insurance plan].

10.Your child is too old to nurse. You’ll decide when that’s true. There are lots of benefits to extended nursing for both moms and children. Toddlers benefit from excellent nutrition and fewer illnesses. When they are sick they may continue to nurse even when they refuse other foods. Mothers get dosed with those helpful mothering hormones, prolactin and oxytocin, which stimulate nurturing behavior. Women may be lowering their risk of reproductive cancers and osteoporosis by extended nursing. Both mom and child benefit from the closeness, soothing, and quiet time that nursing provides. Extended nursing is common in many cultures and is probably the human norm.

Julie Brill, CCCE, CLD has been a perinatal educator since 1992 and on the CAPPA Faculty since 2003. She teaches childbirth and labor doula trainings in New England and offers childbirth classes, Prepare for Cesarean Birth workshops, and birth option consults by phone and Skype. She is the homeschooling mother of teenage daughters. Visit her website at

Ten Tips for Beginning Childbirth Educators by Julie Brill, CCCE, CLD

By Julie Brill | February 8, 2013 | Comments Off on Ten Tips for Beginning Childbirth Educators by Julie Brill, CCCE, CLD

1.Be upbeat. Convey that birth is safe. Begin each class with a brief outline of what you will be covering so students can know what to look forward to. End with time for questions and a brief preview of the next class. Always end on a positive note.

2.Use word of mouth advertising. It’s effective and inexpensive. Call and email your friends and family to tell them you are now teaching birth classes. Ask them to spread the word. If you have a related business (doula, pregnancy massage, prenatal yoga, etc.) call your past clients and ask them to tell others about your new business. If you have a nitch (twins, vbac, specific community such as Spanish speaking, deaf, lesbian, etc.) be sure to promote this aspect.

3.Start with a weekly series. They’re easier to prepare for than a weekend class and if you don’t know the answer to a question, you have a week to find out.

4.Be organized. Have an outline of everything you plan to teach so that if a question diverts you, you can get back on track. Arrive early so you can set up the room and have all handouts and teaching aids handy before students arrive.

5.Learn students’ names. Have a positive attitude about remembering names, it’s a learned skill. Review the class list ahead of time to familiarize yourself with names. Allow time for frequent rounds of introductions. Use name tags. Ask students to say their names when asking a question. Use names when greeting or referring to students. This will help to create a sense of community in class which will make students more comfortable asking questions, more likely to continue friendships when the series is over, and more likely to keep coming back to class.

6.Don’t be afraid to say you don’t know. This happens to all educators. Tell the student you will get back to her or him next class, or if it seems to be an urgent matter that you will call them with the information. Make a note about the question and who asked it to remind yourself. Education for childbirth educators is always ongoing.

7.Get them moving. They will remember much more of what they do than of what they only hear. Have them practice comfort techniques, breathing, and labor position and role-play getting informed consent. Break them into groups to answer questions or go over labor scenarios.

8.Remember you can benefit from deep breathing, affirmations and visualization too. The skills you are teaching have life long benefits. If you’re feeling nervous take a few deep abdominal breaths to allow the extra oxygen to calm you. As you drive to class, visualize your class going smoothly. See yourself calmly greeting each student by name, effectively answering questions, using visual aids, and leading discussion. Choose an affirmation such as “I am a skilled educator” and repeat it aloud while you drive.

9.Appeal to all learning types. Use posters, handouts, and an easel or white board for visual learners. Pass around the doll, pelvis and placenta models, a bag of tools such as amnio hook, vacuum extractor, bulb syringe, for tactile learners.

10.Be confident. Remember you are trained and certified and you do know more than your students. Smile, it releases endorphins.

Julie Brill, CCCE, CLD owns and manages WellPregnancy in Bedford, Massachusetts. She has been teaching childbirth classes and attending births since 1992, and mentoring new birth professionals as a member of the CAPPA Faculty since 2003. She is also certified to present Peggy Huddleston’s Prepare for Surgery, Heal Faster workshops. Her website is

Why the Science of Birth Doesn’t Matter

By Julie Brill | February 8, 2013 | Comments Off on Why the Science of Birth Doesn’t Matter

I recently got to hear Joel Salatin speak. For those who don’t know, Joel is a farmer and an advocate of the right of American consumers to purchase raw dairy, meat, eggs, and vegetables from small, local farmers. He says that if our Founding Fathers could have imagined that this right would ever be taken away, they would have protected it in our Constitution.
During the Q and A, an audience member asked about the science that shows that raw milk is safe. I’m paraphrasing, but the point of Joel’s response was that the science is there of course, but that the science doesn’t matter. He said that even the scientists sometimes don’t believe their own science. That is why it is important to frame this discussion in the context of the right of the consumers to purchase and eat whatever foods they choose.
I have long been fascinated by the similarity of the politics of birth and raw milk. We have the science to show that less intervention in birth usually makes birth safer and that much of what is done in obstetrics is not evidence based. We know that ACOG evaluated their own recommendations and found only 30% to be evidence based. We watch as the rate of American maternal mortality rates climb, along with the rising rates of inductions and cesarean births. It makes me think that Joel is right, it’s not about the science.
The way to protect birth freedoms and midwives is to frame the issue as one of consumer freedom. Women are smart and our right to make informed choices about our bodies, our health, our babies, and our births needs to be protected. This is another right American founders could hardly have imagined disappearing.
In my childbirth classes we talk about how ultimately birthing decisions are heart choices. I watch the pregnant students in my VBAC classes sometimes struggle to decide if they want to VBAC or have another cesarean birth. We talk about safety and science. But ultimately the decision is about the heart and not about science. My natural childbirth students sometimes struggle to decide if they want a home birth or a hospital birth. We discuss the data, but ultimately this too is a heart decision.
When birth advocates work to protect the right of a mother to choose where, with whom, and how to birth, when we move the discussion away from the science, then real change will begin.

Julie Brill, CCCE, CLD is honored to have taught thousands of childbirth education students and hundreds of CAPPA childbirth educators and labor doulas. To register for a New England CAPPA childbirth educator or labor doula training visit To follow her on Facebook, visit

A Better Doula Training?

By Julie Brill | February 7, 2013 | Comments Off on A Better Doula Training?

For the first time weather has forced me to cancel a labor doula training. Doulas go out in the snow, but with a forecasted New England blizzard on the way, it seemed like the only responsible action to take. It got me thinking about tongue and cheek conversations I have had with other doulas about how to hold a training that would best prepare doulas for a career of being on call:
1. Trainings would be held in all weather.
2. Trainings would be held at any time of the day or night, 7 days a week, 365 days a year.
3. Some trainings would be short, while others would go on much longer than average. There would be no way for students to accurately guess how long their particular training would be.
4. Sometimes I would text or email students hours before the training would start, to tell them that I had feeling it would be soon, and allow them to make last minute preparations or rest. Sometimes I would call them telling them they had to get to the training as quickly as possible. Occasionally I would let them know I thought it would start soon, but not actually start it for another week.
5. Occasionally we would assemble for a training, hold class for a few hours, and then it would peter out to begin again a few days or weeks later.

Who has other ideas for the new and improved doula training?

Julie Brill, CCCE, CLD is honored to have trained hundreds of CAPPA professionals over the past 10 years. To register for a labor doula training which will actually be held at times visit


Ten Tips for Reducing Stress While Living With Your New Baby by Julie Brill, CCCE, CLD

By Julie Brill | February 7, 2013 | Comments Off on Ten Tips for Reducing Stress While Living With Your New Baby by Julie Brill, CCCE, CLD

1. Ask for what you need. This is often difficult for new parents but if friends and family offer to help, ask them for specific favors. Do you need someone to vacuum, pick up your pictures or something at the grocery store, or fold laundry? Can a different person bring you dinner for a week or two? Consider registering for meal assistance at Tell visitors ahead of time that they will only be able to stay a short time since you are busy taking care of your new baby. You may also want to consider hiring a cleaning service or postpartum doula.

2. Practice the breathing and visualization you learned in childbirth class. Deep breathing can help you to relax now. Extra oxygen is a natural tranquilizer and can help you feel less stressed. When calming a crying baby, try taking a few deep breaths. You may have used visualization during labor, now try seeing your body relax, or imagine yourself in a restful spot, such as the beach. Picture breathing in a pleasant smell or color. Smiling releases endorphins so that may help as well.

3. Reach out to other new parents. Call or email other students from your childbirth class to see how they are doing. Attend a La Leche League meeting or a breastfeeding support group at your local hospital, a postpartum yoga class, or a mom and me play group.

4. Breastfeed. Nursing releases oxytocin, which makes you feel calmer and lowers your blood pressure. It also promotes mother and baby bonding. Breastfed babies have fewer colds, ear infections, colic, and allergies; healthier babies are less stressful to care for. Healthier babies mean less sickness for parents and other members of the household as well. Breastfeeding is a time for the mother to rest. It promotes uterine contractions. The faster the uterus contracts the less lochia flow there will be. This leads to higher iron levels and less fatigue. Breast milk never needs to be prepared or heated and there are no bottles to clean or trips to the store. Set up a nursing station where everything you need will be within arms reach: a snack, a drink, the phone, the remote control, someplace to put the baby down, a book, etc. If you live in a two-story house establish a changing station with diapers, wipes, and clean baby clothes downstairs so you can reduce the number of trips you make up and down stairs.

5. Plan ahead. If there are specific times of day that seem to be fussy times for your baby plan to call or meet a friend during that time. If dinner-time is difficult try making dinner earlier in the day, order out, or eat cereal for dinner. If you have a few minutes in the evening, gather together what you will need for the next day so your diaper bag, purse, and keys are ready. Or set up snacks such a water or juice in sippy cups, raisins, sliced cheese or pretzels in Ziploc bags that your older child can help him or herself to when you’re busy with the baby. While you’re at it, set up some easy-to-reach, healthy snacks for yourself.

6. Focus on what you’re eating. Good nutrition doesn’t have to be fancy. A scrambled egg is quick and easy. Cheese on whole-wheat crackers is a good snack, so are bananas, apples, nuts, yogurt, dried fruit, natural peanut butter, edamame or a glass of milk. Eating well will lower your stress level and help you heal faster.

7. Sleep as much as possible. Sleep deprivation is actually a form of torture! Prioritize sleeping during the day when your baby sleeps since you know your night-time sleep will be interrupted. The more you rest now the faster you will heal from birth. During the day, lie down even when you cannot sleep. Remember women in traditional cultures have a lying in period where all they do is rest in bed and feed their babies. Try to learn to nurse the baby lying down so you don’t have to sit up for every feed. To nurse lying down, put several pillows behind your back so you can comfortably lie on your side, place your baby on her side so you are belly to belly and her mouth is as high as your nipple. Move your bottom arm out of the way and cradle her head with your top arm. If it seems your baby needs to be higher place a folded receiving blanket under her head.

8. Try to exercise a bit. Once your body has healed from birth, walking with your baby will release endorphins that make you feel better. Even just standing for a few minutes on one foot will reduce your stress as your body focuses on keeping your balance.

9. Lower your standards. Your home will now look like you share it with a new baby. It’s ok if it’s not quite as neat as it was before. It may take a while for those thank you notes or birth announcements to get out. Taking care of a baby is a full time job.

10. Think about what is helpful for you. For some new mothers the whole day seems better if they can greet it dressed and showered; they prioritize showering before their partners leave the house or they have a visitor watch the baby so they can grab a shower. Others would rather sleep as much as possible and find that staying in their pajamas causes visitors to shorten their stay. Arrange for someone to watch the baby so that you can take a warm bath or a walk by yourself. Try to keep in mind that the intensity of caring for a newborn is temporary. Someday you may look back on this time with nostalgia. Even though your nights may seem long now, babies grow quickly so takes lot of pictures and record your baby’s milestones. Most importantly take moments to enjoy his or her babyhood and be fully in the moment.

Julie Brill, CCCE, CLD has been teaching childbirth classes for twenty years and training birth professionals throughout New England as a member of the CAPPA Faculty for ten. For more information about attending a childbirth educator or labor doula training please visit Phone Prepare for Surgery, Heal Faster and Skype childbirth educator classes and consults also available. For perinatal updates and other info follow Wellpregnancy on Facebook at

Contact WellPregnancy

Julie Brill, CCCE, CLD, IBCLC
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You can't spoil newborns because their wants and their needs are the same. It's later that they want a cell phone or a pony. - Julie Brill, CCCE, CLD

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