Monday, May 31, 2010

New Data Show Connection Between Childbirth and Spirituality

As posted on PRLog

Spiritual beliefs may have a place in the clinical assessment for women having babies.

PR Log (Press Release) – May 27, 2010 – While having a safe and healthy birth is typically a primary concern for pregnant women, new research shows that most women view childbirth as a spiritual experience as well. The just-published research shows that women across diverse cultures correlate having a baby with “growing closer to God.”

The study, published in the spring issue of the "Journal of Perinatal Education," found that understanding the spiritual dimensions of childbirth is essential in clinical settings. As such, authors of the study recommend clinicians include the question, “Do you have any spiritual beliefs that will help us better care for you?” during their clinical assessment.

“Childbirth and motherhood provide many women with an ideal context in which to recognize the spiritual aspect of their lives,” said Lynn Clark Callister, R.N., Ph.D., FAAN, a professor of nursing at the Brigham Young University College of Nursing and study co-author. “Our research illustrates that for most women, childbirth is a deeply spiritual experience. As healthcare providers, we need to recognize and support this evidence, and listen to women’s voices to guide their care.”

In their study titled “Spirituality in Childbearing Women,” authors Callister and Inaam Khalaf, R.N., Ph.D., dean and professor of nursing at the University of Jordan Faculty of Nursing, discovered five themes in a secondary analysis of the published and unpublished narrative data collected over the past 20 years from about 250 culturally diverse women.

“This study is both insightful and intuitive,” said Sharon Dalrymple, president of Lamaze International. “It’s no surprise to see a woman’s spirituality is an important part of her well-being, but it’s interesting to consider how this information can be used by women and their healthcare professionals to enrich and further empower women when they are giving birth.”

The themes that emerged in the study included: childbirth as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, childbirth as a time to make religiosity more meaningful, the significance of a Higher Power in influencing birth outcomes and childbirth as a spiritually transforming experience.

“At Lamaze, we understand childbirth is not just another day in a woman’s life, childbirth is a major life event and it can be a transformative experience that profoundly affects women and their families for generations to come,” continued Dalrymple. “It is important to acknowledge the inherently spiritual nature of childbirth and create a birth environment that lets women give birth simply and safely. A key component to creating this environment is avoiding unnecessary medical interventions.”

To support women in their efforts to have safe and healthy births, Lamaze International developed the Six Healthy Birth Practices based on recommendations by the World Health Organization and backed by extensive research that support a woman’s natural ability to give birth. The Six Healthy Birth Practices are:
  • Let labor begin on its own
  • Walk, move around and change positions throughout labor
  • Bring a loved one, friend or doula for continuous support
  • Avoid interventions that are not medically necessary
  • Avoid giving birth on your back and follow your body's urges to push
  • Keep mother and baby together; it's best for mother, baby and breastfeeding
To learn more about Lamaze’s Six Healthy Birth Practices, please enroll in a Lamaze childbirth education class and visit

Saturday, May 29, 2010

Quick Update on Dr. Biter and His Birth Center

Dr. Biter is moving forward after his resignation from Scripps Encinitas Hospital. There is a new blog to follow the development of his birth center: Build Babies By the Sea

Here is a message from Dr. Biter:

"I am happy to say that I still am able to do 100% of my gynecological practice. As far as my OB practice goes, my staff & I are currently arranging the schedule only for pregnant women at this time. In many OB practices, a doctor sees a patient at some visits and a stranger delivers. You know that I do not practice that way. Everything that I have done has kept you, my patients, as first priority. This has cost me hospital privileges that I rightfully won back, a lot of money, and even more nights of lost sleep. I don't know what to say to reassure you other than that. My commitment to you has never been up in the air. My refusal to allow your birth to be a political or financial deal has put me into this unwanted situation, but you and your baby are worth it. Ours is a huge trust of faith....keep the faith. Birth matters."

Friday, May 28, 2010

Thoughts on Preterm Labor & Birth

This is a topic I've thought a lot about over the past few months. A friend of mine was experiencing contractions at 34 weeks gestation. She went into the hospital and underwent some tests. It was confirmed that she was actually in labor. It was also discovered that she had a urinary tract infection that triggered her body to start contracting. She was given antibiotics to resolve the UTI and was told that her labor would subside as a result.

I wonder how often an underlying infection is the cause for preterm labor?

When there's an infection, the pregnant woman's body has a defense mechanism to protect the baby from the infection: start labor to try and get the baby out.

It doesn't matter if it's 40 weeks into the pregnancy, or 20. The woman's body is designed to protect the baby.

Infections can be tricky things. A woman can have a UTI and not realize it because the symptoms can be subtle. I think many women in our culture are so busy that they're not tuned in to their body's signals. If we slow down, take care of ourselves and pay attention to how we feel, we can often sense when there is a problem and catch it before it becomes serious.

There are ways to prevent preterm labor, and scientists are feverishly trying to pinpoint them, particularly because preterm labor is becoming more common in this country. The United States recently received a "D" on the March of Dimes 2009 Premature Birth Report Card, and it's important that we do something to change the trend of preterm labor and birth. One study found that a woman's DNA can predispose her to preterm labor, but there are other factors as well.

For one thing, you can do your best to stay healthy and low-risk through proper nutrition and exercise. This can help you avoid an infection that could trigger early labor. Proper nutrition can also help avoid preeclampsia and toximia, which are often culprits for prompting early induction resulting in possible preterm babies.

One thing I personally believe would make a big difference is for women to tune in with their bodies. Take some time each day to check in with yourself. How are you feeling? Do you have energy, or are you struggling to get things done? What did you eat, and how did that affect how you were feeling? Did you drink plenty of clear fluids? Did you do something for you today? Are you happy? Do you have an overall feeling of well-being, or does it feel like something may be out of balance? Often, how you feel emotionally can be a signal of how things are going in your body, and a woman's intuition can really clue her in to some possible problems. I'm a true believer in intuition, and I've personally been working on listening more closely to my intuition and acting on even the smallest promptings I feel. I'm finding my life goes a little smoother and I'm better able to handle things when I pay attention to what my body and my feelings are trying to tell me.

This process of checking in with yourself can take as little or as much time as you have. It can be 2 minutes, or 2 hours. It can involve deep, focused breathing and meditation, or just a quick mental checklist. Find what works for you, and try it.

What do you think? Does any of this seem to fit together, or am I way out there?

Monday, May 24, 2010

The Shape of a Mother

In media everywhere we are given the impression that women should get back to their pre-pregnant body immediately after having a baby. What celebrity photos and the media don't tell you is that a woman's body is permanently changed after pregnancy and birth. This doesn't have to be a bad thing.

This website features women from all walks of life, at various stages of pregnancy and postpartum. Each story is from that woman's perspective, with no judgement, just her experience and her body. I think it's a great resource for women to realize that their body changes after pregnancy are normal and beautiful, and it can help them embrace their new body image. The pictures and stories are submitted by the women themselves, told from their perspective.

I think it's important to be healthy and fit, but I also think that women need to be comfortable in their own skin regardless of their size or appearance. It's important to love yourself and your body no matter how it looks. If you're unhappy when you're out of shape, you're not going to automatically find happiness with a trim figure, because happiness really comes from within.

I must advise, there is nudity on the site.

Saturday, May 22, 2010

Dr. Biter Reinstated at Scripps Encinitas Hospital and Resigned

"After over 1600 signatures to a petition, days of crowds supporting Dr. Biter, cars and trucks painted with slogans such as “We love Dr. Biter” and “Bring Biter Back,” we are pleased to confirm that an email was sent by the administration at the hospital that obstetric privileges were reinstated yesterday for the popular doctor. His gynecologic privileges were never suspended and also remain in place. While we are all excited to celebrate the reinstatement of Dr. Biter’s OB privileges at Scripps Encinitas, he has contacted one of his biggest supporters to request that no public rallies take place today at the hospital. He has also chosen to not make a public statement at this time."

That statement was made here: Bring Dr. Biter Back: Rally Cancelled!!!

Then later, I came across a news article with more information.

"A popular Scripps doctor who embraces natural childbirth had his privileges to deliver babies briefly reinstated at Scripps Memorial Hospital in Encinitas on Friday morning, then hours later voluntarily gave up those privileges, according to a one-sentence statement released by the hospital."

The difficult thing is that neither the hospital nor Dr. Biter is offering any more information. There is much speculation about the reasons behind Dr. Biter's initial loss of privileges and subsequent reinstatement and resignation, but no one really knows for sure what has happened here and why.

I have two feelings about this situation:
  1. What amazing results grassroots action can achieve! To have Dr. Biter reinstated 12 days after his suspension, and 6 days after a large rally outside of the hospital. The community action involved in this issue was absolutely amazing. More communities should take action and stand up for what's important.
  2. How sad that Dr. Biter will no longer be providing his incredible support to women at Scripps Encinitas Hospital. He has had plans to open his own birth center in the area, and I only hope that he will be able to see those plans play out and be able to offer his services more fully under his own terms at his own birthing center. He may be better able to serve his patients in that capacity than he could if he were to remain at the hospital.
There, you have my 2 cents.

Friday, May 21, 2010

Articles About Breastfeeding

The American College of Obstetricians and Gynecologists (ACOG) recommends 6 months of exclusive breastfeeding for all infants. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) similarly recommend exclusive breastfeeding for the first 6 months of life, continuing at least through the infant’s first birthday, and as long thereafter as is mutually desired. The World Health Organization (WHO) recommends at least 2 years of breastfeeding for all infants.

"Health outcomes differ substantially for mothers and infants who formula feed compared with those who breastfeed, even in developed countries such as the United States. A recent meta-analysis by the Agency for Healthcare Research and Quality reviewed this evidence in detail:
  • For infants, not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS).
  • Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC).
  • For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome."
Low Breastfeeding Rates and Public Health in the United States - This is an excellent article which provides an overview of the history of breastfeeding as a public health issue in the last century. It's chock full of information and explains very effectively the need for more mothers to initiate breastfeeding and continue breastfeeding as long as possible. It opened my eyes to some of the real issues in the ongoing debate of breast milk versus formula.

Wednesday, May 19, 2010

Substance Found in Breast Milk Kills 40 Types of Cancer Cells

As published on

"Swedish researchers have discovered that a substance found in human breast milk has the ability to kill cancer cells, according to a study published in the PLoS One Journal.

"The substance known as HAMLET (Human Alpha-lactalbumin Made Lethal to Tumor cells), was discovered years ago, but has just recently been tested on humans.

"In the trial conducted at Lund University in Sweden, patients suffering from bladder cancer were treated with HAMLET. After each treatment, the patients excreted dead cancer cells in their urine, healthy cells remaining intact.

"Previous laboratory experiments showed that HAMLET has the ability to kill 40 different types of cancer cells, but this was the first test conducted on humans. The next step will be to test the substance on skin cancer and brain tumors.

"The trial breakthrough increases the hopes that HAMLET will be developed into a cancer treatment medication in the future."

Monday, May 17, 2010

NY Midwives Lose Right to Deliver Babies at Home

"It's pretty shocking that in a city where you can get anything any hour of the day a person cannot give birth at home with a trained practitioner"

Article: NY Midwives Lose Right to Deliver Babies at Home

As I bask in the glow of the memory of my wonderful home birth, my heart aches for those in NYC who are now being denied that opportunity.

Epidural Procedure Photos

Have you ever wondered what the epidural procedure looks like?

It's really interesting and can be helpful in educating yourself about epidural anesthesia.

I've also posted in the past about epidurals:

It's important to educate yourself so you can make an informed choice in the birth of your baby.

Sunday, May 16, 2010

Join Me in Marching for Babies

I'm proud to announce that next Saturday, May 22, I'll be marching for babies with the March of Dimes!

"When you walk in March for Babies, you give hope to the more than half a million babies born too soon each year. The money you raise supports programs in your community that help moms have healthy, full-term pregnancies. And it funds research to find answers to the problems that threaten our babies. We’ve been walking since 1970 and have raised an incredible $1.8 billion to benefit all babies."

I'll be doing the 3 mile march with my 5 kids. Please make a pledge in support of my march for babies.

"Your gift will support March of Dimes research and programs that help moms have full-term pregnancies and babies begin healthy lives. And it will be used to bring comfort and information to families with a baby in newborn intensive care."

Saturday, May 15, 2010

Update on Dr. Biter Rally

If you're following the story and events surrounding Dr. Biter's loss of delivery privileges at Scripps Memorial Hospital, here is an article about the latest rally event yesterday:

More info at

I also want to include a video that shows just how effective grassroots activism can be in making a positive change in a community. It's a great motivator to get involved and stand up for what's important to you:

Wednesday, May 12, 2010

Planned Home Birth Survey

If you have had a planned home birth, even if you transferred to the hospital, you are eligible to take this survey!

"This project will investigate the reasons women choose home birth and try to determine their common characteristics. Your participation is important! Other women may benefit in the future from what we learn as a result of this survey. The results of this study may help to ease the stigma associated with home birth. The information you provide will be kept confidential. The results of the study will be used for scholarly purposes only. The survey will take approximately 15 minutes to complete.

"*If you know of others who have had a planned home birth and may be willing to complete this survey, please give them the link to this survey.*"

Tuesday, May 11, 2010

San Diego's Beloved OBGYN Dr. Robert Biter Lost Scripps Encinitas Privileges

Date: Friday, May 14, 2010
Time: 1:30pm - 3:30pm
Location: Scripps Encinitas Hospital
Street: 354 Santa Fe Dr.
City/Town: Encinitas, CA

As of Friday May 7, Dr. Robert Biter's privileges to deliver at Scripps Memorial Hospital Encinitas have been suspended. The hospital refuses to give a reason, and Dr. Biter is legally unable to comment at this time.

Dr. Biter is a Board Certified, capable obstetrician gynecologist, who is famous in the community for his dedication to his patients and commitment to natural childbirth. He does not cut episiotomies or rush his patients off to the operating room for Cesaerean. Dr. Biter is a physician who truly cares about his patients and respects their birth plans.

The suspension of Dr. Biter's privileges has left hundreds of pregnant women without a doctor. It is also part of something bigger. The 'medical' establishment is fighting hard to remove our rights to birth naturally, peacefully and without unnecessary intervention. Midwives have recently been barred in North Carolina, California and Ohio, and the closing of St. Vincent's hospital in New York City left midwives without a hospital backup, as required by law for them to practice.

We must stand up for our rights and act now. We will not be bullied or fearfully forced into birthing according to what the 'medical' establishment deems best. It is our right as women and mothers to choose our birth place and our care providers.

This Friday, May 14, join Ricki Lake, Anna Getty and many others who support choices in childbirth. We will be peacefully rallying in front of Scripps Memorial Hospital in Encinitas in support of Dr. Robert Biter.

Please wear green to represent peace, nature & eco-consciousness, which are all things Dr. Biter supports.

Please bring signs that read:
Bring Dr. Biter Back!
Bring Biter Back!
How is this Mother-Baby Friendly?
This is NOT Mother-Baby Friendly behavior!
Hey Chief of Staff! Bring Biter Back!
Shame on MacCormick-Chief of Staff!

Please bring 5 of your closest friends or family members!

Can't make it? Here's what you can do from home:
Write letters to Dr. Ron MacCormick, demanding that Dr. Biter be reinstated immediately.
Please direct letters to:
Dr. Ronald MacCormick
Chief of Staff
Scripps Memorial Hospital Encinitas
354 Santa Fe Drive
Encinitas, CA 92024

and cc them to:
Mr. Chris Van Gorder
President & CEO Scripps Health
4275 Campus Point Court
San Diego, CA 92121

Please also send a digital copy to:
Carol Yeh-Garner

Monday, May 10, 2010

Newborn Breast Crawl Video

In the time since I published this blog post the person who put this video on YouTube has decided to make it a private video. You can send a friend request to that person on YouTube in hopes they will accept it so you can watch the video, or you can watch the other breast crawl video below which is still public.

Saturday, May 8, 2010


"What keeps our faith cheerful is everywhere in daily life, a sign that faith rules through ordinary things: through cooking and small talk, through storytelling, making love, fishing, tending animals and sweet corn and flowers, through sports, music, and books, raising kids up; all the places where the gravy soaks in and grace shines through. Even in a time of elephantine vanity and greed, one never has to look far to see the campfires of gentle people."

- Garrison Keillor

Friday, May 7, 2010

Avoiding The First C-Section

This entry was posted by The Midwife on Monday, 12 April, 2010

In honor of Cesarean Awareness Month, featured in the Courtroom Mama blog, I am continuing the topic of avoiding the first c-section. Why is it so important to avoid the first one?

  • It’s major abdominal surgery, and carries increased risks for mother and baby
  • It often puts the mother in the position of having repeat c-sections, because she cannot find support for vaginal delivery after a cesarean
  • It increases the risk of abnormal implantation of the placenta, which can lead to hemorrhaging or need for hysterectomy
  • It increases the risk of unexplained stillbirth in a subsequent child.
No one will argue that c-sections can be lifesaving under certain circumstances. Placental separation, placenta previa, cord prolapse, and certain abnormal presentations of the baby might cause injury or death to mother and child if it were not for the ability to deliver a baby by cesarean. I am thankful we have the ability to perform this surgery in a very safe manner. However, the majority of c-sections are not done for emergent, life-saving reasons. It’s those c-sections I want to focus on preventing.

Since most women having a primary (first-time) c-section are also having their first baby, I have five simple precautions that have been invaluable in my practice in helping women to avoid a c-section. I am writing from the perspective of hospital birth, knowing that the majority of women will not choose home birth, although I believe this is the number one way to avoid a c-section:

1. Stay at home in labor as long as possible, and consider giving birth at home. Why?
  • Consider an animal in labor. If you’ve ever observed a cat or dog preparing to give birth, you may have noticed that they seek solitude. If they are disturbed during labor, they ahve a natural “fight or flight” reflex that slows or halts labor, allowing them to move to a safer location. While we as human women can intellectually understand the reasons for moving to another location (the hospital) to give birth, our bodies may still respond with a slowing of the labor process.
  • It is understood that pain relieving medications can have a slowing effect on the process of labor. Epidurals are associated with a higher rate of vacuum, forceps and cesarean births in some studies. Yet it is difficult for a woman in hard labor to resist the offering of total relief of her pain. When you are at home, you know the pain medication is not available, and so the mind does not focus on it. It is easier to work with the contractions when you aren’t constantly thinking of the epidural available to you in only minutes.
  • Staying home in the earlier stages of labor helps you to avoid the urge that hospital staff will feel to “speed things along” if your first part of labor takes many hours. It is common for dilation from zero to four or five centimeters to take many hours, and sometimes more than one day. If you are in the hospital and you are not yet dilated to four centimeters and having contractions three or four minutes apart, you are not in active labor. This part of labor is best spent at home.
2. Hire a doula if you can possibly afford it. If not, seek out an older woman who has had several children naturally herself, or has been present at several natural births, to be with you at home until you decide to go to the hospital.
  • A woman who is familiar with the process of a normal birth will be invaluable to you in helping you know when it is time to got to the hospital. She can reassure you that what you are feeling is normal, that you can do it, and that you are stronger than you think.
  • Many women are afraid to stay home in labor. A doula or experienced woman will be aware of the normal process of labor and be able to help you feel calm about laboring at home.
3. Find a practitioner who does not put arbitrary time limits on how long you can be in labor. If you are feeling strong, the baby is doing well, and you want to keep going, there should be nor reason to rush to a c-section simply because the labor is taking longer than average.

4. Carry on your usual activities as long as possible. Far too many first-timers make the mistake of doing everything they can to speed labor along. All too often, their efforts succeed at nothing but making them miserable and exhausted. Allow labor to unfold in its own time. Ignore the contractions until you are physically incapable of doing anything else during a contraction as well as in between contractions. This is where many women take their labor too seriously. They think because they have to breathe with a contraction, they are in hard labor. The actions of the mother between contractions are more indicative of the stage of labor. During the latter stages of dilation, the woman is usually quiet, tired, and may even fall asleep between contractions. She does not feel like talking much, or doing anything but resting before the next contraction. If your labor starts in the day, do what you normally would have been doing if you’d not started labor. If your labor starts at night, stay in bed and try to sleep, at least between contractions. If you cannot sleep, at least rest until your normal getting-up time.

5. Stay off the fetal monitor! The American Congress of Obstetricians and Gynecologists has published guidelines for intermittent auscultation of the baby, stating that it is just as safe for low-risk pregnancies as continual monitoring. It has the added benefit of having a lower c-section rate. This suggests that many c-sections are done for “fetal distress” seen on the monitor tracing, when the baby is actually fine. Once you allow someone to connect you to the continual monitor, you most likely won’t be off of it for the rest of your labor. What is intermittent auscultation? It is not being connected tot he monitor for 20 minutes out of every hour, as many hospitals’ protocols require. Rather, it is listening to the baby’s heart rate with a hand-held doppler before, during, and after a couple of contractions every 15-30 minutes during the first stage of labor. A skilled practitioner can determine if the criteria indicating fetal well-being are present, even with a hand-held doppler.

There you have it–my top five precautions to avoid the first c-section. I’d love to hear your ideas for other ways to avoid an unnecessary cesarean.

Wednesday, May 5, 2010

Directed Pushing vs. Mother Directed Pushing

Have you seen childbirth portrayed in movies and on TV?


Everyone in the room: doctor, nurse, staff and family seems to be yelling at the birthing woman while she strains and tries to push her baby out.

A doula has written a blog post about her feelings on directed pushing:

She makes some really good points, and while the post is a bit angry it has some excellent information.

First, directed pushing is NOT based on evidence. In fact, it can lead to a greater chance of damage to the perineum and pelvic floor. As long as the baby is doing well, there is no need for doctors, staff and family to try to hurry or direct the pushing stage.

Directed pushing is sometimes referred to as "purple pushing" because many times women are told to hold their breath for the 10-count, resulting in a flushed face and sometimes even popped blood vessels in their eyes.

There is also the issue of how unfriendly directed pushing is, and how contrary it is for a woman who has had a peaceful labor and desires a calm birth experience. Another doula describes the practice in her own blog post:

Her description is somewhat comical, but still accurate.

The best part of that blog post is the explanation and videos of Mother Directed Pushing. This may also be called spontaneous pushing. The concept is simple. Allow the mother to listen to her body cues and push as she feels the urge, and on her own schedule. This also includes allowing the mother to choose the position she wants to be in to push her baby out. As long as the baby is doing well (normal heart tones) then this approach is more favorable than directed pushing.

  • Less likely to damage the perineum or pelvic floor
  • A more peaceful, gradual birth experience, without people yelling and shouting
  • Empowering and supportive of the mother in allowing her to decide how to birth her own baby.
This video about mother directed pushing was made by Sheridan, the author of Enjoy Birth Blog:

Please check out the links I posted above. There's also a good one about mother directed pushing at home:

Monday, May 3, 2010

Position Change and Movement During Labor

It's important to be active during childbirth. Change positions every 20 minutes, even if it's a small shift from one side to the other. These movements help the baby shift and descend into and through the birth canal, and they can even help give the laboring mother comfort during labor.

I found this great blog post on At Your Cervix (written by a Labor & Delivery Nurse):

Getting in position -- making changes to shake, rattle and roll

"Up. Move. Lean forward. Lie on your far left or right side. Squat. Walk. Dance. Hands and knees. Modified lunges. Sway from side to side."

The author discusses the common issue of back labor, which most often is a result of a posterior or otherwise malpositioned baby. She explains how position changes during labor can help move the baby into a favorable position, make labor less uncomfortable for the mother, shorten the duration of labor, and even avoid a c-section.

"Why so many posterior babies? Simply put - we're a reclining society. We sit back in our recliners, couches, office chairs, dining room chairs, rocking chairs and more. Our babies get into these funky positions from us lying back...This is why it is so very important to get up and move in labor"

She also explains that even with an epidural position changes during labor are possible, and important.

Please read the post.

Here are some more resources for information about positions during labor:

Saturday, May 1, 2010

Using Epidural Anesthesia Judiciously

I've blogged about epidurals before:

Those two blog posts discuss some of the risks and negative impacts of epidurals, and it's important information to consider when you are deciding which birthing options you will utilize for your baby's birth.

I found a really good blog post on The Unnecesarean about using epidural anesthesia judiciously:

It's written by a Certified Nurse Midwife, and discusses situations in which an epidural might be beneficial to use, and ways of approaching its use to provide the best support for the mother and baby.