Midwives and supporters of HB-955 are currently conducting 24-hour vigil in hopes there will be a hearing for HB-955. You can read the proposed bill in it's entirety  here . HB 955 would establish a pathway for traditionally-trained, non-certified birth attendants to legally practice in Hawaii.
 
I am not typically one for getting politically involved and in all honesty have never stepped foot at the capitol nor have I ever lobbied for a bill in any way shape or form. I'm not here to persuade you to lean for or against HB-955 or educate you about the nuances of this bill. Instead I would like to share how my views of midwifery have changed dramatically in the last 4 years. 
 
If you had talked to me 4 years ago, I would have said that all midwives need to be trained through an accredited educational program and follow to steps laid out by their national regulatory body. This is standard of practice for nearly all health professions in the United States, including my profession, occupational therapy. Why should midwives be held to any less of a standard? Getting training from a reputable and recognized program, following the regulatory guidelines and then pursuing licensure is the way it is done. I most certainly would have leaned against the wording in HB955. 
 
Now 4 years later, I see how deeply naive and discriminatory this view is for several reasons. 
 
First, "midwives" (I'm using this term loosely here) have been attending births for literally thousands of years. Far longer than ANY modern medical practice that is now overseen by regulatory boards, including Obstetrics, the modern practice of supporting women that began in the late 19th century. Midwifery is based in tradition, culture and passed knowledge from generation to generation. Even today, children are born into families of birth workers and begin learning about and even attending births from a young age. By the time they would be of age to attend an accredited educational program (that costs thousands of dollars), they are already attending births where they are participating in meaningful and powerful ways, far beyond the skills they would learn at such an institution. Midwives DO NOT all require modern education to develop the skills necessary to practice safely and effectively. 
 
Second, birthing women will continue to choose to birth at home as they always have. Each woman who chooses to do so does for her own reasons. The vast majority also do this with clear acknowledgement of the risks. By limiting the access they have to quality midwifery care, they either birth in a hospital against their wishes, birth alone or potentially birth with a birthing attendant that is less than qualified due to the lack of oversight. Allowing licensure in midwifery through varied channels protects birthing women. It protects their right to choose and their right to know that who attends their birth is qualified. 
 
Finally, by not allowing traditionally trained midwives to receive the recognition they deserve, we are further marginalizing indigenous practices in a state where these practices have already been marginalized far too much. Western methods and procedures simply do not and can not apply to ALL segments of the population. These midwives are just as knowledgable and capable as there “western” trained counterparts. Give them the same rights! 
 
I stand with ALL midwives in Hawaii and honor their choice of how to train and acquire the skills to practice midwifery. Let's honor their diversity and create paths for licensure that reflect the diversity of our state! 
 
If you also stand with me and have not already, please add your name to a petition with well over 30,000 signatures from around the world in support of HB-955
CLICK HERE

I have a new little routine that is providing me with so much inspiration and freshness to begin my day. I take a short 10-15min walk after I drop my girls at school and before I begin working. I intentionally began this for 2 reasons

      -To get more movement in my day
        AND
      -To help me settle and clear my mind before shifting from mom to professional
 
I'm sharing this because I struggle with mom-brain, monkey-brain, overwhelmed brain, too much on my plate brain… just like you, right? 

So, to help clear your mind for better focus, could you find a movement based activity that you can sprinkle into your routine?

on't go crazy here, just something that feels enjoyable and easy enough to do most days- dance, walk, stretch, breath… so many things could work.

By separating our to-do's by moments of mindful movement you will get fresh blood flow to your brain, preparing you for more success with what your next to-do is. 
​
Try it out and let me know how it goes…

​Habits...we all have them. Ones we need to consciously think about and ones that are so ingrained we could do them in our sleep. There are ones we like and those we have a more complicated relationship with. There are the ones we think of first when you hear the word "habit" and there are ones you're not even aware of, not yet at least. Habits anchor our days, set rhythm and routine, bolster or break health, and are the steadfast behaviors we rely on to do bigger, grander things. Without habits, most of us would be awash in a mix of unorganized actions strung sloppily together until we passed out from exhaustion. Yes, habits conserve a significant amount of energy because they our brain's way of reducing the energy it takes to get through the day.

For some, the mere mention of habits causes an uptick of anxiety and overwhelm...if this is you, your probably of the mindset that habits are hard to come by, hard to break, and hard to form. And your right...to some degree. Forming and breaking habits IS effortful, because the new actions you are taking to form or break the habit is not a habit, yet. Behaviors that are not habitual require a lot of energy. So our brain doesn't like it, making the process challenging... unless you break it down!

This breaking down is what I spent a large part of my graduate education in occupational therapy (OT) school learning about. Discussion, research, and theory around habits and health abound in the occupational therapy literature. Why you may ask? Well OTs help individuals engage in their desired and necessary daily activities in spite of physical, emotional, mental, environmental, social, or even sensory challenges to engagement. So essentially, if you are finding it challenging to do what you want or need to do because of _______ (stress, broken arm, depression, sensitivity to sound, overcrowded work environment, bullying, pain or anything else creating disruption in your day), occupational therapists are THE best health professional to help you get to where you want to go. You don't need to be sick, disabled or injured to benefit from OT... in fact I mostly work with pregnant and postpartum women who often are the "picture" of health on the outside, yet are finding something in their day to day disruptive to their routines and habits.

Enough about what I do, lets get back to how breaking down habits can help you grow or break a habit...

What is breaking down a habit? Let me explain this through an example...

You want to begin a meditation routine and have a goal of 15min per day. You have tried sitting down for 15min and it simply doesn't happen... here are some ways to break it down:
-What is the tiniest little piece of that desired goal habit that you can begin doing?
How about sitting for 1min or taking 10 deep breaths or pausing to admire a flower for 30sec?

-What place are you most likely to do this? 
Maybe your favorite chair, at your desk, on your bed or on a bench in the park? 

-When do you feel most ready to meditate?
Is it as soon as you get home from work, first thing in the morning, after dinner?

Once you decide on those details, how does beginning the habit of meditating feel now?

Another way is to combine your meditation with another already automatic habit...everyday when you arrive home you put your keys on the hook and go pee then sit for 1 min on your favorite chair to meditate... could stringing the 3 tasks together push or nudge your closer to the ultimate habit? Does the process sound a little easier now?

Now you have taken a tiny bite out of your desired habit, and as you have success with this "tiny habit" allow it to grow. 1-min becomes 2-min which becomes 5-min and before you know it your at 15-min... voila! A habit is forming, your brain is conserving energy, and added bonus, since this is meditation, your brain has now begun to function more optimally by turning on the rest and digest (parasympathetic nervous system) everyday --- but that's for another blog post...

What habit will you begin tapping into through this approach? Share in the comments below!

In honor of C-Section awareness month, I put together this quick and easy guide to C-section recovery. These are the recommendations I provide to all my new moms with a c-section delivery. 

What is a regulated nervous system? 
A nervous system that is functioning optimally which in turn allows the persons automatic, or not consciously controlled, bodily functions to run smoothly. This includes a stable heart rate and blood pressure, normal digestive function and breathing rate, appropriate bowel and bladder functioning and normal sexual functioning. When your nervous system is “regulated” you feel good, you feel safe, you feel comfortable, you feel calm. The signals your body is sending your conscious brain feels appropriate and helpful for the situation you are in. 


How does regulating your nervous system benefit labor progression and birth? 
If we consider labor, this is not an everyday experience. There are things your autonomic (unconscious) nervous system is doing that aids your labor progression and birth, but they are not normal events outside of labor. Some of these include: 

• Evacuation of bowel and bladder to make space for the infant to go through the birth canal
• Uterine contractions causing pain that is productive and purposeful for birthing an infant
• Increased heart rate and breathing rate during contractions due to the pain (normal pain response)
• Reduced hunger sensations 
  
  

These physiological responses are not due to poor nervous system regulation. During labor, there are symptoms that under ordinary circumstances would be a sign of nervous system dysregulation, but when in labor they are normal and essential. 
For many birthing people these sensations bring about their fight-flight-freeze response because the sensations are scary, painful, intense and for first timers, unfamiliar. This raises the birthing person's fear and/or anxiety which dysregulates their nervous system. Other external factors can add to this, such as their environment and their interactions with others.  If a birthing person has heightened anxiety in a medical environment or they have someone present who makes them feel uncomfortable their nervous system can be even further dysregulated. 
Labor in of itself does not cause nervous system dysregulation. In fact, we don’t need to do anything consciously to birth our child. Our body will do it for us. It is our own conscious brain and our response to the signals we receive from our body and environment that causes nervous system dysregulation during birth. 

What happens if my nervous system becomes dysregulated during birth? 

When a birthing person becomes fearful, stressed, anxious, scared, or even mad during the labor process their emotional response interferes with their bodies automatic responses that allow labor to progress. This can result in a slower labor progression, increased perception of pain, higher muscle tone and tension particularly in the pelvic floor, diaphragm and jaw, as well as a higher risk of elevated blood pressure and difficulty controlling breathing rate. These responses can lead to more nervous system dysregulation. 
So things can quickly and easily spiral out of the birthing person's control resulting in a birthing experience that is not what was originally envisioned. 

How to keep your nervous system regulated during labor? 
Simply understanding this spiral of events can go a long way! Knowledge is power when it comes to birth. The more you understand what is happening the better you can stay in a regulated nervous system state. 
Here are my top recommendations for learning strategies that help keep your nervous system regulated during labor:

1. Take a childbirth education class. Whether it’s at your local hospital or through a private provider of childbirth education, it is priceless! Locally I would recommend: Maluhia Mama Hypnobirthing by Nadine Gilmore https://maluhiamamahypnobirthing.com  

2. Take a prenatal yoga class that focuses on body awareness, breath and helps you feel good about the power of your body to birth your child. I loved the prenatal classes at Open Space Yoga- due to COVID-19 they are not open but they have an online class for prenatal yoga with teacher Yuko Kowal on their website: https://www.yogaopenspace.com/yoga-hawaii

3. Dive into meditation. Here is my blog post about meditation and learning to meditate during pregnancy: http://www.windwardmaternalwellness.com/blog/i-wish-i-had-done-this-when-i-was-pregnant#/

4. Identify what sensations comfort you best in times of stress and pain. I suggest identifying 2-3 senses that feel the most soothing to you- seeing, hearing, smelling, touching, tasting, movement, and pressure. Your senses are the way your body receives internal and external information and sends it to your nervous system. Knowing the ones that are best for calming you down gives you a direct link to some excellent comfort measure for labor. These comfort measures assist you and your nervous system to stay better regulated while your body does the work. 

• If you are comforted by sight, you feel calm looking at a tree blowing in the wind or a picture of nature. Find something visually calming to you and put it in your hospital bag. 
• If you are comforted by hearing, you feel calm when you listen to a certain type of music or hear a certain affirmation. Make sure that playlist and/or affirmations will be available during labor. I would recommend you download the “Insight Timer” App and begin exploring. It has thousands of calming music and meditation tracks. 
• If you are comforted by smell, identify what ones… lavender, vanilla, ylang ylang, mom’s chocolate chips cookies? Put a few essential oils in your hospital bag or ask mom to bake cookies when you go into labor. 
• If you are comforted by touch, try to identify what kind of touch. Maybe it is fiddling with rosary beads or snuggling in a favorite blanket or someone gently rubbing your back. Tell your support person and/or place that special item in your hospital bag. 
• If you are comforted by tastes… eat or drink that before heading to the hospital. If it’s mints or something suckable even better, slip some in your bag. 
• If you are comforted by movement, talk to your support person about what you like to do. Is it walking, swaying, stretching? Laboring at home as long is you can is the best way to ensure movement as some medical interventions limit or prevent you from moving (think epidural). This is something to discuss with your care provider and/or birth doula. They can help advocate for allowing movement and make a plan for maximizing movement during labor. 
• If you are comforted by pressure, think about where and how much. Tell your support person and practice finding that just right pressure. Some people like a certain tool to apply pressure, that’s great too!

As your due date approaches you will be able to stay in a more regulated nervous system state if you have put in the time for self discovery and learning that comes with really engaging in any of the above recommendations. Everyone’s path to get there will look different, but we are all capable of getting there. 

I wish you the best on your path to an empowered, confident, calm, and beautiful birth!

Pregnant women have unending decisions to make and choices to contemplate during their pregnancy; from what should I be eating to best support my growing baby, to why am I still so nauseous and where will I give birth, all the way to how the heck will I be able to breastfeed for an entire year as recommended! Choosing a doula is often a decision pregnant women do not even know is available to them, yet if they did know it could quite possibly make all of the other decisions and choices related to pregnancy and birth that much easier and less stressful. 
 
A birth doula is defined as a support person for pregnant people. Our job is to provide education and support pregnant people both physically and emotionally before, during and after the birth of their baby(s). The word “doula” comes from ancient Greek meaning “a woman who serves”. For generations women have been supporting other women during labor. It just makes sense. Yet, with the evolution of modern medicine, many traditional means of supporting women during birth went to the wayside. Modern medicine took control of the birthing process in an effort to make it more predictable and safer. In this effort, whether you view it as well intentioned or misguided, the role of women supporting women in labor moved to the wayside. In the 1970s the natural birth movement shifted the focus back to supporting women through labor with the view that childbirth is not a medical procedure but rather a completely natural process. With this movement the role of a doula became a professional, paid and valued service. Whether giving birth in a hospital, birth center or home setting, doulas filled the role that traditionally female family members did, providing continuous support during labor. 
 
When in labor in a hospital, where the majority of births still occur, there are stretches of time where there may be no in person medical support and there is never continuous 1:1 support from any hospital staff. The OB/GYN typically arrives only a short time before pushing occurs in the second stage of labor. Nurses are available but are typically helping several patients at the same time. Many women do not understand this reality and have unrealistic expectations of the kind of physical and emotional support that will be available to them from a professional. 
 
On top of the physical and emotional support, comes the necessity in many cases to make tough decisions regarding medical procedures and options while in labor. An unprepared birthing woman may agree to something that she ultimately regrets due not having the knowledge and support to make the most informed decision when the options are presented to her. 
 
With a doula on the care team, the birthing woman has guaranteed continuous 1:1 emotional and physical support. She will also begin labor with more knowledge regarding the potential choices she may encounter while in labor. This is because birth doulas work with their client’s prenatally to educate, plan and prepare for labor and delivery. There is a relationship that is developed during the prenatal visits that builds trust and confidence between the doula and birthing mother. This relationship establishes a framework for working as a team during labor. There is no need to spend time figuring each other out between a contraction, which often is the case with the labor and delivery nurse assigned to the birthing mother.  The doula knows the birthing mothers birth preferences and/or plan as well as comfort strategies that are best received by the mother, because all of this has been discussed and often practiced before labor begins. 
 
By having a doula present at your birth, evidence has shown that the birthing mother is more likely to reflect on her birth as a positive experience. She is less likely to have a cesarean delivery and to require an epidural or pain medication. It has also been shown that pain perception is less with doula support and the duration of labor is reduced. Some of these outcomes have more statistical significance than others but all stack the cards more in your favor for a positive birthing experience than if you did not have a doula on your care team. 
 
Finally, imagine a birth where you are with only your partner for up to 30-60min at a time while you go through countless contractions, you have no idea how to make yourself more comfortable and feel out of control because you don’t know what to expect or what to ask. Now imagine a birth where from the moment you thought you were in labor you had support from a trained birth professional, your doula. In early labor she will coach you over the phone on what to do to rest, relax and be comfortable.  She will help you make an informed decision on when to go to the hospital. Once you arrive at the hospital your doula is by your side the entire time. She is providing you with suggestions on positioning, relaxation and breathing, while supporting you physically in any position that gives you a sense of relief, rest or comfort. When and if things go not as planned, she is prepared with evidence based information to base your decision on. She is by your side every step of the way, serving your needs and yours alone. Which birth would you prefer?
 
I would be remiss if I did not comment on how birth doula support may look in the context of the current COVID-19 pandemic. The benefits of birth doula support are unchanged but the process may look different due to certain restrictions placed by organizations including hospitals and the CDC. To begin prenatal visits are likely to occur over a video platform such as Zoom. These visits are likely to be longer due to the need for the doula to provide more upfront education to prepare the birthing mother (or couple) on how to perform many of the physical support strategies that the doula would typically do at the birth. This is a because there is a higher possibility of the doula not being physically present during the birth due to hospital support person guidelines during the pandemic. 
 
If the doula is unable to be present during the birth, she will be available for intermittent phone or video based check ins throughout the labor stages. This will look different for each client due to the vast variability of labor progress and presentation, as well as differing individual needs for each birthing mother. However, a typical pattern would be to check in when things change, for example when transitioning from the first to second stage of labor. During the check in the doula is available for educational and emotional support, intended to boost the mothers morale and help provide evidence-based information for any decisions she needs to make. The doula will also provide suggestions for physical support strategies that the birthing partner or nurse may be able to provide to help progress labor or provide more comfort during and between contractions. 
 
Despite the uncertainty of today, a birth doula’s value has not changed. How we deliver services, just like the way we shop for groceries and socialize with friends, has changed. Fortunately, doula’s are masters of flexibility, rolling with the punches, remaining clear headed, calm, nurturing and last but not least supportive. 
 
If you or someone you know may be interested in birth doula support during this exceptionally unpredictable time, please contact Windward Maternal Wellness at windwardmaternalwellness@gmail.com. We are currently accepting clients for January, February and March 2021. 
 
 
 

Learn how to meditate. Yes, I wish I had learned how to meditate and made it part of my daily routine when I was pregnant. Unfortunately, I did not and it never ever crossed my mind, nor was it ever recommended to me by anyone or in any book on pregnancy. Instead I focused on reading as much as I could about birth, labor and what the heck you do with a baby. I didn’t think much at all about my postpartum period and ultimately came to the conclusion that it wasn’t anything I could plan or prepare for so I will just have to wing it. In retrospect, I don’t believe this is entirely true. I think there are ways to prepare, but there is no way to truly understand what it will be like until you go through it.  I feel the time I had during pregnancy would have been well spent learning how to meditate and would have prepared me for what was to come much better than anything else I could have done. The research behind the benefits of meditation abound and the postpartum period is likely the most stressful and transformation time in a woman’s life. Having meditation in your life and daily routine could do wonders for your mental health and overall sense of wellbeing during this time. 
 
Let me tell you about my recent journey into the world of daily meditation while in quarantine with a 1 and  3 year old. I have meditated on and off for about 8 years, my longest stint was about 4-months when I would meditate 5-6x/week for about 10-15min in the morning. This was when I was childless and even then it felt like such a chore and was never easy or routine, so it never made it into the habit phase. Since that time I dabbled here and there, going to lectures and guided meditations whenever possible and to be perfectly honest, whenever convenient which was not often. Over the years I have read about the unending benefit of meditation and know the science pretty much not debatable. Meditation is the best medicine for our brains, hands down. I tried to learn, I tried to teach my clients what I learned in hopes it would help them, but it always felt so hard.  I knew it was supposed to feel easy, what was I doing wrong? I have come to find out that I was trying too hard, too infrequently and without a clear plan or recipe to follow but rather a mish-mosh of techniques mostly designed for monks rather than “real” people. 
 
“Wait a minute, I have been learning meditation intended for individuals who spend their entire life in meditation and there is a meditation out there designed for normal people? Why has no one been talking about this?!”
 
In March, I found myself furloughed from my clinic job with more time on my hands than I had ever imagined I would have until my kids left home. After the first week I had exhausted my social media and news apps on my phone. I had cleared my inbox and in doing so realized I could get a pretty sweet deal on just about any home exercise program I could possibly want yet nothing piqued my interest. Then on a childless (thank you mom and dad) drive to the grocery store I heard about Ziva Meditation taught by Emily Fletcher on some “mom” podcast. I was immediately sold by her description of the meditation she taught being for regular busy people instead of monks. I thought, “wait a minute, I have been learning meditation intended for individuals who spend their entire life in meditation and there is a meditation out there designed for normal people? Why has no one been talking about this!”. It sounded like exactly what I needed to embrace the slowing down being forced on my life. So I signed up and diligently learned the Ziva Meditation technique over a 15-day period, spending 20-30min in the early morning then another 15min in the early afternoon. I had committed to this twice a day routine with the support from my husband who graciously agreed to take over morning duty to allow me the time to meditate before coming down to greet the day. This change in routine was a life changer! 
 
I am now about 4 months into my daily meditation routine and I have not skipped a day and have only missed a meditation about 10 times. My energy immediately surged and my mental clarity has greatly improved. My thought trains feel more clear and organized. My anxiety brain is so much quieter, I worry less, and I feel a greater sense of peace in my days. I still get overwhelmed, angry, sad, mad, stressed, and anxious but the intensity and frequency in which these unpleasant emotions arise is markedly improved. The Ziva meditation technique has made it to the level of habit. I miss it, I yearn for it, I look forward to it- especially the 2nd one of the day. Without it, I’m wiped out and exhausted by days end. With it, I can often sit down and bang out another solid 1-3 hours of focused work after my kids are asleep. This was unfathomable 6 months ago. 
 
“Every first-time pregnant mom should take the time during pregnancy to establish a solid meditation habit and routine”
 
I could go on and on about my adoration for meditating twice a day, instead I am going to shout from the rooftops right now that in addition to childbirth education classes, every first-time pregnant mom should take the time during pregnancy to establish a solid meditation habit and routine.It will be a challenge to adjust the routine when your baby arrives, but I believe it can be done. For me, I would have definitely done it while breastfeeding my marathon feeder who would sometimes go for 45-60minutes! I could have been meditating instead of reading about what so and so is doing and your not and going down the “oh my god, I’m a horrible mom” train, I could have been nourishing my brain by de-stressing and finishing with manifesting what ever the heck I want- including be the best mom on the block or whatever floated my boat at that moment. Any new mom with the ability to maintain a brain that is routinely distressing and building up its reserves will function better, feel better and be better. Meditation is a new mom’s best tool for feeling like herself in the midst of complete life transformation. 
 
“Life would have been a bit easier, a bit more hopeful, and a bit more peaceful”
 
So yes, I wish I had learned to meditate when I was pregnant. I wish I had this tool in my routine 4 years ago. Life would have been a bit easier, a bit more hopeful, and a bit more peaceful. I also hope that moms out there will read this and take what I have to say to heart and find benefit in their life with this advice. 
 
Please spread the word, share this post, tell a friend, post to your Facebook page! 
 
This post comes from my heart to yours. I have no connection what so ever with Ziva. Ziva is one method of meditating. It worked great for me and could work great for you. I encourage you to look into Ziva (Click here) but above all else I encourage you to find your own path to a routine meditation practice.