Long on information, short on opinions, Your Birth Plan is a how-to guide filled with practical descriptions, insights, stories, and tips to make it easier for you to pick where, with whom, and in what way you would like to give birth.

Your Birth Plan is comprehensive and free from judgment and prescriptions. It offers unbiased, evidence-based information about all birthing options, including birthing in a hospital, at home, or in a birthing center; having an epidural or an unmedicated birth; induction of labor; vaginal or Cesarean birth; giving birth to multiples; and more.

This is a new, inspiring, inclusive, and much-needed guide to help you plan for a birth where you are empowered to make your own choices and to have your needs met, whatever they are.

For many parents, a little information about what to expect can be empowering, so learning the basics before your baby arrives is a great way to get off to a good start and build confidence.

LEARNING THE BASICS

We suggest you take a look at the following resources now and make a mental note of where they are so you can revisit them from time to time once your baby has arrived.

This very short (2-page) KellyMom.com article, Breastfeeding Your Newborn: What to Expect in the Early Weeks, is a great way to understand normal newborn feeding patterns and how to tell that your baby is getting enough milk. (Instead of randomly Googling questions about nursing, KellyMom.com is a good evidence-based site to bookmark!)

This 30-second video demonstrates a good latch, audible swallows, and a pause to breathe that you should see and hear when your baby is nursing efficiently after your milk has increased or “come in” around day 3-5.

This graphic illustrates the difference between how we often imagine that babies nurse versus how they actually tend to nurse (cluster feeds, feeds of varying sizes/lengths, etc.). This is often a stumbling block for parents who incorrectly interpret their baby’s normal feeding patterns as a sign that they don’t have enough milk.

ON YOUR BABY’S BIRTHDAY

Your baby has been born and now our story begins. After your baby has declared their entrance to the world with that exhilarating initial cry, they should be placed “skin to skin” on your chest. At this moment, a baby’s instincts kick in and they slowly make their way to the breast, latch, and nurse. This is called the “breast crawl.”

Being skin to skin helps to regulate a baby’s body temperature, respiration, heart rate, and blood sugar. It also helps to keep a baby calm and lets you respond more quickly to feeding cues.  Beyond this initial feed, holding your baby skin to skin in the early days and weeks is a great way to start nursing sessions and calm your baby.

The first hour of life is often called the “golden hour.” Your baby will be awake, searching for the breast, and suckling. It’s an incredible moment for parents to share with their baby. After the “golden hour,” babies need their sleep. They often sleep for 5-6 hours. There is no need to wake to feed, so get some rest yourselves!  If you give birth by cesarean, having your baby skin to skin and the breast crawl may be delayed until you are in recovery. If you are having a planned cesarean birth, you can discuss  a “family-centered” or “gentle” cesarean with your provider, which may make it possible to hold your baby skin to skin.

Once your baby wakes from this initial long sleep, expect to feed your baby 8-12 times (or more) per 24 hour period for the first 6 weeks or so. A feed is at least 10 minutes of active sucking and swallowing, but it’s best not to limit your baby if they are actively sucking. (Watch this short video to see what that looks and sounds like.)

In order to make sure your baby gets enough milk and that you establish a good supply, feed your baby on cue. Having your baby sleep nearby per the American Academy of Pediatrics means you’ll catch those cues before your baby gets frustrated and cries.

• Early cues: stirring, mouth opening, turning head, seeking/rooting

• Middle cues; stretching, increasing physical movement, hand to mouth

• Late cues: crying, agitated, turning red

• If your baby is distressed, try to calm your baby by holding them upright on your chest skin to skin, then feed!

Be aware that when your baby is swaddled, those cues can be suppressed, so if your baby isn’t waking on their own, you might want to unswaddle them to see if they are ready to nurse. Try to be patient with your baby and yourself in these first days as you learn a new skill and wait for your volume of milk to increase. Keep in mind that this is a phase and easier days are around the corner.

If you and your baby are separated after the birth, no need to worry. Start doing breast massage and hand expression to stimulate your supply and get small amounts of colostrum to feed your baby with a syringe, spoon or medicine cup that you can request from the hospital staff. Use a free, hospital-provided breast pump every 2-3 hours for longer separation.

THE FIRST TWO DAYS OF NURSING

Keep in mind: On Day 1, your baby would rather sleep than eat. On Day 2, your baby would rather eat than sleep!

In the first few days of life, your baby is drinking colostrum. Your body makes colostrum during your pregnancy, so you already have the perfect newborn food available from the beginning! Colostrum lines and protects your baby’s gut, supports their immune system and helps prevent jaundice. It’s also highly concentrated and nutrient-dense, so your baby only needs small amounts. On day 1, a full feed is approximately 2-10 ml or from less than ½ to 2 tsp; by day 2 it ranges from 5-15 ml, 1-3 tsp.

In the beginning, it is very normal for newborns to be sleepy when they nurse. You can do “compressions,” gently squeezing your breast to increase the flow of milk and encourage your baby to keep sucking and swallowing.

If your baby does not latch or swallow when at the breast or falls asleep quickly, then you can hand express colostrum into a teaspoon or medicine cup and use those or a syringe to feed this expressed colostrum to your baby. This is more efficient than pumping and offering a bottle in these first days of life. Sometimes offering a little colostrum to a sleepy baby can give them energy to nurse, so you can try that at the beginning of a feed too.

Here are two videos that demonstrate hand expression: Hand Expression of Breastmilk with Dr. Jane Morton (good for the first few days of life) and The Basics of Massage and Hand Expression with Maya Bolman (especially good for engorgement and after your milk supply has increased).

To be sure that your baby is getting enough milk, look for 1 wet and 1 dirty diaper on day 1 and on day 2, 2 of each.

NURSING DURING DAYS 3-5

Between day 3-5 you will transition from colostrum to mature milk and the volume will increase. A full feed on day 3 is about 15-30 ml, ½ to 1 ounce and day 4 is about 30-60 ml (1-2 ounces). So you can see that the amounts your baby takes are increasing rapidly! You may experience engorgement (your breasts will feel heavy, hard and warm and it may be harder for babies to latch easily, because as your breasts expand with milk and excess fluid, the nipple becomes less pronounced and the areola is firmer). To avoid and relieve engorgement: nurse on cue; do the reverse pressure softening technique to make it easier for your baby to latch; use warm compresses for 2-4 minutes before and cool compresses after nursing; and hand express milk. You can also use plain green cabbage leaves to relieve engorgement. (Peel off a couple leaves from a head of cabbage, wash them, scrunch them in your hands or crush with a rolling pin and then wear inside your bra for about 20 minutes. Stop doing this after about a day since using cabbage leaves long term can reduce your milk supply!) If you were on an IV during labor (whether for a vaginal or cesarean birth), you will likely experience more pronounced engorgement due to the excess IV fluids in your body. In this case, it’s best to avoid using an electric or manual pump for more than 3-5 minutes, because it can actually draw some of that excess IV fluid into the areola and nipple area, making it even harder for your baby to latch. To help move that fluid out of your breasts, try doing “breast gymnastics” per Maya Bolman. This extreme engorgement should resolve in about 24-48 hours.

When you’re nursing your baby, aim to let your baby “finish” the first breast, then burp them and offer the other side. When your baby is done on one side, they might unlatch on their own or just suck way more slowly, even when you do compressions. You can also check to see if they’re a bit more relaxed in their brow, shoulders, arms and hands (e.g., are their hands still balled up into fists or open?). Your breast should also feel softer after they are done on that side. Remember that this isn’t an exact science and it’s okay if you don’t always read the signs just right! If your baby won’t take the second breast or stays on for only a very short time, that’s fine– just start with that side the next time.

Until your baby is back at birth weight, wake them to feed if it’s been 3 hours since the beginning of last feed during the day or 4 hours during the night. (You might try leaving them unswaddled during the day and only swaddling at night since the swaddle can suppress their feeding cues.) Again, ideally you will be feeding your baby by following their cues instead of watching the clock. Remember that it is normal for newborn babies to feed in an irregular pattern, to “cluster feed” (nurse several times in a row), and to vary the length of time that they nurse each time and at each breast! None of these things on its own is reason for concern as long as your baby is gaining weight appropriately and making enough wet and dirty diapers, as noted below.

Babies usually lose 5-7% of their birth weight by day 3. Losing 10% or above is a sign that you should seek lactation support. Be aware that if you were on an IV during labor, your baby’s birth weight is likely artificially inflated and you may see a larger drop in weight.

In addition to having your baby weighed at our office, you can assure yourself that your baby is getting enough milk by counting your baby’s wet and dirty diapers. To know that your baby is getting enough milk between day 3-5, look for one wet and one dirty diaper for each day of life, so 3 wet and 3 dirty on day 3 and so on. After day 4, your baby should be making yellow poops that are the size of a quarter or larger. They will be loose (soft and runny) and may be seedy or curdy. Urine should be totally clear after day 3.

IF YOUR BABY ISN’T GAINING ENOUGH WEIGHT

If your baby has lost over 10% of their birth weight or isn’t gaining quickly enough, we will ask you to supplement your baby’s nursing sessions with expressed breastmilk and we will provide guidance about how much to offer. If you aren’t able to express enough milk at first (either by hand or with a pump), then you can use formula to make up the difference. You can use paced bottle feeding to help your baby go back and forth easily between breast and bottle.

When you are pumping, you will get more milk if you begin each session by doing some massage and hand expression, then wearing a pumping bra (that holds the pump parts against your breasts) and doing compressions (gentle squeezes) during pumping. Try pumping for 10-15 minutes and know that it might take a while to get used to pumping, so don’t worry if at first you aren’t expressing much milk.

When we are asking you to supplement, we will have you come back to the office so we can check your baby’s weight and discuss how and when to end the supplemental feeds. It’s also important to make sure that we have gotten to the root of the problem, so we may suggest that you see a lactation professional for additional support.

NURSING WEEK 1 TO 2

Babies should be back to their birth weight by 1-2 weeks, then should gain about 1 oz/day up until 4 months. By one week you’ll want to see at least 4 yellow poops every day (until around 4-6 weeks when those might decrease) and at least 5-6 wet diapers (the equivalent of 3 Tb/ 45 ml of liquid) every day. By one week, your baby will take around 45-60ml (or 1.5-2 ounces) at each feed. And by day 10, that increases to about 60-81 ml (or 2-3 ounces).

Again, once your baby is back at their birth weight and you’re seeing 5-6+ wet and 4+ dirty diapers per 24 hours, you can stop waking your baby to feed at night. It’s up to you if you choose to continue waking your baby every few hours during the day. Babies are usually much sleepier during the day and more wakeful at night.

Around two weeks of age, you’ll likely notice that your baby will be more wakeful and will likely develop a fussy period in the evening where they “cluster feed,” nursing a number of times in a row. This is not a sign that you don’t have enough milk or that something is going wrong, but rather it’s a normal part of newborn development and it will pass! (Again, you can monitor your baby’s diaper output to be sure that they are getting enough milk.)

BUILDING AND MAINTAINING A SUPPLY

The best way to build and maintain your supply of milk is to follow your baby’s feeding cues. This will work way better than any lactation cookies or teas! (Of course it’s good to eat nourishing food that you love, so if you adore lactation cookies, go for it!) The bottom line is that more milk out means more milk made. Here are some things to remember:

• Your supply will increase rapidly over the first 4 weeks and then begin to level off

• If possible, wait to pump until about 3 weeks so that you and your baby can get really comfortable with nursing

• Avoid pacifiers until nursing is “well established,” per the AAP. (A good choice is the Soothie brand pacifier.)

HOW TO MAKE NURSING COMFORTABLE

Pain while nursing is a sign that your baby’s latch (the way they are attached at the breast) isn’t right. And, in fact, when you’re in pain, your milk won’t flow as quickly, so a poor latch isn’t good for you or your baby. Put your finger in the corner of your baby’s mouth to break the seal, take your baby off and try again. Some discomfort or soreness is normal and in the beginning, the first 20 seconds after your baby latches may be uncomfortable as they suck vigorously to get your milk flowing.

So, how do you get a good latch and avoid pain?

• Start with a calm and unswaddled baby

• You should be in a comfortable position

• Let gravity help you by leaning back with baby against your body instead of lifting baby up to your body

• Hold baby close, with baby’s chest/belly touching your body

• Check that baby’s ear, shoulder and hip are in line, so they’re comfortable and it’s easier to swallow

• Focus on an asymmetrical latch, bring baby’s chin in first

• Aim baby’s nose to your nipple

• When possible, let the baby latch; don’t chase the baby with your nipple!

• If you need to support or shape your breast, think about lining up that “sandwich” in the same direction as your baby’s mouth and keep your fingers out of the way of where they are trying to latch

• Gently support your baby across their shoulders, don’t push on the back of your baby’s head

If you have sore nipples, try a gentle warm saline rinse for about 1 minute on each side (1 cup of hot water with 1/2 tsp of table salt, mix to dissolve and use when cool enough). See this Kelly Mom page about healing sore nipples for guidance on this & other tips. Consider using hydrogels (like the Soothies brand) for healing nipples. You can also put coconut oil on a disposable nursing pad and wear that inside your bra for extra comfort/protection against any chafing. (You might consider avoiding lanolin if you have broken skin on your nipples, since it can trap bacteria and irritate some people’s skin.) If the skin of nipples is cracked, wash nipples once a day with mild, unscented, non-antibacterial soap.

But remember, the best way to heal is to fix the poor latch! If you still are in pain after trying the tips below, please reach out for help. Premier Pediatrics has an IBCLC (International Board Certified Lactation Consultant) in our Brooklyn and Manhattan offices once a week.

HOW PARTNERS CAN SUPPORT

• Do skin to skin to calm baby before or after a feed

• Bring water and food

• Burp baby after feed

• Do diaper changes

• Learn how to “babywear” (in a carrier or wrap)

• Become a super baby soother

• Provide encouragement

• When the time is right to start pumping and bottle feeding, learn how to do paced bottle feeding

HUMAN MILK STORAGE GUIDELINES FROM CDC

Freshly expressed or pumped milk can be stored:

• At room temperature (77°F or colder) for up to 4 hours.

• In the refrigerator for up to 4 days.

• In the freezer for about 6 months is best; up to 12 months is acceptable.

• Leftover milk in a bottle which you have fed to your baby should be refrigerated and used within about 2 hours.

Use breast milk within 24 hours of thawing in the refrigerator (this means from the time it is no longer frozen or is completely thawed, not from the time when you took it out of the freezer).

Once breast milk is brought to room temperature or warmed after storing in the refrigerator or freezer, it should be used within 2 hours. Don’t refreeze breast milk once it has been thawed.

ADDITIONAL INFO & RESOURCES

• Per the AAP, nursing babies should get 400 IU (International Units) of vitamin D per day beginning soon after birth. We recommend D Drops or Carlson’s Vitamin D, which has no added flavors or colors and is a single drop dose per day.

• Whether you’re nursing, formula feeding or a combo, babies go through growth spurts, during which they want to feed more and may be a bit fussier. Common times for growth spurts are during the first few days at home, around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less, depending on the individual baby, gestational age, etc.).

• Infant Risk Center at Texas Tech University Health Sciences Center are the foremost experts on the safety of medications while pregnant or breastfeeding.

• To learn more about insurance coverage for lactation support, check out this resource from National Women’s Law Center.

• If you’re having trouble with your insurance company coverage, here’s a short guide written by Medela that might be helpful.

This article is for the baby who has acquired these skills but needs a little convincing before he can make it 11 hours.   There are many different strategies to coax your baby to use their skills and sleep through the night.  Each strategy shares one common theme – consistency.   The key is to choose the strategy that speaks to you and do it consistently for two weeks.   

One of my favorite techniques is the sleep wave from the book The Happy Sleeper.   This method employs a very short scripted visit from a parent every 5 minutes after a baby has begun to cry.  It is important to keep the script short (“I love you and I know you can do this”) and recite it each time you enter the room.  It is also important to leave immediately after you say your scripted words.   Each visit should take about 10 seconds.  Initially, your baby will  become frustrated when he realizes that you are not bringing the goods.  Over a few nights, he will begin to recognize your behavioral pattern.  The predictable nature of these 5 minute visits reassures and comforts the baby and allows him to fall back asleep.   

This is an excellent tool during the 9 month sleep regression.  At 9 months, babies have developed object permanence and separation anxiety.  Even the best sleeper awakens every couple of hours when he realizes his parents are not there. The sleep wave provides an excellent vehicle to reassure him that you are present while still giving him space to settle himself to sleep.  

As occupational therapists, we’re often asked what does ‘occupation’ have to do with infants and children? What is an infant or child’s occupation?’  A child’s job is to play and learn daily living skills that will help them succeed in  school, at home, and on the playground.  For an infant, it begins with integrating both sides of the body, developing eye hand coordination, and achieving an upright body orientation. 

Eye hand coordination starts developing from day one, as an infant begins to focus and track stationary and moving objects in their environment.  The growing understanding and control of their bodies facilitates coordination of vision with reaching, grasping, and shaking objects.  Their eyes and hands are beginning the life long, never ending process of learning and doing.

Essential to this development (and to the thinking of pediatric occupational therapists) is sensory processing. Sensory processing is defined on one of my favorite OT websites, the STAR Institute, as “…the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a sandwich, riding a bicycle, or reading a book, your successful completion of the activity requires accurate processing of sensation.”  Sensory input is taken in through the five senses, i.e. vision, touch, hearing and the ‘hidden senses’ proprioception and vestibular, which I call the movement senses.  For an infant, accurate processing of sensory input is essential as they gain confidence through successful attempts at sucking and holding a bottle, grasping and shaking a rattle, or rolling from their back to their belly.” 

In this lecture — (should we say ‘question and answer time’ instead)—, we will explore different exercises that  enhance eye hand coordination and sensory processing.  We will also teach you how to analyze and break down complex tasks so you can better help your little ones when they get frustrated with a seemingly simple task.  

Before the baby arrives, introduce your child to the idea of becoming a big sibling. Try to get him excited about the new baby, but also be honest about how the new baby may take up a lot of time and attention. 

• Read books together
• Get a baby doll or stuffed animal so your child can practice taking care of his own baby
• Look at old baby pictures and videos of your child, and tell him stories of when he was a baby
• Get him involved in the preparation by letting him help set up the nursery, pick out clothes, toys or decorations
• Try to avoid major changes right around the new baby’s arrival such as toilet training or transitioning out of a crib

Once the baby arrives, it is normal for your child to act out, experience jealousy and have regressive behaviors. Previously toilet trained children may have accidents, your child may engage in baby talk, want to drink from a bottle or use a pacifier. 

• Try to ignore these behaviors. Instead, catch your child being good and praise her for acting like a big kid. Remind her of the benefits of being a big kid, such as all the fun toys she can play with and delicious foods she gets to eat
• Keep routines as consistent as possible. Don’t hesitate to ask other caregivers for help
• Let your child feel like she has a role in caring for the baby. Give your child small tasks such as getting clean diapers, burp clothes, breast feeding pillows, etc., and praise her for being a great big sibling helper
• Set aside special one-on-on time with your older child, even if it is just for a short period of time each day
• Check in with your child’s feelings. Feelings of sadness, anger or jealousy in addition to the excitement and joy are normal. Remind your child that you love her, and allow some time for her to adjust to her new role

As for popcorn, hard candy, and gum, the AAP advises against them until age 4. No matter how old your children are always supervise kids when they’re eating.

Objects that are hazardous:

• Latex Balloons (Never tie them to cribs or where children are not always supervised)
• Round Objects ( Coins. marbles, small balls)
• Toys with small parts ( Not easy when we have more than 1 child. Teach your older one to clean up his toys. I know this is not an easy task. Maybe encourage playing with a high risk  toy when their younger sibling is napping.
• Pen or marker tops
• Button Batteries ( Extremely toxic and dangerous. They are found everywhere including  cameras, TV remotes, child’s toys.)
• Magnets
• Hair barrettes
• Safety pins
• Doll parts & Legos

Pearls:

1. Ban eating on the run!!
2. If you go to a party, make sure to check out all the food on the serving tables as well as objects that might be lying around the area.
3. If you have a second child in tow, remember to always keep an eye on your toddler when you venture outside of your home.

What to do if your child is choking and you are not there.  

At around age 4, your child will be away from you for periods of time during the day whether it’s school, play dates or a visit with grandparents. This is the perfect age to teach your child what to do if they choke and how to alert an adult. They should know their phone numbers, address and how to dial 911.

Teach them they are not BAD and it is not their fault.  Many children fear that they will get in trouble and run and hide.  You should teach your child to go to an adult and do the universal sign of choking.  The adult should ask if the child can talk and if they are choking.  If they cannot answer and shake their head yes, perform the Heimlich.

When you are ready to begin, your first step is to look at your own relationship with food and disabuse yourself of any preconceptions that you might have about infant eating and mealtime.  We have asked Marci Silver, an outstanding speech pathologist, to discuss some of the common misconceptions around infant eating and mealtime.  She has developed a list of the top 10 mealtime myths.

10 Mealtime Myths of America

1. Eating is the body’s number one priority.
2. Eating is instinctive.
3. Eating is easy.
4. Eating is a two step process: first, you sit down and then you eat.
5. It is not appropriate to touch or play with your food.
6. If a child is hungry enough, he/she will eat.  They will not starve themselves.
7. Children only need to eat 3 times a day.
8. If a child won’t eat, they either have a behavioral OR an organic problem.
9. Certain foods are only to be eaten at certain times of the day (i.e. breakfast foods only for breakfast, lunch foods only at lunch, snack foods only at snacks, dinner foods only for dinner), and only certain foods are “good for you”.
10. Mealtimes are a proper social occasion.  Children are to “mind their manners” at all mealtimes.

Marci will join us on Instagram Live on Thursday to talk a bit more about teaching your baby to be a happy and healthy eater.    She will bring her unique perspective of a speech pathologist and discuss early feeding milestones, feeding cues, how to establish a cooperative relationship around food among other topics.  Please feel free to submit your own questions  and we will make sure to get to them.

If you cannot make the IG session but would like to see the video, we will have the link up by Friday for you.

While virtual doulas have operated for many years, the appearance of the novel coronavirus has transformed this once largely in-person role into a remote and critical one.

I am the founder of boober, a platform that connects expectant parents and new families to maternal care providers, like birth doulas, lactation consultants, postpartum doulas, and mental health therapists. Until March 2020, we were known for matching clients with expert care providers for in-person visits. I have always maintained that there is a time and place for virtual care, but there are certain aspects of support that can only happen in the same place. The time and place for virtual care has come. The pandemic has plunged us into unparalleled times and we all had to adapt. For us, that means providing the best support possible under current circumstances, matching parents to virtual care providers, so that we can meet people where they are right now: isolated, in need of support, and unequivocally at risk from in-person care. Our experience has shown that virtual doulas can be a tremendous help to new families during and after birth.

As hospitals work hard to reduce the possibility of transmission, extra people, including doulas in some cases, are currently not allowed in several hospitals around the US to support laboring people. Even when they are permitted to join, the risk of contagion (bringing the virus to the hospital unknowingly or bringing it home) has led many providers to choose not to attend in-person labors for the safety of their families, healthcare workers and the doulas. Now online remote doulas can be anywhere supporting pregnant people during the COVID-19 crisis.

What do doulas do?
Doulas provide physical, emotional, and informational support to you (and your partner, if applicable). Doulas can vastly improve your birth experience and reduce the rates of interventions in labor. According to the American College of Obstetricians and Gynecologists, one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. Doulas have always been about in-person care, but these extreme times call for significant changes in how we work and support people.

How do virtual doulas provide support to laboring people during a pandemic?
Virtual doulas provide independent, supportive care through video platforms, phone conversations and text. While particular services and styles can vary between doulas, a good doula will make sure that their clients have evidence-based information, practical pain-relief tools, and emotional and informational support. There is significant evidence that doula care improves birth outcomes. With doulas—and now partners—often being excluded from many delivery rooms, virtual support may be the primary option for many laboring people.

What services do virtual doulas typically provide and how do they do it?
1. Prenatal planning. The prenatal meetings are easily done virtually. During these planning sessions, doulas will educate their clients, help inform them about their choices, and empower them to ask questions of their care providers as they prepare for birth. This process also allows clients the opportunity to express any fears and concerns about the birth experience. This session is a great opportunity to learn what to bring in your birth bag, especially if your partner won’t be able to join you during labor and will help you feel more confident about approaching your labor.
2. Emotional support. Your virtual doula is there for you 24/7. They’ll take your phone calls, text with you, or be on continual or occasional video chat as you wish, to “sit with you”, support you and be there through the challenges and the joys of birth.

3. Helping you figure out when to leave for the hospital during labor. One of the more challenging aspects of hospital birth is figuring out when is the right time to go to the hospital during labor. With care providers recommending that people minimize their time in the hospital at this time, doulas can help you figure out how far along you are in labor through non-clinical cues like the strength, length, and duration of contractions, how the birthing parent is acting and what they report they are feeling.

4. Pain-management techniques. Your virtual doula can work with you during labor by telling or showing you pain-management tools and techniques throughout labor. They can talk you through guided breathwork and imagery, acupressure points to reduce pain and birthing positions to try.

5. Answers and reassurance. Your doula is on stand-by to answer any questions you may have about what is happening during labor. They’ve seen labor before and they are trained to know what is normal. They can also be your trusted cheerleader, reflecting realistically what is happening and how you are progressing with their knowledge of the stages of labor.

6. Evidence-based information. Did your doctor offer to break your bag of waters and you want to consider the risks and benefits in order to make an informed decision? Doulas can talk it through the process, or can send you information to help you make the right decision for you.

What types of devices do virtual doulas use to provide support?
Doulas can be available to you online in a variety of ways throughout your labor, including laptop video, smartphone, or simply via text or email. It really depends on your needs and your preferences, as well as what your place of birth is open to. Several OBGYNs and hospitals have said they will help and welcome virtual birth support, so talk to your care provider now. This product or something like it can help you clip your phone right on to the hospital bed so your doula can be close at hand.

Virtual doulas can make a true difference for laboring parents, guiding them through the labor with information, emotional support and giving them some sense of control. Help does not stop at birth, though. When nobody is coming over to help with their newborn, virtual postpartum doulas provide postpartum support teaching new parents how to care for their infants, answering questions about newborns, supporting parents through early lactation, and providing an educated ear to listen and hear what the experience of becoming a new parent is like. While we all hope for the return of safe conditions for families, in-person care providers, and our community at large, in the meantime, we are glad to be able to support improving health outcomes of new families remotely. 

Jada Shapiro is the founder of boober and a longtime birth and postpartum doula, childbirth educator, certified lactation counselor, birth photographer, and mother. An expert in maternal health, she frequently moderates and appears on panels at top parenting conventions and provides birth and breastfeeding consultation to TV shows, A-list actors, and major films. She is a media expert on childbirth, lactation, and parenting, regularly sought out by the New York Times, The Today Show, Time Out New York, NBC, CBS, E!, TLC and other outlets. She is also the founder of Birth Day Presence, which, since 2002, has helped 20,000+ New York families bring their babies into the community with childbirth education classes and doula services. 

Avoid List:
• Hot Dogs
• Whole nuts and Seeds
• Grapes
• Popcorn
• Raw Veggies (carrots especially)
• Raisins
• Fruit chunk
• Chunks of meat
• Sticky foods (Nut butters, String Cheese, Gum, Marshmallows, Gummy Bears)
• Hard round Candy

Pearls:
1) Slice hot dogs and raw vegetables lengthwise into sticks (julienne style) instead of round chunks.
2) When your baby graduates to finger foods, keep them pea-sized and soft, or at least very easily gummed, like O-shaped cereal.
3) If a piece of food like a blueberry or black been has an intact skin, squish it before handing it to your infant.
4) Take infant CPR and be prepared.

Kids 1 to 4

Choking prevention at this age is all about the prep work. You can offer your toddler or preschooler many of the foods on the to-avoid list above as long as they’re safely prepared. Don’t give your child round, firm foods (like hot dogs and carrot sticks) unless they are chopped completely. Cut or break food into bite-sizes and cut fruit and cooked vegetables into small pieces. The American Academy of Pediatrics (AAP) recommends giving kids pieces no wider than a dime.

As for popcorn, hard candy, and gum, the AAP advises against them until age 4. No matter how old your children are always supervise kids when they’re eating.

Objects that are hazardous:

• Latex Balloons (Never tie them to cribs or where children are not always supervised)
• Round Objects ( Coins. marbles, small balls)
• Toys with small parts ( Not easy when we have more than 1 child. Teach your older one to clean up his toys. I know this is not an easy task. Maybe encourage playing with a high risk  toy when their younger sibling is napping.
• Pen or marker tops
• Button Batteries ( Extremely toxic and dangerous. They are found everywhere including  cameras, TV remotes, child’s toys.)
• Magnets
• Hair barrettes
• Safety pins
• Doll parts & Legos

Pearls:

1. Ban eating on the run!!
2. If you go to a party, make sure to check out all the food on the serving tables as well as objects that might be lying around the area.  
3. If you have a second child in tow, remember to always keep an eye on your toddler when you venture outside of your home.  

What to do if your child is choking and you are not there.  

At around age 4, your child will be away from you for periods of time during the day whether it’s school, play dates or a visit with grandparents. This is the perfect age to teach your child what to do if they choke and how to alert an adult. They should know their phone numbers, address and how to dial 911.

Teach them they are not BAD and it is not their fault.  Many children fear that they will get in trouble and run and hide.  You should teach your child to go to an adult and do the universal sign of choking.  The adult should ask if the child can talk and if they are choking.  If they cannot answer and shake their head yes, perform the Heimlich.