How to find an LGBTQ+ competent birth team in NYC

PRIDE brings rainbow-filtered Facebook profiles, multicolored corporate messaging, and some of NYC’s best summer celebrations. And I must say, I think this is a fabulous development. The fact that everyone wants to be included in PRIDE is beautiful. But when it comes to healthcare, rainbow swag in the waiting room doesn’t necessarily equate with LGBTQ+ competent providers. During pregnancy, birth, and postpartum, it can be especially challenging to feel fully supported as an LGBTQ+ parent.  

The birth world is so steeped in hetero- and cis- assumptions, that it can be hard to imagine what an LGBTQ+ inclusive birth team would even look like. So let’s begin by talking about what makes an LGBTQ+ competent provider:

  1. Inclusive language: At the most basic level, a practitioner should have the vocabulary to discuss your health. Fluency in relevant terminology shows a commitment to making sure LGBTQ+ people don’t feel like an inconvenient anomaly in the birth world

  2. Asking the right questions: An intake form allows clients to share their basic medical history but, only if the right questions are being asked. A competent provider recognizes that a person’s identity as LGBTQ+ is relevant to their health preferences, needs, and expectations.

  3. Relevant resources and referrals: Clients count on their birth team for all sorts of referrals and resources during pregnancy and postpartum. An LGBTQ+ friendly provider may not realize that the majority of books and facts sheets are heteronormative and don’t reflect their LGBTQ+ families. But a competent provider will consider the extra financial hurdles that parents may have gone through just to become pregnant, and will take into account the impact this may have on options for services during the pregnancy.  

  4. Commitment to continuing education: LGBTQ+ competency, like any type of expertise or specialization, takes training and ongoing education. The resources, legal rights, and medical research for the LGBTQ+ community is constantly growing and changing. To offer full support to LGBTQ+ people during pregnancy, birth and postpartum, providers need to be committed to ongoing education.

 Now that we have this picture of an ideal provider, where do we find them? How can we pull together this queer competent birth team? Here are some ways to begin building a list of options: 

1. Ask other LGBTQ+ parents.

Families who have been through the birth process are an amazing resources.  Queer parent groups are a great way to hear about people’s experiences first hand. They’ll be able to tell you who was the all-star on their birth team, and who you might want think twice about working with. Personally, I can recommend the groups at Brooklyn Acupuncture Project and here at Love Child Yoga.

2. Ask the hospital or birthing center for a list.

If you’re doing a tour of a hospital or birthing center, ask for a list of LGBTQ+ competent providers. Not all institutions will have this, but it’s a good reflection of how much effort they’ve put into making sure that all birthing people and families are supported in their space. You may also want to ask for clarification on whether the list differentiates between “friendly” and “competent” providers. 

3. Going to a LGBTQ+ inclusive childbirth education class.

A childbirth education class is a great place to start asking questions and collecting referrals for all your pregnancy, birth, and postpartum needs.  An LGBTQ+ inclusive course will be designed to meet the needs of a broad range of expectant people.  Some that I would recommend are Bilen Bernahu, (Love Child Yoga), Morgane Richardson (Juniper), and the educators at Manhattan Birth.

 4. Contact LGBTQ+ competency trainers

There are a handful of people who offer trainings to health care providers in LGBTQ+ cultural competency. They’ll know who's done the work and who is just offering rainbow colored swag. Morgane Richardson trains OB’s, midwives, nurses, and doulas around the US; and the Birthing Beyond the Binary team looks like an amazing initiative as well.

If you have other tips about how to find your LGBTQ+ competent birth team, please do send them in! We would love to hear about your ideas and advice so that we can include them here.  

About the author:

Dr. Alexandra Garcia is a doctor of Acupuncture and Chinese Medicine working with the Love Child team to support new and expectant parents and their children. She also provides acupuncture and acupressure to laboring people at NYU Lutheran Medical Center in Brooklyn where she serves on the hospital’s LGBT+ Advisory Board. She is working toward becoming an LGBTQ+ competent provider; She gives great thanks to her wife Morgane V. Richardson who has encouraged her to constantly challenge her own assumptions about the world of birth.

Preparing for the biggest change in your life: How preventive couples counseling can protect your relationship after baby

By Avi Klein

In my psychotherapy practice and many others, it’s become commonplace to receive calls from couples who want to work out the issues in their relationship before they get married. They want to better understand themselves and their partners before they hit the kinds of big road blocks that are inevitable in any long term relationship. I always applaud and encourage those couples because I think they have insight into something that is at the heart of relationships: the true measure of a good relationship isn’t about how good it is at any moment, it’s about how flexible it is. Couples counseling cultivates that flexibility by creating more intimacy and knowledge about yourself and your partner.  But, if I had to suggest one time when preventive couples counseling could really be needed, it's when you're about to grow from a couple into a family. It’s no coincidence that studies show that many couples become dissatisfied with their relationships when they become parents. Not much really changes when you get married, but for many couples, everything changes when you have kids. Every parent wants to give their child everything in the world. I would encourage every expectant parent to consider the advice of renowned couples expert John Gottman: "The greatest gift you can give your baby is a happy and strong relationship between the two of you."

A few common questions people ask about couples counseling:

1. How can I tell if it’s a good time to go?

There is no bad time to go, but don't make the mistake of waiting until it's unbearable. It's much easier to work on your problems when you can still appreciate and enjoy your partner. Some couples seek therapy as a last ditch effort before divorce, which is obviously much harder to fix since months or years of hostility and hurt feelings need to be dealt with first. For soon-to-be parents, it's also worthwhile to ask when you'll have time and energy after your baby arrives.

2. Does couples counseling mean we have a bad relationship?

Not at all! Going to couple counseling means you love your partner and value your relationship. You're spending time and money to make it better for you and your kids. That's something to be proud of. The truth is, everyone knows that relationships take work and effort. It's more efficient to do that work with an expert. Is your relationship something you really want to improve through trial and error?

3. What if my partner doesn’t want to go?

In about 75% of the couples I see, couples therapy is initiated by one partner not mutually agreed on. It’s normal for someone not to want to go to couples therapy. They might think that it means their relationship is worse than they thought or that their partner is saving couples therapy to surprise them with a list of complaints. Two helpful things to try when your partner is on the fence: 1. Reassure them that this is to make things even better, not that things are in a bad way. 2. Suggest that you go once or just speak to the therapist on the phone together for a brief consultation - giving it a test drive is a good way to get over any apprehension. 3. If your partner is on the fence, it’s worthwhile to find a therapist that you think they’ll get along with.

4. How do I find the right therapist?

There are a lot of therapists out there, so it can help to add a personal connection to find the right fit. If you know someone that had a positive experience in couples therapy or you’ve seen a therapist individually, that’s a great place to start. Consider asking on a community message board. Your MD or midwife may also know some good therapists as well. Consider speaking with more than one therapist to make sure you’ve found a good fit for both you and your partner. When you speak with them, what kind of information is important? While qualifications or geographical convenience matter, the most important thing is to trust your gut: you’ll be able to tell immediately if you feel comfortable with them, if you’re open to trusting them, etc. Lastly, don’t be afraid to ask them directly how they think they can help you. Therapy shouldn’t be an endless process - they should be able to explain the steps that you will take in your work to make a meaningful difference in your relationship.

5. How long will it take?

Every couple is different, so it’s impossible to say. It’s better to measure it week by week and to check-in with yourself and your partner: is this making a difference? Can you feel the difference and point to incremental changes that are happening? Couples therapy is different than individual therapy - it has always been intended to be short-term and to have the couple take what their learning from therapy out into the rest of their lives.  When I speak with a couple that is on the fence about committing to therapy, I usually ask for a commitment of several weeks to give a good faith effort to see if it’s helpful. Four weeks should be enough time to notice a shift and twelve weeks should feel like you’ve done a good amount of work. Everyone has their own timeline, so this isn’t intended to apply to all cases but just to serve as a general benchmark. And remember: it’s always okay to check-in with your therapist and partner about your progress. Discussing why things aren’t changing is often a very productive conversation.

6. How can we get the most out of going?

A few suggestions: 1. Take care of yourself and your issues: Work to better understand yourself, your reactions to things and how your partner experiences them. Much of couples therapy is about helping each partner understand things from the other’s experience. Learn to walk in their shoes. 2. Make it something enjoyable both during and after: make every effort to be open and kind and honest in your therapy sessions and then do something nice together afterwards. Many couples that I see often go on a date after their session with me. It’s a nice ritual and will leave you feeling closer after working hard together in therapy. 3. Try and make a conscious effort to take something from each session and bring it into the rest of the week. If your partner feels ignored or under-appreciated, make an effort to give them that attention their craving. If you’ve learned that your feelings are hurt when your partner makes plans without you, take a risk and share that experience with them the next time it happens.

The best part of a relationship is the feeling of being connected with someone - of sharing important moments, having new perspectives and being exposed to new things with someone you deeply care about. But the worst part? It's when those different perspectives don't easily align with yours, when new interests or attitudes not only don't feel supportive, they feel invalidating or leave you feeling neglected. One of the times of greatest strain on a couple is that transition into parenthood and it’s easy for many new experiences to pull you apart. If you’re worried that this could happen to you, talk to your partner about discussing these worries together with a therapist. Those conversations will bring you closer and more connected at exactly the time when you and your new family need it most.

Avi Klein is a psychotherapist, father of two and native New Yorker practicing in Union Square. Avi has been working with individuals and couples since 2009. He is trained in AEDP (Accelerated Experiential Dynamic Psychotherapy) and EFT (Emotionally Focused Therapy), two forms of therapy that emphasize the power of emotion, healing & transformation in relationships. He has a special interest in supporting new families and is currently working on a workshop to support new and expectant parents. If you are interested in upcoming workshops focused on preparing your relationship for postpartum, sign up here.Inquiries can be directed at avi@aviklein.com or at his website https://www.aviklein.com If you are interested in upcoming workshops focused on preparing your relationship for postpartum, sign up for updates here: http://eepurl.com/cK0UI5

 

What Is Diastasis Recti? Everything You Need To Know Prenatally & Postpartum.

Diastasis recti is the separation of your 6 pack abdominal muscles. It often occurs in pregnancy but can also occur in men from improper lifting and workout techniques. If the 6 pack abdominal muscles aren't able to expand as the baby grows, the small cartilage connecting the two sides can separate. It is measured in centimeters or fingers. It’s usually painless and can be fairly common occurring in ‘cross fit moms’. It’s why we don’t recommend crushes and sit ups in pregnancy. It’s also why we always recommend that you turn to one side and use your hands to help you sit up rather than lurching forward from laying back.

You can check if you have diastasis by laying down, lifting your head and shoulders to engage abs and feeling along the line of your 6 pack abs. 

If you have a separation, wearing a belly band and doing the belly pull exercises can help reduce the separation. It’s important to do so because the separation weakens your core and can cause low back pain and hip pain but also potentially a malpositioned asynclitic baby that could make labor more challenging. 

Separation is treated postpartum with targeted exercises to knit the abdominal muscles back together. Make sure to get the help of a specialized PT before you start your regular workout because you again want to make sure to avoid sit ups and crunches until the dialysis has healed.

What Do People Wish They Had Been Told About Birth?

The most common things I hear from folks who come to my postnatal classes are that no-one told them about how common birth injuries and trauma can be and how to prevent them, how challenging breastfeeding is and how they could have never expected how hard it is to go back to work. 

The most important choice you will make is picking you care provider. I recommend not using someone just because they were your gynecologist, recommended by a friend or you like them personally. Make sure that they share and respect your point of view. Especially for those who are planning to try a non-intervention, un-medicated birth, you can do yoga, get a doula, take all the classes and be incredibly prepared but if you and your care provider don’t see eye to eye on electronic fetal monitoring, laboring at home, doulas, inductions, eating and drinking during labor, pushing techniques and positions it can not only create unexpected challenges and tension in your birth but also result in not being able to have the kind of birth you may want. 

Birth injuries in both vaginal and cesarian births are extremely common. It could be pelvic pain from a vaginal birth, headaches and spinal tenderness from an epidural or getting an infection from surgery. Another reason for why you want to be able to trust your care provider whole heartedly. Do you feel like you’re in good shape physically for this very physical and emotionally challenging event. I had one client tell me that she felt like she was in the best shape of her life just before she gave birth and completely prepared for the endurance needed for birth - that’s how I want you all to feel!

Breastfeeding support in hospitals are diminishing. Most clients only get about 5 minutes with a hospital lactation consultant. New parents go home with very little information, expecting things to go perfectly and they almost never do. Take a breastfeeding class prenatally and seek help from a lactation counselor as soon as possible. 

Many of my clients are high-powered, ambitious, career-oriented women. Most planned to take their maternity leave, usually about 3 to 4 months and then go back to work. About half of those who intend to go back to work have either extended their maternity leave by an additional 3 - 4 months and a few who have have quit their jobs. The shift and change in identity is hard to explain unless you go through it yourself. Be prepared and and expect as much as you can for the transition back to work to be challenging and hard. The easiest way to transition back to work is to do so slowly. If you are able negotiate to work from home, come in a few days a week or part-time before you go back to full time. Most people have found it easier to go back to work at around 6 - 9 months. I’m sure you’re already planning financially so something to take into consideration. 

Is It Okay To Sleep On My Right Side When I'm Pregnant?

The reason why pregnant people are asked only to lay on their left side is because of a condition that can occur called vena cava syndrome. Your vena cava, the vein that takes blood back to your heart is on the right side of your body and pressure from the uterus and baby when you’re laying back or on your right can sometimes constrict this vein causing breathlessness and nausea for you. Some people find it extremely uncomfortable to sleep on their back and others are okay. For the most part, being on your back or on the right side for a short amount of time is usually okay and fine to do.

Many people tell me they wake up in the middle of the night panicking that they’ve been on their back. If everything feels okay, you’re probably okay. Usually we wake up for a reason, it could be our body telling us to turn over or to go to the bathroom :) Listen and trust your body and your intuition and do what feels right for you. 

For stomach sleepers, it’s not safe to lay flat on your stomach however, you can fashion your snoogle into a circle around your belly and lay on top of it. You can also use half inflated pool floats or a maternity raft under your belly. Place a pillow under your ankles to ease any strain on your legs and low back. 

How Can I Naturally Induce Labor?

STIMULATE PRESSURE POINTS & INCREASE BLOOD FLOW

Acupuncture

Acupuncture can help more blood flow to your uterine muscles. Recommendations: Geneseed & Propper Acupuncture

Acupressure

Certain pressure points in our body can stimulate uterine contractions - the webbing between your thumb and your finger and two inches above your inner ankle on both feet. Massage with Clary Sage essential oil. The aroma is said to have contraction inducing properties. 

STIMULATE OXYTOCIN

Oxytocin, the love hormone, kickstarts labor and uterine contractions!

Nipple Stimulation

Nipple Stimulation helps to produce oxytocin. Manual nipple stimulation is great as well as using your breast pump for 10 minutes of each side a few times a day can help!

Sex 

Sex not only stimulates the production of oxytocin but if you have a male partner, prostaglandins in semen can help soften the cervix.

MOVE

Walking & Climbing Stairs

Walking helps to open your pelvis and the more you move, the more you allow baby to move and descend into your pelvis. Climbing stairs is another great way to help open your pelvis and encourage baby to move.

Spinning Babies

These movements can help loosen ligaments, reset your pelvis and encourage baby to shift position

Forward Leaning Inversion

Rebozo Sifting

Side lying Sacral Release

Squats, Pelvic Circles, Figure 8s, Swaying your hips from side to side

Think of your pelvis as a sieve. In order for baby to move down, movement from side to side can help!

Bounce on a Yoga Ball 

Bring movement to your baby and encourage them to lower into your pelvis! Check out this mom!

Dance!

I’ve heard that belly dancing came to be to help encourage labor. i’m not sure if there’s any truth to that rumor but moving your hips certainly can’t hurt!

EMPTY YOUR BOWELS & BLADDER

Create more space for baby to move down and stimulate uterine contractions

Castor Oil

Ingesting one tablespoon of castor oil (a natural laxative) mixed with 4 ounces of orange juice to dilute can help. Can cause diarrhea so please stay hydrated!

Enema 

If you have done at home enema’s before, it can help to empty your bowels and stimulate contractions. I would not recommend this unless you’ve done this before!

EAT & DRINK

Drink

Lots of fluids, empty your bladder often. Raspberry Leaf tea is known to help uterine contractions. We instinctively release our pelvic floor in the bathroom and know to let go. 

Eat

Pineapple, Papaya, Black Licorice (Panda Brand) to stimulate the production of prostaglandins. Spicy food can also help empty your bowels. 

Evening Primrose oil

Can be applied on the perineum or ingested in pill form can help to release prostaglandins.

RELAX

Sometimes, our mind can get in the way. We’re so used to planning and having a schedule that when confronted with an experience that we can’t fully control can lead to stress and worry. The exact opposite of the warm cuddly oxytocin feelings that can help labor. Take a bath, meditate, get a massage whatever helps you relax and let go.

OTHER OPTIONS

Stripping Membranes

This is a procedure where a medical professional manually separated the bag of waters from the cervix to stimulate the release of prostaglandins. Check with your care provider if this is right for you. If you’re scheduled for an induction, asking for this procedure a few days prior may cause labor to start spontaneously. 

METHODS OF INDUCTION

Balloon Catheter

An instrument that is inserted in the cervix and manually helps dilatation. It stays in the cervix until it is able to easily be removed when dilation reaches bout 5cms. It can be uncomfortable but allows you not to take medications. 

Prostaglandin Gels

Such as Cervadil are inserted in the cervix. They can cause nausea and abdominal cramps

Pitocin

Artificial oxytocin delivered via IV. Usually used as a last resort to induce labor, once you are on Pitocin, you are required to be monitored on the Electronic Fetal Monitor at all times and contractions via Pitocin can be quite painful leading many to get an epidural. You can also read about the side effects of Pitocin here. Without the epidural however, you can still move and walk for pain relief. To avoid labor stalling early on I recommend using your natural pain management techniques for as long as you can, if the contractions become unbearable or you really need to rest, then an epidural is helpful. Know what to expect from an epidural here

Artificial Rupture of Membranes

This is called breaking your water and it’s usually done by a medical professional with an amnihook. Also only recommended as a last resort, once contractions are well under way. Once your water is broken, often you’re put on a time clock and the baby must be born within 24 hours or so. You are also more prone to infections if the water has broken. 

What Do I Need To Know About Getting An Epidural?

What can you expect from the procedure should you choose to undergo an epidural for pain relief during labor? When is the best time to ask for it? What positions can you be in? How long does it take to work? How long will it last?

I’m also introducing a concept called the Gate Control Theory of Pain, which explains how we can most effectively manage pain in childbirth with natural alternatives. This goes hand in hand with the idea that rather than fearing the pain of labor and delivery, by being informed and prepared, we can embrace the physical challenge for better experiences and outcomes.

  • An Epidural is spinal anesthesia offered to you at the Birth Center or Hospital.
  • Epidural medications fall into a class of drugs called local anesthetics, which includes bupivacaine, chloroprocaine, and lidocaine among others. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. 1
  • An epidural can take time to be administered depending on the availability of the anesthesiologist. Just keep in mind that you may not get it the minute you ask for it; there can be a bit of a wait–anywhere from 15 min to 2 hours. Plan to cope with a potential wait using breathing, massage and relaxation techniques.
  • After a local anesthetic is administered, a catheter delivering the medication is placed in your lower spine.
  • You’ll start to feel the effects of the medication in 15 minutes or so. After it’s turned off, these effects will wear off in an hour or two.
  • You will not be allowed to leave the bed; however, you will be able turn on your side and use a peanut ball between your legs. 2
  • Since you won’t be able to get up to go to the bathroom, a urinary catheter will be inserted as well. They’ll put it in once you’re numb and take it out before you push.
  • Whether you have an epidural or not, most hospitals and birth centers will require you to have an IV, usually inserted in your non-dominant arm. If you choose not to have an epidural, you can ask for a hep-lock instead so you don’t have to carry the IV bag around with you. However, if you get an epidural, a continuous IV will be placed.
  • The fetal monitor is essentially two discs that are placed on your belly to help record the baby’s heart rate and monitor your contractions. It significantly limits your mobility. If you choose not to have an epidural, you may ask for intermittent fetal monitoring. However, in the case of an epidural, continuous electronic fetal monitoring is necessary. Studies have shown that there is no difference in birth outcomes between continuous and intermittent fetal monitoring and continuous fetal monitoring is associated with a greater chance of cesarian section. 3
  • You can ask for the button to control your own epidural medication. Studies have shown that when self-medicated, women give themselves smaller dosages! 4
  • Labor will likely slow down when you get an epidural. If labor does not progress, pitocin may be introduced to augment labor. 1
  • Occasionally, the epidural will be uneven, with more feeling in one leg or the other. Let your care provider know as soon as possible if that is the case. 5
  • Our recommendation si to wait until you are 6- 7cm dilated to get the epidural. Getting the epidural too early can stall labor. Once you’re at 8cm, you’re so close that it may not make sense unless it's been a really long labor and you're looking to rest. 
  • Occasionally, some women are allergic to the medication. There isn’t a good way to test for this allergy, but you can ask for it to be administered in small test doses to start. 6
  • Studies have shown that epidurals can cause maternal fevers and in turn affect the baby. If you have a fever after birth, often the baby is taken to the NICU for 48 hours to ensure that they haven't developed any infections. 7
  • There is a risk for pelvic and hip injuries caused when pushing. Injury can occur both with an epidural and without but not being able to fully feel your internal musculature can put you at a greater risk. 
  • The medications in an epidural are the same as those used for anesthesia in Cesarian sections. In case of a C-section, the epidural is left in for about a day to help numb the pain after surgery. You will be given pain meds after the epidural is taken out, and the scar from the incision will be kept numb for a few weeks.

The Gate Control Theory of Pain–A natural alternative to relieve pain

Have you ever burned your finger and immediately run it under cold water for relief? The Gate Control Theory of Pain explains that there are two types of fibers that transmit messages to the brain–slow-acting fibers, and fast-acting fibers. However, before the pain signals reach the brain, they encounter neurological “gates” along the spinal cord. These gates filter pain signals to determine which ones reach the brain. Pain is perceived when the gates give way to these signals, and is less intense when the gates close. If the fast fibers are stimulated more than the slow fibers, the gates close, inhibiting transmission of pain impulses and reducing pain perception. So when we pour cold water over a burn, the water activates the fast acting fibers which closes the gates, which results in fewer pain impulses reaching the brain and reduces our perception of the pain from the burn.

When we apply sensory stimulation–such as heat, cold, water in a bath/shower, firm pressure, intradermal water blocks, Transcutaneous electrical Nerve Stimulation (TENS) and massage–the fast fibers are activated, endorphins are released, and the transmission of pain never reaches the brain, preventing us from perceiving it.

So while waiting for the epidural (if you choose to have one), to manage your pain most effectively use methods that take advantage of the Gate Control Theory of Pain. For example, place a heat pack on your low back in the same spot where an epidural would be administered, or have someone massage you in that same spot. You can see exactly where on your lower back an epidural is administered at this link.