Author Archives: Mandi Hardy Hillman

What's in your nursing basket?

What’s in you nursing basket?

Preparing you Nursing Basket
By: Sandi Hoover of Roots Prenatal Yoga in Des Moines

In all the wonderful ways you are preparing for labor and birth, here is an idea to help prepare for the first few weeks at home with baby. For all the time you will spend feeding your little one you may find it extremely helpful to have a portable basket (a bag works, but I like a basket to easily see and get to contents) to have for when you are nestled in for a nice long session of feeding baby.

Here are a few things you may consider having in your kit:

nursing nest basket~Water bottle – It never failed that when I was in bedroom my water was in the living room, or when I was in nursery water was not there. My sweet husband could almost anticipate my, “honey, could you please bring my water bottle” a minute after baby latched on and my thirst kicked in.
~Breast pads and nipple cream (Newman’s Nipple Ointment is the BEST and can be prescribed by your provider to be compounded at your pharmacy)
~Burp cloth(s)
~Nail file, hand creme – for you. My nails never looked as good as they did those early days of nursing!
~Chapstick, or better yet coconut oil that you can use for yourself and baby.
~Positive affirmation – this could be on a notecard or even on your phone. Some affirmation ideas: “I may not be perfect, but I am the perfect mother for this baby” “My baby and I are getting to know each other more each day. I take motherhood day by day”, “I give myself space and grace to get used to being a mama”.
~Baby nail clippers – I found it easiest to clip baby nails when they were asleep, which is often after they nursed.
IMG_2211~Your phone – while it is nice to check email or social media from time to time I hope you will leave at least one feeding session media free where you can just relish in the wonder of your baby. You will not regret this special time together.
~Kleenex – I was so emotional those first few weeks and just smelling my baby and remembering their birth story could easily bring on the waterworks.
I’m sure there are more things you could pack your basket with, but I’m a simple gal. Personalize your basket to suit you. I would restock my basket before I went to bed for the night to feel ready for the next nursing session. Blessings! I bow to you mamas.

Written by: Holly Figueroa

When you find out that you’re pregnant, one of the biggest and most important decisions you’ll be faced with is which healthcare provider to see throughout your pregnancy.  There are several different types of providers that you can choose from depending on the type of care you’re looking for.  For some a traditional obstetrician (OB) is the right fit, others seek the more natural approach taken by midwives.  

The first step is to evaluate whether you are considered a “high-risk” pregnancy or not.  If so, you’ll probably see a perinatologist, a doctor specializing in high-risk pregnancies, such as having a medical condition such as diabetes, high blood pressure or genetic disorder, or who have had complications during previous pregnancies.

For women who are having a low-risk, or routine pregnancy, most consider either an obstetrician (OB) or a midwife.  According to the American Board of Obstetrics and Gynecology an OB is a specially trained medical doctor who specializes in the care and surgery of women, specifically related to pregnancy.  Obstetricians follow a more medical course of action throughout the pregnancy and always deliver in a hospital setting.  

Advantages to using an OB:

  • Trained to handle medical complications that may arise during pregnancy such as preeclampsia, placenta previa and preterm labor
  • Have undergone specialized surgical training and therefore have the ability to perform a cesarean section of necessary

Disadvantages to using an OB:

  • Increased risk of medical interventions such as an episiotomy, induction, epidural and cesarean birth
  • Must give birth in a hospital rather than a birth center or at home

According to Midwives Alliance of North America, a midwife is a “trained professional with expertise and skills in supporting women to maintain healthy pregnancies and have optimal births and recoveries during the postpartum period. Midwives provide women with individualized care uniquely suited to their physical, mental, emotional, spiritual and cultural needs. Midwifery is a woman-centered empowering model of maternity care.”

Advantages to using a midwife:

  • Decreased risk of medical interventions such as an episiotomy, induction, epidural and cesarean birth
  • Decreased risk of preterm birth, infant mortality and perineal tearing
  • Increased satisfaction with quality of care

Disadvantages to using a midwife:

  • Some midwives aren’t permitted to deliver in a hospital setting (but some are!)
  • Unable to treat some complications so a transfer to an OB may be necessary
This graphic was included in the 1st and 2nd editions of the Iowa Birth Resource booklets.

This graphic was included in the 1st and 2nd editions of the Iowa Birth Resource booklets.

Things to consider when making your decision:

  • The type of birth you desire: natural or medical interventions
  • Where you wish to deliver: home, birth center or hospital
  • Whether or not you have a preexisting medical condition that may cause complications during pregnancy
  • The provider’s philosophies in regards to pregnancy, labor and delivery and whether they fit with your own beliefs
  • Training/certifications the provider has
  • The provider’s induction and cesarean section rate
  • If the provider is in a group practice, will you have a chance to see all of the providers prior to delivery
  • Do you plan on writing a birth plan?  If so, will the provider respect and follow your wishes
  • Does the provider have professional or patient references
  • Protocol that will be followed should you go past your due date and does that plan align with your wishes

One of the most important decisions that you will make during your pregnancy is the person whom you choose to care for you and your unborn baby.  To find someone who respects your wishes, aligns their practice with your pregnancy beliefs, empowers you as a woman and mother and supports you choices in terms of your pregnancy, labor and birth experience is invaluable.

IBO Care Provider


American Pregnancy Association

Midwives Alliance of North America

American Board of Obstetrics and Gynecology

Cover image by: New Creation Birth Photography, Cedar Rapids/Iowa City

The Iowa Birth Resource

Cover image by: New Creation Birth Photography, Cedar Rapids/Iowa City

Cover image by: New Creation Birth Photography, Cedar Rapids/Iowa City

It’s here, it’s finally here!!!  The second edition of The Iowa Birth Resource is published!  


Once again, this publication was a true labor of love that required the efforts and talents of numerous individuals.  This booklet is our annual big education campaign and we think we hit it out of the park this year.  We didn’t do it alone.  Here are some of the people we need to thank. 

We owe a huge thank you to Rachel K., who appeared like an angel at the 11th hour (seriously, we were a day or two away from saying, “print it”), and took over the design of the booklet.  She donated her time and talent to take this publication to the next level visually and we’re grateful beyond words.  A most sincere thanks to you, Rachel!   Also to Christian Printers in Des Moines Iowa who were, again, a pleasure to work with.  Thank you for your patience and outstanding customer service!

This publication was once again 100% funded by the generous support of advertisers.  Because of your generosity and support we were able to publish nearly 10,000 copies of this information and provide it FREE to the public!

 Platinum sponsors: 

Gold Sponsors:

Silver Sponsors:

Bronze Sponsors:

Photography Contributions:

Additionally, we must thank the authors of the articles within the booklet.  This is the heart and soul of the publication and reason it was created – to get this information into the hands of expectant families.  We are grateful for the contributions you’ve made.  Without them we, quite literally, wouldn’t have this book!

Finally, Where can you get your hands on some?  Here is a list of current public business locations that have copies of the booklets.  If you’re a business and you’d be willing to keep a box (or 2) at your location for public pick-ups please contact us at and we’ll make arrangements.



Central Iowa

Southeast Iowa



Peace. Love. Birth

mandalaHere it is:  We are proud to debut the first t-shirt in support of access to safe, respectful evidence-based care in Iowa.

Peace, Love, Birth – that about sums it up.  We debated for quite a bit about what the perfect quote would be, but in the end we realized two things: 1) simple is usually best and 2) these 3 words really sum up what we’re all about.

We commissioned Iowa henna artist Sarah Norman, of Alternative Artistry to create this mandala for us and Iowa screen printing company, Eight Seven Central (the same shop that prints for Raygun) to do the printing.

These t-shirts are a fundraiser campaign for IBO.  We are running the campaign between June 3-17.  The funds raised from the sale of these shirts will go towards filing fees for non-profit status (estimated to be around $500) and general operating fees.


What are they made out of?  50/50 Poly-Cotton (“super soft”) blend shirts.  This is the uni-sex design.

What colors? There are 3 color options (shown below).  Black Aqua, Heather Vintage Green, and Heather Lieutenant.


Heather Vintage Green

black aqua

black aqua

Heather Purple

What about size? These are American Apparel brand UNISEX shirts.  View the size chart here.

How do I order? Use the form below!


I don’t want a shirt are there other items with this artwork? We understand that not everyone is a “t-shirt person,” we get it.  ight now we are only printing on t-shirts, but if we have a good fundraiser we’d like to consider other items.  We’ll stock those in our shop if/when that happens.

Help us spread the word: Since FB has made it harder and harder for businesses to share information about fundraising we need your help to spread the word.  Every time a post is liked and/or shared it makes it more likely that folks will see it in there feed.  Therefore, if you “like” this post and you share it you’ll be automatically entered to win a FREE shirt!

Launch: Resource Guide 2.0

I cannot believe I’m about to say [type] this, but we’re ready to launch the Iowa Birth Resource Guide 2nd edition, or as I’m calling it 2.0!

Guide 2015

Iowa Birth Organization’s Inaugural Birth Resource Guide

Our mission was to create an eye-catching booklet that allowed evidence-based information to be easily accessed and shared.  Overwhelmingly the feedback we’ve received has been positive and reinforced that overall, we were quite successful.  We published over 5000 copies of the Birth Resource Guide in the early winter of 2014 and have been working to distribute them across the state since.  In the process of creating the guide we learned many valuable lessons.  We knew that there would be hurdles and challenges that we couldn’t anticipate, and boy were we right!  However, we kept pressing forward knowing that the first time you do something is often the hardest. We’re taking all that we learned and we’re ready to make the 2nd edition even better!

Here’s the plan for the 2nd edition:

  • Publish more copies.  Aiming for 10,000 (1/4 of the births that happen in Iowa annually).
  • More specific and strategic plan for distribution.
  • Clearer guidelines and stricter deadlines for advertising and article submissions.
  • Release date: Labor Day!

Advertising: We have 4 size options available

  • Full page, qty 12
  • Half page, qty 15
  • Small, qty 20
  • small square, qty 50
  • Visit our shop to purchase advertising.

Directory listings: Our directly listings are free, and always will be! We have an extensive online directory and it’s consistently expanding and updating.  If you’d like to list your business or organization in this directory, please complete this form.

At this point our leadership team is determining whether or not it is valuable (as a resource and a financial investment – number of pages) to publish the directory listings in the Resource Guide.  The discussion revolves around the necessity of print phone books – they just are not used in the 21st century, websites are.  The alternative plan, if the listings are not published in the print guide, would be to pepper the guide with reminders about the online directory resources.

Cover Image Contest: Anyone is welcome to enter as many photographs as they would like.  There is a $25 entry fee per image (purchased in our shop). Entry deadline is July 1, 2015 at midnight.  Full rules and entry guidelines here: Photo contest rules and guidelines.

Still looking to get your hands on some of the 1st editions?  There are a still a few hundred waiting to be snagged up and spread around.  Here are some locations (if these don’t meet your needs let us know, we want these to be in the hands of the people who can use this information):

safe sleep

Information leads to safer decisions

The following post is a copy of a letter written to major media outlets in central Iowa, regarding the coverage of infant deaths that occurred in May 2015.  We believe the summary of information may be beneficial to our followers; therefore, we are sharing it with you here.

andrew_sketch_final_lowresIn the wake of extremely tragic events we urge you to please take the opportunity to educate the public on safe sleep habits. Informing parents that sharing a bed with their baby is unsafe is not just inaccurate but only serves to promote fear. Certainly, there are instances when bed sharing is not recommended, in smoking homes, when baby was not born full term, when the baby is bottle fed only, but to indicate it is always unsafe is truly a disservice to the public.

Many families share a bed with their baby (co-sleep). In many other countries around the world, it is the social and medically accepted norm. This sleeping behavior is neither new nor dangerous, it’s a normative behavior that is as old as humankind. Culturally, we shifted away from co-sleeping based on the best information available to us at the time, but now we know better, and it’s time to realign.

From what limited information I have been able to gather through media reports on these recent cases it seems clear that unsafe sleep habits played a significant role in these tragedies – not co-sleeping, but unsafe co-sleeping. Making this distinction is crucial. When an infant death occurs in a car accident and it appears to be due to improper or unsafe use of a car seat, tips for safety in the car are provided, not recommendations to never take a child in a car. Similarly, when a drowning occurs the message is not “do not swim,” but rather “here’s how to stay safe when you do swim.” Giving such recommendations, in a world where taking infants in the car or going swimming are quite normal, is extreme and a public disservice.   Providing current evidence and suggestions for increasing safety in this circumstance is no different.

Health psychologist and an International Board Certified Lactation Consultant, Kathleen Kendall-Tackett, reports that her research has shown that fear of co-sleeping actually increases the likelihood that parents engage in dangerous activities, like falling asleep with baby on a couch or recliner. This is why we urge you to not make statements that claim co-sleeping in unsafe, but rather to provide the public with information about how to do so safely. Informed families are then better able to make their own decisions about what is best for them and their babies.

There are many reputable professionals and organizations that support safe co-sleeping. La Leche LeagueLLLI Safe Sleep 7 International, a world-renowned organization dedicated to supporting breastfeeding, published their first book on this subject in 2014. The book, Safe Sleep, is a thorough and current review of the evidence for safe co-sleeping. They provide several excellent research summaries, including the Safe Sleep 7: Smart Steps to Safer Bedsharing and Rhyme for Sleep Time on their website. According to La Leche League International’s findings, if these steps are followed a baby is as safe as in a crib. Dr. Bill Sears, a well-known author and practicing pediatrician for more than 30 years states, “Instead of alarming conscientious parents, sleep advisers should be teaching parents how to co-sleep safely.”

James J. McKenna, Ph.D. Professor of Biological Anthropology, Director, Mother-Baby Sleep Laboratory at the University of Notre Dame, and author of Sleeping With Your Baby: A Parent’s Guide To Co-sleeping, provides the following guidelines on his website:

  • Safe infant sleep begins with a healthy gestation, specifically without the fetus being exposed to maternal smoke.
  • Breastfeeding significantly helps to protect infants from death including deaths from SIDS/SUDI and from secondary disease and/or congenital conditions.
  • Post-natally safe infant sleep begins especially with the presence of an informed, breastfeeding, committed mother, or an informed and committed father.
  • Infants should sleep on their backs, on firm surfaces, on clean surfaces, in the absence of smoke, under light (comfortable) blanketing, and their heads should never be covered.
  • The bed should not have any stuffed animals or pillows around the infant and never should an infant be placed to sleep on top of a pillow.gorilla-co-sleeping-with-newborn-gorilla--9136
  • Sheepskins or other fluffy material and especially bean bag mattresses should never be used. Water beds can be dangerous, too, and always the mattresses should tightly intersect the bed-frame Infants should never sleep on couches or sofas, with or without adults wherein they can slip down (face first) into the crevice or get wedged against the back of a couch.

Home Birth: What you need to know

Home Birth: What you need to know

Monica Basile, PhD, CPM, LMT

Home birth is a safe and reasonable alternative to hospital birth. For many families, home birth provides optimal conditions for achieving physiologic birth in a familiar and intimate setting, with personalized and expert care.

How common is home birth?

The CDC reported in 2012 that home birth is on the rise nationally.[1] While less than 1 percent of all births in the United States take place outside the hospital, the number of these births increased by 3.5 percent between 2003 and 2006. The CDC reports that Iowa’s rate of home birth is significantly higher than the national average. Approximately 500 women give birth at home every year in Iowa.

Why do people choose home birth?

Photograph submitted by the family.

Photograph submitted by the family.

People choose home birth for a variety of reasons based on physical, emotional, cultural, and spiritual factors. Those who decide to birth at home span socioeconomic classes and they come from every demographic,  profession, and religious and political affiliation. A 2009 study in the Journal of Midwifery and Women’s Health reported on the motivations people cite for choosing home birth.[2] The most common were:


  • Increased safety (24%)
  • Avoiding unnecessary interventions (24%)
  • Previous negative hospital experience (23%)
  • More control and autonomy (22%)
  • Comfortable, familiar environment (19%)
  • Trust in the birth process (16%)

 Is home birth safe?

Many peer reviewed, scientific studies have found that for healthy women who experience normal pregnancies, a planned, midwife-attended home birth is just as safe as hospital birth, with far lower rates of medical interventions.[3] While the nationwide cesarean rate is over 30 percent, the rate of transfer for a cesarean during a planned home birth is only 3.8 percent. The safety of home birth has been affirmed by public health organizations such as the World Health Organization and the American Public Health Association.[4]

 What type of care do home birth midwives provide?

Home-birth midwives specialize in providing primary health care in out-of-hospital settings, and in supporting women to maintain a healthy pregnancy and birth. They provide comprehensive prenatal, birth, and postpartum care to low-risk women. Home-birth midwives can also recognize deviations from the norm and they will refer care to other healthcare providers when appropriate. There are several types of midwives who attend home births: Certified Nurse Midwives (CNMs), Certified Professional Midwives (CPMs), and Traditional Midwives.

The average length of a prenatal visit with a physician is 10 minutes, whereas the average length of a prenatal visit with a home-birth midwife is about an hour. Home-birth midwives value respectful treatment, personal attention, informed decision-making, appropriate monitoring and risk assessment, instilling confidence in a woman’s body, natural techniques for comfort in labor, family-oriented care, and parent-child bonding. Six weeks after a home birth, more than 90 percent of mothers are breastfeeding successfully.[5] The midwifery model of care is holistically oriented, seeking to enhance the physical, psychological, and social well-being of the mother throughout the childbearing cycle. Midwives also offer excellent continuity of care.

What about complications?

Photograph by Laura Eckert, A New Creation Photography

Midwives screen clients carefully and care for only healthy, low-risk women. Midwives are trained in emergency skills such as neonatal resuscitation, and in facilitating a safe transfer of care, if needed. The vast majority of transfers during labor, from home to a hospital setting, are non-emergent.



Is home birth for everyone?

No. Home birth is contraindicated for women who have risk factors for certain health conditions, or for those who develop complications arising during pregnancy. Also, it is not for women who have a personal preference for birthing in the hospital.


[1] MF MacDorman, TJ Mathews, E Declercq. “Home births in the United States, 1990–2009.” NCHS data brief, no 84. Hyattsville, MD: National Center for Health Statistics. 2012.

[2] Debora Boucher, CNM; Catherine Bennett, RNC, BSN; Barbara McFarlin, CNM, PhD, RDMS; Rixa Freeze, PhD, MA “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” JMWH, Vol. 54, No. 2 (March/April 2009), p. 119.

[3] Kenneth C Johnson and Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ 2005; 330:1416 (18 June); S Vedam, K Stoll, L Schummers, C Fulton, “Home Birth: An Annotated Guide to the Literature, 2013.

[4] American Public Health Association, “Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-Entry Midwives (Policy Statement)”. American Journal of Public Health, Vol 92, No. 3, March 2002; Maternal and Newborn Health/Safe Motherhood Unit of the World Health Organization, “Care in Normal Birth: A practical guide.” World Health Organization, 1996.

[5] Kenneth C Johnson and Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ 2005; 330:1416 (18 June);


VBAC Supportive Care

Like many moms out there, I’d never expected to be part of the “cesarean club.” Surgery didn’t exactly fit my natural birth plan — so much so that the hubs and I pretty much snoozed through that whole portion of the labor and delivery class offered by a local hospital. Things quickly changed upon the discovery that my firstborn was breech at my 37-week prenatal appointment.

Despite trying everything I could, she would not turn. At that point, I’d never heard of family-centered cesareans, and my providers never offered one as an option. However, I had a good cesarean and recovery. But it was a far cry from the natural birth I’d dreamed of.

It seems silly to admit this now, years later, but when I was pregnant with my firstborn, I selected where she would be born and who would deliver her largely based on convenience and ambience. I say silly because I ended up going to great lengths, including a transferring my care at 39.5 weeks and driving two hours to have my second child delivered by providers who practice evidence-based care that supported my wishes.

When I discovered I was pregnant with Baby No. 2, I searched for a provider who was supportive of VBACs and delivered in a hospital, our preference at the time. Unfortunately, no midwives offered VBACs in hospitals in central Iowa, where I live. So I chose a group with an OB our pediatrician said was VBAC-friendly.

Each physician with whom I met started off my prenatal office visit with, “You’re an excellent candidate for a VBAC.”  However, at my 17-week appointment, the ARNP said something that raised an alarm inside me. She said they’d do a “routine” ultrasound at 38 weeks to check my baby’s size given my firstborn was so “large” at 8 lbs., 10 oz. (for reference, my husband’s 6’4’’ and I’m 5’ 10’’).

This made no sense to me, so a friend suggested hitting up the local ICAN (International Cesarean Awareness Network) group for advice.

An ICAN leader told me about the American College of Obstetricians and Gynecologists’ (ACOG’s) guidelines for VBACs, which included that my firstborn did not meet its definition of macrosomia (a big baby) and that the group concludes that mere suspected macrosomia shouldn’t put a halt to the possibility of a VBAC. She was very supportive and mentioned some other options to consider, one being transferring my care to UI Women’s Health Center’s Midwifery Clinic (UIHC). However, at the time, I honestly thought driving two hours in labor sounded crazy.

At my 19-week visit I asked one of my OBs about the 38-week “routine” ultrasound. She said that so long as I was measuring normally, I wouldn’t have to have it.

During my following prenatal visits, I waited until after all of the other physicians said I was measuring right on schedule. Then I started asking them questions and began getting red flags when they did not concur on a definition of a “big” baby. One told me the ultrasound was mandatory and that if the results showed my baby was 9 lbs., I’d have to have a scheduled cesarean. Given the margin of error with ultrasounds, I wasn’t comfortable having a routine cesarean solely because of size, when I could be carrying an 8 lb. baby. Another physician made other comments to me, including suggesting another ultrasound at 35 weeks, which led met to believe we definitely did not have the same plans for the birth of my baby.

Then I learned that physician was known for pushing cesareans and that the group as a whole was known to “pull the rug” from plans for VBACs toward the end of pregnancy, leaving moms to feel like they have no other options.

At my 37-week appointment, after measuring right on schedule, the same physician whom had assured me the routine 38-week ultrasound wouldn’t be necessary so long as I was measuring on target tried to push the test on me three times within the short visit.

At this point, I was a mess, feeling like I could not trust all of the physicians in the group to honor what I believed to be in the best interest of my baby and me. So I called the physician in the group whom had delivered my firstborn and with whom I was the most comfortable to discuss my concerns.

After speaking with her, I came to the conclusion that I would continue to be an “excellent candidate for a VBAC,” should all the stars align (I happen to go into spontaneous labor before my due date, the right physician was on call, my labor progressed quickly, etc.). And for me, the answer I needed to hear was, We will support your VBAC and your wishes to withhold interventions so long as you and your baby are doing okay.

So I called the UIHC midwives who thankfully accepted me as a patient at 39.5 weeks. During my first and only prenatal visit there, the midwife told me, “In your case, it would be a real shame not to try for a VBAC.”

I went into spontaneous labor three days later. Despite having been in labor for 15 hours with mostly frequent, intense contractions, I was at two centimeters dilated upon admission. However, because I was a VBAC mom, the midwife on call wanted to admit me. I expressed my concern about “being on the clock” by being admitted so early, and she said, “We don’t have those clocks here.” And she meant it!

The next day, seeing my exhaustion after 31 hours of labor and going on a total of eight hours of sleep in two days, the midwife suggested Pitocin. Despite it being a “no” in boldface type on my birth plan, she said otherwise I could be one of the moms who labors for days. But she never pushed it on me, saying only, “I would offer you this…,” which made me not think twice about it. Had I not elected to receive the drug, I know I could’ve continued to labor there without being pushed into unnecessary intervention. But because of ACOG’s “immediately available” VBAC guidelines, I know in my heart that I would’ve been pushed into another cesarean, had I stayed in Des Moines.

I traveled to Iowa City because it was the only place I felt I could be guaranteed evidence-based care for my baby and me that supported my wishes. But the person-centered postnatal care at UIHC was far superior to my experience in Des Moines as well.

Mom and baby skin-to-skin immediately after birth.

Mom and baby skin-to-skin immediately after birth.

I’ll forever be indebted to the UIHC midwives, ICAN of Central Iowa and my doula for the blessing of holding my baby immediately after she was born for as long as I wanted, my birth “war” story, being able to pick up my firstborn (and shower upstairs!) upon returning home and for reduced risks, should we decide to have another child.


The “silliest” part of my VBAC story is the fight I had to put up to have it.

 More VBAC resources:


When Stars Align

When Stars Align (and Evidence-Based Care is normal)

By: Andrea Shandri, M.Ed, CD(DONA), CCCE
Mercy Medical Center, Des Moines, Iowa

© 2015 Blessings Photography & Birth Services, LLC

Amanda McClannahan holds daughter for the first time.

Although a statement typically reserved for pure-luck instances, when stars alignis a phrase that makes us think of a lucky, blissfully decadent, once-in-a-lifetime occurrence, with little chance of naturally happening again. As a birth worker, there are many examples I could think of that fall under this .whats the word.phenomenon of star-aligning events, when enough prayers are said, or when the lucky get luckier. Lack of intervention during a highly medicalized event, spontaneous start of labor when the induction date is set, or complete belief in a womans body to birth a baby on her own, by her own power, are events that many of us dream of seeing.

© 2015 Blessings Photography & Birth Services, LLC

Daughter Emily bonds with mom Amanda following Cesarean birth

To think of the things a birth worker (specifically a doula) would love to see on a regular basis is easy: start with the natural process of labor and identify those critical elements that allow the process of birthing both a baby and a mom to not only happen, but flourish. For many doulas and birth workers, those critical elements typically include waiting for labor to start on its own, delayed cord clamping, immediate skin to skin, and breastfeeding. But what if labor doesnt start on its own? What if a Cesarean birth is the only viable option a mom has? Do the processes of bonding and elemental birth that help a mom and baby flourish get disregarded?

The stars aligned today.

Those evidence-based elements of birth that we know are safe, combined with an inspirational care team, created an astronomically unpopular, yet so incredibly important, birth experience.

© 2015 Blessings Photography & Birth Services, LLC

Amanda McClannahan holds her daughter for the first time following Cesarean birth

A woman was treated with dignity and respect. She was valued and felt she had a say in determining the course of her birth. Although for many reasons she felt forced into a repeat Cesarean, she knew she could still have a say on some elements that were critically important and valuable to her and that would lead her to feel more involved in the birth of her baby and help ensure a healthier postpartum recovery. Amanda wanted to be a participant in her birth (to see her baby born) and she wanted to hold her and nurse her immediately (skin-to-skin) after birth. She valued these and knew these were important elements for both her and her baby. Most of all, she knew they were still possible to have, even in the event of a cesarean birth.  However, Amanda also knew that, sadly, she wouldn’t be automatically offered these critical element, despite the fact that they are supported by evidence. She knew policy and protocol many times override evidence-based practice. So what’d she do? She worked hard to learn her options. She interviewed multiple care providers to determine which one would respect her desire for a family centered cesarean. She trusted her intuition, prayed, and even changed her surgery date based on the provider who agreed to support her wishes for this birth. On the morning of the scheduled Cesarean, feeling overwhelming anxiety, she trusted herself, reminding herself of the abhorrent birth of her first daughter, and asked for what she wanted.

“Honestly, I just wanted to hold my baby. With my last pregnancy, not being able to hold my daughter for four hours affected me greatly, even to this day. No baby, no matter how they are brought into this world, shouldn’t be ripped away from their mothers- the only thing they know- for hours on end unless it’s a true medical emergency.”

The stars aligned and she got everything she wanted.

© 2015 Blessings Photography & Birth Services, LLC

Family Centered Cesarean made possible in part with the cooperation and support of nurse Lauren

With the help of Dr. Massey with West Des Moines OBGYN, Dr. Touney with Mercy anesthesiology, and nurse Lauren, Amanda experienced a fundamentally different birth with her first cesarean, and one that not many mothers have gotten to experience in Des Moines (if at all). This approach to a cesarean birth supports both physiologic and emotional importance of birth experiences. Family Centered Cesareans value the mom and partner in the process of the birth of their baby.  Amanda was “allowed” to: see the birth of her baby (surgery techs dropped the sterile surgical drape), have delayed cord clamping (beneficial to any baby just born), have immediate skin to skin on the operating table (temperature, blood pressure, and hormone regulation) and breastfeed while she was being sutured.

© 2015 Blessings Photography & Birth Services, LLC

Baby Emily enters the world

As Amanda’s doula, I encouraged her to not only research what she wanted to happen, but also have the trust in herself to ask for those things while being prepped for surgery. Amanda and her husband were confident in their requests and verbalized them to their nurse, Lauren. She not only listened, but encouraged the requests! She validated and shared in their desires. Lauren was the first star that was aligning. The second star of the morning, Dr. Massey, not only agreed to do Amanda’s c-section earlier in the week, but also agreed to let Amanda’s husband videotape the surgery. Not only that, she agreed happily to hold baby in the sterile field while the umbilical cord stopped pulsing. Dr. Tourney (anesthesiologist), the third star that aligned, agreed wholeheartedly to allow Amanda to hold her baby after the NICU team checked her out, but also keep her skin to skin and initiate breastfeeding. During the surgery, I made sure to beam ecstatically through my face mask, hoping that my body language would signal my complete and utter shock that this gentle Cesarean was even occurring. Dr. Tourney mentioned, “This never happens.” I replied, “I know. You’re changing lives.” It was true, and I still don’t know if he fully understood what the impact of his support truly means.

© 2015 Blessings Photography & Birth Services, LLC

Amanda McClannahan watches as her daughter is born

This monumental composition of factors hold so much importance to Amanda and her husband, more than anyone will ever understand. The difference in the postpartum experience this time around that Amanda will feel over the next few weeks is undeniable…her perceptions about her birth experience are so much more positive than the birth with her first daughter, and that’s what I’m most concerned with as a doula.

So the stars aligned. Amanda participated fully in her birth instead of just experiencing it.

The big question here is, why did Amandas experience have to be a star- aligning event?

Amanda’s care team was quick to mention that this only happened because “the stars aligned”… each care provider “happened to be working that day”, because otherwise no other partners in either the OB practice or anesthesiology practice would “agree to do these things”.
But why do the stars have to align for a mom to hold and smell her baby? Why do the stars have to align so perfectly to allow a baby to breastfeed undisturbed minutes after birth? Why are normal, physiological functions so easily dismissed or less valued in a cesarean, leaving moms to agonize over being told no after asking for these evidence-based practices? Without Amanda’s determination, she could’ve been left alone on the operating table, while her baby was removed from the room for ‘medical observation’, and not given a chance to breastfeed for hours.

Amanda was the reason her stars aligned, “Even though having a repeat c-section wasn’t ideal, my c-section was picture perfect in the terms of getting exactly what I wanted. I knew this was an answer to prayer that I had prayed for nine months. All that was important to me was a healthy baby, no matter the delivery, and that I would be able to hold her immediately. This shouldn’t be such a dramatic request, it should be part of standard protocol. Hopefully, someday it will be.”

© 2015 Blessings Photography & Birth Services, LLC

Daughter Emily nurses for the first time, still in the OR

For astronomically beautiful events to take place, stars have to align just once. Cosmic shift
happens much like tidal waves that start from a small wind. What butterfly effects will this Family Centered Cesarean have? How many moms will ask their care providers to be treated as the one birthing, worthy of attention, after reading this article?

Be a part of the cosmic shift.  The voice of the consumer is an extremely powerful tool when it comes to promoting change. Share this article and make sure to tag your own local provides, but also those mentioned here (West Des Moines OBGYN and Mercy Medical Center) to say thank you for providing evidence-based care.  We’d love for these providers (and others) to see what family-centered cesareanan impactt their family-centered care is making.  Every time a page is tagged on FB they get a notification – a way that they’ll see that folks want this type of care and that they [might be] willing to switch to a provider who supports it.  Let’s show these providers what an impact the care they provided is making. Events like these do not have to be star-aligning events. If we persist, if we are vocal and if we question “protocol”, we can change the birthing environment for many.


I know you can make the stars align for you too.

Watch Amanda’s full birth video

The Birth of Emily McClannahan from Andrea Shandri on Vimeo.


Andrea Shandri, M.Ed, CD(DONA), CCCE, is a certified doula, certified childbirth educator, and birth photographer. She is the owner of Iowa Doula Agency and Blessings Photography & Birth Services, LLC.

For more information on how a doula can help encourage evidence-based birth practices, please follow Iowa Birth Organization and ICAN of Central Iowa on Facebook, or write to Andrea at:

Babywearing Basics

Intern Birth Blog: Babywearing for Beginners

This week I wanted to look into all things babywearing! My interest was sparked by a cousin of mine who started showing up at all of our family gatherings carrying her daughter in beautiful pieces of cloth. Every time I saw her, she had a new carrier and even started buying them as gifts for other family members when they were pregnant. She went on and on about this new trend of babywearing and has been doing it for the last 3 years.

In order to learn more I got in touch with with Suzi Lang of Babywearing International of Central Iowa. So, for those of you who are not aware of what this babywearing is all about, have no fear, I think I’ve figured it out!

What is babywearing?
Babywearing is the practice of wearing or carrying a baby in a sling of another form of carrier. Although this is a recent trend here in America, babywearing has been around for centuries and is done all around the world. There are four main kind of carriers which range in price anywhere from $40-$300.

1.) Soft Structured Carriers
babywearing soft structured (180x281)







2.) Wraps
babywearing wrap (600x600)





3.) Ring Slings/Pouches
babywearing ring sling





4.) Mei Tai

babywearing mei ties






This whole concept can be a little confusing at first for us beginners, so here’s a video if you’d like a more clear image of how exactly a wrap is worn.  This is one of the many, many ways a wrap can be worn. Caregivers can carry babies up to any age as long as they feel comfortable doing it, and baby is wanting to be carried.

What are the benefits of babywearing? Beyond the trend…
Besides the fact that all these wraps and carriers can be super cute accessories, there is much more to it than that! Babywearing has countless benefits for both mom and baby:

Hands free what mom doesn’t want that?! As someone who works at a daycare facility, I know there are times a baby needs to be held, yet I have a million other things I need to get done with two hands. Babywearing allows the mother to have the baby close to offer that comfort, yet both hands free to complete tasks.

Suzi filled me in on a few more benefits:

• “Happy Babies.
It’s true…carried babies cry less! In a study published in the journal Pediatrics, researchers found that babywearing for three hours a day reduced infant crying by 43 percent overall and 54 percent during evening hours. “

“Healthy Babies
Premature babies and babies with special needs often enter the world with fragile nervous systems. When a baby rides in a sling attached to his mother, he is in tune with the rhythm of her breathing, the sound of her heartbeat, and the movements his mother makes—walking, bending, and reaching. This stimulation helps him to regulate his own physical responses. Research has even shown that premature babies who are touched and held gain weight faster and are healthier than babies who are not.”

• “Confident Parents
A large part of feeling confident as a parent is the ability to read our babies’ cues successfully. Holding our babies close in a sling allows us to become finely attuned to their movements, gestures, and facial expressions. Every time a baby is able to let us know that she is hungry, bored, or wet without having to cry, her trust in us is increased, her learning is enhanced, and our own confidence is reinforced. This cycle of positive interaction deepens the mutual attachment between parent and child, and is especially beneficial for mothers who are at risk for or suffering from postpartum depression.”

•” Loving Caregivers
Baby carriers are a great bonding tool for fathers, grandparents, adoptive parents, babysitters, and other caregivers. Imagine a new father going for a walk with his baby in a sling. The baby is becoming used to his voice, heartbeat, movements, and facial expressions, and the two are forging a strong attachment of their own. Baby carriers are beneficial for every adult in a baby’s
life. Cuddling up close in the sling is a wonderful way to get to know the baby in your life, and for the baby to get to know you!”

•”Comfort and Convenience
With the help of a good carrier, you can take care of older children or do chores without frequent interruptions from an anxious or distressed infant—which helps to reduce sibling rivalry. Baby carriers are also wonderful to use with older babies and toddlers; you can save those arms and go where strollers can’t. Climbing stairs, hiking, and navigating crowded airports all can be done with ease when you use a well-designed baby carrier!”

Okay, what’s the catch?
There isn’t one!  If mother and baby are both content and mom is practicing safe babywearing techniques, there are no proven physical or emotional negative effects. This graphic includes the main babywearing techniques:
babywearing abcs

Get Connected:
Great news, there are several babywearing groups in Iowa right here in Iowa!  There is even a babywearing retreat happening in April.

I hope you’re learning something along with me. Please do not hesitate to comment below with your babywearing experiences, or any questions. Lastly, if you or someone you know would like to be featured in my next blog, email me at

~ Intern Marianne