The Midwife Is In

Advice column about healthcare, vaginas, sex, & all the things that come from that. Ask box is open only on Sundays - please FIRST reference the Ask a Question page for FAQs, and search through the archive for related questions.

[themidwifeisin]

Epidural Informed Consent Script

[image: the card I carry with to explain epidurals during labor, created by Penny Simkin]

I had a few requests for me to share my epidural informed consent ‘script’, so here it is in it’s MOST general version. Please remember that this is just an idea of what I might say, and it would definitely be different when I am with a laboring person, as I take their specific health and priorities and concerns and personality into consideration when I discuss this with them. This script is for someone who is undecided during labor about whether or not they want an epidural and is asking for more information.

*Of note: I don’t bring pain medication up without them starting the conversation unless I see them truly suffering. If I bring it up and they say no, I don’t bring it up again.

The conversation usually includes a few parts:

Explaining what an epidural is and how it works

Explaining the process for inserting the epidural

Discussing risks, benefits, and alternatives

Reviewing everything, answering questions, and then stepping out of the room to give them time to discuss if they would like that.

Occasionally it may include offering a vaginal exam ahead of time if they think the information gleaned from the exam would change their decision

“I remember from your birth plan that you didn’t want to talk about pain medication unless you brought it up yourself - now that you’ve mentioned that you might want an epidural, do you feel like you’d like to talk about it?  There’s no rush since I KNOW that you can do this and ARE doing this in the exact right way for you right now.”

If yes, I continue.

“Epidural anesthesia is a pain medication that numbs you from here [show them the top of the uterus/diaphragm area] down to your toes. Everyone experiences them differently, so some people are completely numb and cannot even move their legs, while most people have some control over their legs but are numb enough to not feel the intensity of the contractions any longer. While you won’t feel the intensity, you will still likely feel the pressure of contractions or of the baby’s head as the descend in your pelvis, and you will still feel touch to the skin. You will definitely feel the baby’s head coming out, and that may be painful or intense even with the epidural in place. Our anesthesiologists usually do an epidural that allows for your legs to move, and so we will definitely help you into whatever position you need - sitting up, lying down, squatting, hands-and-knees, lying on your side - as long as you are still in the bed. It’s not usually safe to try standing with the epidural since most people don’t have enough sensation in their legs to hold their weight.

“The way they place the epidural is they have everyone but one partner/doula/support person step out of the room and you sit at the edge of the bed with your shoulders slumped over. The anesthesiologist will give you a numbing shot to the skin on your low back which some people say is the most painful part of the whole ordeal - it feels like a bee sting. Once that area is numb, they insert a larger needle into the epidural space, in your spine. [I carry an illustration of this to explain what I mean.] Then just like an IV in your arm, a tiny plastic catheter (tube) is threaded into that space and the metal needle is removed. The epidural medicine drips in a small amount at a time through the catheter. This way we can give you more or less medication at any time depending on what you want or need. Sometimes we will increase the medication if the regular rate isn’t strong enough, or we will decrease if you need more sensation to move or push.  It usually takes about 15 minutes to place the epidural and 15 minutes for it to start working.

“In order to have an epidural placed you will need an IV running fluids through your arm, continuous fetal monitoring, and a urinary catheter since you won’t have enough sensation to empty your bladder yourself.”

When it comes to talking about pros and cons I talk specifically about each person’s scenario instead of more generally, since the person I’m talking to is in labor! They don’t have much ability or desire to be thinking about anything that isn’t directly pertinent to them. Because of this I will discuss the epidural’s effects on the part of labor that they’re in now vs the future, but ignore the past. As in, if they’re in active labor I won’t talk about how an epidural might slow down early labor, but I might talk about it’s effects on pushing. For example:

“At this point you are in what we call ‘early labor,’ which means that your labor is still ramping up. It doesn’t mean that early labor is necessarily easier or that you will be in this place for much longer, but I have seen labors slow down when people get an epidural at this time. If that happens, we will talk about trying to stimulate your labor again either by position changes (though slightly limited in bed), nipple stimulation, membrane sweep, or pitocin. If you are coping well and able to go another hour without pain relief, I would recommend that we continue without. However the minute you tell me you have decided on epidural pain management, I will call the anesthesiologist. You are the only one who knows what’s right for your body.”

Another option for someone in active labor:

“At this point in your labor it’s unlikely that your contractions will slow down if you get an epidural, and in fact it’s possible that the relaxation of your pelvic muscles that comes with an epidural could allow baby to descend more and help to open your cervix with the pressure of their head. There’s no knowing what will happen either way.”

“The main risks to an epidural are the possibility that: 

Your contractions may space out [discuss what this would mean for their labor]

The possibility of a postpartum headache (this headache happens to about 1 in 100 people and is treatable with pain meds, but is still a very frustrating experience in the postpartum period)

The possibility that your blood pressure will drop and therefore your baby’s heart rate will slow (if this happens you can expect us to move you from one side to another, give you a ‘bolus’ aka large about of IV fluid, and maybe give you oxygen through a mask. Sometimes this can be scary because many Drs & RNs will come into the room all at once to address the issue.  Though this may seem scary, when it is treated with the usual measures, it does not cause harm to baby or increase the risk for cesarean birth.)

The possibility that the epidural won’t work at all or will have a small ‘window’ in which the epidural doesn’t work. If that happens our options are to grin and bear it, to try boosting the dose, or to take it out and try replacing it entirely.”

Here is a more extensive chart from LaborPains that I bring out sometimes when people are interested/in the right mind space to discuss further:

[image source]

“The research is ambiguous when it comes to whether or not the medications passing through the epidural will affect the baby as well as the laboring person.  There are no known long term disadvantages for babies.  Babies are much less affected by epidurals than other medications used in labor that are administered by IV.”

“There are other things we could use as well to support you in coping with these contractions:

Nitrous oxide - laughing gas (aka gas and air)

IV medications (Morphine, Stadol, Fentanyl, Nubain, Demerol)

Hydrotherapy - hot water in the tub or shower

Sterile water injections - local pain relief without medications for back pain

TENS units

Massage, position changes, labor support”

See my post going into depth on those topics here.

“What questions do you have?  Would you like me to step out for a moment so you can discuss this with your partner/doula/support person?”

Occasionally, if I think it would be useful, I will offer a vaginal exam before an epidural.  For some people going through transition, the knowledge that they are close can give them some very needed encouragement.  Vice versa, the knowledge that the cervix has not changed in many hours can also give people the information they need to decide that they would like an epidural.

“Would you like a vaginal exam before you decide on whether you would like pain medication or not?  Many homebirth midwives will almost never use vaginal exams since they are quite right in thinking that vaginal exams don’t change the course of labor.  However, in a hospital setting things change.  There are interventions like epidurals to be considered, and a vaginal exam can give useful information to someone deciding on using an intervention.  The exam itself IS an intervention in its own right.  The information derived from a vaginal exam may tell us what stage of labor you are at right now.  It does not tell us what will happen in the next 5 minutes (I’ve seen people dilate from 5cm to 10cm in 5 minutes) or in the next 5 hours (I’ve seen people be fully dilated for 5 hours before starting to push or giving birth).  A vaginal exam is not required before you get an epidural, though.  If you know for sure that’s what you want right now I will call the anesthesiologist right away.”

Resources:

Pain Medication Preference Scale - by Penny Simkin, for use before labor

https://www.ncbi.nlm.nih.gov/books/NBK279567/

Post by me on Epidural side effects

Is it ok to get an epidural?

What other pain relief options exist besides epidurals?

[themidwifeisin]

I’m pregnant but really worried about labour. I have heard a lot about forced epistiostomys (sp?? Soz). I have spoken to a few doctors about it and they all say they only do it when necessary but it still worries me that it will be done anyway even when not.

An episiotomy is a cut that is done in an emergency situation to widen the vaginal opening and help babies to come out faster.

I’ve only done one episiotomy in my 4 years of practice as a midwife, and that was when my patient had experienced genital mutilation as a child and due to the scar tissue her vaginal opening was unable to stretch to allow the passage of the baby’s head.

It is important to note that an episiotomy will ONLY help if the issue is getting the baby out through the tissue - it will not help if the baby is having trouble navigating the pelvic bones.  This makes it not useful for many situations, since most of the time the tissue will just tear if baby needs extra space.

The very few times an episiotomy will be done:

If the baby’s heart rate is dropping to a dangerous level and the provider thinks it will take the birth parent more than a few minutes to push the baby out - a situation in which even 10 more minutes of pushing could be harmful to the baby.

If an instrument is about to be used to help the baby’s head be born, like a vacuum or forceps and the instrument can’t fit through the vaginal opening.

If the birthing parent has an anatomical difference (genital mutilation, excessive scar tissue from a prior surgery) that makes it difficult for the baby to be born.

An emergency called a Shoulder Dystocia in which the provider needs to fit their whole arm into the vaginal canal along with the baby - sometimes an episiotomy can give them more room to work.

You can talk to your provider ahead of time and ask them a) how many episiotomies have you done in your life?  b) what are all the possible reasons you can think to do one?  c) will you tell be before you do one?

If you have a provider that you trust, you will know that if they elect to do an episiotomy it is because they could think of no other safe way to support your baby being born healthily.  

[themidwifeisin]

I recently had a medical abortion (just wasn't the right time) my bf and I are only people who know I was even pregnant. I've been going through emotions such as regret guilt and depression a lot recently and was wondering if you had any advice for coping or healing emotionally ?

I’m sorry to hear that you’re having such a difficult time right now.  Being in a hard situation like an unplanned pregnancy, no matter what the outcome is, can be very emotionally draining, especially if it feels like you’re completely alone.

Definitely give some of these hotlines a call:

NAF After-care & follow up

Understanding abortion grief

Abortion care network

Other suggestions

Resources and suggested reading

Reach out to a friend, family member, co-worker, or guidance-counselor-type-adult.  It might be scary, but 1 in 3 people able to become pregnant has had an abortion by the time they turn 45.  You definitely know someone who has had an abortion, it may just take a bit of detective work to figure out who it is.

Find a therapist.

Sometimes it can make a big difference to re-connect with your body after you’ve experience something like this.  A good way to try that is by using Grounding & Centering exercises:

Sit comfortably with eyes closed and focus your energy inward.

Start with your energy at the top of your head and let it move slowly down your body, taking a moment to recognize each part of you.  Move all the way down your body, moving your consciousness, your energy, your being down at the same time.

Keep moving downward, below your floor, below your house, deep past the roots of the trees, below the bedrock, moving ever downward.  As you near the center of the earth feel it grow warmer around you.

Move yourself into the hot lava of the core, swimming, floating, pushing yourself deeper until you’re in the dead center of this planet, completely surrounded by golden hot energy.

Float there for a moment, letting all your baggage get burned clean away from you.  While keeping your awareness in the center, the dark, calm star, feel the cord, the roots, the rope ladder you came down that connects yourself to your body on the surface.  Know that you’re protected and grounded and safe.  You are held, lovingly, by the earth, and you can feel this at any time.

Allow yourself to hear a word, an image, a key of some sort to bring you back to this space whenever you need it.  Hold it close to you.

Slowly move backwards through the pathway you left for yourself, climbing back up the ladder you let down.  Give yourself the time and space you need to come back from that warm cocoon.

Later, when you’re having anxiety or sadness about your decision, bring to mind that key, hold it within yourself, and remember how loved you are by this earth, how precious you are, how safe it is to be cradled by the gravity of our planet.  You are grounded.

Remember, it is healthy to feel grief intensely for the first 6 months after a trauma or loss.  Feeling it intensely for longer than that is a sign of maladaptive mourning.  You can get help.

Sending you so much love and light.

[themidwifeisin]

Do you think midwifes should be able to object to taking part in abortion services? I live in the UK where midwifes are the primary care giver in pregnancy and labour, but also in some cases can take part in abortions. Do you think it is ok to refuse to take part?

Midwives have always provided abortions.  As long as there have been midwives, and it’s worth arguing that midwifery was the first profession, midwives have provided birth care AND abortion care.  

There should be NO laws to prevent midwives from offering abortions, since there is lots of research showing that midwives provide as safe, if not safer care than Obstetricians for low risk birth & abortion care.  

However, I would never insist that someone provide abortions if they didn’t feel comfortable with it.  That would be harmful to them & to their patients.  The other side of that, though, is that they must refer any patients who want an abortion to an appropriate provider who will provide the abortion.  

[themidwifeisin]

I have PCOS and rarely have periods. I have gone 18 months without one but then had consecutive periods every month for 4 months. So very random. I don’t want children right now and am looking into bc- but tbh I don’t want to deal with regular periods. I heard that hormonal bc could regulate them- I don’t want that as I hate having my period so don’t want regular ones. What methods (other than condoms) could I try that wouldn’t cause me to have regular periods. Or is that a myth? :)

When you have PCOS with little to no periods, you have to be super careful to make sure that you protect your uterine lining.

If you’re not having a period because of PCOS, it means that your uterus is being exposed to estrogen for months & months at a time, when normally it’s only exposed to that level of estrogen for 2 weeks out of each month.  That estrogen tells the uterus to build up the lining for a potential pregnancy, and it’s the progesterone that comes in the 2nd half of the cycle that tells it “ok, no baby this month, clear everything out.”

If nothing is telling the uterus to have a period, the lining just keeps growing & growing & growing…. and that’s when your risk of cancer significantly increases.  The definition of cancer is cells that mutate so that they grow without stopping.  That’s basically what’s happening here - the uterine lining just keeps growing, and any potential cancer cells that would be cleared out once a month otherwise are now being allowed to hang around & keep growing.

So you have 3 options:

Use a progesterone-only birth control that will stop your period all together (with the progesterone it will protect you from this problem even if you’re not getting a period)

Use a normal birth control to have a regular period

Induce a period at least 4 times a year.

I think what you might like most is a Long Acting Reversible Contraceptive (LARC) like an IUD or implant that has progesterone.  With those you are very likely to have either a light, short period or no period at all and your uterine lining is safe!

Look into:

Mirena

Liletta

Skyla

Kyleena

Nexplanon

Good luck!

[themidwifeisin]

✨HAIRY PITS✨ I got some angry comments on my last post because my hairy pits were showing. Whoops! Y’all know that shaved armpits in the US weren’t a thing until 1915 when Gillette invented a safety razor & needed a reason to market it to women. It’s NOT a universal beauty standard. Also, who the fuck cares? I love my armpit hair. I hate the ingrown hairs and cuts I get from trying to shave a fleshy concave area of my body that I can’t see without using a mirror. So fuck off. Men who give me a hard time for my body hair are the most beautiful example of hypocrisy in sexism. If you think armpit hair is gross shouldn’t you be getting rid of your own?? #lovemyhairypits #hairyarmpits #bodyhair #itsliterallythewayiwasborn #wtf #idonthavetimeforthatshit

[themidwifeisin]

Who has two thumbs and is tired of being asked by straight AND gay ppl to prove just how queer they are????? This gal right here. As Pride month comes up I just want to make a quick PSA that bi & pansexual people are still bi and pansexual no matter who they are with at that moment. I don’t become a vegetarian just cause I’m eating a salad. I don’t become straight just cause I’m married to a man. Sorry, I know that makes it harder to make assumptions about people, but maybe you shouldn’t be making assumptions in the first place? #QUEER #notstraight #goddamnit #howdareyouassumeimstraight #bisexual #pansexual #pridemonth

[themidwifeisin]

Happy Mothering Day!

A quick proposal to change the name from “Mother’s Day” to “Mothering Day.”  To 'mother’ is a verb, and it can be done by anyone, not just the cis woman who gave birth to an individual.  Mothering is caring, loving, nursing, and nurturing others.  So Happy Mothering Day to:

✺ People who step in to mother others, whatever their connection is.  Thank you for making the world better one person at a time.

✺ Women who don’t want to give birth to their own children because they’re nurturing themselves, their careers, their animals, and their friendships instead.  Thank you for being true to yourself and filling the people around you with love.

✺ People who’s bio-mothers weren’t the best, whether they were neglectful, self-involved, abusive, or just absent, and they ended up having to learn how to mother themselves.  Thank you for being strong, for working on your own healing, and for moving forward.

✺ People who’ve had miscarriages or can’t become pregnant or have a stillbirth - the attention and energy and love and hoping and giving that you do each time for that little person that’s trying to come into this world is earth-shattering.  Thank you.

✺ People who have abortions because they know that it’s the best way to be a mother to that potential child, or to their existing children, thank you for making those hard decisions.  No one can know the difficulty of that choice but you.

✺ People who do everything for their children, who work, who fight, who challenge themselves to be radical parents, who offer love and compassion and activism as the scaffolding that their parenting relationship is built on.  Thank you for making the world a better place.

✺ People who adopt, no matter the reasoning, and remember that adoption is not about themselves or “saving” a child or replacing that child’s parents, but about making more love and giving that child more parents and more opportunities to learn and feel comforted by the world around them.

✺ People who aren’t cis women but who birth babies anyway, who say fuck the hetero-patriarchy and make beautiful, new, unusual families that are based on more than obligation and expectation.  Trans women who teach their bodies to lactate, who impregnate their wives and husbands, who carefully instruct their existing children on how to call them “mom.”  Trans men who show up to the pregnancy clinic each week looking more and more pregnant and ignoring the looks from the other patients, who teach the hospital staff how to refer to them as “dad”, who birth a child out of their own flesh.  Nonbinary parents who come up with new, amazing terms for themselves as parents, who teach their children the intricacies of gender.  Trans and Gender Nonconforming parents who adopt since they have no interest in giving birth.

Thank you.  You make the world a better, more loving, more inclusive, more tender, more compassionate place.  We owe you.

[themidwifeisin]

A few days ago in the shower I was washing “down there” and accidentally got some soap inside of me and it burned like crazy and ever since I’ve been getting this odor. I don’t know what I should do, because I don’t feel comfortable talking to my mom about this so I don’t have a way to get to like a gynecologist or someone. Can you help me?

Ouch, that sounds super uncomfortable!  It seems like you might have a vaginal infection of some sort - yeast or bacterial.  

Vaginas host a very fragile ecosystem that is easily thrown off.  The part of the vaginal ecosystem that is the boss is the pH balance.  The pH balance is a measurement of how acidic or basic the fluid in the vagina is.

A healthy vagina is pretty acidic, which is GOOD because it fights off bad bacteria & keeps even the good bacteria from growing out of control.  If you mix something basic (alkaline/non-acidic) into the vaginal fluid, though, it will make it LESS acidic and LESS able to fight off bacteria.

Things that get into vaginas that are basic:

Blood - since blood is basic, many people get vaginal infections around their periods as the period blood changes the pH

Semen 

Soap

Other chemicals/fragrances

Getting any of those things inside your vagina can make the fluid less acidic and therefore make you MORE LIKELY to get a vaginal infection.  

Don’t be embarrassed - talk to someone about going to see a healthcare provider so you can get the right treatment!  

That might be your mom, but it might also be a friend’s mom/older sister, the school nurse, someone on your sports team, etc.  It’s nothing to be embarrassed about as it can happen to anyone.  It has nothing to do with sex or sexually transmitted infections, so it’s not something you can get in trouble for.

Good luck!  Feel better!

[themidwifeisin]

not a question, but I just wanted to tell you that you're a hero. I'm looking at a career in midwifery because of you.

Thank you so much!!! <3 <3 <3 <3

We ALWAYS need more midwives, so please please do become one! I can’t wait to have you as a future colleague!

[themidwifeisin]

I got an IUD and it unfortunately expelled itself a month later. Someone told me it was probably b/c I've never given birth and am fairly young. How long should I wait before getting another one? I'm not sexually active atm so it's not a big deal. Are the chances of expulsion higher the second time around? I really liked my IUD (the ParaGard) and would prefer not to use a hormonal BC method.

It’s not because you’re young or because you haven’t given birth before, but it could have to do with the size or shape of your uterus.  OR it could have been a fluke or just the way it was inserted.  No way to know.

Getting a second IUD placed is worthwhile if you’re willing to try it again.  You can try any IUD, but it might be worth trying one of the smaller ones - Kyleena or Skyla.  

A lot more people have unusual uterine shapes than realize they do, so it’s also possible that your uterus just won’t comfortably house an IUD.  If that’s the case there’s probably nothing to do about it.  Beyond that, you might have an asymptomatic polyp or fibroid (see below) that gets it the way.

If you try having an IUD inserted a 2nd time and it comes out again, it’s a pretty good sign that it just won’t work for you. 

Good luck!

[themidwifeisin]

I dont orgasm when I'm getting penetrated. I do feel good but it only lasts for like, 20 minutes and then I get tired and it starts to hurt, even with lube. I only orgasm through clitoral stimulation. I wonder if that makes me abnormal for someone my age? I'm 19

Ok, repeat after me:

Only 20% of people with a vagina will EVER orgasm without clitoral stimulation.  The other 80% require more than vaginal penetration, usually clitoral stimulation, in order to achieve orgasm.

It is a classic story: vaginal penetration feels good, then like nothing much, then uncomfortable.  What you need, if you’d like to keep having penetrative sex, is simultaneous clitoral stimulation!

Again, let me repeat: this is NORMAL.  This is how your body is built.  If you’re not aroused, your tissue is much more fragile.  During arousal there are a bunch of changes in the vaginal canal to make it better equipped to enjoy penetration (including lengthening, swelling, lubrication, etc).  But if you stop enjoying it (maybe you just get bored, or maybe you’re frustrated that you’re not orgasming) then your arousal fades, and your vagina stops enjoying the sensations.  It TOTALLY makes sense that you have pain and frustration after 20 minutes of penetration without great sensation or arousal.  

If you don’t want to keep having penetrative sex, you can just call it off all together.  If you want to try to have orgasms during penetration, here are some ideas:

You or your partner(s) can use fingers to stimulate your clit during penetration.

You can use a vibrator.  It can be small or large, strong or not - just something to add a little zing.

Have sex with multiple people - one of whom is going down on you at the same time that another person is penetrating you.

Here are some vibrators designed for clitoral stimulation during penetration (and remember there are a zillion different types - going to a local sex toy store & fiddling around is the best way to find the right one for you):

If the person you’re having penetrative sex with is using a penis or dildo, you can get a vibrating ring to put at the base of their penis/dildo so that when they are deep in you, the ring presses on your clitoris.

A finger vibrator is a vibrator that you stick onto one finger.  It’s small and easy to hold in the right place during penetration.

There are some internal vibrators that are designed to be used during penetration, such as the We-Vibe.  One half of the U-shaped vibrator goes inside the vaginal canal & the other goes outside, and then a partner can penetrate at the same time.

The JimmyJane Form 2 and the Crave are both *very* strong vibrators that can usually fit between two bodies joined at the genitals.

The Eva is theoretically hands-free.

And so on!  There are so many options! You’re not broken, you’re not abnormal.  Nothing is wrong with you!  Go out there and have fun!

[themidwifeisin]

How early is it possible to tell if you're pregnant?

A lot of people say that they just *knew* as soon as they got pregnant, but that’s not confirmation.

Pregnancy happens like this:

You release an egg and it is fertilized within the first 24 hours.

The newly fertilized egg floats down the ovarian tubes to the uterus and implants on the wall of the uterus.

At implantation the cells that will eventually become the placenta start releasing a hormone called Human Chorionic Gonadotropin (hCG).  This is the “pregnancy hormone”.

The level of hCG in your blood (and therefore in your urine) will steadily increase over the next few days & weeks.

To confirm pregnancy at home, you need to take a urine pregnancy test.  Urine pregnancy tests look at your pregnancy hormone level give you only a YES or a NO response, but they’re not testing just if the pregnancy hormone exists or not.  They will only turn positive if the hormone reaches over a certain level, and that level is different for each test.

So the answer is different depending on which pregnancy test you get.  The test should say on the box how soon after unprotected sex it will give you an accurate result.

VERY IMPORTANT: if you have a negative test, don’t assume it’s actually negative.  Re-test 1 week later to allow the hormone level time to increase in your urine.  If it’s still negative then you should be fine.

You can also go to a clinic to have a blood test drawn.  The blood test will actually tell you the level of hormone, and if you follow it up with another test 2-3 days later it will tell you if that number is going up (you’re still pregnant) or down (you’re not pregnant anymore).

[themidwifeisin]

The Midwife Is In’s etsy shop is open!!

I got fed up with wanting certain herbal products to exist for my patients but never being able to find them - so I made them myself!

Current products available include: 

Soothing Vaginal Inserts - herbal suppositories for vaginal infections/chafing & burning post penetration

Nourishing Abundance tea - fertility enhancing herbal infusion

Products to exist within the next week or so:

Cesarean Birth Healing Tea - tea for postpartum specially mixed for people healing from a cesarean birth.  Great for cramping, improving wound healing, supporting lactation

Tender Tissues Perineal Bath - herbal infusion for soothing the perineum after birth.  Feels great and promotes healing for tender perineal tissue (with or without stitches) and hemorrhoids.

Milk Maker infusion - the best tea for promoting lactation

I’ll keep everyone updated when they come out.  Check it out!  Let me know if you have questions, and if you try the products please let me know what you think!!

[themidwifeisin]

I dont orgasm when I'm getting penetrated. I do feel good but it only lasts for like, 20 minutes and then I get tired and it starts to hurt, even with lube. I only orgasm through clitoral stimulation. I wonder if that makes me abnormal for someone my age? I'm 19

Ok, repeat after me:

Only 20% of people with a vagina will EVER orgasm without clitoral stimulation.  The other 80% require more than vaginal penetration, usually clitoral stimulation, in order to achieve orgasm.

It is a classic story: vaginal penetration feels good, then like nothing much, then uncomfortable.  What you need, if you’d like to keep having penetrative sex, is simultaneous clitoral stimulation!

Again, let me repeat: this is NORMAL.  This is how your body is built.  If you’re not aroused, your tissue is much more fragile.  During arousal there are a bunch of changes in the vaginal canal to make it better equipped to enjoy penetration (including lengthening, swelling, lubrication, etc).  But if you stop enjoying it (maybe you just get bored, or maybe you’re frustrated that you’re not orgasming) then your arousal fades, and your vagina stops enjoying the sensations.  It TOTALLY makes sense that you have pain and frustration after 20 minutes of penetration without great sensation or arousal.  

If you don’t want to keep having penetrative sex, you can just call it off all together.  If you want to try to have orgasms during penetration, here are some ideas:

You or your partner(s) can use fingers to stimulate your clit during penetration.

You can use a vibrator.  It can be small or large, strong or not - just something to add a little zing.

Have sex with multiple people - one of whom is going down on you at the same time that another person is penetrating you.

Here are some vibrators designed for clitoral stimulation during penetration (and remember there are a zillion different types - going to a local sex toy store & fiddling around is the best way to find the right one for you):

If the person you’re having penetrative sex with is using a penis or dildo, you can get a vibrating ring to put at the base of their penis/dildo so that when they are deep in you, the ring presses on your clitoris.

A finger vibrator is a vibrator that you stick onto one finger.  It’s small and easy to hold in the right place during penetration.

There are some internal vibrators that are designed to be used during penetration, such as the We-Vibe.  One half of the U-shaped vibrator goes inside the vaginal canal & the other goes outside, and then a partner can penetrate at the same time.

The JimmyJane Form 2 and the Crave are both *very* strong vibrators that can usually fit between two bodies joined at the genitals.

The Eva is theoretically hands-free.

And so on!  There are so many options! You’re not broken, you’re not abnormal.  Nothing is wrong with you!  Go out there and have fun!

[themidwifeisin]

Do menstrual cups go bad? How can you tell?

Yes, menstrual cups can deteriorate over time.  Yes, you likely will have to replace yours eventually, but with good maintenance probably not for a while.

DivaCup, for example, used to say that you could use the same one for up to 20 years, but recently they changed their tune to say you should buy a new one every year.  This is not because of any change in the materials or knowledge about the cup, it’s because they’re trying to abide by certain regulations & governmental standards.  Now they say, “Since The DivaCup is a personal hygienic product, a general guideline is to replace it once a year, but ultimately, it is up to the consumer to decide when it is necessary to replace the cup.”

Keeper, on the other hand, says to use for up to 10 years.

Compare & contrast the most popular menstrual cup brands here or head over to this website to compare ALL cup types.

Ways to tell if you need to replace your menstrual cup:

If it feels like the silicone is sticky or ‘tacky’ to the touch even after you clean it.

If you see that the it is breaking/cracking in some places.

If it starts to look or feel powdery

If it is seriously stinky and nothing works to get rid of the smell.

If you feel any irritation after wearing it.

How to keep your cup clean & happy:

Use the cup for up to 12 hours at a time, but make sure to remove at least twice a day.

Rinse off with water only before reinserting.

Boil for 5-10 minutes in a full pot of boiling water & be careful not to allow water to boil down & melt the cup to the pot.

If it needs to be washed use oil-free, unscented soap.

If it smells, follow the steps in this post.

[themidwifeisin]

Can you explain the whole "take the pill at the same time everyday" thing? Maybe it sounds silly to ask but does that really mean the SAME EXACT time? Is it wrong to take it at 7 one night then at 7:30 the next?

Different pills have different recommendations, even though the blanket statement for most is to take the pill “at the exact same time everyday".

For combined birth control pills (pills that have both estrogen and progesterone) the efficacy of the pillow only drops when you have not taken it within 12 hours of your normal time.  That means waiting 12 hours MORE than 24 hours after the last pill.

If you miss your combined birth control pill:

If its within 24 hours of the missed pill’s time, take it ASAP and continue taking your pills normally (on your original schedule) after that.

If it has been more than 24 hours, take both pills the next day (the missed pill and the pill for that day).

If it has been 2 days, take 2 pills 2 days in a row.  For example: On Day #1 of realizing that you’ve missed your last 2 pills, take the 1st missed pill + the pill for that day, and then on Day#2 take the 2nd missed pill + the pill for that day.

If you miss more than 2 days, use condoms, let yourself have a “period” and start over again with a new pack after that.  Use condoms until 1 week into your new pack.

For most progesterone only pills (pills that have no estrogen) that timeframe is a little shorter.  Check in with your healthcare provider about the specifics for YOUR pill, and read the pack.  In the US, most progesterone-only pills (aka mini pills) have a 3 hour window.  That means that if you take the pill at 6am every morning, you have until 9am to take the pill without decreasing its efficacy.  If, however, one day you sleep in until 10am, its as if you haven’t even taken the pill that day.

If you forget to take your pill: Take your pill as soon as you can. If you take your pill more than 3 hourslate, use a barrier method for the next 2 days (while taking your pills regularly).

If you forget to take 2 pills: Take your pill as soon as you can. Take your next pill at theusual time. Use condoms or spermicide for the next 2 days. Use emergency contraception(EC) if you have unprotected vaginal sex.