Friday, April 30, 2010

Doula Double Header: Part 2

My Third Birth as a Doula

Monday morning I was awoken by a text from my client's husband saying "mucus plug is out!" Ah, the life of a doula ;]

At about 1:45 he called me to let me know that your contractions had begun and that you had left work to go home and would be timing your contractions to figure out if you were in labor. You told me you were going to try eating, napping, etc for a while to see how the contractions behaved. I didn't hear from you until about 7:15. You said you were watching tv and your contractions had been about 3 minutes apart, then up to 5 minutes apart, and were bouncing around like that so you didn't know if they were progressing or not. I figured you were in early labor, but since this was your first labor I knew it could take a while. As I left for my first birth I hoped that you would hold off until tomorrow!

I didn't hear from you during the entire time I was at the other birth so I was hoping things were fine. You had told me that you wanted to labor at home as long as possible, right up to the last minute if you could have your way. Secretly you'd love a home birth but your husband would be too nervous for that and your insurance covered your hospital expenses. So I was surprised when your husband called me at 12:30 am as I was driving home and asked me to meet you at the hospital. After we hung up I called the boyfriend to let him know I would not, in fact, be home any time soon and to express my frustration. 1. I was already in a weird mood at the nurses from the first hospital who wouldn't give mom her baby for 3 hours. 2. I was a little bit sad I wouldn't be sinking into my comfy bed after all, and 3. I thought that if I was meeting them at the hospital it would be too late to count for DONA certification again! Plus this had never happened to me before and I was very nervous.

I drove 45 minutes to the hospital. It was extremely quiet and empty and calm. I met your husband on the L&D floor and he told me you weren't actually admitted yet because you were only 2 cm dilated. PHEW! I wasn't too late! He went to find some coffee and a snack while I walked around the floor with you and we chatted. You said the contractions were very painful. The staff had wanted you to wait an hour and then check your progress again. While we waited dad-to-be brought me some yogurt, which was nice of him! You felt a little sick and spent some time in the bathroom. I gave you a cool, wet washcloth to wipe your face with. You couldn't get comfortable standing or on the bed as you worked through your contractions. I suggested you lean over the back of the bed and you liked that one. An OB came in to check you, about an hour and a half after your first check, and found you to be at about 3-4 cm. He said they could start getting your admission paperwork together. Your husband was pleased with the progress, but I think we were all a little unsure about staying at the hospital for what could be a very long time still.

A second OB came in to talk to us. She told us that she noticed in your birth plan that you do not want to have your membranes artificially ruptured or any pitocin, but that if you stay there and you're not progressing quickly enough they would want to do Pit or AROM. I thought it was really nice of her to come in and let us know that this was the reality, did we still want to stay? I helped you both weigh the options. The hospital generally like to see a dilation of 1 cm per hour, which isn't always realistic, and like the doctor said there is a likelihood of intervention. I reminded you that you had wanted to labor at home as much as possible. I let you know that you'd probably progress faster and more comfortably in a private, stress-free environment. You and your husband decided to go home and we could all get some rest.

When we arrived at your home at about 4 am you went straight into the bedroom and I turned the lights off for you. You had been contracting for probably about 16 hours at this point and you were tired. Your husband offered me a snack and proceeded to blow up an air mattress for me on your living room floor. This was sweet, but I would have just stretched out on the carpet with a blanket! He went into the bedroom with you and I tried to close my eyes and rest. I didn't manage to fall asleep before I heard someone get up and go into the bathroom. Your husband came in and told me that your water had just broken (4:30 am). You got into the shower for a little while. When you came out you began laboring in the hallway.  You were standing and swaying and breathing. I suggested to your husband that he put on some relaxing music for you. It seemed to be a playlist on a loop of the same 3 songs over and over. When I commented about this later he told me that it was because he had left your computer with your chosen playlists in the car! I wish he had let me know because I have a ton of relaxing music on my ipod :)

Your husband and I sat with you a bit. You didn't want to lean over the birth ball but you did get into hands and knees for most of your contractions. You mentioned to me after that the contractions that came after your water broke were much easier to manage than the ones before. You were totally in your zone, doing perfect breathing and swaying and positioning. Your husband kept asking me if we should go to the hospital yet. I said I didn't want to rush you. He was eager to do something and to know your progress. I suggested he read a birth affirmation narrative to you that I had given you. I asked you if you'd like him to massage your back and shoulders and you said yes. He put oil on your back but then you realized you did not want him touching you during contractions so he stopped.

I reminded you to change positions after 30 minutes. You went back to standing. I suggested that you and your husband slow dance if that would feel nice, but you declined. I remembered the ways to check labor progress without an internal exam and asked your husband to try to check for the "bottom line," but he didn't know what he was looking for and I had never seen it before so I couldn't describe it. Then we tried the fundus method, where 3 fingers between your bra line and the top of your uterus meant 5 cm dilation, but that didn't seem helpful either (and I learned later it was probably wrong). Oh well.

We left you in your zone after that because you were doing well. I went across the room and took out a book to read. Where you were you could see us both if you needed us. You were vocalizing a bit now and back on the floor on your hands and knees. It sounded a bit like grunts in there with your moans, and I'll know better from now on. It was hard to tell, though, and to believe that you would be at a "pushy" stage, because you had just begun getting vocal. I couldn't tell your progress very well just from sound. I know this is because I am not very experienced, but I'll definitely know from now on! I had been timing your contractions from across the room, looking for the 411 rule to know when to go to the hospital (contractions 4 min apart (or less), 1 minute long for 1 hour). It had almost been an hour of 1 min-length contractions and I was about to suggest we leave when you quietly said, "the baby is coming." I lept up and said "Are you feeling an urge to push?" and you said yes. And your husband and I both said "Ok its time to go to the hospital." And you said, "No." (After the birth you told me that at that moment you were perfectly content with birthing the baby in the house!)

We got our shoes on and you out the door ASAP (6:30 am). Almost to the car, you squatted by a tree with a contraction and said again "the baby is coming." I said "if you feel the urge to push in the car I want you to raise up your chin and arch your back and do light breathing" and demonstrated. She nodded and we got in the car. It took about 15 minutes to get to the hospital. Your husband grabbed the birth ball but you definitely didn't need it! We walked in the lobby and you had another contraction that you grunted through. The woman behind the desk looked shocked and scared and said "is she pushing?!" She put you in a wheelchair and we went to L&D. As soon as we rolled in the nurses and staff recognize you and said "you're back!" and you stood up and squatted. They all jumped into action and said "don't push your baby out here, he'll land on the floor!" I guess you made them all nervous. We got into a delivery room and as the room filled up with nurses and equipment tables they told you that you had to get onto the bed. You said you wanted to squat and they said that was ok as long as you got on the bed. You climbed up and got into a hands and knees position, holding the baby's head with your hand. You were so calm. "His head is coming out and then going back in a little," you said to me. I said yeah thats how it happens! The staff were lowering and raising parts of the bed while the OB's (two, one was in training) tried to configure themselves to catch the baby in your position.

A nurse came in and said, "I noticed it said on your birth plan that you want to catch your baby, and you can't do that in the position you are in. A squat would probably be a better position for that." So awesome that she remembered that! You got into a squat on the bed, with dad supporting you on one side and a nurse on the other. You were bearing down with your urges and smiling in between contractions. It was beautiful to see... you knew exactly how to listen to your body and you were so happy to be pushing! The female doctor held your baby's head as it began to crown and told you to bear down. I did not give any instructions because I could see you were doing great, and you did not want any directed pushing. After the baby's head was out the OB maneuvered his body out and your son was lifted into your arms at 6:57 am. I wish I had captured your face on camera at that moment. You were so calm the whole time and then you had a huge grin on your face. You you were immensely pleased! And then I noticed there were tears streaming down your husbands face. It was an awesome moment.

You held your baby to you as they examined your small tear and third stage began. You insisted they not clamp the cord until it stopped pulsing and they honored that wish. They kind of tugged on the cord to get the placenta out which always makes me nervous... I'm not a fan of managed third stage, but it turned out fine. The OB administered some local anesthetic and stitched up your small tear. I think that you probably would not have teared at all if they hadn't tried to direct your bearing down, because you were pushing the baby out perfectly on your own with great perineal tissue stretching. I chatted with you and told you how amazing you were and tried to distract you from your stitching which was causing you discomfort. I took a bunch of photos, and loved watching your husband speaking in Hungarian to his first baby boy.  You were still holding your baby since his birth, wrapped up and keeping him warm on your chest, when you said, "what his weight and height? did I miss all that?" And I laughed and said, "they haven't done that yet - you're still holding him!" And you said "oh yeah!" :)

After the OB's and nurses mostly left I grabbed my DONA evaluation form and ran out to chase down a nurse and doctor to ask, though I wasn't sure who to ask since there were more than one! A nurse saw me walking towards the nurses station with a piece of paper in my hand and she yelled, "I'll do it!" and put out her hand for the paper. I looked her like ...huh? Because she hadn't even seen the paper yet! She said, "I'll fill out your evaluation! I'll help you get certified!" haha it was so funny. And then she rushed off and made copies of it and had a second nurse fill it out for me as well. It was such a nice surprise, even though I only need one nurse eval! :) Then I asked her which of the OB's I should ask, and she grabbed a form and said, "I'll take it to him." And went and got the OB to fill it out for me! It was so great. I was really loving the L&D staff of this hospital.

We were only in the hospital for about 15 minutes of pushing, mind you, so no one really had much to go on to evaluate me, but I did get great reviews. I noticed in the comments section on my form the nurse had written "better birth plan. but great job!" Personally, I think if two people, on separate occasions, noted and brought up points from her birth plan, then it was a pretty well-written one! The obstetrician wrote, "be a little more vocal w/ coaching during final stages of delivery." I was purposely NOT coaching her because she was doing exactly what she needed to do, and she hadn't wanted directed pushing. She told me later that she thinks the OB telling her to bear down and her complying is the moment she tore. So to that I say - have faith in women's instincts!

Baby was weighed and found to be 7 lbs 11 ounces. He was born 2 days shy of 40 weeks gestation. He had Apgars of 9 and 9. I took some photos of dad and son, and then the father asked me if I'd like to hold the baby. How could I say no? He took a photo of me with the baby (I'll post it when I get it from them). I noticed the baby was putting his hands in his mouth - a sign of a desire to nurse! So we helped mom get positioned to try breastfeeding. Unfortunately I think most first time moms don't know much about breastfeeding, and its not a part of most childbirth education courses. I helped her get the baby in a good position, explained how to encourage baby to latch, what a good latch will look like, how to tell if baby is drinking, told her she could do breast compressions to expel more milk if baby stops drinking, gave her advice and reassured her that even if baby's latch wasn't perfect now it would be. The nurse helped too and told her they have great lactation consultants and I encouraged her to ask lots of questions! After sitting with you for about another half hour I decided to head out, at about 8:45 am.

I realized I wasn't even tired - I was on such a high from your incredible birth!


Some things I've learned from these two doula births:
1. "Regular" or "progressing" contractions in true early labor can vary up to a minute in either direction in minutes apart, and several seconds in length.
2. A multip who is already considerably dilated and effaced before going into labor can have a very very very fast birth.
3. There are hospital OBs who will let you squat to deliver your baby - insist on it!!
4. A birth wish list/birth plan with only about 15 bullet points on with the things most important to you will be remembered by good hospital staff.
5. Even a primip can progress quickly without you knowing it by look and sound. Make sure I ask her to tell me when she's feeling an urge to push, and pay attention to anything that sounds like any form of grunting.
6. I need to figure out the fine line between knowing when to let the laboring woman be in her zone without interruption and knowing when to offer up comfort measures. Sometimes I may have simply been annoying in my attempts to help when they weren't needed, but how do I know if she might really need help but not be asking for it? I think this is something that is learned.
7. Sometimes I'll end up helping dad-to-be a lot more than mom-to-be!
8. Bring lots and lots of snacks.
9. Every birth experience, whether it counts for DONA or not, is worthwhile. I am learning SO MUCH. I am helping these women and they are helping me. I'm loving my doula journey!

Thursday, April 29, 2010

Doula Double Header: Part 1

Two days ago I had my first doula double header! It was a crazy incredible night! I'm so honored to have witnessed the beautiful births of two amazingly strong women... and also quite proud of myself. Here is the birth story of the first birth of the night, from my new doula eyes.

My Second Birth as a Doula

On Monday afternoon you called me to tell me you had just left your doctor's office and she had performed a membrane sweep. You had gotten yourself worked up about it because you had heard it would hurt, but you were surprised to find that it didn't hurt much at all. You were hoping to go into labor this week because next week you had a law final exam that you did not want to stress out about while nearing your due date! Your OB seemed confident that you would go into labor soon after the sweep since you were already 4 cm dilated and 80% effaced. After chatting about some concerns and hopes we hung up. You called me about an hour and a half later to say your contractions were definitely intensifying, and you had been walking around the neighborhood with your husband. I suggested you try laying down, drinking water, and so forth while timing your contractions for an hour to see how long and far apart they were. Because my other doula client had also been calling me throughout the day with what seemed like early labor contractions, I called my volunteer emergency back up to let her know I might have two births in one night and just to give her a heads-up, I might need some help!

You called me an hour later saying you were in the bath tub while your husband got your daughter ready to go to grandma's house for the night just in case. You told me you couldn't tell if your contractions were regular because they were varying at 4-5 min apart and 40-50 seconds long. While we were on the phone you had 3 contractions within a short time so I knew you were definitely in labor. I said I'd get my things together and call when I was on my way. I called my doula mentor, B, to discuss both your and my other mama's labor signs. She said I'd better suggest to meet you and your husband at the hospital because as a second time mom already at a 4 you could go quick! I was about to call you to tell you this when your husband called me and told me your contractions were definitely picking up and a lot more painful so I should meet them at the hospital.

I beat you to the hospital by a few minutes, at around 9 o clock. You came into the emergency room moaning and yelling and they called for a wheelchair and someone to take you up to L&D. An obstetrician happened to be down there and heard you vocalizing and offered to take you up in the wheelchair himself to speed things along. He was being funny and friendly, joking about how he was pushing you while also holding two giant bags of take-out food, but you didn't notice and could have cared less! We got to L&D and you had another contractions, yelling audibly. I reminded you to breathe, relax your face, blow out. They got you into a delivery room quickly and you asked for an epidural. Your contractions were so painful, and you'd only been in labor for about 3 hours, you were SURE you were going to be in labor for hours at this pain level or worse.

They suggested they do an internal check first to see where you were at. You were already at 8 cm dilated, 100% effaced, +1 station! You asked if it was too late for the epidural and I reminded you that if you got one it would only slow things down, you were so far already. You declined the epidural. They tried to put an IV in you but you didn't want to get on the bed right away during your intense contractions (I don't blame you!) Did end up putting an IV in your hand. Your husband and I were by your side, reminding you to breathe, not scream, make low sounds and relax your body. We told you you were doing great, you're almost there.

Your obstetrician prepped the bed for you to push. They had you lay on your back and told you to pull your legs up to your chest and push, but you weren't able to do it that way. You weren't feeling any urge to push in that position. You asked to be able to squat (I was so proud!!). The OB and nurse glanced at one another, said "sure, why not? ...how would we do that? on the floor?" And they got you down on the floor in a squat at the foot of the bed. Your husband supported you on one side and the nurse on the other. You definitely felt the urge to push then! The OB guided the baby's head out. You reached out and caught your baby boy after only two pushes, held him to you, stood up and backed onto the bed. He was born at 9:26, 20 minutes after you arrived at the hospital, about 3 and a half hours after your contractions started.

You and your husband marveled at how different your birth experience was this time. Last time you were induced at 41 weeks, on pitocin for 25 hours in the hospital with no drugs before pushing. This time labor was so fast that you were racing down the highway and dad was afraid baby would be born in the car! Your body was ready and so were you. Your son weighed 7 lb 5 ounces. You only tore a little bit along your previous tear scar tissue. You held the baby for a while, then dad got his turn. In one of the most wonderful moments of the evening, dad took his first son to the other side of the room and talked to him, telling him all about his birth, his family, his older sister, and how life would be. I couldn't hear it all because the talk was meant for the baby, but I gushed at how sweet the moment was.

We did hit one road bump. The nurse swaddled the baby and told the mom that she could not yet breastfeed because the baby had fluid in his lungs from her pushing him out so fast. I wasn't sure if this was BS or not so I got on twitter on my phone (when I had a moment) to ask. Most people said this was probably BS, that nursing would help clear it out. But the nurse then said the baby was breathing too quickly and wouldn't be able to nurse and they had to take him to the nursery to monitor him. I knew nothing about fast breathing, but I did wonder why they couldn't monitor him while he was skin-to-skin with mom, which they would both benefit from even if they couldn't breastfeed. Skin-to-skin has amazing benefits premature babies, surely if would help his "fast breathing"? Mom asked if she would be able to breastfeed him within the first two hours and the nurse said yes, so she seemed satisfied with that. I didn't know what to say to try and get mom and dad to insist on baby being with them sooner. (Any tips?) She was moved to the postpartum room, and we were told they were washing baby and then they had to dress him and get him warm before he could come. I was so silently irritated. Mom could warm him better than a warmer! It took almost 3 hours from birth before mom finally started breastfeeding. Luckily, he latched on and breastfed great! I was so thankful!

The hospital birth was definitely way more intense than the home birth. Mom was screaming and had a hard time getting her breathing in-check, and the staff were all over her with questions and commands and sticking her with needles, telling her when and how to push. I was also minorly annoyed with the nurse who didn't seem breastfeeding-support friendly. The OB was nice and I was so pleased she caught the baby on the ground while mom squatted, and she filled out my evaluation (though the birth was too quick to count for DONA certification). I was also a little peeved at one of the nurses hanging out in the nurse's station. Mom said after the birth she was feeling some back soreness so I grabbed my heating pad and went to find a microwave. Didn't see one so I asked at the nurses station. The nurse turned to another and asked if I could use the microwave, who looked at me and my rice sock and shook her head with a mean look on her face (must have been anti-doula). So I went back in the delivery room and asked my client's nurse where to find the microwave, because the nurse at the desk said she couldn't show it to me. She directed me where to find it and I found it myself! And mom said it felt really great on her back, so there you mean nurse!

Gave the mom and dad hugs and left the hospital at around 12:30 am. Was in my car thinking about what I would eat when I got home because I was hungry, and how nice it would be to sink into my comfy bed and sleep...

Then my phone rang. And that was the start of birth adventure number two...

TO BE CONTINUED!

Wednesday, April 28, 2010

Women and Health Care

I like this recent article in Time magazine focusing on the women's powerful effect on family healthcare. I found it interesting because it touches on both anthropology and public health! And its interesting to see that health care companies will target women to get a message out, because if women are convinced they will have a large effect on everyone else in their families.

Here are some excerpts to the article (emphasis mine), the full version of which is linked below.



Lady Madonna: It's not easy to keep a family healthy, and the burden nearly always falls on women. For reasons big and small, nobody does it better



For humans, there has always been something about a health message coming from a woman that gives it special authority. The father may traditionally have been the head of the home — and the family doctor may traditionally have been male — but it was the mother who saw to it that the kids got vaccinated, Grandma made it to her heart specialist and Dad stayed on his blood-pressure meds. And while much about family life has changed over the decades, that part hasn't.

Women make the primary health care decisions in two-thirds of American households. They account for 80 cents out of every dollar spent in drugstores and are likelier than men to choose the family's health insurance. Even when both parents work, wives shoulder 75% of domestic responsibilities, including making the kids' doctor appointments and getting them there on time. "Women are the main brokers of health care in the United States," says Dr. William Norcross, a family physician and faculty member at the University of California, San Diego, School of Medicine. "This has long been the case and is probably true elsewhere in the world too."

It is, and the rule is not limited to mothers. In the 1990s, when Nepalese children faced an epidemic of vitamin-A deficiency, which can be deadly, and health experts needed someone to help distribute supplements, they recruited the nation's grandmothers, knowing they had both the time to get the pills out and the moral authority to make sure kids took them. By 2005, 48,000 grandmothers were distributing vitamin A to 3.5 million kids.

"Global development agencies are cuing into this kind of thing too," says anthropologist Sarah Blaffer Hrdy of the University of California at Davis. "When you give resources or money to women, more winds up in children's health. When you give it to men, it's likelier to wind up going for things like tobacco."

There are a lot of variables that explain the mom-as-health-czar phenomenon. As with so many things, it begins with evolution, but it doesn't stop there. Females of nearly all species expend far more time and energy producing young than males do and are thus far more motivated to protect that investment. "I could count on two hands the number of species in which males are primary caregivers," says Hrdy.


In the infinitely more complex human world, of course, there's much more to it than that. One reason women may be more attuned to health issues, according to some researchers, is simply that their biology gives them more reason to be. "Women go through their childbearing years and are told to have regular checkups," says Patricia Braus, a public-health expert and author of the book Marketing Health Care to Women. "They're more likely to keep up a relationship with their doctor. Men drift away and don't come back until their 40s or 50s, when they have concerns like prostate cancer."

And as the Nepalese learned, there is almost no calculating how much good a grandmother can do. "In traditional societies, there are well-documented behavioral and cognitive benefits of having grandmothers in the home," says Hrdy. "Recently, behavioral ecologists have also found that in countries with high child mortality, there is actually an increase in survival when grandmothers live nearby."




This article also points out a great reason to INVEST IN WOMEN worldwide. If you are going to get involved in microfinance loans in order to alleviate poverty or improve health, the best place to put your money to loan it to a woman! They are more likely to put their money into their families and their community. 

Tuesday, April 27, 2010

Various Things

Some random things that I've got to share:

1. I've added labels to my posts, so if you'd like to explore one topic in particular you can find it by scrolling down on the right side and finding all the posts with that label. For instance "doula journey" would take you to all my posts where I specifically talk about my experiences as a new doula.

2. I'm really very jealous of bloggers who have nice banners and matching blog buttons. I know I am not skilled enough to design one on my own, and I wish someone would make one for me... but for free. My blog does not get enough traffic to warrant spending $$ on that.  Anyone want to help me out? I will pay you in love... :]

3. iPhone/iPod Touch Users! Here are two Birth-related Apps that I recommend to make Labor easier:

I downloaded "Labor and Contraction Timer" because of the many contraction timing apps, this one is free! And it functions exactly as it is supposed to. You click "Start Contraction" and it times it until you click "Stop Contraction." It keeps track of how long your contractions are, how frequent they are coming, and what your hourly average is. Clean and simple! Haven't yet used it at a birth.

I also recently discovered the iBirth application, which costs $4.99. There are other similar apps but none quite like this one. It is a "Childbirth Class in a Nutshell" that discusses prenatal nutrition, preparing for birth, and labor coping techniques for all types of birth. It includes videos and tips for use during pregnancy and during labor. I think it would be useful for labor partners like dads to watch, who maybe haven't read all the prep books as thoroughly as mom has, and want a quick reference :)


4. To quote and borrow from Stand and Deliver... Here are two "totally freakin' amazing birth stories" that are just begging to be shared!

  • Baby Ada's Birth Story at Life in Slow Motion: It is possible to be in labor and not be in pain. She had some tightness that wasn't painful, didn't believe she was in labor at all. Midwife came and told her she was definitely in labor and already 7cm dilated. She still was not in pain so didn't believe she was actually in labor! Water broke and finally the painful contractions came... Baby born 35 min later. 
  • Birth and the Big Baby: An Unnecesarean Avoided at Birthing Beautiful Ideas: It is possible to vaginally birth a large baby and not tear. "11 lbs. 10 oz.  24 inches.  With an intact perineum. Need I say more?" 

5. Babies Around the World Weekly Fact: In Chile, choosing godparents is a decision that can take months of deliberation. Traditionally, a baby is assigned two godparents - a male and a female - that are expected to be fully present throughout the child's life.


6. DOULA! The Ultimate Birth Companion - filmed in the UK, it will be released there first. Check out the preview!




a NEW 65 minute documentary film that follows three BIRTH DOULAS as they support three couples before, during and after their births.
The Doula! DVD features actual footage of doula supported births.
We also see POSTNATAL DOULAS providing practical and emotional support  to new mums after their babies are born.

Monday, April 26, 2010

Myths of Breastfeeding, Part 4



I find these myths/frequent concerns to be very very important to read for EVERYONE, not just for birthing mothers. Learn your facts.
(Part four of a four part series)
Click here for Part Ihere for Part II, and here for Part III)


More and More Breastfeeding Myths
Jack Newman MD, FRCPC, IBCLC, 2009©


1. Breastfeeding mothers cannot breastfeed if they have had X-raysNot true! Regular X-rays such as a chest X-ray or dental X-rays do not affect the milk or the baby and the mother may breastfeed without concern.Mammograms are harder to read when the mother is lactating, but can be done and the mother should not stop breastfeeding just to get this done. Furthermore, there are other ways of investigating a breast lump. Newer imaging methods such as CT scan and MRI scans are of no concern, even if contrast is used. And special X-rays using contrast media? As long as no radioactive isotope is used there is no concern and the mother should not stop even for one feed. Herein are included studies such as intravenous pyelogram, lymphangiogram, venogram, arteriogram, myelogram, etc. What about studies using radioactive nucleotides (bone scans, lung scans, etc.)? The baby will get a little radioactive nucleotide. However, as we often do these very same tests on children, even small babies, and the potential loss of benefits if the mother stops breastfeeding are considerable, the mother should, in my opinion, continue breastfeeding. If you feel you must stop for a period of time, express milk in advance so that the baby can be fed your milk and not formula. After two half lives, 75% of the compound will be out of your body. This is surely waiting long enough (the half life of technetium, which is used in most radioactive scans is only six hours, so that 12 hours after the injection, 75% of it will be out of your body). The exception is the thyroid scan using I131. This test must be avoidedin breastfeeding mothers. There are many ways of evaluating the thyroid, and only very occasionally does a thyroid scan truly have to be done. If the scan must be done, doing it with I123 requires the mother to stop breastfeeding for 12 to 24 hours only depending on the dose. Check first before taking the radioactive iodine—the test can wait until you know for sure. In many cases where the scan must be done, it can be put off for several months. Incidentally, lung scans with radioactive contrast no longer is the best test to rule out a lung clot. CT scan is now the preferred test to prove or disprove the diagnosis. [See also Information SheetBreastfeeding and Medications)

2. Breastfeeding mothers' milk can "dry up" just like thatNot true! Or if this can occur, it must be a rare occurrence. Aside from day-to-day and morning-to-evening variations, milk production does not change suddenly. There are changes which occur which may make it seem as if milk production is suddenly much less:

  • An increase in the needs of the baby, the so-called growth spurt. If this is the reason for the seemingly insufficient milk, a few days of more frequent breastfeeding will bring things back to normal. Try compressing the breast with your hand to help the baby get milk (Information Sheet Breast Compression).
  • A change in the baby's behaviour. At about five to six weeks of age, more or less, babies who would fall asleep at the breast when the flow of milk slowed down, tend to start pulling at the breast or crying when the milk flow slows. The milk has not dried up, but the baby has changed. Try using breast compression to help the baby get more milk. See the website nbci.ca for videos on how to latch a baby on, how to know the baby is getting milk, how to use compression.
  • The mother's breasts do not seem full or are soft. It is normal after a few weeks for the mother no longer to have engorgement, or even fullness of the breasts. As long as the baby is drinking at the breast, do not be concerned (Information sheet Is My Baby Getting Enough Milk?).
  • The baby breastfeeds less well. This is often due to the baby being given bottles or pacifiers and thus learning an inappropriate way of breastfeeding.

The birth control pill may decrease your milk supply. Think about stopping the pill or changing to a progesterone only pill. Or use other methods. Other drugs that can decrease milk supply are pseudoephedrine (Sudafed), some antihistamines, and perhaps diuretics.

If the baby truly seems not to be getting enough, get help, but do not introduce a bottle that may only make things worse. If absolutely necessary, the baby can be supplemented, using a lactation aid that will not interfere with breastfeeding, or by cup if the baby will not take the aid. However, lots can be done before giving supplements. Get help. Try compressing the breast with your hand to help the baby get milk (Information SheetBreast Compression).

3. Physicians know a lot about breastfeedingNot true! Obviously, there are exceptions. However, very few physicians trained in North America or Western Europe learned anything at all about breastfeeding in medical school. Even fewer learned about the practical aspects of helping mothers start breastfeeding and helping them maintain breastfeeding. After medical school, most of the information physicians get regarding infant feeding comes from formula company representatives or advertisements.

4. Pediatricians, at least, know a lot about breastfeedingNot true! Obviously, there are exceptions. However, in their post-medical school training (residency), most pediatricians learned nothing formally about breastfeeding, and what they picked up in passing was often wrong. To many trainees in pediatrics, breastfeeding is seen as an "obstacle to the good medical care" of hospitalized babies.

5. Formula company literature and formula samples do not influence how long a mother breastfeedsReally? So why do the formula companies work so hard to make sure that new mothers are given these samples, their company's samples? Are these samples and the literature given out to encourage breastfeeding? Do formula companies take on the cost of the samples and booklets so that mothers will be encouraged to breastfeed longer? The companies often argue that, if the mother does give formula, they want the mother to use their brand. But in competing with each other, the formula companies also compete with breastfeeding. Did you believe that argument when the cigarette companies used it?

6. Breastmilk given with formula may cause problems for the babyNot true! Most breastfeeding mothers do not need to use formula and when problems arise that seem to require artificial milk, often the problems can be resolved without resorting to formula. However, when the baby may require formula, there is no reason that breastmilk and formula cannot be given together.

7. Babies who are breastfed on demand are likely to be "colicky"Not true! "Colicky" breastfed babies often gain weight very quickly and sometimes are feeding frequently. However, many are colicky not because they are feeding frequently, but because they do not take the breastmilk as well as they should. Typically, the baby drinks very well for the first few minutes, then nibbles or sleeps. When the baby is offered the other side, he will drink well again for a short while and then nibble or sleep. The baby will fill up with relatively low fat milk and thus feed frequently. The taking in of mostly low fat milk may also result in gas, crying and explosive watery bowel movements. The mother can urge the baby to breastfeed longer on the first side, and thus get more high fat milk, by compressing the breast once the baby sucks but does not drink. (Information Sheets Colic in the Breastfed Baby and Breast Compression). Also see videos at nbci.ca

8. Mothers who receive immunizations (tetanus, rubella, hepatitis B, hepatitis A, etc.) should stop breastfeeding for 24 hours (3 days, 2 weeks)Not true! Why should they? There is no risk for the baby, and he may even benefit. The rare exception is the baby who has an immune deficiency. In that case the mother should not receive an immunization with a weakened live virus (e.g. oral, but not injectable polio, or measles, mumps, rubella) even if the baby is being fed artificially.

9. There is no such thing as nipple confusionNot true! The baby is not confused, though, the baby knows exactly what he wants. A baby who is getting slow flow from the breast and then gets rapid flow from a bottle will figure that one out pretty quickly. A baby who has had only the breast for three or four months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

Sunday, April 25, 2010

My First Solo Birth as a Doula

My phone rang at 3:30am on April 23. I was jerked out of sleep by my loud and insistent ring, and I knew this must be a birth call. My client's husband was on the other end, calmly letting me know that my client was in labor, her water had broken a half an hour ago, and the midwife was on her way. It was time to go! I lept out of bed excited but still partially asleep. My boyfriend also sat up and asked what he could do to help me, because he was also really excited for my first birth! I really couldn't think - being excited/nervous/asleep all at the same time - so I decided to start with taking a shower and getting dressed! My boyfriend helped me pack my bag and made me a lunch in case the labor was long. I was out of the apartment in about 30 minutes and at my client's home in a half hour more. Everything was dark and quiet when I approached the house. Mom's two sons, mother and sister were were all sound asleep. The midwife had arrived just before I had.

Mom was on the floor of her room, sitting cross-legged, leaning on a small chair ottoman and swaying. She was in her zone. She quietly moaned in the semi-darkness of her bedroom. She was breathing, making "horse sounds," moaning, rocking all by herself. I sat quietly on the floor nearby and just held the space. Dad sat with her a bit and rubbed her a bit, then left her alone when she seemed to want it. She laughed a bit through silent tears saying she felt the presence of her great grandmother, who was a midwife. I rubbed her lower back a bit when she said she felt some pain. I brought her a wet washcloth, encouraged her to drink water. I wanted to help (anxious new doula!) but I also wanted dad to be able to be involved and not feel like I was taking his place. The midwife sat quietly in the dark, waiting for when she thought she might be needed. Mom said her mouth was dry so I asked dad if he had chap stick or lip balm, but he didn't seem to find any, so I pulled out a lanolin sample and had mom use that.

Mom said she felt uncomfortable sitting how she was but didn't want to lay down. We suggested she move to the bath tub. She didn't really have a strong desire to be in the tub, surprisingly to her, but felt it might be more comfortable than her present position so dad helped move her in. The midwife offered to do an internal check and mom agreed. She was at 8 cm (less than an hour after I had arrived). I let mom and dad have a couple minutes alone in the bathroom. The midwife began to gather her birth materials. Then with the next contraction mom said she was already feeling an urge to push, but that she didn't want to. We all joined her at the tub, dad supporting her upper body. She said that she was afraid to push, that she didn't feel ready for that part yet. The midwife assured her that she was ready. I reminded her that her great grandmother was with her.

Through the windows above the large tub we could see the early morning glow of sunrise over the lake behind their home. The whole sky was a beautiful blue glow. It was very serene. Mom was grunting and panting quietly, then said "I'm tearing." Midwife said "no you're not" in a reassuring way, but then looked down and said "the head is out." And indeed it was! We waited what felt like a couple minutes for the next contraction to come, and when mom felt like it she pushed the rest of the body out. Midwife pulled the baby up onto mom's chest and mom held it there where it was very calm and cuddly. Mom looked very happy. Midwife noted the birth time at 6am.

Dad kept saying "boy or girl?" because they didn't know ahead of time, but mom was reluctant to disturb the peaceful baby to check the gender right away.  I remembered that mom wanted pictures of the birth because they hadn't gotten many last time. I said to the dad "do you have a camera?" And he ran out. I felt bad because he was gone for longer than I thought he'd be finding the camera, and it was his baby's first minutes of life! I hadn't realized he had to go around looking for it and a battery, and I apologized. He didn't seem to mind and handed me the camera. I took pictures of mom and dad and baby while mom was still cuddling baby in the tub, keeping it warm with blankets.

About 15 - 20 minutes later the afterbirth came and the midwife clamped the cord.  Mom lifted up the baby and said "a penis!" and laughed. Dad cut the cord (which I tried to get a photo of, but I had a bad angle). Then went and woke up the oldest of their sons, who is about 7, and brought him in to meet his baby brother. It was the cutest scene EVER, the boy greeting his new baby brother for the first time with disheveled hair and sleep and wonder in his eyes. He didn't know he'd wake up to a new baby brother! The midwife offered to show me the placenta, which was cool. I'd only seen one from afar. Then we started getting baby and mom ready to get out of the tub. I was sitting on a stool in the bathroom watching mom latch the baby on for the first time, and dad wasn't in the room, so the midwife handed me a towel. I thought she was having me hold it for her, but suddenly the newborn baby was on my lap in the towel and she was telling me to dry him! So I held a baby who was only a half an hour old! I felt a little bit weird to be holding the baby before dad even did, but dad and midwife walked in a minute later and wrapped him up in a baby blanket and into dad's arms. I took photos of dad and baby and the midwife helped mom out of the tub.

We whisked mom to her bed and covered her in blankets to warm her up. I went down with the big brother to make mom some hot tea with some after birth pain easing drops that the mom had. The brother was so excited to have a new brother and to be helping! We brought tea to mom and midwife had things set up to weight and measure the baby. He was 8 lb 5 oz and 20 inches long! Mom said he definitely looked smaller than her first two babies. She also noted that he had barely any vernix. Midwife and dad helped mom walk to the bathroom to get cleaned up a bit more, and I sat with the brother while he held the baby. Took some cute photos. He said he was going to be a big help for his mom with the baby, bring its clothes and things like that. Then he said the CUTEST THING that no one heard but me. "I wish I could nurse the baby for mom, too." I laughed out loud at that. I definitely shared it with the parents and midwife!

Midwife said she'd like to examine the mom for tears. She had a short but deep tear that the midwife wanted to sew up. She asked me to be her assistant. I held the lidocaine vial and the flashlight while dad, bro and baby cuddled mom on the bed. Unfortunately, I hadn't eaten anything this whole time. That combined with concentrating on holding the flashlight in exactly the right place and witnessing a lot of bloody stitching made me feel woozy. I tried to ignore it. Dad went to wake up the younger brother and he came running in to meet the baby. My eyesight got fuzzy and my ears started to have muffled sound and I was worried I would faint! So I said "I'm sorry I have to sit down." And the midwife said "Getting woozy? That happened to me the first time I assisted with this too." All I said was "I'm HUNGRY" and dad grabbed the flashlight. Haha kind of funny in retrospect. At the time I was very embarrassed! Oh well, I had no intention of becoming a midwife anyway :) I stood up when I could see again and grabbed my snacks. All better! And the stitching was done.

Mom and baby cuddled and nursed a bit more while I made more tea and helped the midwife clean things up a bit. We marveled at how short a labor it was - only four hours long! Though she had been contracting for weeks and almost thinking she was in early labor several times. Finally they sent the boys down to wake up the baby's grandmother and aunt. When the boys said "wake up and come see our baby brother" they were shocked! They had no idea while they were sleeping a baby was being born! They hadn't heard a thing. I'm so glad they slept through it all, because my client had been a little stressed about her mom being there during the birth, since she is not too supportive of home birth. But it all worked out! The midwife left and after grandma and aunt got to see the baby they got the boys downstairs to make breakfast and let mom and dad rest. They hadn't slept at all! I let the mama know that I can't wait to come back for a postpartum visit to check in on her and find out what they decided to name the baby!

Oh yes, too cute: The youngest of the brothers decided they should call the baby "backpack." I'm not sure why, I think it had to do with a conversation they had previously had about baby names. It was the funniest thing, they kept calling it "backpack!"and giggling.

The whole birth experience was just so PEACEFUL. The sun rose through the window over the water behind their home, everything was quiet. I think for the mama it was very intense being so short - she kept repeating that - her contractions were very close together and she had little time to recover before the next one started. I was only there a grand total of about 4 hours! Unfortunately, this birth will not "count" for my doula certification... DONA requires that I am there with mom when she is just at early active labor (about 3-4 cm dilated, still talking between contractions).

I know my other births will not be anything like this one, so I will cherish this memory forever.

Friday, April 23, 2010

Went to a Birth!

The long awaited announcement has come: I WENT TO MY FIRST DOULA BIRTH!
So sorry I don't have time to type it out now, but I wanted to leave you all in anticipation.

It was a home birth and a beautiful baby boy was born in his parent's bath tub in a labor that was a total of 4 hours long!

Stay tuned! :)

Thursday, April 22, 2010

The Great Earth Mother

To Woman and Man the Mother gave birth,
And then for their home, She gave them the Earth,
The water, the land, and all Her creation.
To use them with care was their obligation.

It was their home to use. But not to abuse.


Earth Day makes me think of Mother Earth, Gaia, and how all Women have the capacity to be an Earth Mother, bringing forth life, and nurturing it in the great circle of life. I know this is a very hippie moment, but it is also an anthropology moment! I love Creation Myth stories. Every culture has one, and many are extremely similar, which is a fascinating point for anthropologists. 
Some common motifs of creation stories are: 
  • a primordial universe and life is made from nothing or ex nihilo, 
  • several stages of creation occur, 
  • the earth (or universe) is the bodily remains of the creator or deity, and
  • humans are created by this deity. 

One of my very favorite creation stories is the Mother's Song, which appears in Jean M. Auel's Earth's Children Series. In her book, the people worship the Great Earth Mother, because she gave birth to all of Earth's creatures. Because women also have the power to give life, as the Mother did, they are venerated.
Below I have typed out the entire creation story, The Mother's Song. Click 'read more' below to view it in its entirety, after the jump. 



The Mother's Song
by Jean M. Auel

Out of the darkness, the chaos of time, 
The whirlwind gave birth to the Mother sublime
She woke to Herself knowing life had great worth,
The dark empty void grieved the Great Mother Earth.

The Mother was Lonely. She was the Only.

From the dust of Her birth She created the other,
A pale shining friend, a companion, a brother.
The grew up together, learned to love and to care,
And when She was ready, they decided to pair.

Around Her he'd hover. Her pale shining lover.

Happy Earth Day!



Wednesday, April 21, 2010

Thank goodness for the Labor Progress Handbook!

I'm still waiting on my home birth client to go into labor, and she may end up not being my first doula birth after all. One of my other clients has been dealing with high blood pressure for several weeks and may have to be induced. Needless to say I have been finding out as much as I can about hypertension, pre-eclampsia, induction and laboring with these conditions.

She is currently being tested for protein in her urine to see if she may have pre-eclampsia in addition to her hypertension. Pre-eclampsia is
a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia--the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth. 
An increase in BP in late pregnancy is fairly common, and does not always become pre-eclampsia. There is no proven way to prevent pre-eclampsia, and the only way to treat it is to have good medical care. The only "cure" is to deliver the baby.

This is why, if the doctor finds she may have pre-e, she will most likely be induced as soon as possible. I have made several suggestions over the past couple weeks for lowering her blood pressure, and she has told me that she has tried relaxing more. Unfortunately her BP is still high, though I don't know how high. I am worried about her being induced, because that is what she had to go through last time for being "late" and she definitely did not have an easy time of it. If she does not have pre-e her doctor still wants to try to get her going as soon as possible, and has said she will be stripping her membranes next week.

For those who do not know what stripping membranes is:
Stripping the membranes is where a health care provider will separate your bag of water from the cervix, it is not intended to break your water, however, it may. It may also cause infection, and may be painful for some. The reason that we tell people that we are stripping their membranes is to "get things going" in regards to labor. This little technique is usually done during a vaginal exam at the end of pregnancy, with or without the knowledge or consent of the woman. Stripping the membranes, we are told, is supposed to stimulate production of prostiglandins in the cervix and bring on contractions. I have heard doctors tell my clients after stripping their membranes they will have the baby in two days. While this may appear to work for some, at term it's all a guessing game. There is no scientific work to date that can back up the routine procedure of stripping membranes. (from Childbirth.org)
Needless to say I am now preparing for the possibility of her being induced very soon, and for the probability of her being told to labor in bed for her hypertension.

And this brings us to the title of my post: Thank goodness for The Labor Progress Handbook!
In my panic of "yikes my first birth might be a hospital birth medical induction stuck in bed omg how do I support a woman in this situation I'm freaking out!" I found exactly the information I needed in Penny Simkin's wonderful doula/care provider labor guide:

- Many caregivers restrict the woman with pregnancy-induced hypertension to bed in labor (and late pregnancy) because blood pressure is usually lowered while a woman lies on her left side. The book states that whether such treatment has resulted in improved outcomes or less progression of pre-eclampsia is not known.

- While caring for a woman who is restricted to the bed with PIH, explain why left-sided bedrest is being asked of her, help her focus on comfort measures that she can use in bed, such as relaxation, breathing patterns, vocalization, guided imagery and visualizations, other attention-focusing measures, massage of back and feet. If some walking is acceptable, have her walk to the bathroom and to the shower or tub. Water therapy frequently lower high blood pressure.

- Assess her emotional state. Raise spirits by having her wash her face, brush her hair, play upbeat music, have a new visitor come chat with her optimistically. She may benefit from a good cry. Acknowledge her frustration and giver her a pep talk.

- Women restricted to bed may still be able to use position changes to improve labor progress (and coping). If the mother does not have any indicators of malposition it is appropriate to try to "rollover." The bed-ridden woman spends 20-30 minutes in each of the following positions: semi-sitting, left-side-lying, left semi-prone, hands and knees lean, right semi-prone, right side-lying, and back around again.


Panic over  :]

Tuesday, April 20, 2010

Myths of Breastfeeding, Part 3

I find these myths/frequent concerns to be very very important to read for EVERYONE, not just for birthing mothers. Learn your facts. 
(Part three of a four part series)
Click here for Part I and here for Part II)


Still More Breastfeeding Myths
Jack Newman MD, FRCPC, IBCLC, 2009©


1. Women with flat or inverted nipples cannot breastfeedNot true! Babies do not breastfeed on nipples, they breastfeed on the breast. Though it may be easier for a baby to latch on to a breast with a prominent nipple, it is not necessary for nipples to stick out. A proper start will usually prevent problems and mothers with any shaped nipples can breastfeed perfectly adequately. In the past, a nipple shield was frequently suggested to get the baby to take the breast. This gadget should not be used, especially in the first two weeks!Though it may seem a solution, its use can result in poor feeding and severe weight loss, and makes it even more difficult to get the baby to take the breast. (See Information Sheet Finger and Cup Feeding). If the baby does not take the breast at first, with proper help, he will often take the breast later. Breasts also change in the first few weeks, and as long as the mother maintains a good milk supply, the baby will usually latch on by 8 weeks of age no matter what, but get help and the baby may latch on before. See Information Sheet When a Baby Does not yet Latch.

2. A woman who becomes pregnant must stop breastfeedingNot true! If the mother and child desire, breastfeeding can continue. Some continue breastfeeding the older child even after delivery of the new baby. Many women do decide to stop breastfeeding when they become pregnant because their nipples are sore, or for other reasons, but there is no rush or medical necessity to do so. In fact, there are often good reasons to continue. The milk supply will likely decrease during pregnancy, but if the baby is taking other foods, this is not a usually a problem. However, some babies will stop breastfeeding if the milk supply is low.

3. A baby with diarrhea should not breastfeedNot true! The best treatment for a gut infection (gastroenteritis) is breastfeeding. Furthermore, it is very unusual for the baby to require fluids other than breastmilk. If lactose intolerance is a problem, the baby can receive lactase drops, available without prescription, just before or after the feeding, but this is rarely necessary in breastfeeding babies. Get information on its use from the clinic. In any case, lactose intolerance due to gastroenteritis will disappear with time. Lactose free formula is not better than breastfeeding. Breastfeeding is better than any formula.

4. Babies will stay on the breast for two hours because they like to suckNot true! Babies need and like to suck, but how much do they need? Most babies who stay at the breast for such a long time are probably hungry, even though they may be gaining well. Being on the breast is not the same as drinking at the breast. Latching the baby better onto the breast allows the baby to breastfeed more effectively, and thus spend more time actually drinking. You can also help the baby to drink more by expressing milk into his mouth when he no longer swallows on his own (See Information Sheet Breast Compression). Babies younger than 5-6 weeks often fall asleep at the breast because the flow of milk is slow, not necessarily because they have had enough to eat. See videos at nbci.ca.

5. Babies need to know how to take a bottle. Therefore a bottle should always be introduced before the baby refuses to take one
Not true! Though many mothers decide to introduce a bottle for various reasons, there is no reason a baby must learn how to use one. Indeed, there is no great advantage in a baby's taking a bottle. Since Canadian women are supposed to receive 52 weeks maternity leave, the baby can start eating solids around 6 months, well before the mother goes back to her outside work. The baby can even take fluids or solids that are quite liquid off a spoon. The baby can start learning how to drink from a cup right from birth or older, and though it may take several weeks for the older baby to learn to use it efficiently, he will learn. If the mother is going to introduce a bottle, it is better she wait until the baby has been breastfeeding well for 4-6 weeks, and then give it only occasionally. Sometimes, however, babies who take the bottle well at 6 weeks, refuse it at 3 or 4 months even if they have been getting bottles regularly (smart babies). Do not worry, and proceed as above with solids and spoon. Giving a bottle when breastfeeding is not going well is not a good idea and usually makes the breastfeeding even more difficult. For your sake and the baby's do not try to "starve the baby into submission". Get help.

6. If a mother has surgery, she has to wait a day before restarting breastfeedingNot true! The mother can breastfeed immediately after surgery, as soon as she is awake and up to it. Neither the medications used during anaesthesia, nor pain medications nor antibiotics used after surgery require the mother to interrupt breastfeeding, except under exceptional circumstances. Enlightened hospitals will accommodate breastfeeding mothers and babies when either the mother or the baby needs to be admitted to the hospital, so that breastfeeding can continue. Many rules that restrict breastfeeding are more for the convenience of staff than for the benefit of mothers and babies.

7. Breastfeeding twins is too difficult to manageNot true! Breastfeeding twins is easier than bottle feeding twins, if breastfeeding is going well. This is why it is so important that a special effort should be made to get breastfeeding started right when the mother has had twins (See Information Sheets Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact). Some women have breastfed triplets exclusively. This obviously takes a lot of work and time, but twins and triplets take a lot of work and time no matter how the infants are fed.

8. Women whose breasts do not enlarge or enlarge only a little during pregnancy, will not produce enough milkNot true! There are a very few women who cannot produce enough milk (though they can continue to breastfeed by supplementing with a lactation aid). Some of these women say that their breasts did not enlarge during pregnancy. However, the vast majority of women whose breasts do not seem to enlarge during pregnancy produce more than enough milk.

9. A mother whose breasts do not seem full has little milk in the breast
Not true! Breasts do not have to feel full to produce plenty of milk. It is normal that a breastfeeding woman's breasts feel less full as her body adjusts to her baby's milk intake. This can happen suddenly and may occur as early as two weeks after birth or even earlier. The breast is never "empty" and also produces milk as the baby breastfeeds. Is the baby getting milk from the breast? That’s what’s important, not how full the breast feels. Look skeptically upon anyone who squeezes your breasts to make a determination of milk sufficiency or insufficiency. See videos at nbci.ca.

10. Breastfeeding in public is not decentNot true! It is the humiliation and harassment of mothers who are breastfeeding their babies that is not decent. Women who are trying to do the best for their babies should not be forced by other people's hang-ups or lack of understanding to stay home or feed their babies in public washrooms. Those who are offended need only avert their eyes. Children will not be damaged psychologically by seeing a woman breastfeeding. On the contrary, they might learn something important, beautiful and fascinating. They might even learn that breasts are not only for selling beer. Other women who have left their babies at home to be bottle fed when they went out might be encouraged to bring the baby with them the next time.

11. Breastfeeding a child until 3 or 4 years of age is abnormal and bad for the child, causing an over-dependent relationship between mother and childNot true! Breastfeeding for 2-4 years was the rule in most cultures since the beginning of human time on this planet. Only in the last 100 years or so has breastfeeding been seen as something to be limited. Children breastfeed into the third year are not overly dependent. On the contrary, they tend to be very secure and thus more independent. They themselves will make the step to stop breastfeeding (with gentle encouragement from the mother), and thus will be secure in their accomplishment.

12. If the baby is off the breast for a few days (weeks), the mother should not restart breastfeeding because the milk soursNot true! The milk is as good as it ever was. Breastmilk in the breast is not milk or formula in a bottle.

13. After exercise a mother should not breastfeedNot true! There is absolutely no reason why a mother would not be able to breastfeed after exercising. The study that purported to show that babies were fussy feeding after mother exercising was poorly done and contradicts the everyday experience of millions of mothers.

14. A breastfeeding mother cannot get a permanent or dye her hairNot true! I have no idea where this comes from.

15. Breastfeeding is blamed for everythingTrue! Family, health professionals, neighbours, friends and taxi drivers will blame breastfeeding if the mother is tired, nervous, weepy, sick, has pain in her knees, has difficulty sleeping, is always sleepy, feels dizzy, is anemic, has a relapse of her arthritis (migraines, or any chronic problem) complains of hair loss, change of vision, ringing in the ears or itchy skin. Breastfeeding will be blamed as the cause of marriage problems and the other children acting up. Breastfeeding is to blame when the mortgage rates go up and the economy is faltering. And whenever there is something that does not fit the "picture book" life, the mother will be advised by everyone that it will be better if she stops breastfeeding.

Monday, April 19, 2010

Doula Musings

I've noticed that Prenatal meetings with first-time moms go very differently than with experienced moms. First-timers listen intently, like a student, absorbing everything I talk about and waiting for more. They ask questions but the meetings are very much led by me. Previous birth-ers talk a lot about what they know, what they've experienced, what they're hoping for next time. Its a lot less teaching, but I still want to be sure they have even better information/support than they had before!

I went to a Bradley class with one of my mamas! Bradley is one type of childbirth education workshop options. It is referred to as "husband-coached childbirth" and is a lot about getting the dad involved as the birth partner. I was perusing the workbook and apparently Bradley method is very big on drinking a lot of orange juice? For both mom and coach? I asked my client about it and she shrugged and said its something about getting fluids + vitamin C. Interesting.

I really enjoyed attending the childbirth class. I got to be referred to as "the doula" in front of a group of people, including by the workshop leader, which was extremely exciting for me. I learned what was being taught to my client, and compared it to what I knew. I learned some possible techniques for turning a mal-positioned baby in addition to some I already knew. Here is a list:

1. Positive thinking and visualization.
2. Walking around/squatting/swimming in a pool.
3. Breech tilt - lay on back and prop legs up to lift hips higher than head
4. Put music in your pocket so baby wants to turn towards the sound
5. Place cold on top of your tummy and warm beneath your bottom (heating pad or shallow bath water). Baby will want to turn towards the warmth.
6. Child's pose with your hips higher than your head can also lift baby out of pelvis.

7. Chiropractor - Webster's breech technique
8. Acupuncture/moxibustion
9. External Version

We also did a review of what the stages of labor would be like for mom and labor coach. Plus 30 minutes of labor rehearsal, with 1 min long contractions every two minutes walking, sitting, laying down. It was great for getting comfortable with one another.

The workshop leader was big on her phrase "Shake Your Booty" as a solution for everything - mal-positioned baby? Put on some music and shake your booty. Labor stalling? Shake your booty. Haha. It was pretty cute.

My first mom (home birth) texted me yesterday letting me know that she's been contracting a lot the past few days and she thought she was in labor a couple times now already and been wrong. So I'm still waiting with bated breath...

Sunday, April 18, 2010

Breast Crawl

The Breast Crawl is truly amazing.

Every newborn, when placed on the mother's abdomen, soon after birth, has the ability to find its mother's breast all on its own and to decide when and how to latch on. 


The videos below show how this works - how a baby, when placed on mom immediately after birth, will find its way to her nipple and latch on all on its own. It is a combination of innate skills, such as the rooting reflex, and the smells on its own hands and mom's breast. 


If you leave the baby alone, it will find and latch on the nipple within an hour of birth.









In my doula training workshop we watched a video of lactation consultants helping women out with their baby's breastfeeding latch.  One way they helped solve the problem of a continually faulty (painful) latch was to allow the baby to do the breast crawl. The slightly older infants would do a "bounce" with their heads, slowly making their way to one breast or the other and eventually latching on all on their own! It seemed like such an easy solution after so much latching hardship - all it took was some patience.

A Poem

Chant of the Pregnant Goddess
by Jana McCarthy

I am the mother of the moon
sister of the stars
child of the light in your eyes.
I am powerful.

The geometry of my shape shifts
from gently curved lines
to expanding circles:
earth, moon, sun.

I am powerful.
I am strong.

The tempo of my vibration quickens,
increasing from
butterfly wings, to floundering fish,
to beating drum,
erupting volcano,
the rhythm as old and constant as
the cycles of the sun
and the turn of the tides.

I am powerful.
I am strong.
I am beautiful.

I hold the hope of my ancestors
the knowledge of my time
the fate of my future.

I am powerful.
I am strong.
I am beautiful.
I am mother.

Saturday, April 17, 2010

Weekend Movie: The Miracle of Birth

The Miracle of Birth
from Monty Python's the Meaning of Life
A tongue-in-cheek look at hospital birth

Those of you who have seen the Business of Being Born will recognize this. Some of these scenes were used in that film to portray ironic comedy about hospital birth.

Friday, April 16, 2010

Myths of Breastfeeding, Part 2




I find these myths/frequent concerns to be very very important to read for EVERYONE, not just for birthing mothers. Learn your facts. 



(Part two of a four part series)
Click here for Part I







More Breastfeeding Myths

Jack Newman MD, FRCPC, IBCLC, 2009©



1. A breastfeeding mother has to be obsessive about what she eatsNot true! A breastfeeding mother should try to eat a balanced diet, but neither needs to eat any special foods nor avoid certain foods. A breastfeeding mother does not need to drink milk in order to make milk. A breastfeeding mother does not need to avoid spicy foods, garlic, cabbage or alcohol. A breastfeeding mother should eat a normal healthful diet. Although there are situations when something the mother eats may affect the baby, this is unusual. Most commonly, "colic", "gassiness" and crying can be improved by changing breastfeeding techniques, rather than changing the mother's diet. (Information Sheet Colic in the Breastfed Baby).

2. A breastfeeding mother has to eat more in order to make enough milkNot true! Women on even very low calorie diets usually make enough milk, at least until the mother's calorie intake becomes critically low for a prolonged period of time. Generally, the baby will get what he needs. Some women worry that if they eat poorly for a few days this also will affect their milk. There is no need for concern. Such variations will not affect milk supply or quality. It is commonly said that women need to eat 500 extra calories a day in order to breastfeed. This is not true. Some women do eat more when they breastfeed, but others do not, and some even eat less, without any harm done to the mother or baby or the milk supply. The mother should eat a balanced diet dictated by her appetite. Rules about eating just make breastfeeding unnecessarily complicated.

3. A breastfeeding mother has to drink lots of fluidsNot true! The mother should drink according to her thirst. Some mothers feel they are thirsty all the time, but many others do not drink more than usual. The mother's body knows if she needs more fluids, and tells her by making her feel thirsty. Do not believe that you have to drink at least a certain number of glasses a day. Rules about drinking just make breastfeeding unnecessarily complicated.

4. A mother who smokes is better not to breastfeedNot true! A mother who cannot stop smoking should breastfeed. Breastfeeding has been shown to decrease the negative effects of cigarette smoke on the baby's lungs, for example. Breastfeeding confers great health benefits on both mother and baby. It would be better if the mother not smoke, but if she cannot stop or cut down, then it is better she smoke and breastfeed than smoke and formula feed.

5. A mother should not drink alcohol while breastfeedingNot true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for breastfeeding mothers.

6. A mother who bleeds from her nipples should not breastfeed
Not true! Though blood makes the baby spit up more, and the blood may even show up in his bowel movements, this is not a reason to stop breastfeeding the baby. Nipples that are painful and bleeding are not worse than nipples that are painful and not bleeding. It is the pain the mother is having that is the problem. This nipple pain can often be helped considerably. Get help. (Information Sheet Sore Nipples and Vasospasm and Raynaud’s Phenomenon). Sometimes mothers have bleeding from the nipples that is obviously coming from inside the breast and is not usually associated with pain. This often occurs in the first few days after birth and settles within a few days. The mother should not stop breastfeeding for this. If bleeding does not stop soon, the source of the problem needs to be investigated, but the mother should keep breastfeeding.

7. A woman who has had breast augmentation surgery cannot breastfeedNot true! Most do very well. There is no evidence that breastfeeding with silicone implants is harmful to the baby. Occasionally this operation is done through the areola. These women do have often have problems with milk supply, as does any woman who has an incision around the areolar line.

8. A woman who has had breast reduction surgery cannot breastfeedNot true! Breast reduction surgery does often decrease the mother's capacity to produce milk, but since many mothers produce more than enough milk, some mothers who have had breast reduction surgery sometimes can breastfeed exclusively. In such a situation, the establishment of breastfeeding should be done with special care to the principles mentioned in the Information Sheet Breastfeeding—Starting Out Right. However, if the mother seems not to produce enough, she can still breastfeed, supplementing with a lactation aid (so that artificial nipples do not interfere with breastfeeding). See Information Sheet Lactation Aid.

9. Premature babies need to learn to take bottles before they can start breastfeedingNot true!Premature babies are less stressed by breastfeeding than by bottle feeding. A baby as small as 1200 grams and even smaller can start at the breast as soon as he is stable, though he may not latch on for several weeks. Still, he is learning and he is being held which is important for his wellbeing and his mother's. Actually, weight or gestational age do not matter as much as the baby's readiness to suck, as determined by his making sucking movements. There is no more reason to give bottles to premature babies than to full term babies. When supplementation is truly required there are ways to supplement without using artificial nipples.

10. Babies with cleft lip and/or palate cannot breastfeedNot true! Some do very well. Babies with a cleft lip only usually manage fine. But many babies with cleft palate do indeed find it very difficult to latch on. There is no doubt, however, that if breastfeeding is not even tried, for sure the baby won’t breastfeed. The baby's ability to breastfeed does not always seem to depend on the severity of the cleft. Breastfeeding should be started, as much as possible, using the principles of proper establishment of breastfeeding. (Information SheetBreastfeeding—Starting Out Right). If bottles are given, they will undermine the baby's ability to breastfeed. If the baby needs to be fed, but is not latching on, a cup can and should be used in preference to a bottle. Finger feeding occasionally is successful in babies with cleft lip/palate, but not usually (See Information Sheet Finger and Cup Feeding).

11. Women with small breasts produce less milk than those with large breastsNonsense!

12. Breastfeeding does not provide any protection against becoming pregnant
Not true! It is not a foolproof method, but no method is. In fact, breastfeeding is not a bad method of child spacing, and gives reliable protection especially during the first six months after birth. It is almost as good as the Pill if the baby is under six months of age, if breastfeeding is exclusive, and if the mother has not yet had a normal menstrual period after giving birth. After the first six months, the protection is less, but still present, and on average, women breastfeeding into the second year of life will have a baby every two to three years even without any artificial method of contraception.

13. Breastfeeding women cannot take the birth control pillNot true! The question is not about exposure to female hormones, to which the baby is exposed anyway through breastfeeding. The baby gets only a tiny bit more from the pill. However, some women who take the pill, even the progestin only pill, find that their milk supply decreases. Estrogen-containing pills are more likely to decrease the milk supply. Because so many women produce more than enough, this sometimes does not matter, but sometimes it does even in the presence of an abundant supply, and the baby becomes fussy and is not satisfied by breastfeeding. Babies respond to the rate of flow of milk, not what's "in the breast", so that even a very good milk supply may seem to cause the baby who is used to faster flow to be fussy. Stopping the pill often brings things back to normal. If possible, women who are breastfeeding should avoid the pill, or at least wait until the baby is taking other foods (usually around 6 months of age). Even if the baby is older, the milk supply may decrease significantly. If the pill must be used, it is preferable to use the progestin only pill (without estrogen).

14. Breastfeeding babies need other types of milk after six monthsNot true! Breastmilk gives the baby everything there is in other milks and more. Babies older than six months should be started on solids mainly so that they learn how to eat and so that they begin to get another source of iron, which by 7-9 months, is not supplied in sufficient quantities from breastmilk alone. Thus cow's milk or formula will not be necessary as long as the baby is breastfeeding. However, if the mother wishes to give milk after 6 months, there is no reason that the baby cannot get cow's or goat’s milk, as long as the baby is still breastfeeding a few times a day, and is also getting a wide variety of solid foods in more than minimal amounts. Most babies older than six months who have never had formula will not accept it because of the taste. 
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