 Early as a La Leche League Leader, I learned from Linda J. Smith the lactating body works like an ice machine: When you remove ice from your ice maker, there is a sensor in your freezer that tells the freezer to make more ice. Its goal is to replace the ice. When you remove milk from your breasts, there is a trigger in your your body that tells the body to make more milk. Its goal is to replace the milk. If you do not use the ice, the freezer does not continue to make more. If you do not remove the milk, the body does not continue to make more. The baby and body expect milk to be removed 12-24 times in the first 24 hours of life. This ensures the baby gets enough. This ensures the body gets the message to start making milk. Once you get past the first 24 hours, it is normal for babies to eat 8-12 times in 24 hours, and more than that can be normal, too. Milk effectively removed at this frequency is often enough to build a robust milk supply. Keys for the first few days include:
Because the body makes milk by wanting to replace the milk that was used, we know cookies, special drinks, supplements, etc., don't improve supply alone. You can't eat lactation cookies and drink Starbucks' Pink Drink and expect more milk if you aren't feeding your baby (or pulling milk out via a pump) 8-12 (or more!) times in 24 hours. We are a culture steeped in instant gratification. We can get things next-day from Amazon. We can get fast food 24 hours a day. We don't have to wait long in many cases to get what we want. Milk supply doesn't work like this. There is an element of work that comes with having an adequate supply, and that is feeding or pumping 8-12 times in 24 hours. To get the most optimal start, it isn't that difficult:
Some people respond more to negative messages, so for fun, let me share ways to make breastfeeding hard:
The biggest success factor for breastfeeding is time for you and your baby to be together. Your baby is programmed to be with you, to want to be close, to want to feed freely. Babies don't come out and say, "Hey, we've been a little too close for a little too long -- please put me in my own room, in my own crib." In actuality, babies do not know where they end and their parent begins. They have been rocked, held snugly, been kept warm, heard all the sounds of your body and your voice, and they have not been hungry -- think about that! They were fed through their blood. So suddenly, it's bright, they're cold, they have no control over their arms or legs, and where's that person!? My person? It is a lot to adjust to. And can you guess what answers all those questions of discomfort? Being at the breast. There is an amazing author out that by the name of Kimberly Seals Aller. I heard her say this at a conference once: The first time you had consensual sex, it probably wasn't the greatest. You may have wondered, How do people do this? Why do people make it seem so easy? I'm pretty sure I did that all wrong. Did you walk away and say, "Well, that didn't work, so I'm never going to do that again." Generally not. We stick with it. We figure things out. It takes time and practice. While breastfeeding is not sexual, the idea that, if it doesn't work the first few times it isn't going to, often causes many of us to quit before we have even had a chance to practice and figure things out better. Repeat this to yourself: Just because it isn't working right now doesn't mean it won't work. Seek help, because it is out there. We should not be expected to figure things out on our own. Heck, if you can't find help, reach out to me! I may be far away from your location, and I can try to help you find support appropriate for your situation. Let me close with Linda Smith's "Coach's Rules": 1. Feed the baby 2. The parent is right 3. It's the parent's baby 4. Nobody knows everything 5. There's another way You can do this! And with support, you don't have to do it alone! Places to reach out to before baby, for support, or if struggling: Find an IBCLC La Leche League Breastfeeding USA Baby Cafe
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 There are different ideas about placenta ingestion after birth. While it is true most mammals eat their placenta right after birth, they do so raw, directly after it is expelled. This cleans up a bloody mess (which keeps predators away), and it provides the mother with energy without her needing to leave her vulnerable babies alone to find food. As humans, we don't do it this way. We process it, and then take it slowly over time. Many lactation experts say this is opposite to how the body works. While pregnant, the placenta sends out hormones that stop us from making milk. This is why, if you pump before birth, you will barely get anything out (and it will be colostrum). Once baby is born, the placenta comes out. It is the placenta that is responsible for the hormonal changes which turn on the body's milk-making factory. If a piece of the placenta is accidentally left inside the body, it can stop the body from making milk due to the hormones it carries and releases. It can also prevent the uterus from shrinking back up like it needs to to stop bleeding. It may contribute to uterine infection, as well. This is why we should never tolerate a doctor pulling on the cord to try and yank the placenta out before it releases on its own -- the cord or placenta can be torn, and pieces can be left inside. Many experts say by putting the placental hormones back into the body, it can confuse the body about what it needs to be doing: growing a baby inside, or making milk outside. Here is tangent, but stick with me, it applies: Medication like Sudafed can cause a person's milk supply to decrease because of how it works (dries up sinuses). Breastfeeding people are told not to use decongestants because of this. BUT a person who has just had a baby will be less impacted, and maybe not impacted at all, because of how their body is making milk at this point -- it is making milk simply because the body had a baby -- the placenta left the body, causing that chain of hormonal responses which turn the milk-making factory on. If a person has a breastfeeding 6 month old and takes Sudafed, they have a higher chance of it reducing their supply because their body works in a different way now -- they make milk in direct response to how often and frequently the baby nurses. This is the difference between endocrine control (automatic because of the hormones of birth), and autocrine control (supply and demand). Another example of how our bodies and hormones differ has to do with the return of our fertility. Some people get their periods back while breastfeeding like normal, 8-10 times a day. Some won't get a period at all until their child has weaned totally and dropped off every single feed, and even then it might take a couple months for their cycle to return. Every body is different. So just be mindful of how things are working for you. Every person is individual, and what lactation experts are noticing is: Some people have robust, healthy supplies when consuming their processed placenta slowly and over time. And some don't. So guidance to know what to watch out for is imperative. If you choose to have your placenta processed for consumption, be sure your encapsulator is aware of this, and that they can give you guidance on what to expect. Be cautious if they feel this is not true -- enough lactation professionals have experienced this for us to believe it is real and it can happen. I may sound opposed to the practice of consuming one's placenta. I really am not. I just want more evidence of the benefits -- thus far, I believe the only documented benefit is that people have increased iron levels. I tend to think more about how things are done across the spectrum of all mammals. There is no mammal who has its placenta processed, encapsulated, and then slowly takes it over time. My belief is, if you want to ingest your placenta, do it like other mammals do -- raw and right after birth.  Babies are built like houses. You have to start at the foundation and go in a certain order. You can't put up walls if you don't have your foundation laid. You can't put on a roof if you have no walls. See what I mean? Growing a baby and a placenta are like this...the same steps have to occur in the same order in all pregnancies. Because of this, ultrasound can give us an idea of how pregnant you are. An ultrasound done in the first trimester has a margin of error of about plus or minus (+/-) 5 days -- which means somewhere in a 10 day span is your due date. So if they say you are due September 15, that could be 5 days either way (10th to the 20th). Remember: just like all the tomatoes on your plant aren't ready at the same time, babies come early and babies come late. But we know the date given in the 1st trimester is the most accurate because the business of building a baby is done in the same order, and the construction looks about the same across the board, so we expect to see similar timelines for everyone at this point. In the early part of the second trimester, the margin or error is about +/- 8 days. This means that September 15th date is now widened to September 7th to September 23rd...again, accounting for variation in baby-readiness. But, just like rain or lack of supplies can make building a house take longer, or a sudden addition of extra workers can make building a house go faster -- the third trimester is where we see this happen. This is why the third trimester is the least accurate when it comes to dating the fetus by ultrasound. The margin of error in the 3rd trimester is about +/-22 days! This means that September 15th date now expands to August 24th to October 7th! This is why, if a care provider changes a due date in the 3rd trimester, we should really ask what evidence is being used to make that decision. The third trimester is where we see genetics come into play. If you are tall, your baby may measure big because their leg bone is long, like yours. If your partner has a big head, your baby may be estimated older because their head measures bigger than most of their unborn peers. The variations in physical traits are like the roof coming on sooner, or later, and the actual age of the baby getting lost in the ways we measure babies (head circumference, abdominal circumference, arm bone, leg bone, etc.). So, all of that to say, in the first trimester you have the closest, most accurate dating of how pregnant you are. Read more about Pregnancy Dating...
 What can I do if I leak milk during pregnancy? Is it safe to pump?
Our breasts start making changes for feeding around 16 weeks of pregnancy. Every lactating person has a different experience, and it sounds like your body is leaking colostrum. Leaking or not leaking doesn't show how much milk we will have later. For example, leaking colostrum while pregnant doesn't mean you will have tons of milk, and not leaking doesn't mean you won't have enough. It is all about our individual responses. Discovering Doulas: Understanding the Differences Between Training, Certification & Experience9/21/2019  I know as a doula and birth professional who works with hundreds of families a year, there will always be families who want a doula who has the most experience at a higher price tag, and there will always be families who are happy to work with a less-experienced doula at a lower price tag. There is no right or wrong, there is just what is right for you.
Doulas aren’t like other professionals we may sometimes link them to – take nurses, for example. You understand when you have need of a nurse that they all met a standard competency, and they all work to keep that license up. Even if your nurse went to school in Washington, or Florida, or the Netherlands, there are core competencies all nurses are expected to learn. There can be some slight variations, but for the most part, the educational requirements are similar.  I have often thought I need that wonderful old t-shirt, "Frankie say relax!", to wear when I am teaching classes or attending a birth. Could you imagine? I often joke that telling someone to relax is like telling someone to calm down -- it isn't helpful, it irritates people, and it often feels accusatory or as if someone overreacted to something. In labor we must learn when to actively relax, and when to work -- here Connie offers her thoughts on the subject. If you were to believe the movies –- coping in labor means that you look like “The Buddha of Birth.” You sit in a lotus position, gently breathing, eyes closed. People in the birthing room often think that if the laboring person is doing well, they are completely quiet and deeply relaxed during each contraction.
 Full-disclosure: I know Allie very well. I even wrote her bio as she is currently out of town at a competitive archery event. I hope I didn't get carried away -- there are a hundred more things I could say about this incredible lady, and I tried to be succinct. Her birth was an incredible journey of strength and surrender. Her husband worked like he had been a doula all his life! The birth team was around, trying to help whenever we could, but Kyle mainly stood at the helm like this was something he did every day. We joked that he needed an honorary doula certification after that. Also on the birth team were midwife LaMonica Bryant, doula and birth photographer Ellie Kolb, and back-up midwife Rachel Donckels. Special thanks to Ellie for allowing her pictures to be shared here. I had been a doula for over a year when I found out I was pregnant. I was so excited to be on this journey I had fallen in love with and learned so much about. Growing a baby inside my body was everything I had imagined it would be. I had a fairly easy pregnancy, lots of support from my husband, family, and friends that were also birth workers. I had access to tons of information and enjoyed immersing myself even more deeply into all things birth related. I was watching livestreamed births, listening to podcasts, and reading all the books!
 In 2014 I shared an opening activity, What's in Your Head? I use this as a way to help families share their concerns and fears about pregnancy, birth, babies, feeding babies, and becoming parents. It helps folks see they aren't alone in the things that might be keeping them awake at night.  Looking for variation, I recreated this idea with Legos -- little plastic building toys we have amassed numerous buckets of over the years. All of these were pulled from our private collection, although the compromise with my kids was to put them in tiny zippy bags so things wouldn't get lost. The first time I did this activity, I passed the Lego head around and had each person pull out a zippy bag and share what they thought the toys might represent. In my next series, I decided to include a card with a general worry that related to the item in the zippy bag. I had participants look at the item first and see if it reminded them of any concerns they had, and if they were stumped, they could read the card. Then we go around the group and share our items and what they might represent.
 I recently stumbled upon a gem of an article which examines pushing positions for the second stage of labor. It was published in 1987 by the American Journal of Public Health. The author, Lauren Dundes, MHS, maintains our traditional Western lithotomy position (person on their back with feet up in stirrups) was never based on any sort of evidence. What it was based on were things like:
 As a doula, it is not unusual for me to see laboring folks who start to feel like pushing when they are in an upright position, such as in the shower or on the toilet. The pressure remains between contractions, building; the person wants to push, and they are told to stop and wait for their provider. When the provider arrives the laboring patient is told to get into lithotomy position and resume pushing. Suddenly the urge seems gone! Whereas the person was just being told, "baby's right here, pant and blow, your doctor is just parking the car..." now it seems to have fizzled out.
The person may have lost the pressure to push, but the pressure to not waste the provider's time has just begun.  I recently had the opportunity to be part of a training for a local hospital's BFHI process. I wanted a tactile way for people to feel the differences in palate shapes. Needing the models to be comparable to a newborn's mouth-size, I had the idea of using plastic spoons.  |
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Stacie Bingham, LCCE, CD(DONA), CBS(LER)Calm, comfortable Lamaze education & experienced support for pregnancy, birth, & breastfeeding serving Bakersfield, Delano, Hanford, Porterville, Tehachapi, Tulare, Visalia + the World
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