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Day 30: Measured in Ounces

5/31/2016

I recently met Nicole at a local doula gathering. When she shared her breastfeeding story with me, I was overwhelmed by emotion. I immediately asked her two things: 1-How will you work through this to help other women as a doula, and 2-Do you like to write? I am so grateful she generously poured her heart out to let others know how painful and confusing it can be to face the obstacle of not producing enough milk. I say it to moms everyday: We don't expect feeding our babies to be so hard. I have worked with many moms experiencing milk supply issues due to IGT, PCOS, breast reductions, and extreme blood loss during birth. Very often there is a deep sense of loss. Thank you to Nicole, for being vulnerable and honest -- I know it will help others.

"Your worth as a mother is not measured in ounces." This, this right here has been my solid ground -- my strength when I just can't seem to stop beating myself up for things I cannot control. Let's rewind a second, shall we?

Being a young mother is never easy, especially when you're the first of all of your friends to have a baby. You have no one to look to for advice or wisdom, it's just you and a new baby who won't stop screaming and nurses who are less than helpful. I was 19 when I gave birth to my greatest accomplishment and I was so proud, but what was I doing wrong? Why wasn't she latching? Sure, I knew breast is best, but as a first time mom, the crying was overwhelming and I just wanted her needs to be met. The night after she was born she got a bottle of formula because she had been crying non-stop and hadn't eaten because she hadn't ever latched for more than two minuets at a time. I was sad but I was just happy she wasn't screaming from hunger anymore. I had about 6 women give or take look at my breasts (or lack there of) and touch them, without permission at that, and no one had any advice for me -- so I went home, formula in tow and with no regrets.

At home I continued trying to pump, trying to latch her, and just trying to get a supply when I only had drops at a time. I tried a nipple shield, pumping religiously, teas, supplements, and I just gave up because I read some women just don't respond to a pump. Afterall, she was fed so she wasn't really going without, was she?

I have since given birth again, 11 months ago to be exact. This time to my son and my second greatest accomplishment. Before I conceived him and during my pregnancy, I devoted HOURS to researching the best parenting practices, and that included breastfeeding. Breastfeeding: Natural. Normal. Tradition. Instinct. The reason the human race has survived for centuries. I learned that every woman should be able to breastfeed if she "tried" hard enough. I learned about proper latch, feeding on demand, skin-to-skin, the benefits of natural labor, tongue ties, lip ties, no pacifiers or bottles for a minimum of 6 weeks. The list is basically endless, I knew it all and I was confident. You can ask my doula, the one thing I wanted the most out of my birth plan was to be able to breastfeed, and my worst fear was not being able to breastfeed.

After 7 hours of labor I gave birth to my son, completely naturally. Yes! I did it! I was so proud of myself and immediately placed him to the breast. I remember looking at my doula and saying, "look, his mouth is big, he should latch nicely," and he did. He latched and we spent so much time nursing. We denied baths and took off that annoying hat they put on him -- everything was textbook. We went home after some time on the lights for jaundice.

Did I mention everything was textbook? It was...until it wasn't. He constantly wanted to nurse, which is normal for babies. But then I noticed he wasn't peeing much anymore, and he wasn't satisfied after nursing for what felt like an eternity. I birthed him on Friday afternoon, and by Monday he had extremely chapped lips, yellow skin, yellow eyes and little urine output, but I was basically in denial. The next day he was admitted to PICU for jaundice and had to spend 24 hours on the lights. I HAD to start supplementing because my son was starving. I was starving him. My body was failing him. I cried and cried and cried. From 7 lbs 6 oz, to 6 lbs 3 oz and NO urine output. I did everything right, why was this happening to me? I was devastated, but despite my pain I kept at it. I met with an LC who gave me an SNS and and an abundance of advice that included "if things don't change in 1-2 weeks then you just might be one of the small percent of women who can't breastfeed."

Can't breastfeed, what? Some women can't produce milk, but why?

We went home the next day and he was thriving from being supplemented, but I hated myself -- hated the body that birthed two beautiful children. It's an awful feeling, a feeling that left a wound that is still as fresh as when it appeared. I kept at everything I had learned and I never got an increase in supply. Between both sides I couldn't even pump to cover the bottom of a bottle. Prescription drugs, water, clean diet -- NOTHING helped, but why?

IGT: insufficient glandular tissue. I found a great support group on Facebook that was my saving grace, they encircled me with comfort and understanding. There are markers for IGT and I realized that I had most of those markers. Buy why hadn't I heard of this before? All of the articles I read and people I talked to and I had never heard of it. All of the medical professionals that had seen me topless and I never heard a word spoken about it. Why aren't people trained to notice this, and why isn't this a more well-known issue?

This has been a long road and I'm still suffering. I can't feed or nurture my baby the way I was designed to. He's missing out on the best kind of milk his little body was designed to live off of. We did donor milk but it's hard to come by, honestly. He's now exclusively formula-fed and I hurt every time I wash or make a bottle.

I have since became a birth doula, and I almost feel hypocritical about it. How can I offer breastfeeding support to women when I can't breastfeed myself?

I'm healing and I've come to be a huge lactivist. Just because I wasn't and couldn't be successful doesn't mean I don't know the dos and don'ts of breastfeeding, and it doesn't mean that I won't run in to someone who will struggle like I did (and still do).

My heart hurts often and I still cry a lot, but I am healing. I need to start loving my body again. My first step to forgiving the things I can't control is writing this in hopes that more people will understand this kind of terrible struggle. It may not be a big deal to some, formula vs. breast, but to others, it's extremely difficult to accept.

And that's what I have learned to accept.

Nicole is a new doula in the Bakersfield Area. The mother of two little ones, she has experienced a wide range in parenting beliefs and ideals in a short time. She understands birth and mothering isn't always about choosing what you want, and rather, adjusting the best to what comes your way. Nicole is dedicated to supporting women during birth AND breastfeeding, to help them find success as they define it, with some fine-tuning here and there according to what the experience brings.

You can find Nicole on Facebook.

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Day 7: Get Up, Stand Up! Upright Positions for Labour & Birth

5/7/2016

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Sometimes I feel like we don't hear enough about the benefits of being active and laboring/birthing in upright positions. Babies have to navigate the pelvis in a series of necessary movements. When Mom is sitting in bed, a baby must do this all on his own; if she is moving around -- sqautting, walking, climbing stairs, rocking on a birth ball, changing her positions from being active, to resting, her baby has more help to get into optimal positions. This is a true partnership between Mom and Baby -- she helps her baby in the race to meet the outside world. And as Bernie points out, this makes things better for birth.

You have just grown a tiny person,
You are Wonder Woman,
Stand up and be proud!

OK, so you may or may not feel like adopting the Wonder Woman stance for your entire labour and birth, but here are 7 great benefits to being upright during labour:

1. Do You Know the 3 Cs? Feeling Calm, Confident and in Control!

Mums who choose their own position during labour will rarely lie on their backs, and they report more feelings of confidence and being in control.
Stress hormones are lowered when adopting an upright position, allowing oxytocin and endorphins (birth hormones) to flow.
Women feel more a part of their birth team and less like a patient when they’re not lying in bed.

You can imagine it could be difficult to feel confident being the only person in the room on your back with no underwear on.

2. Shorter labours!

In a study by Lawrence, et al 2013, it was found women who birthed in an upright position had shorter births than those lying down, by up to 1 hour and 20 minutes.
The effect of gravity on the baby within the uterus helps to create more efficient surges.
With more efficient surges, birth hormones are flowing and helping to nudge baby down as well.
Stands to reason (excuse the pun) that gravity would help when you look at how we are designed – it’s a much smoother exit for baby! When you’re on your back it’s like trying to push baby up a hill!

3. Less chance of Distress to your Baby!

Getting off your back allows maximum circulation (blood flow and oxygen) between you and your baby.
Your baby is 54% less likely to have abnormal fetal heart rate patterns.
It reduces the risk of aorto-caval compression.

You know how you’ve been told not to lie on your back during pregnancy?It usually gets quite uncomfortable from somewhere in your second trimester anyway. The reason is that the main abdominal artery and vein can be compressed by the uterus and the weight of the baby, limiting blood flow. This can result in low maternal blood pressure, feeling faint, sweating and dizziness, and it may also effect baby’s heart rate. It doesn’t sound like a good idea at the best of times, never mind when you’re in labour. This does not occur when a woman is in a side lying or upright position.

4. More Comfortable Labour!

Moving into comfortable positions will help you manage your sensations. Think about what you did the last time you had a cramp in your leg – you probably got up and wiggled your foot until the cramp eased...same idea.
Women tend to move and sway during their surges. Standing, leaning on your partner, squatting, hip circles on your birthing ball and rocking on all fours can all be comfortable positions for labour.
Mums who use movement in labour find their labour sensations more manageable and have less need for epidural and other pain relief.
Birth partners can easily support mums and use comfort measures like massage and counter pressure with greater access to her back.

5. More Room for Baby!

Standing, squatting, kneeling, all fours and sitting facing forward in a chair all increase space in the pelvis.
Squatting can increase the space in the pelvis by up to 30%!
More room makes it is easier for baby to get into the perfect position for birth (back to point 2 – shorter labours!).
Babies who start out in the OP (back to back) position have more room to turn, and surges help baby turn in the uterus when the mum is supported. Helping the baby to turn increases mum’s comfort level as well.

6. Decrease Chance of Assisted Delivery by 23%!

In 2012 Cochrane Review of 22 studies, including over 7,200 women, those who were in an upright position for labour were 23% less likely to have a forceps or vacuum-assisted delivery.
An assisted delivery can be prevented by avoiding birthing on your back and common interventions such as the epidural or amniotomy (artificial rupture of membranes).
The benefits of avoiding assisted deliveries include less damage to the pelvic floor and a gentler birth for baby.
An assisted delivery may be necessary if baby is in distress or if the mum is exhausted after a long labour or long pushing phase.

7. Decrease Chance of Episiotomy by 21%!

In the same review, it was found that women who were upright in birth were 21% less likely to have an episiotomy.
An Episiotomy is a surgical cut to the perineum as baby crowns.
Disadvantages to episiotomy are increased pain after birth, more likely to cause 3rd / 4th degree tears, infection and longer healing times.
To avoid an episiotomy, birth off the bed, no purple pushing (pushing when you want to versus because you are told to), slow controlled “pushing” phase, labour in water, practice perineal massage and pelvic floor exercises during pregnancy.

Reasons NOT to Lie Down in Labour:

Because there’s a bed in the room!
Because you’ve seen it on TV and in the movies!
Because “Everyone” gives birth like that!
Because “insert name” told you to!
Because your care provider expects you to!

To Sum It All Up:

Choose whatever position you feel comfortable in:
Lie down if you need to rest or you’ve had the epidural
Choose a side lying position
Use pillows / peanut ball to create space in your pelvis
Get your partner & midwife to help you change sides every half hour.

More Information:
Whole, Healthy and Intact - Avoiding Perineal Trauma, by Tracy Donegan
What is the Evidence for Pushing Positions?

References:
2012 Cochrane review, Gupta et al., de Jonge and Lagro-Jansenn 2004; Green and Baston 2003; Green et al. 1990. Lawrence et al 2013

Bernie Burke is a GentleBirth Instructor and DONA trained Birth Doula, with a background in Holisitic therapies. Bernie found GentleBirth during her second pregnancy and fell in love with the program, it transformed how she felt about birth. She is passionate about all things birth and she has seen first-hand the positive change in her clients and their partners while using the program.

Bernie believes that when women and their partners feel empowered to make decisions about their birth, no matter what path it takes, they step into parenthood feeling confident and secure. Bernie is looking forward to assisting families as a Doula in 2016.

Supreme love and thanks to my friend Christine for allowing me to share her amazing pictures. She deserves to be a meme <3. Stacie

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Changes in the Pregnant Body: A Learning Activity

9/4/2014

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I said before I am frugal. If I had all the money in the world, I am still not sure I would buy supplies if I could get away with making them.

In my first class of six, we go over the different changes in the pregnant body. I found these paper ladies at an educational supply store, and immediately I knew how I was going to use them!

I am not an artist, but you don't have to be! I broke down the pregnant body into 9 different regions or topics. In my own interpretation, I drew. Then I glued or taped the baby doll form on the mom. On the back of each lady are the common issues associated with each topic.

In class, each person or couple gets a lady (depending on class size), and I have an order I like to go in. One by one, participants read from the back of their paper ladies. I check in with the moms, asking if anyone has experienced certain ailments, how she has coped, etc.

In my curriculum I have extensive back-up material for each of these changes, in case a family wants more information about something. An alternative to the paper ladies but still using the research information is one that always gets people giggling. Once I forgot my paper ladies at home and I wasn't sure how I could offer the information without just lecturing. I decided to have each couple draw their own pregnant lady, and label the issues themselves. Then they shared with the rest of the class. Hilarious -- I have kept some of those drawings. You wouldn't believe how much grown-ups can have drawing stretch marks or hemorrhoids!

The basis of this activity is finding the current information about the physical, emotional, and hormonal changes that happen in pregnancy, and going from there! Get out your markers, tape, and scissors, and start having fun!