The benefits of breastfeeding, or providing breastmilk to your baby, are well known. Most of my clients intend to breastfeed for some length of time.
What I try to impart in prenatal discussions with clients, however, is that intention is usually not enough to get off to a good start with breastfeeding. Maximizing the breastfeeding relationship also involves education, planning, and knowing where to turn if difficulties arise.
1. Take a prenatal breastfeeding class. There is so much more to breastfeeding than putting baby to the breast. While breastfeeding is a natural process, that doesn’t mean it is necessarily intuitive, easy, or without complications.
A good prenatal breastfeeding class should cover most of these topics:
While you may not retain or need all the information you learn in a prenatal breastfeeding class, you never know what important facts will be helpful as you learn to feed your baby. Misconceptions you may have had will be dispelled, enabling you to use the most accurate information to support your efforts.
Plus, it will be much easier to find the time and energy to learn about breastfeeding before your baby is born, rather than while you are recovering from birth and learning to feed your baby, all with limited sleep.
2. Get hands-on help with latch. A good, deep latch is one of the most important factors in establishing a good breastmilk supply.
When your baby suckles at the breast, it signals to your body to produce the hormone prolactin, which stimulates the production of breastmilk. Oxytocin is also released, triggering the let-down reflex which expels the breastmilk from the milk ducts.
When the latch is shallow, or there is a problem with latching, this hormonal interplay is interfered with and over time, your milk supply and/or baby’s ability to transfer milk from the breast can be negatively affected.
Most hospitals offer lactation support, sometimes immediately after birth and in postpartum recovery. Birth center and home birth midwives also help with breastfeeding and latch; during postpartum home visits, midwives assess baby’s weight gain and can make recommendations for additional lactation support if needed.
As a birth doula, I can help my clients with that initial breastfeeding right after baby is born, showing them the hallmarks of a good latch. Or, I can help them to facilitate baby latching on his or her own, either via a breast crawl or with a laid-back breastfeeding position. If there is separation from baby for a period of time, I can help them hand-express colostrum into a cup or syringe that can be given to their baby instead of formula, if that is their preference.
And when I visit my clients at home, either at the follow-up postpartum visit or as a postpartum doula, we can continue to work on latch after their milk has come in, trying out different positions. If there are signs of a complication beyond my scope as a doula, I can refer them to a local lactation specialist for professional support and problem solving.
Getting frequent, hands-on help with latch can ease anxiety and frustration in the birthing person, possibly avoid supply issues and injury to the nipples, ease pain or discomfort during nursing, and make the experience more enjoyable.
3. Turn to the experts for help. Breastfeeding problems and solutions can be complex and can involve several factors, including breast anatomy, baby’s anatomy, diet and nutrition, hormones, birth influences, emotional and cultural considerations, the need for supplementation, and more.
Sometimes, people get advice or help from family members or friends, or even professionals, including lactation consultants, pediatricians, and family doctors, that aren’t based on the latest research. Or the advice doesn’t take into account all of the factors mentioned above that can make breastfeeding issues challenging. They may not be familiar with alternatives or breastfeeding best practices. And they might not have the availability or resources to provide the frequent, hands-on help that nursing people often need.
When my clients need breastfeeding help beyond what I can provide, I refer them to the infant feeding experts: International Board Certified Lactation Consultants (IBCLC’s). The requirement to become an IBCLC includes extensive education, over 1,000 hours of clinical experience, and passing a rigorous exam. IBCLC’s know breastfeeding and can help you work through a myriad of problems, with solutions tailored to your individual needs and preferences.
See my Parent Resources page for some local IBCLC’s I know and trust.
4. Support for breastfeeding goes beyond actual breastfeeding. Knowing how to support breastfeeding and actually having the support you need to breastfeed are two different things.
When you are recovering from birth and learning to care for your new baby, it becomes much more difficult to learn to breastfeed when you also have to worry about preparing meals, keeping your house in order, caring for older kids, entertaining visitors, or “bouncing back” to a preconceived notion of how your life should look.
Anything that adds stress instead of reducing it can interfere with breastfeeding. Making a postpartum plan while you are pregnant, reframing in your mind for what the postpartum period should look like, and enlisting help wherever possible— whether that be from your partner, family and friends, outsourcing tasks, or a hiring a postpartum doula— are all ways to support breastfeeding.
5. Be gentle with yourself in your journey. Breastfeeding doesn’t always go as you plan. Sometimes you find that supplementation, or exclusively pumping, or formula feeding, or sourcing donor milk, or weaning, or some combination of these, is the best choice for you at any point in time.
Know that what works for you now may not be what works for you down the road. Know that if you struggle now, that doesn’t mean you will be struggling later. Know that if you hit a snag, there are people in the community who can help.
And know that your mental and physical health matters. There is no “right” time to wean, except when you and/or your child are ready. Be gentle with yourself and allow yourself the grace to find your own way.
I am a certified birth doula, postpartum doula, and childbirth educator serving clients in Boise, Meridian, Eagle, Nampa, and the Greater Treasure Valley.
What kind of breastfeeding help will you need when you have your new baby?
Most people give birth vaginally, and the majority of birth plans focus on wishes and goals for a vaginal birth. Some desire very strongly to avoid a Cesarean birth, choosing to exhaust all other options before deciding that surgical birth is their best option.
But roughly 1/3 of the time nationally (and 18.1% of the time in Idaho according to cesareanrates.org), whether due to a medical emergency, complication, or other circumstance, people find themselves giving birth in the operating room.
The circumstances of your pregnancy and labor, how prepared you are for the procedure, who is there to support you during the surgery, and how your wishes are respected during your Cesarean birth, are all things that can affect your birth experience. Even when the unplanned happens, you can still have a positive birth!
So even if a Cesarean birth is your "worst case" option, it can be helpful to plan for it anyway. Here are some things to consider, and ways a doula can help you plan for the unplanned:
1. If you are familiar with the steps of the procedure, you won’t be caught off guard. Policies and procedures can vary by hospital and care provider. Will you be alone at any point? How many support people can accompany you? Is it commonplace to have your arms strapped down? What medications will you receive? What will it feel like, sound like, smell like? Will you be able to see and touch your baby right away, or even initiate breastfeeding in the OR? What can you expect after the surgery?
Your doula can help prepare you for what to expect, and help you formulate questions for your care provider. Some policies and procedures are negotiable, and having a discussion with your care provider ahead of time can make for a more positive experience. She can also help you create a Cesarean birth plan to accompany your standard birth plan.
2. You may have more options than you think. Some of what happens during a Cesarean birth is dependent on the reason for it. If it’s a true medical emergency, you may not have as many options as if you had an “urgent” or even planned Cesarean.
In a true emergency, you are likely to be put under general anesthesia and the baby born within minutes. This is a small percentage of Cesareans. Usually there is a lot more time, and more variability in the experience. You may have a choice in:
3. Your postpartum needs may be different. Do you have a support system at home that can also accommodate your needs after a Cesarean birth? Will you need extra help moving around, breastfeeding, someone to make you meals, someone to help out with the baby? Your doula can be a great resource to plan for what additional support you may need, as well as provide referrals to specialists. You can opt to hire the support of a trained professional in your home, like a postpartum doula.
4. Your emotional needs may be different. This is where a doula can really help to listen, provide a supportive presence, validate your experience, and if needed, help you find additional resources so that your emotional recovery is treated as importantly as your physical recovery.
Planning for a Cesarean birth when you desire a vaginal birth isn’t thinking negatively, or setting yourself up for one. It’s preparation for one outcome, out of many. It’s the first aid kit in your backpack as you hike up the mountain. It’s a mental exercise.
And it’s something you can do with a supportive, knowledgable, compassionate person on your side, looking out for you no matter what happens or how you give birth— your doula.
I am a certified labor (birth) doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley.
Feel confident and prepared no matter how you give birth. Let's talk about how I can help!
It’s one of the top sources of anxiety in pregnancy . . . . . . POOP.
Whether it’s the constipation that arrives well before you have any sort of baby bump, or the fear some have about pooping in labor, there’s a lot of attention paid to poop when you are pregnant.
So let’s talk about it! Here's what you need to know about poop in pregnancy and childbirth.
1. Constipation is common. The hormones released throughout pregnancy, especially progesterone, make food move more slowly through your intestinal tract. You are able to absorb more nutrients for your growing baby, which is a good thing. The downside of this slower digestion is constipation. It can start in the first trimester, when you’re not even showing, and last throughout your entire pregnancy.
Constipation can be frustrating and uncomfortable. Straining to poop can in turn cause hemorrhoids, which can be downright painful.
Some things that can relieve constipation include:
2. Diarrhea toward the end of pregnancy can be exciting! That’s because it is one of the signs of early labor. Up to several days before you feel your first crampy contraction, your body may clear itself out in preparation for birth. Be sure to stay hydrated if you experience diarrhea, and keep yourself nourished by continuing to eat. You will need your strength for labor.
Note: If you have a fever or suspect that your diarrhea could be caused by food poisoning, then be sure to consult your care provider.
3. You will probably poop a little while you push. This is a big concern for some people. They get really anxious about the thought about pooping while they are pushing, and having their partner and birth attendants see it happen.
First of all, yes, it happens. It happens all the time. Your friends and relatives, celebrities, that put-together mom at school drop-off, your great grandma-- they probably pooped while they pushed out their babies, too.
And trust me, nobody in the room cares. The birth workers have seen it many, many, many, many, many times before. It is a total non-issue. They will just discreetly wipe away any poop, replace the Chux pad if necessary, and continue on.
In my experience, your partner doesn’t care, either. At this point, you are actively pushing out your baby, and your partner will be laser-focused on the baby, and on supporting you. They will be concerned, and excited, and hopeful, and probably won’t notice there is any poop at all, especially amidst what is infinitely more attention-worthy at that time-- like your baby being born. And when that baby is laid upon your chest and you hear those first cries, the last thing on anybody's mind will be whether or not you pooped a little.
Second, pooping during pushing is a sign that you are pushing effectively. You often hear birth attendants tell their patients to “push like you’re taking a huge poop.” Those are the muscles you need to engage to push out your baby. It’s a positive thing when you poop!
Third, if you are still really, really, stressed about pooping in labor, talk to your care provider about administering an enema in early labor. For some people, this gives them peace of mind about not having to think about poop at all.
4. Postpartum Poop. The first poop after birth can also be anxiety-producing for many. Your vagina has gone through a lot, and your perineum can feel sore as well. You may still have hemorrhoids, you may have minor tearing, or perhaps stitches.
If you had a Cesarean birth, pooping for the first time can also be uncomfortable. After a Cesarean, your first poop might take longer to arrive than with a vaginal birth. The muscles in your abdomen will be sore after surgery, which can make that first poop a not-so-fun experience.
Some care providers will prescribe a stool softener after delivery to make those first few bowel movements easier. Some will require you to have a bowel movement before you can go home, especially if you’ve had a Cesarean (true with any major surgery).
Staying hydrated after birth can help keep your stools loose. Waiting until you really have to go, and avoiding straining ,can be helpful as well.
5. Your poop situation will improve! The more you are able to rest and heal postpartum, the better you will be able to recover from birth. Eventually your poop won’t be such a source of tension in your life.
Your focus will shift to your baby’s poop, which will provide months (and years) of interest, antics, and discussion. If you don't talk much about poop now, just wait until you have a toddler. It's one of their favorite subjects.
I am a certified labor (birth) doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa and the greater Treasure Valley.
Do you have anxiety about anything in pregnancy or labor? Having a doula might help!
This is a two-part series. Look for the first part in my previous post:
What this Doula Wants You to Know About Birth
What this Doula Wants You to Know About Postpartum
1. The postpartum period is underestimated. Many people focus on the birth of their baby, choosing a care provider, a birth place, and making a birth plan. These are important endeavors, and require adequate research and planning. Yet often little consideration is given to the specifics of how life will function after the baby is here. Researching options for baby gear, registering for diapers and essentials, and choosing a pediatrician is only part of what you need to decide. Just as you need to determine who will take care of your house, older children, pets, work commitments, etc. before and during your birth, these needs will continue and perhaps be more difficult to meet when your baby is earthside. Factor in the need for physical healing, dramatic hormonal changes, and caring for your baby-- all with limited sleep-- you may realize that you need much more help than you planned for. Making a postpartum plan during pregnancy can help prepare you, your partner, and extended support system to meet the needs of the entire household after the birth.
2. Your body may take longer to heal than six weeks. There is a popular meme circulating on social media that pictures a paper dinner plate. That dinner plate represents the size of the wound in your uterus where your placenta was attached. I admit, as the mother of two kids and a trained doula, I had never considered the size of the wound inside my body after birth. It's a powerful visual. If that wound was on the outside of your body, no one-- including yourself-- would expect you to do much for several weeks after birth.
If your birth was physically difficult, you had tearing that required stitches, complications, a high-intervention birth, or a Cesarean birth, your body may take even longer to heal. In the immediate postpartum you may experience vaginal soreness, pain while urinating, difficulty pooping, heavy bleeding, contractions as your uterus shrinks back down to its pre-pregnancy size, sore breasts from learning to breastfeed, irritation or pain from your Cesearan incision site, swelling, profuse sweating, and a host of other physical discomforts.
Your care provider may "clear you" at six or eight weeks, but your body may need more time. You may not be ready for intercourse, work, chores, or outings. You may need more periods of rest, even if you feel physically better. You may need additional treatment, like physical therapy. Accept that your body went through a LOT, and allow yourself the time and grace to heal.
3. Be proactive with lactation support. If you choose to breastfeed, know that it can be difficult to get started. Taking a breastfeeding class in pregnancy is a good idea, but it may still confusing to implement what you learned when baby is actually at your breast. Add in hormonal changes, a baby that needs to eat, and conflicting advice from those trying to help you, and you have a recipe for anxiety and unnecessary stress. Seek out the support of a postpartum doula or lactation specialist early in the postpartum period to get you off to a good start. Any issues outside of normal may be more easily identified and addressed. If needed, referral to an IBCLC (International Board Certified Lactation Consultant) can be made.
Two IBCLC's in the Treasure Valley I refer clients to are Melanie Henstrom at Baby Bonds and Lynnelle King at Family Seasons, LLC.
4. Pelvic floor therapy is a no-brainer. Pregnancy and childbirth do a number on our pelvic floor muscles. Complications include urinary and fecal incontinence, uterine prolapse, pubic symphysis pain, diastasic recti, and more. In France, postpartum pelvic floor therapy is standard care. In the United States, it is not, and unresolved injury can be left untreated, causing years of pain, discomfort, and embarrassment. Check out my blog post all about the pelvic floor.
Seeing a pelvic floor specialist in pregnancy can set you up for easier care after your baby is born, or even prevent issues postpartum. In the Treasure Valley, pelvic floor therapy is now even easier to obtain, with the launch of Treasure Valley Pelvic Health, a mobile pelvic therapy provider who will come to you. Your first visit is 20% off in the month of May.
5. Your emotional and mental health needs as just as much attention as your physical health. Postpartum mood and anxiety disorders (PMAD) affect 15-20% of women. These include postpartum depression, postpartum anxiety, postpartum panic disorder, postpartum obsessive-compulsive disorder (OCD), and rarely, postpartum psychosis. Educating yourself, your partner, and close family and friends in pregnancy about the signs of these disorders can help to identify them and get treatment as soon as possible.
Even just noticing that you feel "off," and "not yourself," can be enough proof to seek out an evaluation from your care provider. Don't discount (or let others discount) the effects of a traumatic or disappointing birth experience on your emotional health, either.
Resources to begin to seek out help include Postpartum Support International (PSI) at www.postpartum.net, your care provider, or local mental health professionals with experience in treating PMAD's. You can find a recommended list of providers on my Parent Resources page.
Even if you don't suffer from a PMAD, you may feel overly tired, stressed out, emotional, sad, disappointed, discouraged, or down at times. A healthy and committed support system that allows you to rest, heal, eat well, and focus on little more than you and your new baby can maximize your chances for a positive postpartum transition. Postpartum doulas can play an important role for those without a strong support system, or those who want or need extra support as they transition to life with a newborn.
By planning for the postpartum period, building a robust support system, and taking advantage of local resources, you can start off on your new parenting journey from a place of confidence and strength. Everyone benefits from a healthy mother or birthing parent-- your baby, your partner, and you especially.
I am a certified labor doula and professional postpartum doula serving clients in Boise, Meridian, Eagle, Nampa, and the greater Treasure Valley. How can I help you plan for your postpartum?
A few years ago my son was attending a birthday party at one of those indoor trampoline places. He asked me to come jump with him, which I gladly did-- for about three seconds. I quickly told him I couldn't jump anymore and excused myself. Many mothers can guess why.
I peed myself a little.
I took one enthusiastic jump, and realized I will likely not jump on a trampoline ever again. The second thought that ran through my mind was, "Chalk up one more way Childbirth messed up my body."
I've given birth to two kids, and during pregnancy and in the postpartum period, I've faced: bleeding gums, worsening eye vision, sciatica, a permanently larger shoe size, backaches, mild carpal tunnel, night sweats, hormonal acne, hemorrhoids, hair loss, melasma . . . Mothers, you know what I'm talking about; the challenges of pregnancy aren't limited to weight gain and labor pain. But since my oldest child is now 10 years old, most of these physical side effects are long gone from my everyday life. By most measures, I have felt like "myself" for several years.
Except the pee. Sometimes it happens when I sneeze or cough when my bladder is full. It's not often enough that it negatively impacts my life-- I don't at all pine to jump on trampolines. And I know that as women age, even if they haven't ever given birth at all, it's common to pee yourself, a little bit, every once in a while. Lisa Rinna does commercials for Depends looking totally fabulous, on this very premise.
It is common. But that doesn't mean it's normal. That's a distinction I'm hearing birth professionals talk about a lot lately. And that's what Chelsea Beyers PT, DPT, OCS, a physical therapist specializing in the pelvic floor muscles discussed during a recent presentation for the Treasure Valley Doulas association. She explained that the pelvic floor muscles, a thin layer of muscles at the base and sides of the interior pelvis, support internal organs such as the bladder, uterus, and bowels. They are vital in regulating the passage of urine and feces, and play a role in healthy sexual function. They provide support for a growing baby in pregnancy. They work with the abdominal and back muscles to stabilize and support the spine. They are really, really, really important.
Weakened pelvic floor muscles can be too relaxed, or too tight. One symptom of a weak pelvic floor is urinary incontinence, and that doesn't mean that you pee your pants all the time like Lisa Rinna's target audience. Just one instance of involuntary urine leakage can signify a weak pelvic floor. Other pelvic floor problems include:
The brain plays a role in these issues, as anxiety over physical pain or discomfort can create a brain/body loop that exacerbates symptoms. Diet, psychology, and past trauma can also play a role in pelvic floor dysfunction.
Women are reminded to "do their Kegels" during pregnancy, to strengthen the mysterious pelvic floor. (Just the mention of Kegels is enough to make a woman secretly squeeze her pelvic floor muscles several times in a row . . . You know you just did some).
But not all women should do Kegel exercises. Those with a tight pelvic floor, such as long distance runners; women with a history of pre-pregnancy constipation, painful intercourse, or tampon usage; and some survivors of trauma, may actually be worsening the condition of their pelvic floor muscles by doing Kegels.
Beyers loves to see pregnant women in her office who visit her before they experience serious symptoms. Many new mothers, overwhelmed with caring for a newborn baby, and trying to heal from their births, delay getting treatment or learn to live with their new "normal." (And contrary to popular belief, women who give birth via Cesarean section are also prone to pelvic floor issues).
When Beyers sees patients prenatally, she can preemptively help them to avoid long term problems. "These are the women who won't have pelvic floor problems in the future," she says.
Then there are patients like me, who maybe didn't know they had a problem, or have been living with pain or embarrassment for years, even decades. Beyers treats women of all ages; she even has patients in their 80's, who may be sedentary but can still benefit from pelvic floor physical therapy. She tailors her treatment to each individual woman's lifestyle and goals. Poor sleep, sexual dysfunction, self-confidence, back pain, incontinence-- just about all women can find relief in these areas with pelvic floor physical therapy.
Mothers can enjoy trampolines. What is normal can and should become what is common.
Update for 2018: Chelsea Beyers, PT DPT OCS now offers mobile pelvic floor therapy! She comes to you with her new company, Treasure Valley Pelvic Health. Get more information at http://www.tvpelvichealth.com
I've worked in the forest, in the lab, and in an office cubicle. My favorite and most passionate work has been alongside clients as they reach inside to find their innermost strength, and give birth to their babies. Each birth is an honor to witness.