Maddie's Musings

On birth doulas and breastfeeding

Tips from the milky coalface

June5

The following article was written for and first appeared in my friend Naomi Kemeny’s book ‘Nurturing New Families‘.positionpic1 A book not only for postnatal doulas but anyone caring for a family with a newborn in those precious first weeks.

 

positionpic1skintoskinAs a Breastfeeding Counsellor and Doula, I spend a lot of time talking to women (and men) about breastfeeding. I also hang out online rather a lot, reading forums and blogs about my favourite subject. Here are a few of the statements about infant feeding I hear most…and my thoughts in response.

‘Before your baby is born, you’ll probably wonder how you are going to feed your baby. Here are some pros and cons of breast vs bottle to help you decide…’
In my experience, most women know what they’d like to do. Infant feeding survey results tell us that over 80% of women put their babies to the breast at birth. That’s 80% of women being pretty positive that they’d at least like to try to breastfeed. A recent NCT survey revealed that 90% of women give up breastfeeding before they’d like to – so what’s happening between birth and switching to bottles?

‘You’ll no doubt have pressure from both sides of the feeding fence!’
As a breastfeeding supporter who also has paid work to do and a family to look after, I don’t really have time to go round pinning pregnant women against the wall and ‘pressuring’ them to breastfeed. There is a distinct difference between public health information and ‘pressure’.  I don’t feel pressure not to eat too many cream cakes. I am aware of the risks of obesity and a high fat diet. I feel a bit guilty when I have one too many biscuits, but no-one is MAKING me feel guilty or pressuring me to eat salad.
There is pressure to formula feed though – from friends and relatives who know nothing else, from TV that never shows a breastfeeding mum – or if they do, she’s having problems – adverts, social networking and free gifts/’carelines’ from formula companies and mothers who have never had the chance to fully debrief from their own experiences and therefore lay their negative feelings on other mothers. Then there are the people who liken public breastfeeding to public defecation, breastfeeding women and their advocates called spiteful names…I could go on…

‘Lots of women can’t breastfeed. My sister’s nipples nearly fell off!’
I listen to a sad stories every day. It is hellish to go through such pain and disappointment. I often wonder if a properly qualified and experienced Lactation Consultant or Breastfeeding Counsellor may have been able to shed some light on their problems. When things veer away from normal and into the category of the more unusual problem, women need a properly qualified specialist – as with anything else. (I wouldn’t expect a midwife to be able to perform a c-section, or a GP to be a consultant dermatologist, for example).

‘If it weren’t for formula, my baby would have starved! All Mothers should be free to make a choice’.
It must indeed be a relief to finally find the resolution to your pain – if no-one is offering a solution that enables us to continue to breastfeed whilst staying sane, most mothers would agree that this doesn’t leave us with much choice! Freedom of choice is of course very important indeed, so I wonder why more women aren’t angrier about the lack of skilled support available to them. Lack of information and skilled support effectively take away our free will to decide how to feed our babies.

‘It’s not as if formula is poison!’
There is a social taboo around talking about the risks of formula. It seems we only have permission to talk about the benefits of breastfeeding – and only if we don’t ‘ram our dripping breasts down people’s throats’. Like every other subject that stirs passionate feelings, there are some evangelical zealots; women who are enthusiastic about breastfeeding and want to share their own happiness with others. They may know quite a bit about the risks of formula and what the baby misses out on when denied the nursing relationship. However, they may not have much experience working with mothers and therefore lack insight into the varied and complex reasons why some mothers may feed their babies formula. They don’t have full knowledge of the social and commercial pressures that impede breastfeeding. They have not learnt to reserve judgement or how to use language that doesn’t appear judgemental – a skill that is really difficult when everyone reacts to things in different ways.

‘The Breastapo should stop sticking their noses in’
So reading my comments so far, would you consider me a card-carrying member of the ‘breastapo’? Seems a strange and wholly rude and upsetting word to choose to describe women who volunteer their time to help, support and counsel new mothers. They are women who work in drop-ins, volunteer on hospital wards, visit mothers in their homes, answer helplines late at night. They do not have an agenda to make women breastfeed. They merely want to support them to reach their stated goals…and if those goals change along the way, they will support them to find the solutions the mum can be at peace with.

But this word ‘breastapo’…is it meant to conjure up images of Nazi thugs who brutalised and murdered millions because they were ‘different’? Perhaps such grotesque language might put off some mothers calling for help? The words we use matter.

‘I thought Breastfeeding would come naturally’
Breastfeeding is an interesting combination of instinct and learned skill. We need more antenatal education, more skilled and knowledgeable support for all mothers, less intervention in birth and unnecessary separation of motherbaby. We no longer grow up surrounded by breastfeeding and therefore learning ‘at our mother’s knee’, so now it’s a skill we have to learn from scratch ‘on the job’.

‘It’s normal for your nipples to hurt at first’
How much pain, and how long for? Just as the baby latches? All the way through a feed? It’s called breastfeeding, not nipple feeding. If it hurts, if the nipple is pinched or the shape of a new lipstick, get help – whether that’s day 1, day 10 or month 36. Breastfeeding is like dancing; at first we need to find the rhythm – with the music and each other – so we can easily thread on each other’s toes. So, whilst pain while we’re learning is common, it isn’t normal.

‘Breastfeeding is time-consuming and tiring’
Really? Popping my little one in a soft sling, letting them latch and getting on with my day is time consuming? Getting to sit down and watch daytime TV whilst I nurse, might be time consuming and a slightly guilty pleasure, but I’d rather do that than stand in the kitchen washing up bottles. Having a baby is tiring and emotionally overwhelming at times. How you choose to feed your baby makes no difference to that. Just so you know, the hormones of breastfeeding are designed to make sure you fall asleep quickly and easily after feeding your baby at night.

‘Nursing in public is difficult and embarrassing’
We live in a culture in which breasts have become sexualised; used to sell cars and make fortunes. Necklines plunge to the navel on an A-list celebrity whilst nursing mothers are asked to feed their babies in the toilet. It’s why we need education, it’s why we need people to be positive about nursing in public and to pass on practical tips to make it less of a daunting prospect. We need existing legislation tightened and greater public knowledge of a mother’s right to nurse anywhere and everywhere. It means empowering mothers to feel good about what they are doing and remember that there is nothing weird or offensive about using her breasts for what they are meant for.

‘Bottlefeeding Mums are judged’
Yes, some women choose not to breastfeed. Many women would be breastfeeding if things had been different. We have no right to judge. A teenage girl may fear the jibes she might get. The woman who has been sexually abused may feel revulsion at the thought of a baby at the breast. A woman so traumatised by trying to feed a previous baby may feel she can’t face even trying this time. We have no right to judge until we have walked a mile in her shoes. And that goes both ways. Breastfeeding mums are judged, criticised, asked to leave, made fun of, called names. They are the last sub-group that it is politically correct to abuse.

‘There are lots of things breastfeeding mums can’t eat and drink’
Breastfeeding Mums can eat and drink pretty much anything! There are more myths about eating and drinking while breastfeeding than anything I’ve ever come across. A mum who is drinking enough caffeine to upset her baby might want to reduce it for her own health anyway. Yes, you can have a glass of wine. And where DID the chocolate myth come from? Or the grapes, lemons and spices? Evolution would have played us a pretty weird trick if suddenly human mothers had to completely remove herself from the diet of her tribe. Since when have you seen cows stop eating grass because they’ve had a calf?

‘You’re making me feel guilty…
Mmm Guilt. That lovely buzz word that immediately gives people the moral high-ground in one fell swoop. I gave formula to both my children. I don’t feel guilty, I feel angry that I didn’t get the information and support I deserved. I feel angry that I was told I didn’t have a choice. These arguments about guilt are intellectually lazy, misleading and ignorant of the complex and subtle pressures and social mores that undermine breastfeeding and line the pockets of the formula manufacturers.

So now I’ve busted a few myths, here are my top tips for getting off to a good start.

Feed your baby as often as he stirs. Keep him skin to skin as much as possible and work with a skilled helper to perfect the latch so it’s comfortable for you both. Consider leaning back comfortably, with your baby on your chest and allowing your baby to find the breast by himself. See www.biologicalnurturing.com

If you feel the help you are receiving is not skilled or appropriate, demand to see the Infant Feeding Coordinator or call a breastfeeding helpline – arm yourself in advance with these numbers and try not to feel shy to use them; they are answered by qualified Counsellors who have trained hard to be skilled enough to support you over the phone. Oh – and they WANT to answer your call, so please don’t think you are bothering them. These women eat, sleep, breathe breastfeeding support. Yes, I know. Weird. We admit it.

Learn to hand express – you can practice this skill before your baby is born, from around 35 weeks onwards. See http://newborns.stanford.edu/Breastfeeding/HandExpression.html

If your baby has low blood sugars or jaundice, there may still be not be any need for supplementation. Hand express and ‘top up’ your baby with colostrum in a syringe or spoon and ask a Breastfeeding Counsellor or Board Certified Lactation Consultant for support.

Sleep when your baby sleeps in the first few days – the ‘cluster feeding’ often happens at the tail end of the day when you’re at your lowest ebb.

Sleep close to your baby – that way you, your boobs and your baby get into synch that little bit more quickly.

Learn to recognise when your baby is drinking, and how to keep him drinking if he is sleepy at the breast. http://www.youtube.com/watch?v=Wj9tLgYn-bA

Trust your body and your baby – just as your body is perfectly designed to birth, so is it set up to feed and nurture your baby in the optimal way.

Problems and challenges do sometimes crop up, but it’s rare that things can’t be sorted out with help from someone skilled and experienced.

If you do decide to supplement with formula, remember that small amounts more frequently are better than large feeds less often, which can make the baby sleepy and less likely to latch back on.

Consider NOT having formula and bottles in the house ‘just in case’. It can be hard to not be tempted at 3am when things feel difficult – and if medically indicated, formula is available 24 hours a day in hospital or in Tescos.

The first days of breastfeeding can be challenging and intense, just like labour and birth. But just as labour works the way it does for a reason, learning to dance the breastfeeding dance usually results in a feelings of pleasure and empowerment for all the family – and the music of the dance is different for everyone, so try to be led by your baby.

Seek companionship and support from other breastfeeding mothers. The female of our species is designed to be surrounded by her sisters during her transition to motherhood. Things never seem so bad when you can share with others who understand. Online, there’s always someone awake with you at 3am (Try Dispelling Breastfeeding Myths for a starter)

Stay in the moment and remember that you are the expert on your own baby!

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Freedom for Birth

September10

What is Freedom for Birth?
“Freedom for Birth” is more than just a film. It marks the beginning of a movement that will focus global attention on the violations of women’s rights during childbirth all around the world.

All women should have the right, protected by law, to decide where and how they give birth.

The problem is that the rise of a dominant obstetric “machine” is robbing women of this right.

The result is that many women are being subjected to medical interventions and c-sections they neither want or need.

Tragically, midwives, the very guardians of normal birth, are being persecuted and criminally prosecuted to the extent that some have even been imprisoned.

“Freedom for Birth” will highlight the human rights abuses happening right now in North America, Europe, Australia and beyond.

And, the film will offer up a solution that can help protect womens’ rights
And that solution involves you!

1000 simultaneous premiers of this important film will take place around the world on 20th September 2012. Is there a screening near you? Find out here http://www.oneworldbirth.net/

Can you come to a screening in Cambridge? We will be honoured to have the film maker at one of 2 screenings at the Arts Picture House as part of the Cambridge Film festival. Details here: http://www.cambridgefilmfestival.org.uk/films/2012/freedom-for-birth

I’ll be at both screenings and will be part of a panel for a Q&A session in the evening together with Francoise Freedman of Birthlight fame and Sophie Messager, trustee of Birthlight and NCT Antenatal Teacher.

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Doulas DO Make a Difference!

March21

Survey Shows Doulas Have Significant Impact on Birth and Breastfeeding

Chances of an intervention-free birth and successful breastfeeding increased with doula support

Parents-to-be are far more likely to attempt and continue breastfeeding, and less likely to require intervention during their child’s birth, if they have turned to a doula for support, according to the findings of a new survey.

The survey has been published by Doula UK ahead of World Doula Week, which begins on Thursday 22nd March 2012. It gathered data from 105 doulas and their 1,106 birth clients across a range of critical birth-related areas.The most dramatic figures relate to breastfeeding and birth interventions. Women who used doulas need significantly less medical intervention in the birth process and had greatly increased breastfeeding success compared against the national average.

With over 500 members, Doula UK represents the largest number of doulas in the UK. Its doulas work with women and their families to prepare for the birth of their baby, helping them to fully explore their options, make informed decisions and support them as they adjust to life with a newborn baby.

Of the doula-supported families, 93 per cent attempted breastfeeding and 70 per cent were still exclusively breastfeeding after six weeks. The figures are significantly higher than the latest national figures from the Department of Health, which show only 74.1 per cent of new mums attempt breastfeeding, and just 47 per cent are still exclusively breastfeeding at six weeks.

The survey showed that only 12 per cent of doula-supported births required medical interventions, such as the use of forceps, ventouse or Caesarean sections, compared to the latest national figures of 37.3 per cent.

Bridget Baker, Board Member and Head of Doula Mentoring at Doula UK, said: “Our survey findings echo previous research in to the substantial benefits of doula support during pregnancy, birth and the postnatal period. The results show that when women and their partners are well informed about breastfeeding, are signposted to good resources and have someone to turn to who is there to listen and offer unconditional support there are significant improvements in breastfeeding success rates.

“Elsewhere, the survey found that the frequency of medical interventions, that many women wish to avoid, decrease by over 25% in births supported by doulas. Though our doulas support any kind of birth and are not there to change outcomes it is startling that when women have this experienced and continuous support available to them during labour, they are much less likely to require serious interventions like Caesarean sections.

“Whatever path a birth takes our doulas always work with the midwives and other medical professionals to ensure that parents are kept fully informed about the choices that are available. This allows parents to confidently make decisions with which they are comfortable with in a nurturing and positive environment.”

To find out more about Doula UK and its network of doulas visit www.doula.org.uk

World Doula Week will launch with World Doula Day on Thursday 22nd March 2012. The international week coincides with the spring equinox, which in a number of cultures represents the return of fertility. For more information on World Doula Week visit www.worlddoulaweek.com

 

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Vaginal Birth After Ceasarean – it IS possible, even after 2!

February20

Stan’s birth – a VBA2C. This story is shared with permission in the hopes that it will provide inspiration to other women who would like to VBAC. Many thanks to our wonderful client for allowing me to share it here!

My third beautiful boy, Stanley, was born on January 24th. After two caesareans I finally got the
natural delivery that I hoped for. It is hard to know where the journey started, but I should give some
quick background and say that I had my first 2 babies in Brazil, a world champion of C sections! I
have always queried the need for both (DS1 – SROM followed by induction and failure to progress at
39 weeks, DS2 – SROM at 37 weeks followed by doctor could not wait and you already had one CS –
seriously!). I was determined and confident that with number 3 it would be different; especially as I
was now having my baby in the UK where natural deliveries are the norm.

How wrong could I be?? My first meeting with the registrar was literally appalling and left me crying
for a few days as he just wanted to book me for an elective caesarean and told me I wasn’t going
to be allowed a natural birth because of the risks I was putting my baby under. After a few days I
picked myself up with the help of a friend who had the most amazing home birth and started looking
for support online. I joined a couple of online support lists and started reading everything on the
subject. The turning point of my pregnancy was the decision to hire a doula to support my VBA2C
and this was indeed the best decision I could have ever made.

My wonderful doula Maddie suggested I had shared care to ensure I would definitely have someone
available during labour and introduced me to the lovely Candie, both of them were fantastic! From
that, I met the Supervisor of Midwives at my local hospital and was surprised to find a lot more
support for my decisions. I had chiropractice sessions to ensure my pelvis was aligned, had a lot of
support from my homeopath and took HypnoBirthing lessons. Everything was coming together and I
was in the right state of mind, despite going through major endless building works at home, the only
thing that stopped me from choosing a homebirth. I prepared a detailed birthplan with the help of
my doulas and husband and felt confident.

As both my boys arrived earlier, I was very surprised when 40 weeks came and went. I started
worrying about getting to 42 weeks and having to renegotiate with consultants. I woke up on Sunday
(40+5) and had a show, which was great and thought things are starting, yay! Sunday night my
surges were picking up on intensity and I kept breathing through them. At around 1am on Monday I
texted Candie and we thought it was time to go in. I was checked at 3am by the most lovely Midwife
who established I was 3cm and with irregular contractions but they were doing the work and she
was happy for me to keep going and agreed to check me later, promising I could go to the pool when
4 cm and have the water birth I so hoped for. She gave me a TENS machine to help with the pain on
my back which really helped, while Candie helped by holding and slightly squeezing my hips.
Unfortunately it was end of her shift and the new midwife looked at me breathing through my
irregular surges and decided I wasn’t in established labour and should just go home without
checking for any progress. I was upset about going home and having to labour with all the builders
and noise around and also trying to deal with the fact that despite having really strong surges I was
apparently not in labour, so would I be able to cope when real labour started? Could they be a lot
more painful than what I was feeling? Although I could cope with the tightenings, my lower back was
in agony. Monday night came and I was still having really irregular contractions, some horrendous
others mild, sometimes 10 minutes apart then 3 minutes, so I kept telling myself I am not in labour
but really thinking I can’t cope any longer. The only comfortable positions were sitting on the loo or
on the birthing ball. At one stage I was sitting on the loo with a blanket and a travel pillow, sending
messages to friends and the online support group asking for reassurance. In hindsight this was
transition and the end was very near, but little did I know.

All of a sudden I noticed the contractionshad changed
and my body was pushing! Still in completely irregular fashion… Then my waters went.

I called my doula and the hospital and God knows how we made it there. With every surge I had
to go on all fours in the hallway leaving the house and in the car. My poor husband was wonderful
getting me there. We arrived at the hospital just past 11pm (I think… it is a bit of a blur). The new
midwife established I was 10 cm and happy for me to keep pushing. I held onto the upright head of
the bed and with each surge I could feel my baby coming to me. My doula Maddie and my hubby
kept coaching me through the surges, all was progressing well. Then a registrar came in to ask a lot
of questions about previous CS and scar pain and we need to put a cannula, and Maddie dealt with
all that. Unbelievably it turned out they had misplaced my birth plan, so I had a clueless MW and
registrar insisting on all the things we had already negotiated and there I was pushing my baby out!
Then baby’s heartbeat started slowing down at the end of contractions and the registrar asked me
to sit on the bed and put my legs on stirrups so she could help out. I seriously panicked and said I
wanted to have one more goal of doing it myself. All I remember was Maddie saying in my
ear: “don’t be scared, push through the fear, really go for it” and then looking my hubby in the eyes
and holding his hand tight and he said: “come on babe, you can do this, push him out” and with the
next contraction I pushed with my body, heart and soul and spoke to my baby to come to me and his
head was out! I touched his little head and felt really empowered. The cord was around his neck so
the midwife asked me to pant while she freed him. The rest felt so easy and surreal, I birthed the
rest of his body and my baby was there in my arms. We had skin to skin and waited for the cord to
stop pulsating before my hubby cut it. Then I just sat there drooling over my newborn while the
midwife was getting worried about my lack of contractions to birth the placenta. After sometime she
just asked to have a look and it turned out it had already detached and it was all out and I hadn’t
even felt it. My beautiful Stanley was born at 12:15 am, just about one hour after we arrived at the
hospital, weighing 7lb 12oz (3,510kg) at exactly 41 weeks.

Due to the speedy super pushing, I ended up with a second degree tear, which needed stitching
unfortunately, instead of my planned breathing baby out calmly. I didn’t get everything I asked for
in my birthplan and I definitely did not have a textbook labour. I should have trusted my body a lot
more and I am very thankful for my doula who coached and supported me and briefed the staff
when it became clear they had lost my birthplan. Also my hubby who believed in me when I needed
support. I still can’t quite believe I did it, I had my VBA2C! I hope my experience helps other women
out there who want the same. Surround yourself with supporting people and trust your body. I am
thrilled with the output and totally in love with my beautiful baby.

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Message to ‘militant Safety-ists’: Not all mums want to strap their babies in. Get over it

January12

The following is satire, designed to show what a load of cobblers this article is. It appeared on the Telegraph blog on the 11th Jan 2012.

Thanks to The Analytical Armadillo for the inspiration.

It is a testament to the wiliness of the safety lobby that even research which discovers that there are benefits to allowing babies to sit unrestricted in cars must nonetheless be spun in “carseats are best” lingo. A research team, which interviewed 300 mums on the temperaments of their babies, babies strapped into carseats whilst travelling in cars are often “more cranky” than unrestricted ones.

That is because it is against the law –  certainly the unwritten laws of polite society – to say anything critical about carseats or positive about cuddling your baby on your lap in the car. As a result of intense campaigning by self-styled “militant safety-ists”, or “the Carseat Nazis”, as some of their female critics call them, the message that “carseat is best” has became a godly diktat in recent years, which you challenge at your peril. The NHS relentlessly advises new mums that they must strap in their kids if they want their baby to grow up healthy and happy, inducing waves of guilt in those who, for various reasons, can’t afford a carseat or who just don’t want to.

Anyone who thumbs her nose at the bible of “carseat is best” should expect flak. When glamour model and businesswoman Pricy Kate said she preferred to to just chuck her kids in the back, you could be forgiven for thinking she had said “I love Hitler”.  She was denounced as “appalling” and accused of taking part in an “extremely cynical stunt”. The end result of the constant “carseat is best” browbeating and the expunging from public life of all images of children floating free in the back is to communicate the idea that there’s only one proper, decent, good way to transport your infant: in a carseat. And if you don’t, you’re an “appalling” mum.

This leads to the guilt-tripping of large numbers of new mums, especially working-class ones. Less well-off mums are far less likely to to buy an expensive carseat than middle-class mums.  Some say this is because working-class women aren’t getting the right kind of  info. That seems highly unlikely. Some of these women, like Pricy Kate, just don’t like the idea of strapping their kids in. And that’s their prerogative.

Or it would be, in any normal society. However, in our carseat-worshipping society, choosing to not strap your kids in the back, in expensive rear-facing seats is depicted as either dumb or wicked. Whatever happened to the idea of choice, to the notion of allowing women to decide for themselves, free from the pressure of health-worker hectoring and Brussels-enforced ‘health and safety nutters’, how they want to bring up their kid?

Disclaimer: Now I KNOW not putting an infant in a carseat is illegal. I’m not suggesting for a moment that formula should be illegal or that the law should dictate that mothers should breastfeed.  We use carseats because we understand the risks of not using them not because the law says we should. The problem with the subject of breastfeeding is that the majority of people just don’t understand the risks of not doing it

Breastfeeding Supporters are not militant nazis. We just work, out of the kindness of our hearts to support women in their choices and offer them the chance to make those choices informed.

2nd dislaimer: formula saves lives – sometimes. The vast majority of women WANT to breastfeed. 90% of women when asked if they would have liked to have breastfed longer, say yes, they would. Baloney about pressure to breastfeed is a red herring – they know they have freedom of choice. What they don’t have is skilled, knowledgeable support – and that’s what stinks.

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Twin Birth – How it CAN Be

October30

A very special, very strong, determined and wonderful client has given me permission to share her story here. After a homebirth first time round, she had implicit faith in her body’s ability to grow and birth her babies in a very ordinary, normal way. It took us a while to get our equally trusting, supportive team together for a planned hospital birth, but we got there – and this is how it went. Much love and thanks to you, Super-Twin-Mum – I know your story will be an inspiration and an education to my readers.

I went into labour at 38+4 (to consternation of doc who wanted to induce at 38w but agreed to wait until 39w).  They faffed around for a couple of hours on my arrival deciding whether to treat possible strep infection (they did).  Then they wanted me to wait for a doc to scan me and check the babies’ positions.  This was a crucial point, when my doula reminded me I had a choice to go to the bath now, or wait.
I got in the bath, fantastic!

Intermittent monitoring throughout.  MW asked me to get out when my breathing changed, doc came to scan me and both babies were head down, a surprise as twin 2 had been transverse/breech for weeks.  I think he turned on the way back from bath, as things felt very strange and the heartbeat moved from high up to low on my bump.  Waiting for the scan proved to be the best decision I could have made.

Then they asked me to kneel on the bed, started continuous monitoring. The shift change was coming up, and they wanted to see where I was up to, so I agreed to another VE, and the MW was surprised I was only 7cm (having been 6cm on arrival).  They offered ARM, which I accepted, because I didn’t want docs brought in.  I do wonder what would have happened if I’d said “wait and see”, but the ARM tipped me into transition just about immediately.  I got the “dream team” of midwives at the shift change, (both v experienced), possibly because I was so obviously in transition, and had been a bit of a pain in the arse arranging my birth plan in advance.  I started demanding an epidural.  The mw explained I would need to lie down for 30 mins monitoring.  I said “oh I can’t do that” and started pushing.

Twin 1 arrived 13 minutes later (back to back), contractions paused briefly for me to say hello, and twin 2 arrived in 3 pushes 6 minutes later.  No syntocinon till after he was born (docs had really wanted it to start immediately after arrival of twin 1, but I negotiated a 15 minutes window).

Babies were born about 7 hours after arrival and we were home 8 hours after that.  Apparently there were obstetricians and paeds knocking at the door, but the midwife told them to go away.

To some extent I was lucky though, not sure how things would have gone if twin 2 had stayed transverse, as the birth plan stated that the mw would have called the docs then.  As it was, it was great to be in the care of confident caring midwives and supported by my wonderful partner and an experienced and confident doula..  The euphoria of the birth carried me through for several weeks.  I wish I could thank them more.  And this also shows it’s never too late for twin 2 to turn.

The Who’s Who of Breastfeeding

September11

Breastfeeding mums can have a variety of people rock up to help in the early days – and in my experience, many parents can be pretty confused as to who’s who and what experience and qualifications they have. This seems like a massive shame to me  - personally, if I wanted to learn Italian, I’d want to make sure that my teacher was fluent in the language and had some accepted, recognised qualification in how to teach it – or at least a wealth of on-the-job experience.

And even if the parents aren’t interested (after all, if this lady can help me, I couldn’t care less if she were the Devil in a dress) it seems that many health professionals and doulas need a quick lesson in who we all are, where we come from and what we are qualified ‘to do’.

So this, to the best of my ability, is a quick run down of who’s who in the breastfeeding world. If you spot any mistakes or ommissions, please take a moment to correct me! I know a bit about BfN and ABM but less about LLL and NCT and am not a midwife or health visitor or any other kind of health professional, so the following is what I’ve picked up along the way.

La Leche League

LLL was founded in the US and has grown worldwide in the intervening years. It is a voluntary organisation run by mothers, for mothers. LLL Leaders learn by working with their local group, with a tutor and home study. In recent years, LLL have begun teaching Health Professionals, like Midwives and Health Visitors to provide training to groups of mothers to become LLL Peer Supporters (local breastfeeding mothers trained to provide emotional and informational support to their peers). LLL Leaders must have breastfed themselves and be willing and able to give to their communities during and after the training. The standard of education is high and Leaders have ample opportunity to debrief from their own experiences, are more than qualified to work with normal breastfeeding, recognise problems and offer suggestions to solve those problems. They are also trained to recognise when to signpost mothers to Health Professionals. LLL do not charge for their training but expect Leaders to work in their local communities or on the helpline after qualifying.

National Childbirth Trust

NCT Train Breastfeeding Counsellors as well as Antenatal Teachers alongside their many other activities. Their training has a reputation for being very academic and rigorous (the qualification is University accredited) and, like the other charitable organisations, Counsellors have a good opportunity for personal growth as well as gaining the knowledge and skills to support parents in their breastfeeding journey. Those wishing to access training are expected to engage with their local NCT group before, during and after training. My understanding is that local groups may provide grants to enable women to train.

Breastfeeding Network

BfN’s entry-level course is the Helper Course. This takes 12 weeks of weekly tutorials and home study. Helpers are ‘well-informed friends’  and considered the equivalent to what others may call a ‘peer supporter’. Helpers can then move on, if they wish, to the Supporter Course which can take up to 2 years to complete (in line with the other organisations) due to the depth of knowledge, skills and personal growth necessary. BfN’s qualifications are accredited by Open College Network. Training incurrs little cost for the applicant, but it is expected that are, or have been, nursing mothers themselves and that they will volunteer in their local communities once qualified. Training is usually face to face in small tutor groups.

Association of Breastfeeding Mothers

ABM is another charitable, voluntary organisation formed 30-odd years ago in the UK. Their entry level course is the Mother Supporter Course, usually done as distance learning with the support of a tutor available by phone/email. The course is sometimes taught face to face by an ABM tutor in group settings. Mother Supporters can apply to Breastfeeding Counsellor training, which comprises a number of modules that the trainee works through at home. ABM also have courses available that have a fee attached so that women who wish to train can access this education if they don’t fit the usual entry criteria.

Whilst the women who train with these organisations are not health professionals, we are trained to be able to support mothers through all manner of challenges to breastfeeding, learn high quality communication and counselling skills, understand our boundaries and work as a member of a team with the relevant health professionals.

All 4 organisations insists on annual re-registration,  supervision and constant continuing education, updates and on-going learning.

You should not pay for help from a woman wearing a badge from one of the charitable organisations above. This support is set up to be free at the point of contact. Some breastfeeding supporters receive payment, for example, from Children’s Centres or the NHS to run breastfeeding clinics, drop-ins or groups.

Some trained breastfeeding supporters are also doulas or in private practice in other, related roles. They should always explain very clearly to you what ‘hat’ they are wearing and what you can expect to receive from them according to the role and the service they are providing you.

Midwives and Health Visitors 

Many midwives are very skilled at breastfeeding support. Many have trained with one of the organisations above; others have picked up a lot of wisdom and skill along the way. Sadly, midwives don’t generally have much opportunity to debrief from their own breastfeeding experiences during their training. Some may not have breastfed their own children. Some of the most amazing breastfeeding supporters I know didn’t breastfeed, though, so that shouldn’t undermine your faith in a midwife who knows her stuff. However, some do pass on advice that might have worked for them, but isn’t evidence-based, or believe certain things about breastfeeding or formula because they are advising you based on their own experience. If your local hospital is accredited by the Baby Friendly Hospital Initiative, all health care workers who care for mothers and babies should have received a certain amount of additional training in breastfeeding – roughly equivalent to peer support training.

Health/Maternity Care Assistants

Some of these are great too – they may have lots of experience, knowledge and skill. However, they may also have next to nothing.

General Practitioners

GPs may have educated themselves. When it comes to training, as far as I can find out, medical school includes a little about the anatomy of the lactating breast and not much more. The Baby Friendly Initiative and the Voluntary Breastfeeding Organisations are trying to address this unfortunate state of affairs.

Doulas

All doulas who have done a Doula UK approved Initial Preparation Course will have a very basic grounding in breastfeeding – some simple techniques to help you latch your baby, for example, and lots of signposts to your local breastfeeding support services. We all have differing levels of skills and experience, so do ask your doula. Some will have trained with one of the Voluntary Orgs above, others will have learnt a lot over the years by on-going learning from study days, reading, internal courses provided by Doula UK-approved Trainers and lots of working with mothers (our best teachers, whatever our training!!)

International Board Certified Lactation Consultants (LCs)

This qualification should be the gold standard of breastfeeding education. LCs have either come up through one of the Voluntary Breastfeeding Organisations or is (or was) a Health Professional. Applicants must have a certain number of hours working with breastfeeding mothers and their babies under their belts, have a large amount of formal breastfeeding (and health-related) education and then have to sit an exam. They must resit the exam every few years as well as commit to continuing professional development. LCs are either working within the NHS or in private practice (or both) and are often the magical panacea for the more difficult, entrenched or challenging breastfeeding problems. LCs are generally angels who can rescue even the most depressed and hope-less mothers and many are now training to be able to divide tongue-ties, thereby saving even more breastfeeding relationships.

Recent events have eroded my faith in the International Board of Lactation Consultant Examiners somewhat but more of that another time!

In reality, whatever your breastfeeding supporter’s origins, please remember that we all have different amounts and different types of experience. Education, however wonderful, only gets you to a place where you begin to realise how much you don’t know! It is only by working with parents for many years and continuing to learn from our colleagues that we begin to hone our skills.

And of course, a big proportion of the work we do is about mothers’ (and fathers’) emotions, preconceptions, family, social and cultural contexts and histories. Mothers may have unresolved emotional issues from the birth or pregnancy that they are still dealing with and there may be worries about the baby as well as often physical pain the mum may be dealing with. This all takes tact, loving care and high quality counselling skills – and we can’t get it right every time – we’re human and we’re all still learning every day.

I look forward to hearing if this has answered any of your questions, or if you can clarify any of my descriptions – or even if you disagree with me!

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When we let the Ad Men decide the health of our children

August24

Cow & Gate, one of the UK’s biggest baby and toddler brands, has shifted its entire consumer PR work to Frank PR and launched a major campaign promoting toddler nutrition.

So says the press release on PR Week

And so the PR machine cranks into action; millions spent on persuading mothers that “Toddler Milk” is somehow part of a nutritious, balanced diet. Not content with selling us the idea that babies need the milk of another species, they now realise they can maximise profits by peddling the idea that toddlers need fortified cows’ milk drinks.

They don’t. In fact, the high content of some minerals (like iron, for example) in these drinks could actually cause a child to have higher than necessary levels – which can have negative ramifications. If a child is getting a balanced diet, why would he need fortified drinks? Why would he even need cows milk – which is only one of a wide range of sources of calcium?

Worryingly, one of the main focusses of this marketing campaign will be on us ‘mummy bloggers’.

It is thought that the growing ‘mummy blogger’ community has been identified as a key target, given its growing importance as an information source for parents.

I can see why – we won’t eat into the marketing budget too much and mums listen to each other.

If you are a ‘mummy blogger’ would you be tempted to get on board the ‘Cow and Gate PR train’?

I for one won’t be exploited in this manner but let’s face it, even a quick glance through this blog would probably scare them off ;-)

Just so we are completely clear here, follow-on milk, toddler milk, night-time milk and every other packaging variation of essentially the same product are concepts dreamt up by the marketing guys in order to get round the law that states infant formula (for babies less than 6 months) can’t be advertised. By marketing this stuff, they increase sales of their infant brands too. You are being persuaded to buy a product that you don’t need by telling you it’s a healthy addition to your child’s diet. Yes, if you call a highly processed junk food, high in starch and transfats a healthy addition.

These kinds of foods increase a child’s chances of developing diseases such as diabetes and heart disease later in life.

Bizarrely, the UN is proposing to work with manufacturers of these ‘foods’ on public health strategies. If you think this is a unholy alliance, do sign the One Million Campaign petition here

A product designed to save infants’ lives in the rare event that breastmilk is not available has been allowed to burrow it’s way into our consciousness so radically that many now continue their brand loyalty til the child is almost school age.

How ironic that it seems easy to buy into the concept that a child needs extra vitamin and mineral support til school age but in the same breath judge those mothers who continue to support their child’s development with breastmilk.

I am now officially old enough to say “the whole world’s gone mad”.

When is speaking the truth passing judgement?

August11

If you spend anytime time at all hanging out on facebook or twitter in the ‘birthy/breastfeeding crowd’ you may well have seen a new crop of pages in recent months. They cover some pretty controversial subjects, such as ‘sleep training’ babies, Baby Led Weaning and ‘natural term breastfeeding’.

Some of the more established pages have thousands of followers and provide community, education and support to a great many mothers. Many of these pages are run by extremely informed women – breastfeeding counsellors, midwives or lactation consultants, for example, and therefore aim to provide and share information that is as evidence-based as possible.

Some of them also feel a vocation to expose bad, dangerous, outmoded and misleading advice that is often dished out by self-styled ‘experts’.

Of course, if you have followed advice from any of these unqualified ‘gurus’, or if you believe that being non-judgemental means remaining completely impartial, then these articles may seem upsetting.

I think this might be just a little short-sighted. When mother supports mother, when father supports father, what we aim for is community. Community means sharing, informing and then, when someone has made their decisions, supporting unconditionally. It doesn’t mean not working out for yourself what you believe to be the FACTS vs the MYTHS and being open about sharing those.

There are people out there who make an awful lot of money from persuading parents to ignore their inborn instincts and follow advice that has no evidence to back it up. If parents are receiving advice that is undermining, detrimental or downright dangerous, then frankly, I don’t think it’s judgemental to say so.

Of course, individual parents need loving, sensitive support, but to with-hold information that might help them parent the way they really want just in case we may make them feel guilty or judged is, to my mind, failing them badly.

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Group B Strep

August3

I’ve been asked about this subject quite a lot recently so I thought I’d write a post about it. Before I begin, as always, remember  I am a doula, not a health professional or medical expert. So, if this subject effects you, do talk to your midwife/doctor as well as reading other resources so you can make informed decisions about your birth.

I will therefore write this post based on what I’ve found out along the way as I’ve supported clients.

So…Group B Strep, GBS, Strep B…what is it and what ramifications does it have for your pregnancy and birth?

GBS is a bacteria that can colonise the human body. It is very common and usually causes no problems. Around a third of women are said to be carrying the bacteria in their vaginas. Most of the time, even when we are pregnant, here in the UK we are not aware of the presence of GBS because we are not routinely tested for it here.

The vast majority of term, healthy babies born to GBS+ mothers are fine. However, sometimes, this infection can cross to the new baby and cause a variety of problems. Here is what the NHS Choices website says:

Early-onset GBS infection

If a baby develops GBS infection less than seven days after birth, it’s known as early-onset GBS infection. Most babies who become infected develop symptoms within 12 hours of birth.

It’s estimated that about one in 2,000 babies born in the UK and Ireland develops early-onset GBS infection. This means that every year in the UK (with 680,000 births a year) around 340 babies will develop early-onset GBS infection.

What complications can it cause?

Most babies who become infected can be treated successfully and will make a full recovery.

However, even with the best medical care, one in 10 babies diagnosed with early-onset GBS infection will die. The infection can cause life-threatening complications, such as:

  • blood poisoning (septicaemia),
  • infection of the lung (pneumonia), or
  • infection of the lining of the brain (meningitis).

Another one-in-five babies who survive the infection will be affected permanently. Early-onset GBS infection can cause problems such as cerebral palsy, deafness, blindness and serious learning difficulties.

Rarely, GBS can cause infection in the mother. For example, an infection in the womb or urinary tract, or more seriously, an infection that spreads through the blood, causing symptoms to develop throughout the whole body (sepsis).

So, whilst it’s a very rare occurance to have a baby become infected, and even rarer for that infection to be serious or God Forbid, fatal, the fear of this possibility for both parents and health professionals shouldn’t be under-estimated.

So, if infection is so rare, why are not all mothers routinely tested in the UK?

My understanding is that routine, universal testing has not been shown to improve outcomes. That means that even if you know you are infected, it won’t necessarily change the outcome for you, or your baby.

Why? Well, for a start, testing is not necessarily 100% accurate. Secondly, treatment for the condition during labour is not guaranteed to prevent your baby becoming infected. Thirdly, treatment during labour can restrict your birth choices (such as place of birth) and your ability to move and change position during labour. Fourthly, there are varying levels of risk factors for fetal infection, so if you are in a low risk group, the chance of your baby being infected are incredibly small. Lastly, the vast majority of newborn (“early onset”) infection if caught early can easily be treated.

As so many of us are GBS+, universal testing would probably mean a huge number of us on IV antibiotics during labour, with all the consequences that entails, not least a contribution to the number of women and babies developing resistance to antibiotics.

As I mention above, most of us will never know our GBS status and have perfectly normal healthy pregnancies and babies. However, for a variety of reasons, some women will find out in pregnancy that they are positive for GBS. They may also have known in a previous pregnancy that they were positive, in which case, any subsequent pregnancy will be treated as if she is positive this time, too.

For many reasons, some women choose to be tested, either by the NHS or privately. My experience with both kinds of testing is varied and I’d love to hear your views. My experience is that the NHS test appears to give quite a few false positive or false negative results. (I’ve seen it quoted that it can miss up to 50% of positive carriers) Whilst the private test seems to have a better repution in this respect, I do find the ‘customer service’ to be severely wanting. I have had more than one client receive a text telling them the result, with no explanation, no counselling through her options and no signposting to sources of information and support. This can be cripplingly upsetting for an emotionally vulnerable pregnant woman. Likewise, I have heard numerous stories of GP receptionists ringing women to tell them the results and informing them that they must therefore now go to hospital to have their babies. Again, very upsetting and frankly none of the receptionist’s business unless she also happens to be a doctor or midwife!

So, if you know you are GBS+ in this pregnancy, what are your choices?

Well, I think the first thing to remember is just that – you have CHOICES. No-one is able to tell you that you are GBS+ and therefore you MUST…

Most woman will be encouraged to have a hospital birth. This is because the recommended treatment is IV antibiotics. Hospital policy seems to differ from place to place, so it may well be useful to find out what your hospital advises. Some give one dose only, at least 4 hours before the birth. Others seem to want to put up another bag of antibiotics every 4 hours during labour. It takes around 20mins for the dose to go through, during which time your mobility is restricted somewhat by the cannula in your arm and the drip pole you are attached to.

IV antibiotics in labour have been shown in research to decrease the likelihood of a baby being infected. A recent Cochrane review concluded however, that many studies are particularly biased, more research is needed in this area and that prophylactic (Just In Case) antibiotics in labour did not decrease the chances of babies dying. Furthermore, there are serious albeit rare) risks to antibiotics being given, including allergic reaction either in the mother or child or thrush colonisation in mother and/or baby after birth, which can be extremely painful when breastfeeding and result in the cessation of nursing, with all the subsequent risks of not breastfeeding for baby and mum. There is also some research to suggest that early exposure to antibiotics as a fetus or newborn can contribute to the risk or allergies or asthma developing later.

In theory, IM antibiotics (an injection) during labour would be a possible alternative. This makes homebirth possible for mothers who feel they want to be treated. A couple of my clients have opted for this, but it was only possible because this choice was made available to them in my city. I am unaware of it being offered elsewhere and the evidence for it’s effectiveness is not there – but only because we need more research!

Some mothers opt for doing nothing and becoming familiar with what to look out for in their babies during the first few days.
(Early Onset infection will happen before one week of age (usually before – around 90% of infected babies will show symptoms by 48 hours) – if infection happens after this, it is unlikely that it has come from the mother but from some other source).

So here are some of the signs to look for in a baby who may be infected, there may be others, like low blood pressure that most parents couldn’t check for themselves.

(Early Onset): grunting, poor feeding, lethargy, irritability, and/or abnormally high or low temperature, heart rates or breathing rates.

So how do parents choose?

Well, many women will want to take their personal risk factors into account when deciding where and how to give birth if they know they are GBS+

Here are the risk factors, if you tick some of these boxes, whether you choose to reassess, or to stick with the original plan, but you do need to know that each of these factors increases the likelihood of fetal infection (risk increases as you go down the list)

If you are in preterm labour. That means before 37 weeks
If your waters have broken before 37 weeks
Where your waters have broken before labour starts and this situation has been going on for more than 24 hours
If you have a temperature, either in labour or before labour starts with ruptured membranes (waters broken)
If you know you are GBS+
If you have been tested and found to have GBS in your urine at any point in your pregnancy. If you do have it in your urine, this is a more serious infection and you should be offered treatment then with oral antibiotics.
If you have had a baby before who developed a GBS infection.

So many of us want straight answers, but unfortunately, in this situation, I don’t think there are any! If this subject applies to you and I were your doula, I would suggest you read some of the resources below (and some of these links in this article go to research abstracts), look at your particular risk factors, listen to your care-givers (ie doctors/midwives) and then listen to your gut instinct. This is one area where we really do need more research as it appears to me that at the moment we are possibly basing routine treatment on studies that may be flawed.

Group B Step Support

AIMS (Association for Improvements In Maternity Services)

Royal College of obstetricians and gynecologists

Homebirth with Group B Strep

Gentlebirth.org

I’d love to hear your experiences and thoughts – do feel free to comment below, especially if you think I’ve forgotten something or got something wrong!

 

 

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