In honor of all the men that support women and their personal birth choice, Sculpted Films presents Dads Discuss: Homebirth. https://www.sculptedfilms.com
Breastfeeding for the first time.
Cracked nipples! Shallow latch versus deep latch! Areolas, milk sinuses, breast compressions. Swallow sounds, colostrum, hand-expression, leaking...breast pads, breast pumps, mastitis...my sister said she got mastitis, was it mastitis? Or was it a blocked duct? Is that a thing? Blocked ducts? Feeding schedules, on-demand feeds, let-downs and nipple shields. How's a gal supposed to sort out all these things while pregnant, let alone in the early weeks of transitioning to motherhood? What does a cracked nipple look like and how will you know you have one? What is a shallow latch? And how will you know if you have the elusive deep latch? What happens when your milk “comes in” and what does that mean anyway? How's a gal supposed to sort out all these things while pregnant, let alone in the early weeks of transitioning to motherhood?
I am here to help! My name is Raquel Knack, from www.grnaturalchildbirth.com, a breastfeeding counselor and childbirth educator, and your resource for all things breastfeeding and birth related.
Many new mothers imagine breastfeeding as a beautiful, blissful bonding time with baby...holding them close and nourishing them with their own bodies. And it definitely can be...but in the early days and weeks that follow birth, it’s sometimes NOT so blissful...in fact, it can be one of the most unglamorous, challenging times in a woman’s life.
The reality of postpartum
You have just pushed an entire human out of your vagina, a vagina that has stretched, opened, and possibly torn as baby made his way to your arms. In addition, your breasts are now starting to produce milk and they are bigger than they have ever been, stretched to capacity, tight, and painful. Add to this a lack of sleep and the wild ride your hormones are taking you on. It’s enough to take even the strongest woman down. Because it is a transition...from a symbiotic relationship with baby inside, to a symbiotic relationship with baby outside. Everyone is learning...adjusting...growing. One mama said to me “I had no idea that I could be this exhausted and uncomfortable and still be awake.”
And now your birth team is suggesting you put a feverishly sucking baby mouth on your breast? Seriously?
Breastfeeding, a “natural” way to feed a baby
Breastfeeding is promoted as a “natural” process. But as a lactation counselor and mother of 3 breastfed babies, I can tell you...it often does not come easily or instinctually. Everyone is talking about how great breastfeeding is for baby and mother, and I agree, but no one really talks about how hard it is. To me, breastfeeding is rewarding, but it takes work, dedication, and sometimes sacrifice. You are literally offering up your body multiple times a day, keeping it healthy and hydrated in order to make the milk your baby needs. If you return to work after baby is born, you commit to regular pumping sessions in order to keep the milk flowing and provide bottles so care providers can offer them to baby when needed. For most mothers and babies, it takes at least 4-6 weeks before breastfeeding begin to feel easier and more “natural”. By 8-12 weeks, you will simply bring baby close to your breast and wah-lah, they do it all on their own. It’s amazing.
One thing I can advise on straight away is that you can’t “try to breastfeed”. You have to “decide to breastfeed”. But there are people here to help you on your journey. So let’s get started…
What is all this amazing milk anyway? Or is it colostrum? What’s the difference?
You may have noticed that towards the end of your pregnancy that you may be leaking something from your breasts, or if you squeeze them gently or experience a great orgasm, something is leaking from your nipples. This is colostrum...the liquidy, sticky magic that helps baby establish amazing gut flora and makes his transition to this world easier. It is made in teaspoons, rather than ounces, and this is why it is important for baby to nurse often after birth. Around day 3-5 after baby’s birth, your milk will “come in”...meaning the colostrum will change to actual breastmilk. When this change occurs, your breasts will feel huge and full...often bursting with milk. It may feel like you can feed 100 babies! And your body wants to feed 100 babies but it will adjust slowly, over the next week, to feeding your one lovely baby. Breastmilk is made from a supply and demand system, what comes out in a 24 hours period, is what is made the next day. So how do you become a milk-making machine? Feed the baby. Often.
How often does baby needs to eat, and how will I know if they are hungry?
Baby needs to eat frequently after birth, about every 2-3 hours, and will need encouragement to do so. They have just had a hard journey out of the birth canal and are tired. Plus the experience of nursing for them is so comforting and calming, that it often lulls them right back to sleep after a few sucks and swallows! But they need many swallows! Rub their feet, touch their cheeks, and sometimes a cool cloth against their skin can help too. So what are the signs or cues that baby is ready to eat? You will notice that baby, even when hours old, will start to show unique signs of being ready for nourishment. Take a look at this cutie: https://www.youtube.com/watch?v=3sA559uk4vI
But how can you get your nipple and areola (there’s that word again!) in their mouth successfully?
Getting baby to the breast
Begin by placing baby tummy to tummy in a side lying position so their mouth lines up with your nipple. You and baby may need a little boost and many mothers find a regular bed pillow or a specific breastfeeding pillow such as My Brest Friend, can raise baby to the right level. Once baby is in this position, encourage him to open his mouth wide...like a big yawn...first. To do this, tickle his lips with your nipple which will stimulate him to open his mouth. You can even say “open wide” as you do this! Once you see a wide open mouth, act quickly and bring baby towards your breast, inserting your nipple into his mouth. Once he feels a sensation inside his mouth, he will begin to suck vigorously. For some babies, this process takes time. It is common for a baby to be a little fussy at the breast when trying to latch on, often taking 2-3 minutes to actually get a good latch. He is learning and so are you. Be patient. Here is a really great video showing a newborn getting to the breast with a real mom. https://www.youtube.com/watch?v=Jq5dWoOGJbM
How does it feel? Like, really?
Once baby is latched, you will experience what I call a toes-coming-out-of-the-top-of-your-head sort of feeling...for about 20 seconds, as baby begins to suck. Stinging sensations on your nipples, possible uterine contractions at the same time, and definitely a feeling that will require those deep abdominal breathes that got you through labor. After this 20 second mark, the sting should subside and you just feel a gentle tugging. If the stinging doesn’t stop, then it’s time to take baby off your breast and try again. It’s a bit tricky at first to break the super suction of a newborn. Gently insert a clean and neatly trimmed finger alongside baby’s gums and gently compress your breast tissue down and away from baby’s mouth. Then remove the nipple quickly, lest baby feels it on his lips and begins sucking again on the wrong parts!
Baby is on, sucking, now what do I do?
Baby is latched and sucking what now?
Once baby is latched well, and you are having little pain or discomfort, listen for swallow sounds. What are swallow sounds? Have a listen here: https://www.youtube.com/watch?v=hBhvlvTESaM And here: https://www.youtube.com/watch?v=RmquR6ETsPs
You will want to hear a consistent pattern of “suck-suck-swallow” with short pauses in between. For instance, “suck-suck-swallow, suck-suck-swallow, suck-suck-swallow, PAUSE”. Then it repeats again. There may also be periods where you hear “swallow-swallow-swallow”, as well as possible coughing sounds as the milk rushes in. If baby begins to cough, gently take him off the breast, catch the milk in a cloth diaper, and re-latch. If you are not hearing good swallow sounds, encourage baby to suck by including breast compressions. Take a peek at this video to learn how: https://www.youtube.com/watch?v=wBrLYhABUlM
Baby will need to feed at least 10-15 minutes with the active “suck-suck-swallow” sequence, or longer if he seems fussy. Most newborn feedings last anywhere from 15-45 minutes. Some babies are all business, getting their colostrum or milk quickly. While others like to have “an experience”, and nurse at a more leisurely pace. Feed on one side first, making sure to completely empty the breast (it will feel softer and less firm), then offer the other side if baby still seems hungry.
One key factor to keep in mind is that it takes energy and burns calories for a baby to nurse. In the early days, it is essential to ensure that baby nurses well at the majority of his feeding sessions. Each feed builds on the next, giving him the energy and calories needed to effectively nurse and remove the colostrum or milk at his later feedings.Watch for baby’s signs of fullness - relaxed hands and arms, relaxed body, and possibly unlatching from your breast himself and falling asleep.
Caring for the ta-tas
Until having a baby and breastfeeding, you likely never touched your breasts so much. Now you are highly familiar with how they look before and after a feeding, how they feel before and after a feeding, and which side produces more (very common) and which side is “dessert”. In order to keep them healthy and milk making machines, just pay extra attention. Does anything hurt? Are there hard spots? Hot spots? If you have to miss a feeding for some reason, make sure to pump. Apply some sort of nipple butter to the your nipples after each feeding. Even if they look great, even if there is no cracking or bleeding (yes, a series of 4-5 bad latches can take a healthy nipple to a very sore, torn up, bleeding nipple fast!)This will keep the tissues healthy and soothed between feedings. (If there is still some emollient on your nipple when baby is ready for his next feeding, just gently remove it with a tissue). I recommend this up to 8 weeks. Right about then the toes-through-the-top-of-your-head feeling goes away for good and your breasts have adjusted to their new lifestyle.
Extras to make breastfeeding easier:
Though I am not much for extras when it comes to breastfeeding, there are three items that I recommend new mothers have in their arsenal. These tools can be essential to help a mother when breastfeeding isn’t going easily.
A nipple shield
A Blue Moon manual breast pump/milk collector
A new electric breast pump
A nipple shield is a silicone sheath that goes over the nipple and areola to protect it and also give baby more to grab onto if a mother has inverted or flat nipples. If your nipples are already to the tender, cracked and bleeding stage, a nipple shield can allow for a gentle barrier between baby’s mouth and tongue and the tender breast tissue. It continues to allow milk transfer but helps to keep mother comfortable when breastfeeding.
The Blue Moon manual breast pump/milk collector can be used many ways, but my two favorite are:
A manual breast pump to aid in relieving pressure when your milk first comes in and soften the breast tissue to help baby get latched.
A milk collection device. It is a soft silicone flange that can be placed on the opposite breast baby is feeding on to collect the milk that is leaking from that breast. Many mothers can get up to an ounce of milk that would otherwise be dripping down a shirt or absorbed into a breast pad!
An electric breast pump is essential if you are returning to work, and also just to “take the edge off” when your milk comes in and your breasts are in that hot, hard, and painful stage I mentioned above. You can pump for 3- 5 minutes, get the breast tissue softened, and then latch baby on for the remainder of the feed. In addition, if your nipples are cracked and bleeding, taking a day or two off of actual breastfeeding and only pumping and offering the baby a bottle in a paced feeding format can be so helpful to actively heal the breast tissue. Once the tissue is back in healing mode, a mother can return to breastfeeding with the assistance of a lactation educator and get baby latched pain-free. Some mothers also choose to pump extra milk for times when they are away from baby, or when their partners take one of the night feedings. (Just make sure to actively empty the breasts at consistent intervals - every 2-3 hours in a 24 hour period - through breastfeeding or pumping in order to avoid blocked ducts or mastitis).
So if you are considering breastfeeding or are in the throws of it, one key bit of advice I like sharing with new mothers in pregnancy or the early weeks postpartum, is to have confidence in your body. In the same way your body knows how to grow your baby, and how to birth the baby out, it knows how to make milk for your baby too. Listen to your intuition. You are the expert on your baby. Nurse often, listen for swallow sounds, and pay attention to baby’s wet and poopy diapers. (See Sara for a great worksheet showing baby’s bowel movement colors and amounts!) Encourage baby to nurse actively, and work to relax while nursing in order to allow the milk to flow.
If you are listening to your intuition, working to nurse frequently, but find that nursing isn’t going well for you, it is important to get help right away. There are so many amazing resources in Grand Rapids! La Leche League meetings offer free lactation support based on mother-to mother guidance (like meeting with your sister or auntie who has amazing breastfeeding knowledge and tips) and many hospital lactation services can be covered by insurance. If not leaving your home sounds more appealing, please contact me for a home visit. For more information, please visit https://www.grnaturalbirth.com/nourish-lactation-services/
Non Hormonal Birth Control
Non Hormal Birth Control
What are the options?
How many of you have thought about birth control? Do you think about all of the types or just focus on the ones most talked about?
Did you know that 48% of the pregnancies in the US are unplanned? 1 in 4 college females get an STI during their first year at school. Women made up 19% of of the 39,513 new HIV diagnoses in the USA in 2015 (86% in heterosexually relationships).
As a woman growing up in the US it was condoms or the pill, I had never heard of the other options until my early 20's. Men never wanted to wear condoms so it purely was up to the women to not get pregnant; however, they failed to see that pregnancy is only part of the issue. Many of my friends contracted STI's. Some chose never to talk about about it, while others used it against the guy who gave it to them. I watched as the heart ache and reality set in for them. Herpes is forever and it does affect your birth choices. Genital warts, again, has long term affects. AIDs was also a big topic for us kids in the 90's and it was thought to be just " A GAY DISEASE." Boy, was that bad thinking. Chlamydia was not unheard of, but at least was easier to deal with and you did not have to tell your future partners about it. Of course there are more but that was high school for me in a nut shell. We should also talk about the 15 unplanned pregnancies that my friends had to deal with. Needless to say being sexually active was not on my priority list!
Half of my friends had no idea when they could get pregnant in their cycles. They other half had bizarre thoughts on how to stop for getting pregnant like douching with Lysol!! Seriously! I have met women who think that anal sex is the safest form of sex, as you can't get an STI that way. With over 17 years in the women's health profession I have heard and corrected MANY strange ideas around sex, pregnancy & STIs.
So here is what we can do to change the conversation, TALK about it with younger women. Start earlier then you think you need to. 10-13 year old women need to know these things. Talk to your boys! Yes you as the mom should talk with them as well. Talk about condoms as a serious life saving tool. Don't let them into the world thinking that they are merely a choice! There is more than just pregnancy on the line. As parents it is OUR job to teach them how to live in the world we are in (not one we wish we lived in). Talk about touching and how that can make them feel, talk about looking before just having sex. Talk about Prep (this is a drug to prevent the hit infection)! We are missing prime conversations because we feel awkward. Seriously, imagine how the conversation will go if they get a life changing STI or a pregnancy. The guilt and the life choices then are forever present.
Talk to your friends! We should be talking about how these things really happen and how we can help prevent them. Sex is part of everyone's life; we should be able to talk about it without feeling weird about "oversharing". We should be talking with our partners about how different birth control affects us and which ones we would prefer using to mitigate the risk of pregnancy. Do you want a medical procedure? Do you want a hormonal form? Do you need a non-hormonal option? These are all things to talk through and get to a good agreement on. BUT it is your body and you are ultimately the one who has to deal with the pregnancy/STI's/hormonal birth control, so if you aren't happy with the choices then don't have sex!
Do you know when in your cycle you can get pregnant? Do you know how your cycle starts and finishes? Do you know how breastfeeding affects your cycle? Do you know how birth control affects your milk supply or even your mood? Do you know what birth control does to your system? What are other medications you should avoid while on hormonal birth control? How do you detect STIs? What do you do if you suspect STIs?
So if you have more questions or want answers to any of these I listed, you should come to my Non-Hormonal Birth Control (and so much more) Class January 14th 4:30 to 7pm at Renew Mama studio.
Collective Care: Many-for-One
[This post is a follow-up to the last one, so start there if you haven't read it yet.]
Imagine a team of like-minded, like-hearted midwives who trust one another, working fluidly together in mutual respect and open communication, alternating days on and off call, helping one another take care of themselves so that they can be at their best for their shared clients. Imagine this small team (3 midwives, plus a couple students) each being invested in your care. Throughout your pregnancy you see each one of them at least twice, growing in trust and relationship along the way.
If you run into hurdles or are having questions during your pregnancy, you know that your midwifery team puts their heads, hearts, and intuition together routinely to collaboratively understand and support your journey. Whereas one of them will emphasize the need to do lab work for the mystery symptom you've been experiencing, another might have a gut feeling that you need to take some time to work through a specific issue in your relationship with your partner. Together, your team is able to develop a more holistic and complete method of caring for you and your baby as each brings her own strengths to the table.
If your birth turns out to be one of those marathon births (God forbid!), stretching across days, with all of your attendants low on sleep and losing higher cognitive functioning, you know that another midwife and student from the team can be pulled in seamlessly to freshen the energy and give renewed perspective while the over-tired midwife goes home to rest so that she also can rejoin you later on with new capacity and better judgement.
In the weeks following your baby's birth, there will be 5 people crooning over and celebrating him and or her, and 5 people who are committed to helping you have a good start together in your postpartum season.
Because each one of the midwives on your team is regularly taking days off to do things that nourish and replenish her, you can be sure that she's showing up fresh and whole, ready to give you the very best of herself whenever she is with you. You can trust that any judgement calls she helps you to make during your labor are not being influenced by her sleep deprivation, exhaustion or burn out but only by the best interest of you and your baby. Your midwives, living in balance and practicing self-care, are better for it, and you benefit from that.
We believe that the world needs more midwives because women and babies need easier access to the kind of care that they provide. We believe that collective care (many-for-one) will enhance the midwifery model of care. Without losing the treasured parts of midwifery care, it will be adding to it.
Growing up with a midwife mom means I know what it feels like to always be second, to know that a laboring mom trumped school events or even just a lazy Saturday with her cleaning and hanging out. I know the deep hurts that left for our relationship and the struggle to heal it. I walked into midwifery hoping I could do it better, I had a dream of a group based practice so life could happen with me in it on both sides. I heard the concept of "Modern Midwifery" by Madeline Murray and recognized it as exactly what I have been working towards and talking about for years. We need more midwives BUT we need Healthy, Whole midwifes. If you never get to go on vacation or even a day to the lake with your own kids how can you be whole? If you have back to back marathon births how can you show up for the next mom without worries. Sustainable midwifery is a change in thought process. It requires the midwife not to hold the space of "I can be all things to all people." It asks us to see that more is not less: you will get more time with your team, you will get more hands to help, you will receive more love and compassion, and you will get presence with a healthy fulfilled group.
By working together, we can achieve such greatness.
We can never underestimate the effectiveness of a healthy, well rested,
and present midwife.~Madeline Murray
We are pleased to announce that beginning Oct. 16th 2017, this is the model of care you will be enveloped into, as we welcome a new midwife to Simply Born Midwifery Services. Kendra Ippel, in addition to students Brooke and Charis, are eagerly anticipating growing as a team with Sara for the sake of each and every one of you.
This growth will start small with Kendra doing every other Mondays prenatals and a weekend of on call time each month as well as helping with births as needed! The students role will remain the same but they will get the new choice of call days so that student life is more sustainable. I can't tell you how excited we are! We are also loving the birth assistants at the Birth House.
As with all change, there maybe some growing pains or things we aren't seeing. We ask that you share your feelings with us and help us to fix those things as they happen to help us be better at serving you and your families.
This collaborative care will have many additional perks.
- Sara's had a long-time dream to do classes and seminars encompassing not just pregnancy and birth but also postpartum, parenting, and behind (if you have ideas of things you or your friend groups want to learn around women's health leave a comment!)
- We love the idea of and are exploring what it might look to implement group prenatals and postpartums
- Offering well woman care for those want to experience the midwifery flavor when it comes to fertility counseling, pap smears and exams
- In-person mom meet-ups, to remind you that you aren't alone or crazy
- Support groups for miscarriage and infant loss
- Holistic health care learning opportunities for using herbs, nutrition and oils for your family
- Enabling time for the team to invest in the behind-the-scenes aspects of midwifery, such as legal advocacy on a state and national level so that midwifery care continues to be a safe and legal option for all women
- Setting aside time for your midwives to continue their education through CEUs on the most current maternal and infant health topics, research and best practices, so that her care is informed by the latest evidence based care
We will go into detail about each of these bullet points in the coming weeks.
One-on-One Care
Somewhere along the line, hiring a home birth midwife has become synonymous with hiring one trained birth attendant who will be with you for every prenatal, your birth, and every postpartum. It's a one-to-one relationship that spans the entire childbearing year. This is part of the appeal: the continuity of care from the very beginning, the knowing for certain who will be showing up to catch your baby, and being well known and respected by your care provider. It stands in stark contrast to the obstetrical model, in which you see "your" OB for several 5-8 minutes appointments through your pregnancy, but may also see the many partners in his/her practice, and you still don't know who is going to show up on the day you go into labor, and whether you will have ever met him/her or not.
Rightfully, women are starting to say, "That's not good enough. I want and deserve better." This is true! And a good home birth midwife will offer a depth of relationship and quality of care that is unrivaled by any other option.
The flip side of that -- and the one you don't hear about often because midwives are passionate, devoted and selfless servants -- is the cost on a midwife's personal life. In addition to you, she is probably serving at least 2 other women (sometimes 8 or 10!) with due dates the same month as yours, plus all the women due before and after you. And she fiercely cares about each of you. But if she is the one and only person assigned to care for you and each of the others, there are some logical "consequences":
- she can't EVER turn off her phone.
- she can't EVER have an alcoholic beverage.
- she can't EVER make firm plans with anyone, not even her own family.
- she can't EVER take a trip to unplug and rest up.
- she probably isn't getting much sleep.
Most midwives are happy to do it. In fact, the thought of taking a day with her phone off can set a midwife into a tizzy of "But what if I miss Ms X's text/call?!". Your midwife loves to be with you. She loves to walk with you through every single appointment and the hours of your labor and birth. It is most sincerely a joyful sacrifice, and it's probably one of the reasons she chose to do the work that she does.
And yet burnout is real. Recent research on midwives shows an alarming array of ill effects on the mental, emotional, physical and relational health of midwives. Somehow, midwives have given the world permission to not give them room to be human. To rest. To process a difficult birth. To give their husbands and children undivided attention. To travel. To know for certain that they can get a full night of sleep now and then. It's not your fault. Midwives themselves have been active in shaping and writing this script because they so badly want to offer something better than what you've had, better than the medical/obstetrical system can offer.
But what if. What if we can write a new script together? What if there can be a middle ground, one that gives both midwives and the women they serve something that is healthy, sustainable, and satisfactory? We're dreaming about how it can be possible.
In our next blog post, we'll be unrolling a plan, which we are very excited to share with you. Stay tuned!
