A Dozen Days of Doula Scoop: Day 12

Yes, I know a dozen is twelve, and I am finally working on my final blog in this series...

Birth doesn't end with the baby coming out.

Sometimes, birth doesn't unfold the way we expect. I would venture to say that our births often deviate from what we planned and/or wanted. I didn't plan to deliver Nathan via c-section. I didn't expect Daniel to need suctioning for half an hour. However, as every mama knows, getting the baby here safely is the number one priority, and doing that often requires adjustments in the plans. When your birth doesn't meet your expectations, you will probably find you need some time to process everything that happened. You may find you need to relive, blow by blow, every detail of the birth, from the first contraction to the moment you are holding your baby in your arms. You may find yourself wondering whether you might have had a different birth experience if you had made different choices. You may find yourself feeling rather blue, or even full-on depressed, even though the beautiful new baby you waited so anxiously for is finally here.

It's so easy to assume that birth ends the minute the baby leaves your body, but the truth is, the emotional aspect of birth can affect you for years. For most women, birth is more than a mere utilitarian means of obtaining a baby. It is a time of transition, the last step you take from being a woman to being a mother. Birth is also an opportunity for the full expression of your femininity. Because birth is such a unique and special time in a woman's life, a birth experience that is less than what you wanted can leave you reeling emotionally. A doula can be invaluable at this point. Since your doula has been with you through the birth process, she can help fill in the details that you can't remember (and there will be details you can't remember). Maybe you need her to remind you that you had long, painful contractions two minutes apart for six hours before you called for the epidural. Maybe you didn't know that the episiotomy was done because the baby's heart rate plummeted suddenly and they had to get the baby out. Because your doula was continuously present, knows about birth, and was not in labor land at the time, she is the perfect person to help you reconstruct the details of what happened. You can talk to your doula about your birth, because she gets it.

Coming to a place of peace about the way you birthed your baby is critical for your emotional well-being. If you are constantly plagued by feelings of inadequacy because you couldn't birth without medication, or you had a c-section rather than a vaginal delivery, you may struggle to adjust to the physical and emotional demands of mothering. The way you deliver your baby does not determine what kind of mother you will be. In fact, the experience of breastfeeding and nurturing your newborn baby can be an exceedingly healing time for a mother who feels like she missed out on having the perfect birth. The way birth happens is, without doubt, important, but it is more important by far that you love on your baby, day after day. Birth is one day; mothering is the rest of your life.

Reframing

Tired of:
Having a messy house.

Thankful for:
Having a house.

Tired of:
My body's limitations.

Thankful for:
My body's capabilities.

Tired of:
Never getting everything done.

Thankful for:
A life so full, I never run out of things to do.

Tired of:
Grimy little hands that dirty up my shirt.

Thankful for:
Grimy little hands that wrap around my neck.

Tired of:
Laundry.

Thankful for:
Clothes.

Tired of:
A husband making one more demand on my time.

Thankful for:
A husband who loves me so much that he wants to spend time with me.

Tired of:
Eating the same old, non-allergenic foods. (Potatoes, anyone?)

Thankful for:
Losing weight while not being hungry.

Tired of:
Managing a tight budget.

Thankful for:
Having a tight budget to manage.

Tired of:
Watching my child suffer.

Thankful for:
God's promise that one day, ALL suffering shall cease.

Tired of:
Messes.

Thankful for:
Mess makers.

Tired of:
Doing so many things wrong.

Thankful for:
Doing a few things right.

Tired of:
Insomnia.

Thankful for:
A little personal time to think through my problems.

Do you need to do some reframing today?

A Dozen Days of Doula Scoop: Day 11

Birth Healing, Birth Processing:

Sometimes we moms can get so focused on getting the baby out that we forget to get ready for what comes afterward. The same moms who tell you every detail of their birth experience often neglect to mention anything about the aftermath of birth. After the baby is born, your body needs time to heal and your emotions will probably fluctuate a lot. These emotional fluctuations are both a result of hormonal changes in your body and a natural response to the upheaval in your life (in the form of a very precious, very needy little newborn). Depending on how difficult your labor was and whether you had an instrumental (forceps or vacuum) or surgical (cesarean) birth, you will experience anything from mild soreness to unmanageable pain following the birth.

What you might expect after the baby arrives:

• You can expect an immense sensation of spaciousness and relief. After all, seven or eight pounds of baby just left your overcrowded abdomen! The first time you stand up, you may feel your organs sliding down into the now roomy pelvic cavity.
  
• If you have birthed vaginally, you still have to push the placenta out. Don't be scared. Unlike your baby, a placenta has no bones and slides out quite easily with one or two pushes.
• Your care provider will check your perineum (your pelvic floor muscle that stretches towards your bottom to make way for the baby) for any tearing. If you have torn, local anesthetic will be used while you are stitched up (unless you already have an epidural in place. Many moms are so distracted (in a good way) by their new baby that they hardly notice this.
• If you have had a cesarean section, expect to be closely monitored for an hour or two until the initial effects of the surgery (and medications) have worn off. In many hospitals, your baby can be in the recovery room with you if you and the baby are both healthy.
• Expect soreness and/or pain. After a vaginal birth, you may find your entire pelvic floor is sore from stretching as you pushed the baby out. You will probably have localized pain and tenderness if you had significant tearing or an episiotomy. Most women also have hemorrhoids that will gradually shrink over the next few weeks. If you had an epidural, your back may be sore where the epidural needle was placed. After a cesarean birth, you will be sore on your lower abdomen where the incision was made. Sitting, standing, coughing and laughing will probably be extremely painful until your abdominal muscles recover from the trauma of being separated during the surgery. It's okay to take pain medication for all these achy parts. Your doctor, midwife, or nurse can tell you which pain medications are safe to take while breastfeeding.
• If you had a completely unmedicated birth (no narcotics, epidural, or Pitocin), you will probably have an incredible birth high. This high is your reward for getting through every bit of your labor without calling for meds. Despite any residual soreness, you may decide you have never felt better and nothing can possibly bother you. Try not to make important decisions until this high wears off. You may agree to something you don't actually want to do because you just feel so incredibly good.
• Be prepared to sweat and pee--a lot. The body has a lot of extra fluids to get rid of, so expect frequent bathroom breaks for the first couple of days. You may want to lay a towel under your head so you don't drench your pillow with sweat.
• Starting breastfeeding may be really difficult, but it may also be really easy. If you're having a hard time getting started, call on your nurse, lactation consultant or fellow nursing mom for help, but make sure you take some time to try to nurse when it's just you and the baby. Sometimes what you really need is a little quiet, private time free from the pressure of other eyes to relax and let it happen.
• Your emotions may be all over the place. You are filled with love for your baby, happiness that you are finally holding her, disappointment if the birth didn't happen the way you wanted, sadness that your life will never be the same, happiness that your life will be changed forever.

Next Post: More on the emotions of birth and beyond

A Dozen Days of Doula Scoop: Day 10

Breastfeeding: Just do it.

After wading the murky pond of labor options and the risks and benefits of various interventions during delivery, its refreshing to enter the crystal clear water of some definitive scientific evidence. Not to give away the punchline, but the verdict is in, and breastfeeding is better for babies. Period. Except in a few rare situations where the mother is HIV positive or has another body-fluid born virus, mothers who breastfeed their babies are conferring a hosts of benefits on their babies with none of the risks inherent in formula feeding and should absolutely breastfeed if they possibly can. A strong statement? Yes. However, scientific evaluation of breast milk versus formula has shown that breastmilk is a superior food for an infant which means, by default, that formula is an inferior food. Breastmilk is tailored to the specific needs of babies at every stage of development, from the colostrum babies get in the first couple of days of life (high in concentrated nutrients but easy to digest), to the milk produced for a breastfeeding toddler that has increased fat and energy contents and continues to deliver protective antibodies (read: less sickness). Formula delivers the same limited nutrients to babies at every stage of development. Breastmilk is chock full of dozens of kinds of beneficial bacteria that subsequently populate the baby's intestines, providing a barrier against infectious agents and potential allergens. Some formulas have one strain of beneficial bacteria that may or may not be viable by the time the baby ingests it. Breastmilk protects against allergies, formula often triggers them (trust me, you do not want this to happen!). Breastmilk is good, good, good stuff!

So why don't more American moms breastfeed their babies? I believe there are two primary problems: cultural stigma and lack of support. Add to that the way that formula is vigorously marketed while breastfeeding makes no one any money, and you have a recipe for babies not getting the perfect food. Somehow moms have gotten the message that breastfeeding is inconvenient, immodest and painful, and while it can be any of these three things, it doesn't have to be. Breastfeeding is, in my opinion, more convenient than bottle feeding. You don't have to worry about sterilizing twenty pieces of equipment (unless you're pumping, which does add a challenge, though not an insurmountable one), you don't have to test the temperature of the milk to make sure it doesn't burn your baby, and you don't have to pay for it (who doesn't love free stuff?). You don't have to stumble around in the middle of the night trying to find a clean bottle and fill it with formula when you can hardly get your eyes open. You just pick up your baby, uncover your breast, and doze while the baby nurses. You can sit in a glider with your feet propped up, recline on your bed, or lie on your side without worrying about a bottle not being held at the proper angle. And many breastfed babies don't even need to be burped since they don't swallow a lot of air while nursing. As for breastfeeding modestly, it is very possible. In most places, you can find a private corner where you can feed your baby without fear of exposure, but even if you have to nurse in the crowded waiting room of your pediatrician's office, you can throw a blanket over your shoulder and feed your baby while staying covered yourself. (My babies never did tolerate the blanket over the head, so I usually retreated to the car if I couldn't find another relatively private location.) Especially once your baby is older, their heads will cover the exposed part of your breast and you can tuck your shirt low enough to cover everything else. Finally, is nursing painful? For some women, it is, and continues to be painful. In most cases, the pain has a cause, i.e. the baby is latching poorly, or mom has a fungal infection of the nipple. For the first few days, breastfeeding is often uncomfortable as baby figures out how latch properly and the nipples adjust to vigorous sucking. This is a time when support from a lactation consultant or another woman who has breastfed a baby is critical. Without help and encouragement, many moms give up before breastfeeding gets easier, because they think it will be that hard the entire time they're breastfeeding. Some mom/baby pairs figure out the nursing dance pretty quickly, while others need a few weeks before it feels natural.

There are a few things you can do to facilitate an easy start to breastfeeding:

• Give birth without pain medications if possible. These tend to make babies lethargic for a few days which makes it hard to get them interested in breastfeeding.
• Forego IV fluids, as they can cause tissue swelling in the breast which makes it more difficult for little newborn mouths to latch on.
• Get the baby skin to skin with mama as soon as she emerges. You may have to fight hospital policy to get your way on this one (they want to wash, weigh and measure, and do the newborn examination right away; if baby is breathing and healthy, these things can wait), but it's worth it because babies who spend the first hour or two of their life skin to skin with mama actually have the ability to find the nipple and latch themselves on without help. It doesn't get any easier than that!
• Room in (keep your baby with you) instead of sending your baby to the nursery. This is not a guilt trip on you if you send your baby to the nursery while you nap for an hour or two! However, moms are able to be in tune with their babies' hunger cues (opening their mouth wide, sucking on fist, rooting around) when they are close. A busy nurse may not notice a baby's hunger cues until he's crying. This is a late sign of hunger for a newborn, and most babies need to be calmed before their mom can even try to feed them if they have been crying.
• Take advantage of the lactation specialist before you leave the hospital. Especially if you're having breastfeeding difficulties, a lactation specialist has a wealth of information about getting babies latched on, pumping, and more. Seek help early if you feel things are not going well. Babies arrive with an energy reserve that allows them a few days to figure out this thing called eating, but it's important to get things moving before this energy reserve runs out.
• Talk to other breastfeeding moms or your doula for encouragement. We all need to know other people have been there and made it through, especially when it comes to this demanding thing called parenting.

I know this entire post has been extremely pro-breastfeeding, and I wish every mom could breastfeed their baby, but I know that, in many cases, the desire to breastfeed is there, but for whatever reason, breastfeeding is not possible. Maybe because the mom has to go back to work and doesn't have much success with pumping or because she has breast infection after breast infection. Not being able to breastfeed when you really wanted to is a loss that you may need to grieve a little bit. That's okay. It's also okay to give yourself a free pass on the guilt. We all want to do more for our children than we ever possibly could. Despite the fact that most parents don't get around to half the things they want to do for their children, most of us turn out okay. Your children will too. If you love them and do your best as their parent, that is the most important thing. But if you can breastfeed your baby, persevere! The benefits are proven, and there is a sweet emotional bonding that takes place when you snuggle your baby to your breast.

A Dozen Days of Doula Scoop: Day 9

C-sections: Having a good birth when a cesarean is necessary

Cesarean sections save lives. This fact is incontrovertible. Unfortunately, currently about a third of pregnant women in the United States will wind up delivering their baby by cesarean section. This number is far higher than the 10 to 15 percent of moms recommended as the target goal by the World Health Organization. The discrepancy between the target percentage and the actual percentage means that some women are having unnecessary c-sections. The problem is that during labor, no one wants to take chances with the life or health of mother or baby, so if there is any reason to believe a c-section may be a safer means of delivery, it will probably be done. Also, doctors often take every action possible to protect themselves from liability so that if something were to happen to mom or baby during a birth, they could say, "Well, I did everything I could." What this means for you as a mom is that (a) you may want to take measures to protect yourself from an unnecessary cesarean and (b) you need to prepare for a cesarean birth even if you are planning a natural childbirth because you end up needing one during labor. Here is an excellent page that covers ways to avoid an unnecessary c-section. I highly recommend you check it out so you can arm yourself with information.

When a c-section is truly necessary, there is no agonized weighing of risks and benefits. There are a few situations where there is no question of whether a c-section should be done:

• Cord prolapse, placental abruption, catastrophic uterine rupture: These are all true obstetrical emergencies that require immediate action to save the baby and sometimes the mother as well.
• Placenta previa: This is the term used when the placenta embeds itself over the mouth of the uterus where the baby would usually emerge during birth. Because the placenta is the baby's oxygen lifeline, he could not be born vaginally because the process of the cervix dilating almost always causes the placenta to begin detaching from the blood supply.
• Baby is in a transverse position and refuses to move: Transverse means the baby is lying sideways in the uterus in much the same position that moms cradle their babies after they have been born. Babies in a transverse position cannot be delivered vaginally. The good news is that about 90 percent of transverse babies can be turned using a procedure called the external cephalic version.

The link above covers most of the situations where it may be possible to avoid a c-section: breech baby, long labor (slow progress), previous c-section, questionable fetal heart rate readings, and multiple births. If you find yourself in one of these categories before labor begins, research! Read The Thinking Woman's Guide to a Better Birth. Ask your doula for other resources. Ask your care provider how he or she usually handles your situation. If you are not happy with the answer, negotiate a better plan. If you find your doctor is inflexible, consider changing to a care provider who is more in line with what you want, even in the last weeks of your pregnancy. If you face one of these problems during labor, use the four questions I discussed in yesterday's post. Ask your doula for information. Talk through the situation with your husband. If you feel like the c-section is needed, give your consent and know that you are doing the right thing for your baby.

If you choose to have a doula at your birth, ask your doctor before labor starts if they allow both dad and doula into the operating room during a c-section. The official hospital policy usually allows one additional person (either dad, doula, or another labor support person), but doctors often have the final say on whether your doula will be allowed in the O.R. along with dad. It's worth making the effort to have your doula with you during the surgery because it is often a tense and emotional time when a calming influence is greatly needed. Also, babies are often taken to the nursery after the mom gets a quick look at them so the nurses can evaluate and monitor their condition. If baby goes to the nursery, it's best for dad to go with her since as her legal guardian, he is the person with the power to make decisions related to the baby's care. However, if he was the only support person with mom in the O.R, she is then left alone during the lengthy surgical repair. When dad and doula are allowed in the O.R, it allows for the most complete level of emotional support for mother and father throughout the process of the cesarean birth. If this is not possible for some reason, your doula will wait for you to return to your room for some recovery time after the surgery, and help you hold and feed your baby if you are both up to it.

Having a c-section is not a failure of the mom to give birth. After all, you grew and carried that baby for nine months, and your baby entered the world from your body, albeit in a departure from the normal pattern of birth. Stuff happens. Life happens. Cesarean birth often requires a lot of emotional processing. You may need to spend some time grieving for the birth you lost. That's okay. But at the end of the day, you need to know that you allowed your baby to be born in the way that he needed, and that is what a good mommy does.

A Dozen Days of Doula Scoop: Day 8

When the birth plan falls apart...

Ask four questions:

• Am I okay? Is the baby okay?
• What happens if we do the intervention?
• What happens if we don't do the intervention?
• Can we have a couple of minutes to talk about it?

I'm a big fan of birth plans. I think it gives you an opportunity to think through the kind of birth you want, lets dad and doula know what your wishes are, and gives you a list of things to discuss with your doctor before the birth. But births don't always follow the birth plan, and sometimes you have to adapt.

The informational support of a doula is invaluable when problems arise during labor and birth. In the throes of labor, no one has the time or energy to research the pros and cons of various birth interventions. Doctors don't always take the time to discuss the risks and benefits before expecting a decision from parents. Sometimes, with the right information, you feel empowered to choose to do nothing for a little while longer, and sometimes, problems will resolve themselves.

There are times when intervention is necessary and unavoidable. During these times, a doula can help you enjoy the experience of birthing your child, even if it isn't happening the way you wanted. An unwanted but necessary induction can still be a good birth. An unwanted but necessary c-section can still be a good birth. Even when your plan falls apart, it can still be a joyous, special, memorable time as you welcome your new baby into the world.