Bacteria, Babies and Breastfeeding

Did you know that 1 out of every 10 cells in your body is human? That means that 9 or 10 are some other type of cell, most of which are bacteria. In fact, in the human gut alone, there is 3 pounds of bacteria. The human skin is also covered in bacteria, good and bad. As humans, we need these "good" bacteria to live and they need us. Babies are born with no bacteria on their skin or in the intestinal tract. They are essentially sterile. So how can you help make sure your baby is colonized with good bacteria (like lactobacillus, bifidobacterium, acidophilus, etc) instead of bad (staphylococcus, streptococcus,)?

There are some simple ways that you can expose your baby to good bacteria.

Your Birth Plan:
Plan on having a vaginal birth. When your baby is born vaginally, he/she comes into contact with good bacteria in your vagina (lactobacilli). This is the first bacteria that colonizes your baby's gut microbiome. Also, as your baby passes through your vagina and past your rectum during a vaginal birth, your baby will come in contact with helpful bacteria near the rectum.  If you have a c-section and the baby does not pass through the vaginal canal, the first bacteria your baby could be colonized by is negative bacteria (staphylococcus) in the operating room.

Skin to Skin:
If your baby is placed skin to skin on your chest immediately after birth, then your baby comes in contact with the good bacteria from your skin. If mom and baby have to be separated, then it is beneficial for dad to do skin to skin until mother and baby can be reunited. Interestingly, the vernix (white coating on baby after born) is very sticky and is food for good bacteria, so leaving this coating on is actually protecting your baby against bad bacteria (i.e. delaying the first bath may be a good idea).

Breastfeeding:

Exclusive breastfeeeding is the most important thing that you can do to ensure that your baby's intestinal tract is colonized by helpful bacteria. Breastfeeding not only contains probiotics, or good bacteria, but also contains prebiotics, which is the food that probiotics eat. The good bacteria can essentially eat up all the food leaving no room for the bad bacteria.

So why is it so important to expose a baby to probiotics?  Probiotics, or good bacteria, improve baby's immunity, reduce diarrhea, help digestion, and reduce the risk of other illnesses. Your baby will be get bacteria in their gut, skin and mucosal membranes. What type they get, is up to you.

Journey in Adoptive Breastfeeding: Part 2

So surprise, yes, I plan to and hope to breastfeed our third child one day. The funny thing with adoption is that you could get a child right away or wait a very long time (years even). So with that in mind, I began the induced lactation protocol. I started the birth control right when we got on the waiting list and continued it for about 5 month (about 20 weeks) not taking the reminder pills. I didn't have my period for that whole time. Then I stopped the pill and began to pump. To my shear delight, I was pumping what looks just like colostrum! I couldn't believe it! It took many days (up to about 7-8 days) for my colostrum to change to mature milk, but eventually it did. I usually pump about every two hours during the day. I decided not to make myself crazy, so I have not been pumping at night. I believe that this is one reason the I don't have a full milk supply. I am able to pump about 10 ounces per day.

My husband bought be a great big deep freezer to store the breastmilk in for 6-12 months. The idea is that I will probably not ever have a full milk supply, so I will have extra to supplement with. I have probably about 500 ounces of milk stored. Exciting!

My hope is that I will be able to successfully breastfeed, even partially. But only time and a new baby will tell. More to come...

Journey in Adoptive Breastfeeding: Part I

Sometimes in my field of work it is hard for me to talk about my personal struggles with miscarriage and infertility. I am able to be a part of so many women's birth stories and am truly honored to do so. But every once in a while I feel like my body has let me down--that what I was meant to do as a woman I can't. So although, I am unable to carry a child, my body is still capable of breastfeeding. So breastfeeding has become very important to me.

Both of my sons are adopted, so I thought breastfeeding was out of the question for me. As I began down the path of adoption, I realized that this was still an option. I read books like, Breastfeeding the Adopted Baby and Relactation and Breastfeeding the Adopted Baby and studied Jack Newman's Protocol for Induced Lactation for hours before my first son was born. I was truly determined. I started the protocol a couple of months before my son was born (although we didn't know that we would be chosen so quickly). My goal was to build up a supply of breastmilk in the freezer and breastfeed as much as I could, depending on my supply. Mason was born and we were selected much faster than I had anticipated, so I wasn't able to complete the protocol, and it showed in my milk supply (or lack there of), but I still tried. Although, I had no mass of breastmilk stored in the freezer, I began to pump. I also bought a special supplemental nursing system called a "Lact Aid" to supplement my milk supply--boy was this thing frustrating to use!

Despite my (I wouldn't say "best") efforts, I was unsuccessful at breastfeeding, but I did pump and bottle feed for four months. My particular breastfeeding experience with Mason was very disheartening and I thought once again that my body had let me down. Time passed and then we adopted our second son, Miles, who I immediately decided I wasn't going to even try to breastfeed him, so that I could avoid the feeling of failing. I guess I thought, "if I don't try, I can't fail." To this day, I wish I had given it a fighting chance with Miles.

So here we are on the waiting list for our third child--a girl! Will I breastfeed or won't I?...more about my addoptive breastfeeding journey to come in Part 2.

My two crazy boys!

Full Circle

My doula career started with a friend. For many years I struggled through miscarriages and infertility, and although very challenging for my spirit, I learned A LOT in the process about pregnancy and birth. Although I had never physically had a child, many of my friends turned to me when they had questions about labor. One particular friend is the one who sparked my doula career and encouraged me to follow my dreams. She went out on a limb and asked me to be her doula. I was very nervous, but I got trained and attended her marathon birth in July of 2012. She had a beautiful little boy, who now, calls me Aunt Annie (and sometimes even momma by mistake). I love that little guy!

So, when she got pregnant again, I was thrilled that she asked me to attend her birth again. This time it was much quicker and she gave birth to a gorgeous baby girl.

My friend was my first repeat client. I felt like my journey was coming full circle. If it wasn't for her asking me to be her doula, I probably never would have been. I am so grateful! On a funny note, at her first birth one of my other clients went into labor at the same time. I, unfortunately, couldn't attend since my friend's birth lasted SO long. During her second labor, another client was being induced the same day. This time I was able to attend both births in one day. Pretty awesome!

Peanut Ball

Many pregnant women are familiar with the classic "birth" ball (basically just a fitness ball) prenatally or during labor. It is great for opening the pelvic floor and getting the baby in a good position. Many women also think it is more comfortable during contractions and labor on it the whole time.

A new type of "ball" that is used in labor is the peanut ball. It is great for using in the bed to open the pelvis and make labor more comfortable. Since it is used in the bed, this ball is great for moms who choose an epidural, but still want to take advantage of effective position changes.

Ask your care provider if they have the peanut ball the birthing environment where they practice. For more information about the peanut ball, check out this video:

Catonsville Birth, Baby and Family Expo

I recently represented Informed Birth Choices at the Birth, Baby and Family Expo in Catonsville located at Bay State Chiropractic. It was a beautiful day with tons of vendors ranging from Prenatal massage to the YMCA of Catonsville. After being there, I was delighted to realize that there is a great birth and baby community right here in the heart of Catosnville. There are many child birth classes, prenatal yoga, acupuncture, chiropractors, and doulas in our local area. Although this was the first expo of this kind in Catonsville and therefore not highly attended, my hope is that next year people will realize the resources that they have right in their backyard.

Here are some of the vendors in attendance:

Bay State Chiropractic
Happy Family Organic
Luz de la Luna
Informed Birth Choices

Short Documentary on Rising C-section Rates in the US

I recently stumbled on this short documentary done by the New Yorker on the rising C-section rate in the US. Following one woman's story, it identifies some causes of the soaring rate of C-sections, offers hope in VBAC, and shows the rewards of natural childbirth. This piece also promotes the use of a doula during labor and childbirth.

TENS in Labor

There are many techniques a doula can use to help you with the pain and discomfort of labor; like massage, counter pressure, heat and cold therapy, position changes, etc. However, recently I was introduced and trained in yet another great comfort measure for labor. The TENS (Transcutaneous Electrical Nerve Stimulation) has been used for years to help control pain and labor is a great place to see it in action.

So what exactly is a TENS?

• It is a handheld, battery-operated device, which transmits mild electrical impulses through the skin to stimulate nerve fibers in the back that is controlled by the laboring client. 
•  It reduces pain in labor while allowing the laboring woman freedom to move and walk.
•  It is especially useful for back labor.

                  

Is there research about the TENS in labor?

• Research findings on TENS (Carroll et al, 1997) have shown that laboring women using the device use less pain medication than women using a “sham” TENS device. 
• The majority of women surveyed (Chamberlain et al, 1993) rated it as moderately or very helpful in relieving pain, and would use it again in a future labor. 
• A study that investigated the use of TENS for back pain in labor found that “TENS has a specific beneficial effect on pain localized in the back.” 

Why does is work?

• Gate Control Theory of Pain: basically non-painful or pleasurable sensations travel to the brain faster than painful sensations, therefore reducing the amount of pain sensations felt.
• The TENS actually stimulates your body to make its own natural pain relieving hormones called endorphins.
• The laboring mother controls the TENS so she is able to take control, in a sense, of what is happening with her body.

Who should use it?

• Any laboring mother who has received consent from their care provider who doesn't suffer from epilepsy or have a cardiac pacemaker.

The TENS is a safe and effective way to reduce the sensation of pain during labor. If you are interested in using a TENS during your labor, contact your doula or feel free to email me and I can give you more information.

*Information modified from Penny Bussell

IBC and the Fistula Foundation

For months Informed Birth Choices has been planning a great event to encourage car seat safety and raise money for the Fistula Foundation. Finally the day had arrived. The weather was perfect for IBC's New Moms Group to host this awesome outdoor event.

Chloe Chrysanthus, an IBC doula and car seat specialist, volunteered her time to check and properly install infant and toddler car seats for free. Since 8 out of 10 car seats are installed improperly, this was a great service to all the moms who came out.

In addition to the care seat check and installation, IBC also asked for donations for the Fistula Foundation, an organization which performs surgeries to correct obstetric fistulas for women in developing nations. People graciously donated baked goods and handmade crafts to sell to raise money.

Danielle Koontz, the director of IBC, was hoping to raise around $50 and to her great surprise the money collected totaled $250! That amount is over half the cost of a fistula repair. The IBC car seat check and Fistula Foundation event was a true success and showed that women all over the world can change each others' lives for the better. Truly this event was a win-win for everyone involved! A BIG thank you to everyone involved!

Breastfeeding and Working

One of the most frequently asked questions that is asked when I am teaching a breastfeeding class is, "when should I introduce the bottle since I have to go back to work?" or "when do I start pumping when I have to go back to work?". Breastfeeding, pumping and working seems like it will be completely overwhelming to new moms, but it doesn't have to be. Learning how and when to pump can happen gradually and doesn't have to cause you anxiety.

Here are some of my tips for moms who will have to go back to work:

1. Establish the breastfeeding relationship with your baby first. It is more important to learn how to breastfeed and then worry about pumping.

2. Introduce the bottle after three good weeks of breastfeeding (if the first week sucks, then three weeks after you and baby got the hang of it).

3. When you do start pumping, try pumping in the morning when your milk supply is at its peak. Breastfeed the baby first and then pump the remaining milk. Add in pumping sessions throughout the day and eventually you will start making enough milk to store in the fridge and freezer.

4. Feed your baby from the bottle at least once a day so he/she gets used to bottle feeding.

5. Let the baby lead the feeding by holding baby more upright with the bottle at a 45 degree angle. Encourage her natural breastfeeding instincts (rooting, flanged lips, switching arms, etc.)

6. If your baby won't take the bottle from you (mom), allow someone else to offer him the bottle.

7. Pump when you can at work. It doesn't have to be when your baby would eat. Take advantage of your "pumportunities"!


How and when do all these things occur? Here is an action plan from the IBC Baby Basics class that I teach.

Are you interested in more information about breastfeeding and working? 

Kellymom.com

Webinar on breastfeeding and working:

From One to Two: Preparing Older Children and You for a 2nd Child

The sibling relationship is likely to be the longest lasting relationship that your child will have, but making that transition from one child to two, isn't always easy. Not only can it be challenging for the older child, but having another baby can also put stress on the parental relationship. Preparing yourselves and your child for the next baby can be very helpful in easing the transition.

Normal things to expect are parental conflicts, increase in stress and workload, ambivalence and/or hostility from the first child. Not all effects of a second child are negative, but the negative aspects are usually the hardest to deal with, so below are some strategies in preparing you and your child for what may come.

Preparing the Parents:
The birth of a second child can sometimes begin the most difficult year in a couple's relationship, therefore working on the parental relationship can have a positive results on parenting. Communication is the key to avoiding conflict.

Here are some questions to ask each other before your second baby is born:

• What is your vision of the division of labor?
• How should we handle it if our expectations aren't met?
• What has worked well for us, as parents, so far?
• What has been stressful about our teamwork?
• How can we prepare for a new baby?
• What causes you stress with our first child?

Every change requires a loss. Think about what you might lose and talk to your partner about your concerns (time together, sex, sleep, personal time, etc.)

Preparing the Child:

Although there are many things that you can do to prepare the older child for a sibling, the child's personality has the greatest effect on the reaction to the new baby. Also, his/her developmental stage can really effect how he/she reacts to the baby sister/brother.

Here are some things to try that may ease the transistion:

• Read sibling books together
• Play baby doll games
• Teach older child the do's and don'ts with the new baby
• Maintain scheduling consistency as much as possible
• Encourage questions
• Describe where they will go and who will watch them during the birth
• Encourage involvement in preparations
• Embrace resistance and regression
• Carve out along time
• Don't make promises that you can't keep.

When children are making the transition into the role of big brother/sister, they need to know that their emotional needs are taken care of. They need to feel included, respected, important, accepted, and secure.  Also, avoid overt favortism, treat each fairly, honor the children's difference, avoid comparrisons and labeling them, and don't assume that all conflict is bad.

Having a second child can be very stressful on the family during which a lot of adjustments occur, but it also a very joyous time. So, prepare yourselves and your child for the wonderful addition to your family.

For more on sibling adjustment you can listen to the is free webinar.

Books:  Beyond One, Jennifer Bingham and How to Raise Emotionally Healthy Children, Gerald Newmark

Easter Surprise!

So the week before Easter was super crazy. I won't bore you with details but it involved an overnight postpartum visit, my parents spending one night, hosting a neighborhood Easter egg hunt, preparing for in-laws coming into town for a 3 day visit, my 31st birthday, and oh yeah, did I mention it was spring break so both kids were home. It was a bit stressful, but totally do-able.

A midst all the hoopla, I remembered that I had a client that was 7 days overdue. So I checked in with her via text. Everything was the same (i.e. no contractions or signs of labor) and she told me that she was nervous about the possible looming induction. So I said not to worry and gave her a list of natural labor starters and with a focus on nipple stimulation 2-3 times a day with a breastpump on low. And I thought, "Ok, great, I'll be able to get through the holiday weekend with no baby."

As I am laying down to sleep after an exhausting Saturday of running around and hosting my in-laws, I get a text that my overdue client is in labor. "Ahhhh!", I think, "not now!" After a couple of hours of phone doula-ing, I knew it is time to go. We met at the hospital. Everything went great and a healthy baby was born bright and early Easter morning.

Despite my original lack of enthusiasm, I was so excited for the parents and they seemed over-joyed with the whole birth experience.  I think the lesson learned there is that you never know how the day will turn out and as a doula we have to always be ready to serve and put our best foot forward for moms (and dads) who really need you.

Happy Easter!

Baby Blues or More?

Are you wondering if you have the "baby blues" or if it's something more?

The baby blues occur right after birth and resolve on it's own in 3-5 weeks. They symptoms of the baby blues are tearfulness, irritability, sadness, sleeplessness, anxiety, exhaustion. But what if those symptoms don't clear up on their own in about a month? You may be suffering from Postpartum Depression or Anxiety (Postpartum Mood Disorder-PPMD). PPMD is not uncommon. Up to 20% of all women suffer from PPMD across cultural and socioeconomic lines. PPMD can occur up to a year (or longer) after the birth of a child and may have begun while you were pregnant.

Early intervention is key if you think you might be suffering with PPMD. There are many sources of help available online and in person, whether you need medical, therapeutic, or social support. Reaching out or having someone reach out for you is the most important thing to getting help.

Ok, so what if you haven't had your baby yet, but you are looking into PPMD as a precautionary measure. Here are some risk factors and stressors that can increase your chance of suffering with PPMD.

Risk Factors:

• Depression or anxiety before or during pregnancy
• Previous cases of PPMD
• Intense fear of child birth
• History of mental illness and/or substance abuse
• Poor support system
• Abuse
• Loss of pregnancy or child
• Loss of one's own mother
• Medical complications in mother or baby
• Social Isolation
• Abrupt weaning
• Thyroid dysfunction
• Multiples (twins, triplets, etc.)

Stressors:

• Environment (home, work, finances, safety)
• Biological (history of infertility, hormones, thyroid issue)
• Relational (partner issues, family issues)
• Genetics (predisposition for PPMD)

Dads (or partners) can also be at risk for depression or anxiety after a baby is born. It is important that they get help too!

If you are suffering with PPMD or think you are at an increased risk, talk to your care provider, your doula, your lactation professional, your child's pediatrician or anyone who can help you reach out. There are also great online resources. Postpartum Support International helps women across the world be well.

It is ok to not be ok... it is not ok to stay not ok. 

There are people who can help!

Vaginal Birth After Cesarean

I attended my first successful VBAC (Vaginal Birth After Cesarean) a couple of days ago. It was long and hard, but my client was able to have a vaginal birth, although she had to let go of a few things that she really wanted in her birth plan. It is so hard to let go of the things you planned on, but otherwise she wouldn't have been able to achieve her main goal of a vaginal birth.

If you've had a previous cesarean section and are now are trying to decide which is the best option, here is some information that might help you make your choice. The International Cesarean Awareness Network has a great website that help you understand the risks and benefits of a VBAC.

VBACs have been popular for years within the natural birthing community, but are just now becoming more mainstream within the medical obstetric community. Research is now showing that VBACs, in most cases, are safer for both mom and baby. Check out this video on a national morning show that talks more about the concept of VBAC and safety.

As always, discuss VBAC with your care provider to make sure it is the best and safest choice for you and your baby.

Some Postpartum Tips

I have been on hiatus, well, kind of. I have taken off the month of January for birth doula-ing, but for the months of December through February, I have had the shear pleasure to work with a great family as a postpartum doula. This "time off" was refreshing and renewing for me. It allowed me to have a more predictable schedule and not be as exhausted. Working with a lovely family has really renewed my passion as a postpartum doula. I was feeling a bit down, after some difficult experiences, but this one really lifted my spirits and reminded me of some great knowledge about the postpartum period that I want to pass along.

1. Breastfeeding. If you are nervous about breastfeeding or are having difficulty, it is so important to get support through it. Whether you visit your local la leche league, use a postpartum doula, or see a lactation consultant, it is just important to have support and correct information. Another important point about breastfeeding is that your newborn (up to around 2 months) needs to eat 10-12 times a day. I know that it seems like a lot, but this is what your baby will require. Sleepy babies do not gain the weight the way they should. Here are some ways to wake your sleepy baby.

2. Get out and about when you can. Or have people to your home so you don't feel isolated. Knowing that you have a break from the "normal" routine may lift your spirits and help you avoid baby blues or postpartum mood disorders. Consult your doctor as to when is a good time to take your baby in large crowds.

3. Wear your baby! This is the number one thing I can recommend to new parents. Babies love to be worn and you can get household chores done at the same time. Baby wearing also counts as tummy time for your newborn. There are so many benefits of baby wearing and you can check them out here. There are great places to check out all the different options for baby wearing. If you are local to the Baltimore area, Greenberries or Soft and Cozy Baby have baby wearing experts.

I wish you all the best in your postpartum period with your family and new baby!

Yup, that's me baby wearing just after putting on a duvet cover on a duvet. Love it!

What you need to know about the NICU

Most parents' expectations of what life will be like after a baby is born is filled with joy, visitors, pictures, and a quick stay at the hospital. But for those facing the challenges of a baby in the NICU (neonatal intensive care unit), life is very different. Usually NICU babies are very sick or premature and life seems to hang in the balance. Although it can be a very sad and hard time, there are things that you can do make life in the NICU a little more bearable.

In the webinar, Different Beginnings: An Inside View of the NICU, nurse, Mary Coughlin, describes what the NICU is like, what nurses can do to make the stay better, and what parents can do to help their infant thrive.

There were two main points that stood out:
1. Parental involvement is key to infant success in the NICU. There are countless studies that show that infants have better outcomes if parents are involved in their daily care. In addition to parental care, skin-to-skin (also known as kangaroo care) is vital to infants health in the NICU. It is so important to be there for your baby when they are sick. Nothing effects their outcome more than the parents.

2. Feeding your infant breastmilk is crucial to an infants ability to thrive in the NICU. Breastmilk is so important to an infant in the NICU that it is sometimes referred to as medication. Breastmilk is nutritionally perfect for infants, and especially beneficial to the sick or premature NICU infant. Breastmilk helps infants grow faster and healthier!!

If you are a parent facing the chance of NICU stay, please listen to the webinar and get support from other parents who have had infants in the NICU.

A Christmas Birth Story

As a doula, when you take a client around the holidays, you know there is a slight chance that a baby will come on the actual holiday and that is exactly what happened to me. My December client was a couple of days over due when I heard my phone chirp on Christmas Eve morning. It was the text that I was hoping to avoid until after Christmas morning, since this year I was hosting my parents and sister. My client was in early labor and so at this point my main goal was to finish cooking Christmas Eve dinner before I had to leave. We finished dinner just in time for me to leave. When I met my client, she was still in early labor so I knew for sure we had a Christmas baby on our hands. After some tough night labor, she had her baby.

I rushed home to open gifts, but my kids were already done opening them. My hubby graciously video-ed them opening each thing. The adults had waited until I got home to open presents, but the only thing I wanted was to eat and go to sleep. I mustered the strength to open and appear thankful (which I was) for all the awesome gifts. Then I crashed.

Later, when I was reflecting on the true meaning of Christmas, I thought about Mary giving birth alone (no doula or midwife), with just Joseph by her side. How scared and confused she must have been, not knowing what to expect from labor. I thought how thankful I am to help women through that unknown and difficult time. I also felt blessed to witness the birth of a child on Christmas day--what an awesome gift! So as it turned out that the best gift I received this Christmas was not all wrapped up in fancy paper and bows, but instead came swaddled up in a pink and blue hospital blanket!