Doulas and their Boundaries

My job as a doula is to help you grasp all of this information as best as you can. When you endure a major life event, it affects your ability to remember previous conversations. A doula chimes in and helps you recall your initial expectations, and then gently helps you shift your perspective to the present moment. This is where boundaries play in a doula’s role.

It should go without saying, that a doula’s opinions should not play into any aspect of their client’s birth. As with any boundary, these lines blur depending on the context. I can attest to growing more opinionated as my experience has broadened. My education allows me the ability to offer unique suggestions, but how do we know when to push for a little more effort, or to step aside and allow for the birthing person to make their choice?

I certainly step aside more often than not. Maybe that is where I’m at in my journey, or maybe that is just how birth should be supported. Birth is many things; Strength, vulnerability, shedding of old ways, and transforming into parenthood. Of all those things, I work hard to be empathetic to my client’s needs. I have had moments in which I felt compelled to push. Some clients follow that guidance, while others push back. Either way they are informed of their options. I have even had clients ask me (and partners) to leave. While it may seem like a slight on my skills, it’s truly just what that birthing person needs. The art of “doulaing” requires a person to set aside their pride, and support individuals where they are.

This is definitely a processing point for me as a doula. Was I enough? Could I have advocated more for this? Should I have advised differently? Is this safe for my clients? Just like everyone else caring for these individuals, I have seen birth many times. Our ability to to draw a line can be compromised. Empathetic roles require a high level of self care. When implementing boundaries that allow me a proper amount of self care, I can continue to grow my knowledge, and still be sensitive to my client’s needs.

Like any fiscal position, I have individuals question my value as a caregiver. These boundaries in particular are the groundwork to maintaining my career. This generally takes place in the interviewing process, but sometimes within the early stages of a professional relationship. Questions arise such as, How are you helpful within a planned c-section? What if you aren't available for our birth? These are valid concerns. This is a place where we sort of web all of our boundaries into a safe space, and through contractual agreements. It’s incredibly important that every person involved in this experience feels heard, so that they feel confident in themselves throughout the whole process. This experience will affect every aspect of their parenting relationship, and doulas are very sensitive to that.

Putting it into words almost feels like a juggling act, which is how I imagine most business owners feel, but most especially us empaths.

Boundaries with Friends and Family

This week’s topic is a follow up from last weeks post. For those that missed last weeks submission on placing boundaries in public scroll down!

Okay, so you have finally figured out how to leave the house  and not feel completely like everyone wants to tell you their life story. Whether you are physically concealing your belly, or simply asking people to mind their business, you are setting boundaries. This concept gets a bit hairy at this point. Now we need to think about placing boundaries with family. Just like pregnancy, birth draws people to you. Especially those that love you the most. The joy of a new baby is special, but we must be able to respect the process that takes place prior to baby’s delivery.

Consider your everyday relationships with these individuals. All interactions both negative and positive will play on a grander scale. You need to have the ability to focus on your body, and allow for the surges to carry you into a very vulnerable state of mind. Even the feeling of being watched or waited on can stall labor. So, if your parent had a traumatic birth experience and draws from that while at your birth, that can create a serious road block.  I have supported couples that didn’t tell family until they were home from the hospital, I have also supported couples that allow a fair amount of their family there, and interacting with the birthing person, and in the birthing space. It can be both a positive or a negative influence. It’s up to you to examine those relationships and start dialogue with those individuals, so that your boundaries are respected.

These are tough conversations, plain and simple. Remind them that your need for privacy is strictly for your benefit, and that it’s not personal. Every relationship carries different qualities. You know from the get go how these conversations are going to play out, so don’t dance around any details, just try and be direct.

I often recommend giving tasks to the individuals that want to be a part of it, but will likely stir up some emotions. Have them take care of pets, make sure that you have groceries to come home to, and tidy up the house. There are many things that will include them in the process, be creative!

When it comes down to it, it is imperative that they respect these boundaries. In the case you feel they will likely disrespect the lines you are setting, then you have every right to keep them out of the picture until you feel it’s okay for them to come. When it’s all said and done, that little bundle will be a nice bridge over sour feelings, and now you have all kinds of responsibilities to give them when you return home with baby!

Next week I give my perspectives of setting boundaries in Doula work, and offer some insight to the insecurities we face as care providers.

Setting in Boundaries in Public

Boundaries. This is a concept we learn overtime. For me it was through a slough of embarrassing moments in my 20s. No lesson is ever learned without a mess. I say this often when I’m attending births. In my role as a doula, boundaries are a large part of the discussion that I continue to have, even on the day of the birth with my clients. Placing such distinctions for your birth is paramount in delivering your baby. Remember. These preparations will not change any potential curve balls in your expectations of your birth, but having a clear idea of the environment you need to have in order to feel safe and vulnerable will give you a leg up in the process.

On paper, that all sounds pretty doable. Now, we add in your current lifestyle. Whether you planned this for years, or your caught by surprise, this is a major change in your individual lives. The stress of finances, the pressure of responsibilities in your work lives, and managing schedules in the hopes of spending a day or two together. This climate isn’t always cut out for the efforts it takes to really come to terms with expanding your family. Naturally we turn to others that have been through it before. How did they cope? Where did they give birth? How was there experience in comparison to their expectations? Most of the time pregnant individuals don’t even get a chance to ask. Pregnancy tends to draw people near you regardless of how you are feeling in the moment. This is a great place to implement those boundaries. It sounds silly, but I always recommend having a specific statement prepared for the unwelcome interactions. “I respect and appreciate your experience, but have to be on my way” Simple, respectful, and concise. How they take that is on them.

Next week we discuss boundaries in your birthing environment. How to decide who you want in your space, and taking the steps to set those standards ahead of time.

The Ergonomics of Postpartum Recovery: Nursing Support

Whether you're breastfeeding or bottle feeding, our posture is a factor. You have spent the last nine months supporting a completely different center of gravity, so our tendency to slouch is much greater now. There is an abundance of accessories on the market that you can get to help prop baby up closer to you. More specifically for breastfeeding people a handful of ways you can hold your baby while nursing. A newborn eats a lot, so you will find yourself seated many hours a day feeding your baby. Consider the state of your posture and set up a functional space to support you and your baby. 

 

Start with a decent chair, one with motion. A rocking chair or a glider are the common buy these days. They double as support during the feed, and then can facilitate soothing motion to help calm baby. The exercise ball you may have purchased prior to having baby. This encourages great posture, and is a great tool in soothing baby. The ball does all the work for you, rather than having to bounce your tired body. 

Start with a decent chair, one with motion. A rocking chair or a glider are the common buy these days. They double as support during the feed, and then can facilitate soothing motion to help calm baby. The exercise ball you may have purchased prior to having baby. This encourages great posture, and is a great tool in soothing baby. The ball does all the work for you, rather than having to bounce your tired body. 

A nursing pillow will help prop baby closer to you. These all can be used for both breast and bottle feeding. The Brestfriend has a clasp that you can adjust at any point on your torso, it also has a little pocket you can fit a water bottle, a pacifier, a nipple shield, really anything you have found helpful in your feeds. I included the Hiccapop because it is an awesome edition to propping baby higher, I personally use it on my lap under baby for bottle feeds. It allows for me to sit up straight and props up baby on an angle for feeds. This is really for pregnancy prior to baby's arrival, but I recommend as another full circle tool for both parent and baby. 

A nursing pillow will help prop baby closer to you. These all can be used for both breast and bottle feeding. The Brestfriend has a clasp that you can adjust at any point on your torso, it also has a little pocket you can fit a water bottle, a pacifier, a nipple shield, really anything you have found helpful in your feeds. I included the Hiccapop because it is an awesome edition to propping baby higher, I personally use it on my lap under baby for bottle feeds. It allows for me to sit up straight and props up baby on an angle for feeds. This is really for pregnancy prior to baby's arrival, but I recommend as another full circle tool for both parent and baby. 

Now for nursing positions. These positions above will be the more common holds taught immediately after baby's arrival. The football hold I recommend to larger breasted individuals, or with nipples that angle outwards. Breastfeeding will bring a whole host of new things to understand, and one of those things is the shape and placement of your nipples and how to best facilitate a feed with them.

Now for nursing positions. These positions above will be the more common holds taught immediately after baby's arrival. The football hold I recommend to larger breasted individuals, or with nipples that angle outwards. Breastfeeding will bring a whole host of new things to understand, and one of those things is the shape and placement of your nipples and how to best facilitate a feed with them.

These are some of the more advanced positions for nursing. I recommend the side lying position for parents that are comfortable with co-sleeping. It's a great night time nursing position, as it requires less effort in moving around. The laid back position I recommend to individuals with fast and heavy let down. When a let down is heavy it can cause some discomfort and frustration in feeding to baby. The laid back helps lesson the force of the let down and allows for baby to work the milk out at its own pace.  That twin hold is wonderful once mastered. Twins require an extra set of hands, so a helpful partner is essential in this position. Your nursing staff should be an excellent resource for you in postpartum recovery, but if you still feel like you need help, check out my blog series on   The Importance of Breastfeeding Support.

These are some of the more advanced positions for nursing. I recommend the side lying position for parents that are comfortable with co-sleeping. It's a great night time nursing position, as it requires less effort in moving around. The laid back position I recommend to individuals with fast and heavy let down. When a let down is heavy it can cause some discomfort and frustration in feeding to baby. The laid back helps lesson the force of the let down and allows for baby to work the milk out at its own pace.  That twin hold is wonderful once mastered. Twins require an extra set of hands, so a helpful partner is essential in this position. Your nursing staff should be an excellent resource for you in postpartum recovery, but if you still feel like you need help, check out my blog series on The Importance of Breastfeeding Support.

When it comes down to it, fed is best. There is nothing more natural than a baby communicating it's needs and receiving it. How you choose to nourish your little one is completely up to you, and you should never justify that to anyone.

Next blog I will present the different styles of baby carriers on the market, and how to choose what is best for you. I will also include some  helpful soothing techniques for baby.

Weaning Baby pt. 3

Now, for the later stages. Introducing solids is an exciting time for parents. By now baby is sitting up on their own, giggling, and even making demands. The timing of the introduction of solids varies for every baby, as well as every mother. Weaning a baby with solids is helpful, because it is an entirely different feeding process for baby, in comparison to bottle/breastfeeding. This way instead of refusing the breast and fighting baby to take a bottle, you can offer a new experience to share with mom, or whomever is feeding them at the time. This practice is often referred to as “don’t offer, don’t refuse.” Once you and your little one establish a rhythm with this, you can begin to utilize breastfeeding as a soothing technique. Maybe a tender intimate moment before naps and bed, or a nurturing moment after a bad spill at the park. This is often how mothers reestablish and/or continue the connection with their older children after bringing new babies home. Some of us can’t even fathom what it would be like still breastfeeding a five-year-old, or even a three-year-old. Oddly enough, a great deal of moms feel this way until they have found the love for these moments with their babies that is the pure joy of making the right decisions for you and your little ones. I commend mamas these days for offering encouragement and not judging other mamas for their choices. These decisions only grow into greater issues in the future, and we need to be able to feel confident that we have our children’s best interests at heart.

One aspect of weaning baby that often gets overlooked is the hormonal changes that come with reducing milk production. Prolactin,  and oxytocin  work in tandem to produce and bring milk down. Oxytocin, also known as the love hormone brings on feelings of calm and comfort, it works as a bonding agent for you and baby. It is hypothesized that any abrupt stop of breastfeeding can cause an influx in your hormones inducing feelings of sadness, depression, and even irritability. Some mother's will be more susceptible  to depression then others. This can be due to past history of mental illness, it could just be the current circumstance. Some ways to reduce the emotional drop would be to gradually decrease your feedings. Try and plan as far ahead as possible, removing one feeding a week and replacing with hand expression. Any sign of depression or change in normal behavior should be addressed. I have pasted a link below to a bonus blog of mine that will cover how to address depression and knowing your options

Weaning takes patience and persistence, similar to teaching your body to produce you are now conditioning it to stop producing. The frustration often arrives when bay becomes frustrated, and mama is exhausted from the changes in her body. Remember to give yourself and baby a break every once in a while, that comfort you exchange will help nurture your experience. Find joy in letting baby taste new flavors, and have a camera ready, those moments can be absolutely priceless. 

Next week we talk storing breast milk basics, in addition to my list of resources for this month's topic!

Here's a bonus link to my latest blog featured with Stork Maternity Consulting. Here I address the steps you can take to get help during times of emotional turmoil:  http://storkmaternityconsulting.com/blog/your-new-identity-mom

Weaning Your Baby pt. 1

Since we kicked off this month with World Breastfeeding Week, I thought we should expand on how breastfeeding looks in the later postpartum months. These next few weeks will include topics on weaning baby, working and breastfeeding, as well as storing breast milk. These are things many don’t really even consider, even after the immediate arrival of their new little one(s).

Weaning a baby from the breast is a mother’s personal decision. I know I stress this in almost every blog I have posted, but mothers often allow the pressures of other people’s opinions to shape their choices for their own baby. It is important for every mother to know that she has the right to make every decision for her baby (within reason, of course, and in times of potential health risks). I also would like to point out that this decision (while it should be discussed with your partner) is solely up to mom, as it is her body.

There are various reasons why babies are weaned off the breast. The most common instance is the six-month mark, when it is recommended that you introduce solids. This process can take place earlier for mamas who have to take meds which are not safe for breastfeeding. Other moms may have to return to a full time job, and some mamas just don’t feel comfortable enough doing it, and have found more joy in bottle feeding.  

How does this process look in the earlier stages of infancy? Starting to wean this early can often seem very tedious. However, it is important that you remain as patient as you can with this change. Baby will often challenge anything unfamiliar to them, especially a substitute to their favorite thing ever.

We will start by discussing the process for mamas that have to go back to work and want to continue giving baby breast milk. You will want to start preparing for this juncture at least 4 weeks out, maybe more (if you can). In order to increase supply and begin storing breast milk, try pumping once each morning. The morning is a prime time to pump, as that is when you have the most milk. The following week, start by replacing baby’s least favorite feed with a bottle. If baby refuses the bottle, it’s likely they can sense “their boobs” nearby. See if dad or grandma (etc.) will take them and try feeding. You will also want to replace that feeding with a pump session, this will help maintain your milk supply for baby, and will help build up your storage supply in the freezer. Your goal is to have baby used to exclusive bottle feeds in the afternoons while you’re away. You will have to work out a pumping schedule with your workplace in order to continue offering baby breast milk exclusively. This is very common in this day and age, and shouldn’t be an issue. One thing to keep in mind while pumping is where you are doing it. Try to arrange your pump session in a place that you are most comfortable. It is important that you remain relaxed during pumps in order to be as efficient as possible with your milk production. In addition to a pump schedule, you will also want to work out a system for storing the milk until you get home. Most, if not all, offices have access to a freezer, I recommend freezing your supply and labeling it at work, then toting it home in a mini cooler so it doesn’t thaw. Remember to date and initial your breast milk supply so as to not confuse it with another mama’s in the office. Any daycare/nanny/partner should have complete access to your breast milk through the frozen supply you will have built up by pumping instead of feeding. If it’s not too confusing for baby, you could keep your nightly feeds together on the breast and continue to use these moments as incentives for baby as they mature.

Next week we will discuss weaning baby off breastfeeding as well as breast milk, how to assess the right formula for baby, and avoiding engorgement and clogged ducts in the process.

 

 

The Benefits of Babywearing: Safety Tips

As with all things baby, this concept also comes with safety tips in wearing your baby properly. Baby’s airway must be open at all times. By wearing baby upright, with their head close enough to kiss, you should be able to observe baby’s breathing. Their chin should be off their chest at all times. It is recommended that baby should only be in a horizontal or cradle position while feeding, otherwise baby should remain in an upright position. The baby’s head and neck should be properly supported in the carrier. A baby’s knees should be higher than its bottom in a squat position against the belly. This will change as baby develops into toddler stage and will not be attainable or necessary. A soft carrier (i.e. ergonomic, Mei Tai, Ring Sling, a wrap, or Moby Wrap) are good options for newborns shifting into toddler years. Always inspect your carriers for any loose threading, holes, or worn fabrics.  It is always recommended that you purchase your carrier from a reputable source, although there are quite a few local communities that can offer trades and safe hand-me-downs for new mamas as well. Be sure to practice using your carrier with a spotter in a safe space, over a couch or bed preffered. Always practice good ol’ common sense- if it doesn’t feel right than it’s probably not safe for you or baby.

There are so many styles and shapes out there, it’s just a matter of finding the right one for you. Thankfully with resources like Babywearing International, we can find local chapters that can assist you through this process. See below for links and resources.

I will also say with every blog I post, there are many interpretations to parenting. I encourage you to use this information to find what works for you, and don’t allow for it to determine what you are doing wrong. There is no wrong way-only your way.

 This concludes our monthly topic for July! As promised I will always list my sources for each month. Please feel free to be a part of the conversation!

http://babywearinginternational.org/what-is-babywearing/

http://www.bwiaustin.org/

http://babywearinginternational.org/about-bwi/chapters/

http://www.skintoskincontact.com/susan-ludington.aspx

The Benefits of Babywearing: For Everyone

 

Babywearing allows for a deeper connection between daddy and baby. Mommies get to wear baby inside for 9 months, so this gives daddy the opportunity to have such an influence on their new baby. This is also highly recommended for adoptive parents, as well as mothers enduring postpartum depression. Baby is able to get used to a parent’s voice, heartbeat, their facial expressions, and unique gestures.

Babywearing also allows for the more practical things in your life to take place. You can keep baby close, and still have your hands free. This allows for play time with the elder sibling, cleaning around the house, and prepping dinner. Imagine the freedom in a crowded neighborhood gathering. No need to push a stroller through large crowds of people, and you can go where a stroller can’t. This makes for nature hikes, and less complicated trips to and from airports.

So, what kind of baby carrier should you buy, and which one is best for you? Next week we discuss a few types of carriers and safety tips for wearing baby. 

The Benefits of Babywearing: Kangaroo Care

Last week we discussed the fundamentals of babywearing in your own home. Now, we will see it's benefits in a medical setting. The US has been fortunate enough to have the technology to support preterm infants. Other countries have had to come up with less costly ways to support these preemies in need. 

 Often referred to as Kangaroo Care (K-Care), hospitals with small budgets in areas like Guatemala have utilized K-Care in lieu of incubators. According to a study done by Susan Ludington at UCLA, having baby close allows mother’s body to regulate to baby’s needs. Preterm babies are placed between the mother’s breasts inside her clothing. This has shown proof of temperature regulation; it also improves respiratory function. Baby attunes to wearer’s heartbeat, breathing, and movement (walking, reaching, bending). This stimulation has proven faster weight gain, and k-cared babies prove to be healthier than babies who have not endured such stimulation. 

Amazing what the human body is capable of! Next week we continue our discussion on babywearing and how this practice can benefit both parents in the home.

The Benefits of Babywearing: The Basics

Babywearing is the practice of keeping your infant/toddler close to you while you go about your daily routine. This is a practice that was used throughout centuries of developing civilizations. Babywearing has developed over the years as a beneficial practice to understand your baby, facilitate their development, and their physical growth.

 Studies have shown babywearing facilitates a closer connection with your baby’s needs. By having baby close, you will better understand their cues before they feel the need to cry. This instills not only confidence in you as a parent, but confidence in your baby in knowing that they are well taken care of by both mom and dad. A study published by The Journal of Pediatrics shows that babywearing for 3 hours a day reduces crying by 43% overall, and by 53% in the evening hours. That is a huge shift in your baby’s demeanor, and you can see why this will help you be a confident parent. 

 Babywearing is a good tool for a baby that cries each night at the same time for hours at a time. Wearing baby close to you for a few hours a day could be just the thing that breaks the cycle. Next week we will discuss this practice in a medical setting. Babywearing, more commonly called Kangaroo care is all some premi babies have. 

Breastfeeding Support Resources

I hope you enjoyed my first blog series this month! Next week I will begin a blog series on Babywearing! We will be addressing the benefits for both mama and baby, it's use in a more clinical practice, as well as how to find the best carrier for your family. I have listed some resources for my previous blog series. I often find myself checking and re checking sources when I read informal blog topics, so to make it easier for those that do - here they are:

http://www.cdc.gov/breastfeeding/pdf/strategy3-professional-support.pdf

http://www.cdc.gov/breastfeeding/promotion/

http://www.nrdc.org/breastmilk/benefits.asp

"Dr. Jack Newman's Guide to Breastfeeding" by Jack Newman, Teresa Pitman

 

The Importance of Breastfeeding Support, and How to Decide What Works for You

Last week we addressed the first few days of being home with baby and breastfeeding. Between adding new responsibilities to your previous agenda and waiting for your milk supply to drop, you can accrue quite a lot of stress. 

This is why breastfeeding support is so important in the early stages. Once you find a rhythm, it will simply be clockwork, but you have to put in the time to find that rhythm. Thankfully, most hospitals have seen the value in lactation support and now offer the support of a Lactation Consultant (LC). The LC will be able to show you multiple ways to find the best latch for you and baby. All latches vary because all breasts are different. Also, consider keeping your baby in your recovery room with you, this way you can allow for cluster feeding and nipple stimulation to bring your milk in faster. If your baby is placed in NICU and you are put on a schedule immediately, don’t let this discourage you, you can ask the hospital for a breast pump to stimulate between each feeding with baby. Some mothers will be asked to supplement with formula; again, don’t let this discourage you; You can continue to nurse in addition to the supplements. Once baby surpasses his/her birth weight, you should have no problem continuing to breastfeed.

 Some women find the first few days home with baby a bit daunting. Those feelings of inadequacy come back, and they feel like the baby is always on the breast. They panic and forget the tips given, and with the lack of sleep, everything can be very overwhelming. Now a’ days, there are resources for the family to have in their own home. Lactation Consultants, International Board Certified Lactation Consultants (IBCLC), as well as Postpartum Doulas will make house calls. Which one is best for you? An LC will help reinstate those tricks learned in the hospital before coming home. An IBCLC will virtually do the same; however, they will be able to assess baby’s latch, in addition to diagnosing a tongue tie on baby, and refer you to a physician that can correct it. Tongue ties are common, and easily corrected. IBCLCs are also great for assisting in better milk production. Some mothers experience low lactation due to meds they take, or previous breast reduction surgery. A Postpartum Doula can assist you in establishing breastfeeding in addition to helping you create the most nurturing space for you and your family.  A PPD can be available in the afternoons to help you attain the goals you have for the house to give you time with the baby, or take the baby while you shower and nap. They even hang out with your other little ones and make sure they are adjusting to having a new baby home. PPDs also offer overnight assistance so you can maintain your feeding schedule, but still get adequate sleep.

It is important to remember that you are human, and you can’t do everything at once. These resources are put in place to help build your confidence as a mother, and to help ease you into the transition. Try and practice as much patience as you can muster, and don’t be hard on yourself, breastfeeding is sure to become an everyday thing added to your agenda.

Here's a list of some of Austin areas own Breastfeeding Support:

http://storkmaternityconsulting.com/lactation-support

http://austinbabyguru.com/

http://texaslll.org/group/central-texas%20

http://mypuredelivery.com/austin

The Importance of Breastfeeding Support, and How to Decide What Works for You

Preparing for a new baby can be exciting and daunting all at once. It’s hard not to hold yourself to a certain standard before baby even arrives. Luckily, there is a slew of information out there to help you prepare for this exciting change in your life. Take breastfeeding for example: the general consensus regarding breastfeeding is that it is the best and most natural way to feed your baby. While that may be true, we have lost sight of how challenging it can be. Over time, we have developed an entire industry to supporting breastfeeding mothers. I’m going to take you through the general facts of breastfeeding, how it can benefit both you and baby, and how to master it.

Unlike our animal counterparts, human babies are born physically and neurologically underdeveloped. Breastmilk has a highly nutritional blend that benefits both baby’s mental and physical growth. You will notice a change in your nipples during pregnancy. Those little bumps on your areola will swell a bit, those are the Montgomery Glands. These glands are highly important in the process of breastfeeding. They secrete an oil to keep the surface clean, in addition to tracking your baby’s digestion needs. When your baby’s saliva comes in contact with the Montgomery Glands, they send a message to your body to produce certain nutrients for baby. They even alert your body of your baby getting sick, sending a message to your white blood cells in order to produce antibodies for whatever illness your baby contracted. According to the Center for Disease Control, breastfed babies are less likely to develop diseases early in life.

Pretty wild huh?! Our bodies have all the right mechanics to support the health of our offspring. We even gain information biologically through kissing our babies on the forehead-that is a whole other blog topic. It really does offer another perspective on a mother's intuition. 

Next week I will cover coping with the first few days after delivery. I vow to stay diligent in posting, give or take the normal bumps in life's road. Thank you for participating, and I look forward to keeping the conversation going!!