What Mamas Need After Baby is Born

I attended my first birth last week!

More on that later, but for now this amazing list of what a Mama needs AFTER the birth. She can, of course, call a postpartum doula as well.

Re-posted from Gloria Lemay Birth Blog

After the Birth, what a family needs

Posted on October 28, 2008 by gloria

 “Let me know if I can help you in any way when the baby is born.” … “Just let me know if you need a hand.” … “Anything I can do, just give me a call.”

Most pregnant women get these statements from friends and family but shy away from making requests when they are up to their ears in dirty laundry, unmade beds, dust bunnies and countertops crowded with dirty dishes. The myth of “I’m fine, I’m doing great, new motherhood is wonderful, I can cope and my husband is the Rock of Gibraltar” is pervasive in postpartum land. If you’re too shy to ask for help and make straight requests of people, I suggest sending the following list out to your friends and family. These are the things I have found to be missing in every house with a new baby. It’s actually easy and fun for outsiders to remedy these problems for the new parents but there seems to be a lot of confusion about what’s wanted and needed…

1. Buy us toilet paper, milk and beautiful whole grain bread.

2. Buy us a new garbage can with a swing top lid and 6 pairs of black cotton underpants (women’s size____).

3. Make us a big supper salad with feta cheese, black Kalamata olives, toasted almonds, organic green crispy things and a nice homemade dressing on the side. Drop it off and leave right away. Or, buy us frozen lasagna, garlic bread, a bag of salad, a big jug of juice, and maybe some cookies to have for dessert. Drop it off and leave right away.

4. Come over about 2 in the afternoon, hold the baby while I have a hot shower, put me to bed with the baby and then fold all the piles of laundry that have been dumped on the couch, beds or in the room corners. If there’s no laundry to fold yet, do some.

5. Come over at l0 a.m., make me eggs, toast and a 1/2 grapefruit. Clean my fridge and throw out everything you are in doubt about. Don’t ask me about anything; just use your best judgment.

6. Put a sign on my door saying “Dear Friends and Family, Mom and baby need extra rest right now. Please come back in 7 days but phone first. All donations of casserole dinners would be most welcome. Thank you for caring about this family.”

7. Come over in your work clothes and vacuum and dust my house and then leave quietly. It’s tiring for me to chat and have tea with visitors but it will renew my soul to get some rest knowing I will wake up to clean, organized space.

8. Take my older kids for a really fun-filled afternoon to a park, zoo or Science World and feed them healthy food.

9. Come over and give my husband a two hour break so he can go to a coffee shop, pub, hockey rink or some other r & r that will delight him. Fold more laundry.

10. Make me a giant pot of vegetable soup and clean the kitchen completely afterwards. Take a big garbage bag and empty every trash basket in the house and reline with fresh bags.

These are the kindnesses that new families remember and appreciate forever. It’s easy to spend money on gifts but the things that really make a difference are the services for the body and soul described above. Most of your friends and family members don’t know what they can do that won’t be an intrusion. They also can’t devote 40 hours to supporting you but they would be thrilled to devote 4 hours. If you let 10 people help you out for 4 hours, you will have the 40 hours of rested, adult support you really need with a newborn in the house. There’s magic in the little prayer “I need help.”

First posted online August 2001

The Breastfeeding Chronicles: I Used Donor Milk To Help Feed My Twins (CP)

One of the beautiful things about being a doula is supporting women and their choices for there pregnancy, birth and postpartum time. We also educate, but we don't pressure or try to sway a woman in either direction or another, rather we can present multiple options and allow the mother to decide.

There is a spirited debate about bottle feeding vs. breastfeeding and I have my own opinions, to be sure. I've spoken to several friends who expressed their desire to nurse there children, but for a variety of reasons were unable to. I've spoken to other friends who didn't think they'd enjoy breastfeeding, but now love it and hope to do it for as long as possible.

The concept of a wetnurse isn't new and it's not something that only the wealthy or aristocratic people do, it's actually more common that we'd like to think. I, for one, think if you've got it, why not give it?

Below is a story of a mother who wanted to nurse hear children and her journey to getting them yummy and nutritionally-dense good, old-fashioned mama milk.

Breastfeeding her twins -- a boy and a girl, born two weeks early -- mattered very much to Melissa, 38, a special education teacher from North Carolina. But when they quickly started losing weight, she and her husband were forced to turn to options like donor milk and a supplemental nursing system to make it happen. As part of our series on what it's really like for new moms to breastfeed, Melissa talks about how it feels to rely on donor milk, and how dramatically nursing can vary from child to child.The BirthThe twins came two weeks early, so they actually made it a long time for twins. I didn't want a cesarean section, but at 38 weeks, my doctor was really insistent that I needed one. It was the end of June, and I was so swollen. I had so much water retention, I ended up needing carpal tunnel surgery to reduce the pressure in my hands, and my doctors were worried about permanent nerve damage. They thought that maybe I could deliver my daughter vaginally, but I'd need a C-section for my boy. I didn't want to do both, so we went with the C-section.
The nurses at the hospital were fabulous. As soon as the babies were born and cleaned up, we tried nursing. I knew I wanted to breastfeed, but I didn't know what to expect. I knew there was a learning curve, but it hurt, and there I was in the hospital, watching their weight drop. The doctor said that we had to start supplementing, because their weights were getting really low. He said we could do formula or donor milk. We were really fortunate that there was a milk bank right there in the hospital.
Going DonorI had heard about donor milk before, but I had a lot of questions about how it works and where the milk comes from. Ultimately though, breastfeeding was so important to me. Selfishly, there were health reasons -- there's breast cancer in my family, and I know breastfeeding can help reduce the risk. Plus, I wanted the twins to have the health benefits of breast milk, so at the end of the day, that's what we went with.
It's amazingly expensive, probably $4 to $5 an ounce. It was a lot of money, but we knew it wasn't going to go on forever, and knew that we really wanted to provide our babies with breast milk. We probably used donor milk for almost two months. I haven't calculated what it was total ... but it was a lot.
The fact that it came from other women was a total non-issue for me. If anything, it seemed like such an amazing gift for these women to be able to provide milk to babies who need it. And we knew it had been screened and tested.

Read the rest of this article on Huffington Post 

The Doula As Witness-Cross Post from The Childbirth Collective

by Jess Helle-Morrissey, MA, MSW, LGSW, LCCE, CLEC

Doulas serve a multi-faceted role in a birthing family’s life: supporter, encourager, normalizer, educator, guide. We rub backs, we squeeze hands, we stroke hair, we breathe, we hold space.  We press cool cloths to a birthing woman’s head as she brings her baby (or babies) forth from the warm, wet womb to the bright spinning world.

One role that is often overlooked, but is perhaps most sacred to my own doula heart, is that of witness. As doulas, we witness over and over again that unique and unparalleled moment in a woman’s life when she becomes a mother. Whether it’s a first birth, or a seventh, a mother is born each time she births a baby.

When a woman has a transformative birth experience (and really, what birth isn’t transformative?), she deserves to be fully seen. And that role is often uniquely the doula’s. Partners are witnessing, but they are most often deservedly caught up in their own personal experience of the moment. Midwives, doctors, and nurses are present, but they have medical tasks to attend to. Doulas are able to attend wholeheartedly to that moment.

We witness the joy of birth. We witness mamas finding their true selves for the first time in their lives as they birth their babies. We see the look on a mama’s face when her baby is five minutes old as she tells us, “Everyone said I couldn’t do it, but I knew I could.” We witness the hilarity of birth – I’ll never forget one mama who turned to me after birthing her twins and exclaimed, “That was f*cking AWESOME!” We get to see the way a partner looks at the birthing woman in complete awe as she makes her way through contraction after contraction. We get to see him or her wipe a tear away as this new little person makes that first yawling cry.

We witness the disappointments, too. And when things don’t go as planned, we can remind her that she is strong because we have seen it with our own two eyes, and we have felt it in our own doula souls. And we remember in a way that she might not.

So as witnesses to those moments, we begin to help her reframe:  Last summer, one of my doula mamas had a surgical birth after a long and difficult labor. In a case like this, it is easy to go to a place of dwelling in what went wrong. I go to my postpartum visit. We talk about all that happened, and I validate the disappointment. I sit with the pain.  But I also tell her, because I need her to hear, “I have never seen anyone work so hard for so long. I have never seen anyone fight so hard for what she wanted. You. Are. Amazing.” And she begins to feel it is true because I have seen it and I know it to be true. She knows I was there. She knows I saw her fully. And as I write this, I remember her fierce birthing spirit as if her baby was born yesterday, and I feel the hair on the back of my neck stand up a bit. Because I will never forget her strength, and the gift she gave me by allowing me in.

Above all, it is that sheer strength of birthing women – no matter how they give birth – that we doulas are witness to. The strength to carry on when it feels like all the reserves have been depleted. The strength to make a choice to go a different direction than we’d dreamed. The strength to joyfully claim a place in the history and lineage of birthing women.

And the repercussions of that witnessing can last a lifetime. I spent a good part of my own life feeling like I was not a very strong person. When I gave birth to my twin boys, I found strength I never even dared to imagine I had in me. Today, more than two years later, each time I see one of my two wonderful doulas, I still stand a little taller and feel that swell in my heart – “SHE has seen my strength! She knows the amazing things I am capable of!” A bit dramatic? Perhaps. But life-changingly, soul-stirringly profound for this mama? Most definitely.

So when you invite a doula into your life for some portion of the nine months of your pregnancy (and a couple months after), know that the benefits don’t end there. We not only witness, but we also remember. I tell my mamas, “If you ever need to be reminded of how incredible you are, call me and I will tell you as many times as you need to hear it to believe it.” So on behalf of all doulas,  thank you to birthing families everywhere who invite us to witness your incredible journey. Thank you for giving us the best job in the world.

What's in a Doula Fee?-Cross Post from Jodi the Doula

Happy Saturday, Everyone!

Guess what?!

I scheduled my first mama!!!

She's due in December, which feels like a long ways away, but it gives me time to do some re-reading of important doula books, I'll have taken one prenatal Yoga course and my essential oils book will have arrived from Amazon.com which means I'll be able to create more room sprays and massage oils for my mamas. And, and this is the most important, it means that I'll have that much-needed, hands on experience to help my doula practice grow.

When I first started to train to be a doula I worried about fees-would I be charging to much, would I be charging too little, should I charge while I'm still certifying.
My December birth's compensation? A metro card. And I'm okay with that.

The organization that I did my doula training and who I will certify with is called Ancient Song Doula Services (ASDS) and their focus is not only to train women to be birth and postpartum doulas, but to make doulas available to women who wouldn't be able to afford them. I'm a volunteer doula with ASDS, which means that some of the births that come through their practice will be done for free of for a minimal fee. I'm happy to do the work, especially as I continue the certification process, but also when I am certified because I truly believe that every woman, no matter her financial means, should have the support of a doula. It is because of that conviction that I want to do low-cost or free births even after I'm certified.

And, I want to be a full-time, full-spectrum doula. I want to become a certified prenatal Yoga instructor, a lactation consultant and a birth educator. In order to do all of these things, to pay for these certifications I, and a lot of doulas, have to pay for it ourselves. Doulas make their living supporting women through labor and birth. Many doulas, myself included, work full-time to cover the bills, but hope and dream of doing birth work exclusively. Which is why we have fees.

I thought hard about how I would charge my doula fees and came up with fees based on financial means. I created a chart that is broken down by income to determine how I charge my doula fees. It's interesting because it's based on trust. I trust that the mamas who come to me are honest about their financial status and they trust that I will fully and holistically support them before, during and after their births.

I was pleased to see Jodi the Doula's recent blog post about doula fees not because it "proved" anything, but because it helps me better explain and understand what a typical week looks like for a full time doula. The opening paragraph and a link to the post is below.

Every doula has heard it at least once…
“So, if my birth is really fast, you’ll refund part of what I paid you, right? Because then you didn’t really have to work that much.”
“How can you be ok with charging so much?”
Or, my personal favorite, “You know, what you’re doing is an act of service. It’s really special. It’s like doing The Lord’s Work. So, don’t you think it’s wrong to not do it for free?”
The money questions… it’s enough to make any doula want to crawl under a rock, or wish we could go live in a yurt, in a nudist colony, on a self-sustaining  farm, so that our living expenses could be lower.
How a doula sets her fee is an unclear concept to many people who are seeking or offering birth services.  On the surface, it may seem like a doula’s fee is a lot of money for what amounts to one big day of work. I offer this so that new parents and new doulas have greater clarity of what a doula’s fee really includes.
A Typical Work Week:  Booking one “due date” per week is more than just one day a week at work – it’s a full-time workload.  Consider this – for every client I take on, I offer up to three face-to-face prenatal meetings, unlimited phone support throughout pregnancy and the first week postpartum, and an in-home postpartum visit.  This means that an average work week for me will have four to six home visits (about two hours each), six to ten hours of phone time, and eight to twelve hours of travel time. Throw in a couple of hours for recordkeeping, appointment scheduling, text and email support, and the extra hours it takes to call everyone and reschedule when I have a mama in labor. That’s typically a 37 hour work week, before I’ve spent even one minute at a birth. When all is said and done, each client, on average, has had the benefit of 30 to 42 hours of her doula’s time, and most of those hours have been when she hasn’t been in labor.

Keep Reading here.

As always, if you or anyone that you know is expecting a baby, please reach out to me to discuss the services that I offer.

All the best,

Erika

Cross-Post: Doula-ing for Cesareans

One of the things that a new doula must do in order to be certified is to attend births, sometimes three and as much as five. This doula has attended a whooping 0 births. Are you willing to be my first mama?

I have, however, been a back up doula to a few of my doula friends, yet none of them have needed a back up, so I'm waiting. I was pretty sure that July would be my month, especially since my doula friend has two mamas with very close due dates. I was a bit disappointed to learn that one mama had elected for a scheduled c-section. Not because I oppose the c-section, but because I knew that a c-section would mean that there was no chance that the two mamas would overlap.

It got me thinking about how important a doula is, even to a mama who's having a c-section so I was delighted to find the following post. Read it here.

Getting Insurance to Pay for Midwives

Cheryl Senter for The New York Times

Earlier this week the NYT posted an article siting America as the costliest place to give birth. Several people, myself included, cross-posted the piece and the comments section has hundreds of replies. Many people blame the insurance companies for the price of birth, while others blame doctors and hospital's often unnecessary and costly interventions. What was missing was other birthing options; at home or in a birthing center with a Midwife.

NYC has only one free standing birthing center, Brooklyn Birthing Center. This is where I hope, Gd-willing/Inshallah/Bezrat Hashem, to give birth when my partner and I get pregnant. The fact of the matter is, birthing with a midwife is substantially cheaper not because you receive inferior service, but because most midwife births are women-centered. A midwife and doula team supports a mother and her partner fully and holistically, relying not on the use of pitocin and monitoring to get the baby out, but on the body's own ability to birth a child.

Here's a quote from the article:

In the United States, the use of midwives varies hugely by state and region; they can deliver babies at a birthing center, in hospitals or in homes. They generally need physician back-up in case a pregnancy has complications they cannot handle. There are few midwife births in the South and Texas, while the rate is above 15 percent in Oregon and New Mexico. In Britain and Denmark, more than two-thirds of all births are attended by a midwife.

Read the entire article on the NYT here.

Study Finds Adverse Effects of Pitocin in New Borns

Cross-posted from The American College of Obstetrics and Gynecology

New Orleans, LA -- Induction and augmentation of labor with the hormone oxytocin may not be as safe for full-term newborns as previously believed, according to research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists. Researchers say this is the first study of its kind to present data on the adverse effects of Pitocin use on newborns.

Given intravenously, Pitocin (a brand of oxytocin), is often used to start labor when a pregnant woman is overdue. It is also used to keep a lagging labor going by increasing the frequency, duration, and intensity of uterine contractions.

Primary Investigator Michael S. Tsimis, MD, and fellow researchers at Beth Israel Medical Center in New York City, conducted a retrospective analysis of deliveries that were induced or augmented with oxytocin. The study included more than 3,000 women delivering full-term infants from 2009 to 2011. The researchers used the Adverse Outcome Index, one of several tools used to measure unexpected outcomes in the perinatal setting and to track obstetric illness and death rates.

Keep Reading

I believe that every mother's birthing choices, whether she delivers vaginally via c-section, in a hospital, at home or a birthing center should have her choices validated. I also think it's vitally important to learn about the risks and benefits of any intervention.

Vaginal Birth and Preemies

Pregnant woman holds her stomach ( Ian Waldie, Getty Images / February 11, 2013)

From the Chicago Tribune

by Genevra Pittman

NEW YORK (Reuters Health) - Very premature babies have fewer breathing problems when they're born through vaginal delivery compared to cesarean section, a new study of more than 20,000 newborns suggests.

Based on those cases, researchers found that regardless of why a C-section was performed - whether because of pregnancy-related complications or the mother's medical problems, for example - vaginal delivery tended to be safer.

"My suspicion is that the labor process, the contractions, that natural squeezing probably does something to clear out the lungs so that when babies are born they have a better breathing status," said Dr. Erika Werner, who led the new study at Johns Hopkins School of Medicine in Baltimore.

"If a vaginal delivery is safe, it's something that should be attempted," she said.

Keep Reading

It is interesting to note that some children born by c-section also have problems breathing when they are born or when they get older. The beauty of labor is that every stage has a function. When the baby moved from the uterus through the cervix and into the birth canal its body is squeezed, helping the delicate longs extract the amniotic fluid and prepare for breathing oxygen through the air.