I recently got to tour the Mother’s Milk Bank Northeast. What an inspiring field trip for someone who is fascinated by all things lactation! I watched donor milk being pasteurized, toured the freezers, and learned about the bank’s operations. It was awesome to see so much human milk at once!
The American Academy of Pediatricians and the World Health Organization recommend human milk for all babies. The first choice, of course, is that a baby receives milk from his or her mother. If that is impossible, the second best option is donor milk. Non-profit Human Milk Banking Association of North America (HMBANA) banks, like the one I toured, screen potential donors, pasteurize donor milk, and provide it by prescription to fragile babies in need. Last year Mother’s Milk Bank Northeast dispensed 202,914 ounces of milk from nearly 500 donors. Much of that milk went to feed premies, who average a quarter of an ounce per meal.
Donated milk makes a dramatic difference for fragile babies. While ten to seventeen percent of preterm babies who get formula develop necrotizing enterocolitis (NEC), a potentially fatal condition, only 1.5% of premies fed human milk develop it. The cost of caring for infants with NEC is .6 billion annually.
“Donor milk saves the lives of some of our most fragile babies.” Morgan Henderson, one of three donor intake coordinators at Mother’s Milk Bank Northeast, told me. “Donating milk is not difficult. Milk processed by HMBANA milk banks is safe for fragile babies because donors are carefully screened, and the donated milk is processed and tested before being distributed.” Some common reasons babies receive donor milk is preterm birth, failure to thrive, malabsorption syndromes, allergies, feeding/formula intolerance, immunologic deficiencies, pre- or post-operative nutrition, and infectious diseases.
“I strongly encourage my friends who find themselves with surplus milk to consider donating to the milk bank,” Mira Whiting shared with me. She’s the mother of two young boys. Since she was lucky enough to have an oversupply, she wanted to share with other moms who were struggling to make enough milk. She initially donated informally, fearing that the donor application and screening process with a milk bank would be arduous. But she says “the hassle I was so worried about when I thought about donating was a total non-issue. I called the milk bank and had a fairly short conversation with one of the donor intake coordinators. She ran through a series of questions to determine if I qualified to be a donor. Then she mailed me a blood sample kit, which I just took to my midwife’s office. When I realized how easy it actually was, I was kind of kicking myself for not doing it the first time around.“ Mira donated 190 ounces to the bank.
“While it was very satisfying with the informal route to give to a baby I knew and would get to watch grow up,” Mira said. “I also felt really strongly that I wanted my milk to help the babies who didn’t have someone in their personal circle who could do that for them. I saw the science, particularly on what a HUGE difference human milk can make for babies who are very premature and medically fragile. I felt the only way I could help to give back/pay it forward this huge gift mother nature had given me in the form of my abundant milk supply was to donate to those babies.“
Some NICUs, such as the one at Brigham and Women’s Hospital in Boston, provide donor milk to all babies whose mothers can’t provide them with enough of their milk. Other times, parents of fragile babies get a prescription and contact their nearest milk bank themselves. To donate extra milk or to receive milk for a baby in need, contact your closest milk bank.
Julie Brill is a childbirth educator, La Leche League Leader, and doula in Bedford, MA. She provides childbirth education classes in the Boston area and by Skype, and trains childbirth educators and labor doulas for CAPPA. She also offers Prepare for Surgery, Heal Faster phone sessions for women with planned cesarean births. Her first book is Round the Circle: Doulas Share Their Experiences.
What do you think? After teaching natural childbirth classes for twenty-four years, I’ve learned that natural birth means different things to different people. Was my four hour Pitocin induced labor a natural birth, because I had no pain medications? Or only my two hour homebirth which my midwives barely made? I once asked my natural childbirth students what natural birth meant; the consensus was anything short of an epidural, including other pain medications, was natural birth. So I’ve come to see it as a continuum.
On one end are homebirths like the ones I was lucky to attend when I was a midwifery apprentice in the early 1990s. Michel Odent calls them undisturbed births. The mother is in her home, and she runs the show. She eats and drinks what and when she wants, is along or surrounded by people she knows well and has invited, walks or rests, moans, complains, sings, or is silent, gets in her tub if she wants. The baby is born and goes directly on mom’s chest with the cord attached. There is no small talk. It is all mamababy time. There are no bright lights, no unnecessary questions or exams, no separation.
The spectrum of natural childbirth, according to many, seems also to include inductions, analgesics, IVs, ruptured membranes, almost anything except an epidural. I don’t feel it’s for me, or anyone, to label another woman’s birth experiences. I love what Joyce Maynard says about her birth experiences. “Before I had children I always wondered whether their births would be, for me, like the ultimate in gym class failures. And I discovered instead…that I’d finally found my sport.” Natural birth can be about discovering what our bodies can do.
I asked readers of my WellPregnancy Facebook page why they birthed naturally. One mom posted, “I didn’t want to experience drug side effects and I didn’t want my baby to experience those side effects. There wasn’t time for drugs and I trusted my body and my baby.” Another remembered, “I didn’t get a natural experience the first time, and that left me feeling disappointed. I gave birth naturally because I knew my body could, and in the end it was the most empowering feeling I have ever had!” And a third shared, “After having an epidural with my first birth, I felt like I had totally lost control over myself and the process. I felt that the process was meant to be honored. So my second and third births were natural, unmedicated. I had control back. I was able to feel what my body was capable of doing. And it was amazing and empowering!!”
As a culture we believe that pain is unacceptable. But when we numb out sensation in labor, we diminish our endorphin levels and the endorphin levels of our babies. The pain is dulled, but so is the exuberance we are meant to experience afterwards, when contractions are over and mother and baby bathe in the highest endorphin levels, higher than what marathoners get. Martha Beck captures it when she wrote, “Anyone who has felt the pain of bearing a child, or pushed past physical limits in some athletic event, or struggled to learn difficult but powerful truths understands that suffering can be an integral part of the most profound joy. In fact, once suffering has ended, having experienced it seems to magnify the capacity… to feel pleasure and delight.”
Because endorphins are released in spurts during labor in the brains of the mother and baby along with oxytocin, when the endorphin levels are tampered with due to the use of pain medication, oxytocin is also reduced. Oxytocin drives labor, and when levels drop, labor slows. That is part of why 50% of women with epidurals require augmentation with Pitocin, which is synthetic oxytocin. Pitocin risks include fetal distress, uterine rupture, cesarean birth, postpartum depression.
Sometimes when a mother has great difficulty relaxing, or is exhausted, an epidural is a blessing. The problem is not the use of epidurals, it’s the overuse. Women with excellent preparation and appropriate support are less likely to find themselves in situations where they need epidurals. Taking an independent childbirth class to learn and practice comfort measures and support techniques, including use of the birth ball, massage, rebozo, hot/cold therapy, counter pressure, ahead of time is invaluable. The more tools the mom has, the better equipped for labor she’ll be. Place of birth matters. Laboring with access to a tub and unlimited food and drink helps. Choosing a professional team that includes a doctor, midwife and/or nurse who regularly support unmedicated women, means laboring with people who know what to do. A doula can also make a big difference; her only job is to provide physical, emotional, and informational support. “Birthing women can never have too much support,” Carol Densmore told me in an interview. “If people seek good support it’s not a sign of weakness or vulnerability. Rather, being well supported and well held, allows childbearing women to access their deepest courage.”
Midwives throughout human history have developed strategies and tools to help laboring women. “The choice is not between anesthesia and unremitting agony.” Sandra Steingraber wrote. “One is not asked to lie in a hospital bed and… bite a bullet and suffer.” Pain in childbirth, unlike most pain, is not a sign that something is wrong. The mom who is in a place mentally where she can understand that and work with, rather than against, her contractions, will experience labor quite differently. And when it is over, when she’s done it, and she’s holding her newborn, she’ll likely have a sense of satisfaction and of her own strength, a great platform from which to begin the work of new motherhood.
“Is this something I have to do?” my childbirth students frequently ask me about cervical exams. The short answer is no. Especially in teaching hospitals, women are often examined in labor frequently, without even knowing why. The most important question to ask when considering an exam, like any other test, is “What will we do with this information?” Discuss your preferences regarding cervical exams with your provider prenatally, and include it in your birth plan.
The good news about exams is they can be helpful when a laboring woman is deciding whether to stay in the hospital and be admitted, or go home, or if this is a good time for her to get pain medication. They can provide encouraging news to women if they show increased dilation in labor. In the absence of increased dilation, they can still be encouraging, if she is able to get positive news about increased effacement (thinning) of the cervix or station of the baby.
The bad news about exams is they increase the risk of infection, especially when they are done after the release or artificial rupture of membranes (water breaking). In a hospital setting, they are usually done in bed, which is often an uncomfortable place to be during labor. Sometimes a woman is laboring successfully in out of bed positions, but after getting in bed for an exam she stays in bed, which can slow labor and increase pain. If an exam does not yield information about increased progress, it can be discouraging. VBAC women especially may wish to avoid exams during their labors until they are quite confident they have progressed past the farthest dilation of their last labors.
We all come from a long line of women stretching back to the beginning of time who have successfully birthed babies. When students ask me if exams are something they have to do, I like to think of those grandmothers laboring without exams, pushing when they had the urge to do so. The energy of birth is down and out, and having an exam in labor can often feel like energy flowing in the wrong direction
What the laboring mom wants to know is how much longer will it be until she is holding her baby in her arms; exams don’t give this information. Imagine driving on the highway and seeing a sign that tells you what town you have entered. Without knowing how quickly you’re driving, knowing where you are doesn’t tell you when you’ll arrive at your destination. Likewise, cervical dilation in labor is only a mile marker, not an indication of when your baby will be born.
For women with a history of sexual abuse, probably about one third of laboring women, exams can be triggers. It’s also important to remember that exams are subjective, what feels like six centimeters to one provider, might be seven to another. In precipitous labors, women will often have transition like contractions before their cervixes catch up to that dilation, and being in transition with a cervix that seems to have only begun to dilate can be quite discouraging.
And what about prenatal cervical exams? While these can be encouraging or discouraging, depending on the information they yield, they don’t necessarily indicate how close a women is to starting labor. Again as with all tests, a great question when considering a prenatal cervical exam is “What will we do with this information?”
- Ask for what you need. This is often difficult for new parents, but if friends and family offer to help, ask them for specific favors. Do you need someone to vacuum, pick up items at the grocery store, or fold laundry? Can a different person bring you dinner for a week or two? Tell visitors ahead of time that they will only be able to stay a short time since you are busy taking care of your new baby. You may also want to consider hiring a cleaning service or postpartum doula, and registering for meal help from friends and family at Meal Train.
- Practice the breathing and visualization you learned in childbirth class. Deep breathing can help you to relax now. Extra oxygen is a natural tranquilizer and can help you feel less stressed. When calming a crying baby, try taking a few deep breaths. You may have used visualization during labor, now try seeing your body relax, or imagine yourself in a restful spot, such as the beach. Picture breathing in a pleasant smell or color. Smiling releases endorphins so that may help as well.
- Reach out to other new parents. Call or email other students from your childbirth class to see how they are doing. Attend a La Leche League meeting, a Baby Cafe, a breastfeeding group at your local hospital, or a new mom support group.
- Breastfeed. Nursing releases oxytocin, which makes you feel calmer and lowers your blood pressure. It also promotes mother and baby bonding. Breastfeeding is a time for the mother to rest. It promotes uterine contractions; the faster the uterus contracts the less lochia flow there will be, which leads to higher iron levels and less fatigue. Breastmilk never needs to be prepared or heated, and there are no bottles to clean or trips to the store. Set up a nursing station where everything you need will be within arms reach: a snack, a drink, your phone, the remote control, someplace to put the baby down, a book, etc. If you live in a two-story house establish a changing station with diapers, wipes, and clean baby clothes downstairs so you can reduce the number of trips you make up and down stairs.
- Plan ahead. If there are specific times of day that seem to be fussy times for your baby, plan to call or meet a friend during that time. If dinner-time is difficult try making dinner earlier in the day, order out, or eat cereal for dinner. If you have a few minutes in the evening, gather together what you will need for the next day so your diaper bag, purse, and keys are ready. Set up snacks that your older child can help him or herself to when you’re busy with the baby. While you’re at it, set up some easy-to-reach, healthy snacks for yourself.
- Focus on what you’re eating. Good nutrition doesn’t have to be fancy. A scrambled egg is quick and easy. Cheese on whole-wheat crackers is a good snack, so are bananas, apples, nuts, yogurt, dried fruit, natural peanut butter, edamame or a glass of milk. Eating well will lower your stress level and help you heal faster.
- Sleep as much as possible. Sleep deprivation is actually a form of torture! Prioritize sleeping during the day when your baby sleeps, since you know your night-time sleep will be interrupted. The more you rest now the faster you will heal from birth. During the day, lie down even when you cannot sleep. Remember women in traditional cultures have a lying in period where all they do is rest in bed and feed their babies. Try to learn to nurse your baby lying down so you don’t have to sit up for every feed.
- Try to exercise a bit. Once your body has healed from birth, walking with your baby will release endorphins that make you feel better. Even just standing for a few minutes on one foot will reduce your stress as your body focuses on keeping your balance.
- Lower your standards. Your home will now look like you share it with a new baby. It’s ok if it’s not quite as neat as it was before. It may take a while for those thank you notes or birth announcements to get out. Taking care of a baby is a full time job.
- Think about what is helpful for you. For some new mothers the whole day seems better if they can greet it dressed and showered; they prioritize showering before their partners leave the house, or they have a visitor watch the baby so they can grab a shower. Others would rather sleep as much as possible and find that staying in their pajamas causes guests to shorten their stay. Try to keep in mind that the intensity of caring for a newborn is temporary. Someday you may look back on this time with nostalgia. Even though your nights may seem long now, babies grow quickly so takes lot of pictures and record your baby’s milestones. Most importantly take moments to enjoy his or her babyhood and be fully in the moment.
While vaginal birth is the safest way to birth for most mothers and babies, there are medical reasons why some babies are born by scheduled cesarean. If your baby will be born by cesarean, here are some things to consider.
Learn more about gentle cesareans, also called family centered cesareans. Watch this video with Dr. Camann and this one which shows what’s possible during a cesarean. One of the most important parts of a woman’s cesarean birth story is usually whether or not she was able to be with her baby right away. With gentle cesareans women are holding their newborns skin to skin, and even breastfeeding them, during the cesarean. If this is not possible, ask that your partner or another family member be able hold the baby skin to skin immediately.
An upcoming cesarean birth can be anxiety provoking and taking a Prepare for Cesarean Birth, Heal Faster one hour phone session will help you to relax prenatally and heal faster postpartum. This program, created by Peggy Huddleston for surgical patients, and developed by me to meet the needs of cesarean moms, includes a book and relaxation cd. It has been shown to reduce anxiety and help with insomnia prenatally, and decrease recovery time. Because the mother and baby communicate constantly hormonally during pregnancy, being able to relax now will allow your baby to relax as well. The baby who is relaxed prenatally, is the baby who will be a calmer newborn.
One support person, often the partner, is almost always present during cesareans. He or she sits on a stool behind the mother’s shoulders, and can’t see the surgery. Both parents see the baby being lifted over the drapes. It may be possible for you to have a second support person, such as your mother, sister, best friend, or doula, with you as well. Doulas aren’t just for vaginal births. A doula can help you remain calm before and during your cesarean birth, and to help you with breastfeeding afterwards. Meet with your anesthesiologist ahead of time to get answers to your anesthesia questions, and to ensure that your doula or other second support person can be with you in the operating room. Having two support people means that if the baby needs to go to the NICU, one person can be with the baby and one with the mom. Your partner, or anyone who has spent a lot of time with you during your pregnancy, will be a familiar and reassuring presence to the baby, who will recognize his or her voice.
Prepare now for postpartum. A postpartum doula will help you during your recovery at home. Moms who have had cesareans are usually told not to lift anything heavier than the baby. That means no laundry and no carrying groceries during the weeks you are recovering. Learn about breastfeeding while you’re pregnant and consider attending a La Leche League or other breastfeeding support meeting now. You will be able to take pain medications that are compatible with breastfeeding.
We’re beginning to understand the human microbiome and how being born by cesarean affects a baby’s microbiome. While the research is in its infancy, some women are now using a vaginal swab to inoculate their newborns in order to expose them to the bacteria they would have encountered had they been born vaginally.
Finally know that even though this baby needs to be born by cesarean, you may be able to give birth to your next baby vaginally (VBAC). The International Cesarean Awareness Network is a great resource for women recovering from cesareans or preparing to VBAC.
This week I’m celebrating World Doula Week and sharing suggestions I give doulas at my trainings.
- Find your niche. No one can be all things to all people. What families are you best at serving? Do you have a passion for working with single or teen moms, moms who are VBACing or working with a midwife, moms who are having scheduled cesareans? Do you want to work with military families? Are you fluent in another language?
- The thing about continuing education is you’re never done. New research is continually coming out and we all must be reading, researching, and attending continuing education events. We also have a great deal to teach each other. Check out Round the Circle: Experienced Doulas Share What They’ve Learned, my new doula anthology that combines advice and information from twenty-three experienced doulas.
- You know enough to be of service now. The most important part of being a doula is showing up when you’re needed with a loving heart and helpful hands. Don’t wait for the moment you know enough to begin. It’s wonderful to learn all you can, but doula work is heart work, not head work. And we all learn as we go.
- Work on marketing. Polish your elevator speech and your website. Get the word out. Connect with doctors, midwives, prenatal massage therapists, chiropractors, yoga instructors, childbirth educators, and other doulas. Our families use our services and move on. For birth professionals marketing is like laundry; it’s never done. It’s probably not your favorite part of being a doula, but it’s necessary. And stay in touch with your families with an annual birthday card; referrals are the heart of most doula businesses.
- Consider expanding your services. Train so you can add childbirth education, postpartum doula services, lactation support, or placental encapsulation. The more you diversify, the more you’ll have to offer your families.
- Network. Attend conferences in your area and beyond. Be active on doula Facebook groups. Connect with other local doulas so you have a community to back you up, refer to, and support you.
- Charge what you’re worth. Think about what you spend on continuing education, childcare, gas, certification.
- Give back to your community when you can. Mentor a newer doula or take on a volunteer or low pay birth from time to time.
- Taking time off is necessary. Schedule time when you can go away with your family, go to sleep with your phone turned off, or buy tickets to a play or sporting event. This will help protect you from burnout so you’ll still be doulaing for years to come.
- Be part of a doula organization that truly supports you. You need an organization that does more than just train doulas. You deserve ongoing support as well.
Julie Brill, CCCE, CLD is the author or the doula anthology Round the Circle: Doulas Share Their Experiences. She trains doulas and childbirth educators for CAPPA, teaches independent childbirth classes, and volunteers as a La Leche League Leader.
- You’re already doing informal childbirth education in person, and by phone, text, email, and Facebook message. Offer formal classes and you’ll get paid to spend more in person time prenatally, getting to know your clients, and less time answering questions piecemeal.
- You’ll know your clients are receiving top quality childbirth education.
- Being able to offer childbirth education is a great selling point at interviews. You can offer doula/cbe packages.
- Your childbirth education students may hire you as a doula.
- Diversify your birth business! Earn money for work that doesn’t require you to be on call. Prevent burnout.
- There is much overlap between doula and cbe certification requirements. Your doula births can count towards cbe certification. Many of the books on the required reading list are the same.
- Your doula experiences will enhance your ability to teach cbe. You know firsthand what really works during labor, and the birth practices in your community.
- Childbirth educator training and certification is an investment in you and your business. Doulas with cbe certification can earn more for births because they have more to offer clients.
Julie Brill, CCCE, CLD, has been teaching CAPPA-approved childbirth educator and labor doula trainings in New England since 2003. Her next childbirth educator training is April 30-May 1 in Westford, MA. Registration is at www.WellPregnancy.com.
Julie Brill, CCCE, CLD, IBCLC
Julie (at) WellPregnancy.com