Archive | May 2010

The Birth-Breastfeeding Continuum

Birth professionals have long been aware that there is a connection between birth and breastfeeding, but in recent years experts are making this link more explicit and the inextricable nature of the two experiences is becoming clearer. Birth and breastfeeding exist on a continuum. They are not discreet events. As speaker and author Dia Michels says, “we need a new word—birthandbreastfeeding.” Human women are mammals and the same things that disrupt bonding and breastfeeding for other mammals also apply to women. Darkness, quiet, no disruptions/interruptions, safe, upright, mobile, easy access to food and drink as they choose….these things support healthy births for female mammals! In brief, a normal, healthy, undisturbed birth leads naturally into a normal, healthy, undisturbed breastfeeding relationship. Disturbed birth contributes to disrupted breastfeeding.

New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed. An example is a mother who has an epidural, which leads to excess fluid retention in her breasts (a common side effect of the IV “bolus” of fluid administered in preparation for an epidural). After birth, the baby can’t latch well to the flattened nipple of the overfull breast, leading to frustration for both mother and baby. This frustration can quickly cascade into formula supplementation and before she knows it, the mother is left saying, “something was wrong with my nipples and the baby just couldn’t breastfeed. I tried really hard, but it just didn’t work out.” Nothing is truly wrong with her nipples or with her baby, breastfeeding got off track before her baby was even born!

Problems with breastfeeding often start before baby is born. According to Linda Smith, BSN, FACCE, IBCLC, co-author of the book Impact of Birthing Experiences on Breastfeeding (2004), birth practices that impact breastfeeding include:

Mechanical forces of labor (positioning of baby, positioning of mother, etc.)
Chemicals (drugs) used in labor
Injuries to mother or baby
Treatment of mother during labor
Treatment of mother after birth
Separation from mother after birth
Procedures that alter behavior

Linda Smith also notes that a mother’s confidence and trust in her body’s ability to give birth is related to her confidence in her body’s ability to breastfeeding. There are several birth related risk factors for breastfeeding problems (please note that not all babies with risk factors will actually have problems):

Induction of labor
Epidural and/or narcotic medications
Cesarean
Instrumental delivery (forceps or vacuum)
Post birth suctioning of baby’s airway

Additional procedures that affect baby’s ability to breastfeed if they are done before baby’s first breastfeeding include:

Separation of mother and baby for any reason.
Weighing and measuring
Vitamin K injection
Metabolic tests
Circumcision
Infant hypothermia

According to the Academy of Breastfeeding Medicine (www.bfmed.org), “unmedicated, spontaneous, vaginal birth with immediate skin-to-skin contact leads to the highest likelihood of baby-led breastfeeding initiation.” Immediate skin-to-skin contact restores the biologic continuum begun during conception.

When I was in graduate school, one of my professors used the following analogy to make a point and I now use it with my own students:

There is a river running through town. Daily, emergency workers are called upon to rescue people from the river who have fallen in and are floating downstream drowning. Day after day they pull the gasping people back to land until one of the workers suddenly realizes, “maybe we should go see what is happening upstream and try to stop these people from falling in to begin with?”

My professor then encouraged us to always remember to go “upstream” when working in the helping professions rather than only addressing the immediately presenting problem. Childbirth professionals are in an “upstream” position when it comes to protecting the birth-breastfeeding continuum!

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For more about the value of keeping mothers and babies together following birth, check on Healthy Birth Practice Six: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding from Lamaze.

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References:

If my mom were a platypus: what we can learn by studying mammal lactation, presentation by Dia L. Michels, La Leche League of Missouri Conference, November 2007.

Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Mary Kroeger and Linda J. Smith, Jones and Bartlett Publishers, Inc.; 1 edition (February 2004). ISBN-13 978-0763724818.

Mother-Baby Togetherness, presentation by Dr. Nils Bergman, La Leche League International Conference, July 2007.

The Power of Touch, presentation by Diane Wiessinger, La Leche League of Missouri Conference, November 2007.

Winning at Birth, presentation by Linda J. Smith, La Leche League International Conference, July 2007.

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This article is adapted from “Celebrating World Breastfeeding Week and the Birth-Breastfeeding Continuum” by Molly Remer, MSW, ICCE, published in the International Journal of Childbirth Education, June 2008.

The Power of Noise in Labor

May26

“I believe with all my heart that women’s birth noises are often the seat of their power. It’s like a primal birth song, meeting the pain with sound, singing their babies forth. I’ve had my eardrums roared out on occasions, but I love it. Every time. Never let anyone tell you not to make noise in labor. Roar your babies out, Mamas. Roar.” –Louisa Wales

When I shared the above quote on the CfM Facebook page, it had the honor of being the most “liked” quote I’ve ever posted. Women responded powerfully with their own stories—with experiences of how they “roared” and experiences of being silenced. (The classic, “Don’t scare the other patients!”)

I gave birth to my first in a birth center and while the staff there were wonderful and kind, I still felt noise-inhibited and was pretty quiet, except for humming to myself and talking somewhat during pushing (saying things like, “how come some people say pushing feels good?!”). My second son was born at home and I roared and I LOVED it. There is a lot of power in that and when I read stories where women say, “I didn’t make any noise” the whole time, or “I was so calm people thought I was sleeping,” I feel like I, personally, wouldn’t have wanted to miss out of the sense of personal power that came with using my voice. The raw intensity of just doing what felt right, with NO inhibitions about what other other people are thinking or feeling. I have written another post about the association between “coping well” and “silence” in some people’s minds. If a woman WANTS to be silent during labor and that feels powerful to her, then obviously, I think that is great, but often when I hear “quiet and calm” stories I feel a little sad because I suspect perhaps she was in an environment where she didn’t feel safe enough to use her voice.

I am talker in real life and it makes a lot more sense to me that I would be noisy in labor rather than silent. I talked to/coached myself through the whole thing. My third labor I also talked myself through the whole thing—out loud, repeating certain things over and over, etc. What I do NOT like during labor is having anyone else talk to me—that was my number one item on my birth plan with my second baby, “no extraneous talking or noise.” I can talk, but no one else!

Information ≠ Knowledge

May24

Last week I attended a webinar about the ethics of childbirth. The presenter, sociologist Raymond De Vries, noted that choice is central to each of the ethical questions surrounding birth and then made the point that the problem with choice is that information does not equal knowledge. (He also mentioned the “ritual” of informed consent.) In the context of the webinar, the point was being made about ethical issues of prenatal testing, birth planning, and asking women to make decisions while in labor, but I think it has broader implications for our work as childbirth educators as well. We spend a lot of time informing and educating women about their choices surrounding birth and are often then surprised that this apparent information does not translate into experience once in the birth room. Obviously, this is partially because the birth room is a context impacted by a large number of social, cultural, psychological, and environmental factors, but I believe it is also because with all of our information we still haven’t managed to help parents develop knowledge and the two are not the same. Parents are often not able to recall or to mobilize information resources while actually embroiled in the birth experience. They need an inner knowing and inner resources to draw on for coping.

While I have known this for a long time, I still find it difficult to translate my conviction into practice. How do people develop knowledge about an experience that is ultimately unknowable until they are in it?

I do think that within the field of childbirth education, Birthing from Within is the method that most attempts to address this issue and I really value these two quotes from Pam England:

“A knowledgeable childbirth teacher can inform mothers about birth, physiology, hospital policies and technology. But that kind of information doesn’t touch what a mother actually experiences IN labor, or what she needs to know as a mother (not a patient) in this rite of passage.”

“While all of your (birth) planning may spin a cocoon of security, in actuality, the course of your labor is unknowable…your critical task is to prepare for a birth that has NO script.”

Personally, though, even with the practices and ideas offered by wonderful resources like Birthing from Within, I find I am still working on the actual execution of the how in my classes of translating information into knowledge…

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Edited to add…I’m working on resolving this discrepancy through my new plan to offer birth workshops as part of a birth network, rather than as an independent educator.

Book Review: The Littlest Sister

May22

Book Review: The Littlest Sister
By Leigh Schilling Edwards
Strategic Book Publishing, 2008
ISBN 978-1-60693-041-0
14 pages, softcover, $12.00
http://www.facebook.com/pages/The-Littlest-Sister/317995643791

Reviewed by Molly Remer, MSW, CCCE

Written from the perspective of a family’s middle child—the big sister of a hospitalized baby—The Littlest Sister is designed for siblings of a baby in the Neonatal Intensive Care Unit (NICU). It would also be a good book for a child who was formerly a preemie themselves. There is an older brother in the story as well, which enables readers of either gender can easily identify with the children.

Color snapshots of a real family grace each page and make the book very genuine and true-to-life. The baby in the book was born at 30 weeks and has Down Syndrome and a mild heart defect. The pictures and text contain a lot of details children will identify with—there is a picture of the big brother touching the baby in her isolette, pictures of the baby sister with a tube in her nose and monitors attached, and so forth. Bottle feeding is mentioned briefly and I wish breastfeeding had been mentioned as well

I have a special interest in the subject area because I worked for the Ronald McDonald House for four years. Written in a warm, personal tone, using easy to understand language and simple descriptions, The Littlest Sister would be a great addition to the lending library resources of Ronald McDonald Houses or NICU facilities.

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Disclosure: I received a complimentary copy of this book for review purposes.

Courage Reading for Mother Blessing

May20

I have already shared a fear release for birth exercise here. I also want to share a “courage” reading that could be used for mother blessings:

Courage Ritual:

(write down fears and burn or bury them them)

Friends gather in circle holding hands surrounding the mother and say:

We accept that you have fears

You are not your fears

You are now cleansed and renewed

Go forward with courage at your side.

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Simple, but meaningful!

Book Review: Brought to Earth by Birth

May19

Book Review: Brought to Earth by Birth

By Harriette Hartigan
Motherbaby Press, 2008
ISBN 978-1-890-44642-0
93 pages, softcover, $25.95

www.motherbabypress.com

Reviewed by Molly Remer, MSW, CCCE

Written by well-known birth photographer Harriette Hartigan, Brought to Earth by Birth is a lyrical ode to the power of birth and babies. The book feels like an extended “poem” expressed in both word and image. The emphasis of the book is the black and white photos of pregnant women, families, and newborns that grace the pages. There are several photos of women in labor and a couple of breastfeeding images. Surrounding the photos are carefully chosen quotes and gentle words.

Brought to Earth by Birth is separated into six “chapters” and contains several birth photos, but no crowning photos or any other photos that some may consider “graphic.” The book is short—under 100 pages—and some photos were familiar to me (cover images in birth publications). The concluding emphasis is on the newborn, the one who is, after all, “brought to earth by birth.”

The book would make a nice gift for a midwife, doula, or childbirth educator and is a nice “waiting room” book to browse through. It would also make an inspirational mother blessing gift. As the author states, “The experience of birth is vast. It is a diverse tapestry woven by cultural customs, shaped in personal choices, affected by biological factors, marked by political circumstances. Yet the nature of birth itself prevails in elegant design of simple complexity.” Brought to Earth by Birth is a lovely glimpse of some strands of that elegant tapestry.
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Disclosure: I received a complimentary copy of this book for review purposes.

In-Utero Practice Breathing

May15

During my pregnancy with my first baby I had a somewhat unique experience in that I was able to feel him practice breathing in the womb. Babies practice breathing movements with increasing frequency towards the end of pregnancy, but usually this is only seen via ultrasound and the mother can’t feel OR see it happening.

A mysterious sensation

38 weeks pregnant with baby #1

I was about 32 weeks pregnant when we had a prenatal visit (and I was up to a whopping 140 pounds—looking back, that seems very thin, but at the time I felt like I had gained a lot of weight!) . Since 30 weeks I’d been feeling what I thought was the baby practicing breathing. My husband was able to feel it too, as well as occasionally physically see it—a rhythmic sort of pulsing sensation located where the baby’s back was and feeling like a rising/falling breath type sensation (like a cat under a blanket). I noticed it once or twice daily. Very different than the hiccups, which I also felt often. I wanted to mention it to the doctor to see if that was really what I was feeling, because lots of books and things say you won’t be able to feel those movements, but I didn’t want to be wrong and be embarrassed for having a kooky idea about feeling him breathe. (When we mentioned the feeling to my mom, she looked at us like we were quite nutty to think we could feel it!)

A prenatal appointment and a doctor’s surprise

At the prenatal appointment, I laid down to have my fundal height measured (32) and the baby’s heartbeat checked and he was conveniently doing the breathing thing at that exact moment! My husband asked the doctor about it and told her we thought it was breathing. She quickly disregarded the breathing hypothesis, saying it was unlikely we’d be able to feel that, but she was fascinated by the movements and listened with the Doppler trying to figure it out etc. She thought for a minute that it had something to do with my pulse and checked that, but it didn’t match, plus was just on one side of my belly where his back is. She also felt with her hands, etc. It was particularly strong that day—usually I felt a sort of pulsing and could also feel it with my hand. On this occasion, it was like the left side of my belly was rising and falling rhythmically in a very noticeable way. She said she’d never felt or seen anything like it before.

Then (this was the weird part), she said that maybe I should have an ultrasound to see what the baby was doing in there. This doctor was a crunchy-mild-mannered-has-you-call-her-by-her-first-name-homebirth-attending -birth-center-low-intervention-doesn’t-break-your-water-unless-the-baby-is-born-in-the-sac sort of doctor, so I was really shocked by that. I said I really didn’t think that was necessary, because I wasn’t worried about it we just thought it was breathing (again, we get a look that vaguely implies that we are nutty). She kept saying she’d never seen it before and said she was going to call one of her consulting doctor friends, “just because I’m curious,” to see what he thought about maybe needing an ultrasound.

After she left to call him, I started to feel nervous that something might actually be wrong. I knew how this doctor was and she did not seem like the type at all who would be calling other doctors unless she was a little worried about something. My husband kept saying that, “no, she is just curious about what it is,” but the “curious” wording felt to me like a don’t-want-alarm-the-mother-but-I-think-something-is-up type of doctor speak. Also, I knew her well enough to know that running off to call other people in the middle of an appointment wasn’t in character for her, especially since the mom (me) was saying it didn’t seem necessary. So, I briefly became petrified that the baby was having seizures or something.

Trust the mother!

She came back in a bit and had consulted with her ultrasound doctor friend who had said, “let me guess. This mom is thin and very healthy” and then confirmed that it was just the baby’s breathing movements we were seeing. He told her that you usually don’t see them on the outside, just via ultrasound, but it is still normal and just means that the baby is healthy and he is getting good practice. When she came back, the doctor also brought the practice’s midwife in to see, since the midwife had never seen anything like it either, but it had mostly stopped by then. This doctor has been in practice since 1992 and has had four kids of her own and the midwife has six kids and a 20-year practice. The doctor explained that she’d seen the breathing movements on ultrasound before, but they were always more like occasional gasp-type things, not steady and pulsing like that and not visible externally. She thanked me for teaching her something new 🙂

I liked being right about what was going on (trust the mother! She usually knows what’s up!) and I liked that my pregnancy had something “new” or special to it to show to someone for whom pregnancy is quite routine. Being able to feel my baby breathe in the womb was one of the special things about this first pregnancy.

(Side note: the doctor then said, “I’ll bet he comes out screaming” and as a matter of fact this baby did begin to cry when only his head was sticking out of my body!)

Note (added 3/2/2013):

A lot of mothers come to this post because of concerns similar to my own…what if my baby is having seizures in the uterus? Of course I am not able to tell you with 100% certainty that your baby is not having seizures, but here are two things to pay attention to that may set your mind at ease and allow you to enjoy this special connection with your baby:

One way to help you feel confident that it is practice breathing is to pay attention to whether it happens at the same time(s) each day. There’s usually a pattern to it.
Another way to tell with almost total accuracy is to notice if the baby gets hiccups shortly after and “episode.” A lot of babies will practice breathe and then get hiccups from their practice.

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This post is modified from a message board posting that I made shortly after the events described above.

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Film Review: Natural Born Babies

May13

Film Review: Natural Born Babies

South Coast Midwifery, 2009
DVD, 24 minutes, $24.95

www.naturalbornbabies.com

Reviewed by Molly Remer, MSW, CCCE

This lovely short film produced by a midwifery service in California, is a great “ad” for the benefits of homebirth and of midwifery care. Natural Born Babies has a very clean, fresh, and contemporary feel and features a multicultural collection of homebirth families talking about their experiences in front of a white screen. Something that is particularly striking is that some of the people speaking with love and enthusiasm about their midwives and their birth experiences include a cardiologist, an anesthesiologist, and an ER physician!

The first part of the film is titled Interventions and features both men and women speaking about birth, referencing how pregnancy and birth are treated like medical conditions and including a lot of discussion about the prevalence of cesareans. The point is made that, “no epidural can replace human touch.” The second part is titled The Birth Specialists and points out that OB/GYNS are pathology specialists, whereas midwives are trained in normalcy—“we take low-risk women, and keep them low-risk.” Midwives are specialists in normal pregnancy and birth. Because of the film’s emphasis is wholly on out-of-hospital birth and hospitals are critiqued very soundly, hospital-bound couples viewing the film may find that it causes their defenses to rise.

Several of the parents are holding their babies as they speak and a CNM speaks briefly as well (citing both ACNM and MANA). The CNM manages Orange County’s only accredited birth center. I enjoyed the presence of a bio-physicist dad originally from Holland saying, “everyone I know was born at home” and noting that “you give birth the same way you live.” Several of the couples speaking do refer to the father as “delivering” the baby, which is a long-term pet peeve of mine.

Special features include a 10 minute version of the film, an outtakes section, and a look inside the South Coast Birth Center. At the end of the film we see that one of the couples is the director/producer of the film.

Natural Born Babies is a fast-paced film and though it is filmed in a “talking heads” format, it cuts quickly from person to person, thus keeping the viewer engaged. If you are looking for an informative video that is homebirth and midwifery friendly, but that does not include any birth footage, this would be a good addition to your library.

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Disclosure: I received a complimentary copy of the film for review purposes.

Empowerment Recipe for Moms

May9

Happy Mother’s Day!

I wanted to share this “empowerment recipe for moms” that I got from the book Celebrating Motherhood by Andrea Gosline and
Lisa Bossi. I thought it was a fitting recipe for Mother’s Day as well as for general happiness as a mother 🙂

Empowerment Recipe for Moms

In a long day, mix:

A walk in the park

Ten minutes reading a positive book

Uplifting and relaxing music

Some time spent on a hobby or personal project

A cup of tea in the afternoon

A little quiet time alone

A twenty-minute nap

An adult conversation with your spouse

Lots of hugs and kisses.

–Cindy Angell Keeling

It has taken me a while to find my rhythm and it is easier now that the children are older, but I do actually manage to include most of these recipe elements into my daily life. I drink my cup of tea in the morning (my husband fixes it and leaves it for me, so when I get up it is ready to drink) before my daily yoga practice. I don’t get to nap anymore, but when I had a napping child, I used to always get a fifteen minute nap in every day and it was a good thing. My husband and I walk together in the evenings for about 30 minutes a day and that allows us time for adult conversation (though sometimes people are riding bikes around our feet at the same time!). I read every night while lying down with the kids to put them to sleep. I don’t have time each day for ALL of my personal projects, but I usually have time for at least one of them. I journal every morning, practice yoga every morning, and usually get some writing time in at least once a week (hopefully more frequently!)…

Book Review: 25 Ways to Joy & Inner Peace for Mothers

May7

Book Review: 25 Ways to Joy & Inner Peace for Mothers

By Danette Watson & Stephanie Corkhill Hyles
Watson & Corkhill Hyles, 2006
ISBN 0646-46588-0

84 page hardcover book & 60 minute CD set, $24.95
http://www.awakenyourbirthpower.com

Reviewed by Molly Remer, MSW, ICCE

Consisting of a book and CD, 25 Ways to Joy & Inner Peace for Mothers contains 25 short breathing meditations with accompanying whimsical, colorful drawings. The meditations are on topics such as “surround yourself with mother energy,” “embrace change,” “feel reverence,” and “trust the rhythm of your baby.”

The final third of the book contains breathing tips, tips for using the meditations in life, and then “10 Healing Practices for Mothers” that are a very nice addition. This segment is followed by “Questions for Inner Exploration” that include journaling questions and prompts based on each of the meditations.

It is not clear at first glance, but 25 Ways is designed for mothers of newborns and infants, not mothers of older children (though, of course, most of the meditations could be adapted to apply to older children). The addition of “new” to the title would have been a useful clarifier.

Inspiring, empowering, and renewing, 25 Ways to Joy & Inner Peace for Mothers is a lovely and nurturing little manual that would make a nice blessingway gift for a pregnant or a congratulations gift for a special new mother.

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Disclosure: I received a complimentary copy of this book for review purposes.

Review originally published in the CAPPA Quarterly, April 2010.