The Birth-Breastfeeding Continuum

May28

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.

Book Review: Pregnant on Prozac

Apr21

Book Review: Pregnant on Prozac: The Essential Guide to Making the Best Decision for You & Your Baby

By Shoshanna Bennett, Ph.D.
GPP Life, 2009
ISBN 978-0-7627-4940-9

248 pages, softcover, $16.95
http://www.clearsky-inc.com

Reviewed by Molly Remer, MSW, CCCE

Written by a clinical psychologist and mother of two, Pregnant on Prozac is a comprehensive look at the benefits and risks of antidepressant use during pregnancy or postpartum. The focus on depression during pregnancy is what makes this book stand out—this is a subject that has received very little attention and it is important for doula and childbirth educators to learn more about the issues involved.

The book includes sections on “natural and emerging treatments” including homeopathy and acupuncture as well as a section on nutrition, though the overall emphasis is on pharmacological treatment methods.

The information presented is very comprehensive, though I was disturbed by the suggestion not to read the package inserts coming with medications, but to trust your doctor to know “what is safest for you and your baby.” This is not the type of informed decision-making I promote in my work with pregnant and new mothers!

Pregnant on Prozac briefly addresses midwives and doulas in a section about “helping professionals who may be of use to you.”

I have three significant critiques of the book. During one section the author waxes eloquent about the non-specific benefits of an unnamed “exercise system” and then later an unnamed “nutritional system.” She glowingly recommends these unidentified systems and refers readers to her website for more information about the nutritional system and to another website for the exercise system. I suddenly felt like I was reading a commercial and the tone called into question for me the validity and reliability of the entire rest of the book.

My third critique is that the segment addressing medication use while breastfeeding is woefully incomplete, falling back on the trite platitude “a calm, happy mother is more important to a child’s healthy development than breast milk.” Though I do not quibble with the truth of this statement in an “ultimate” sense, my concern is that it summarily dismisses the fact that many women can take medication AND breastfeed—it is not an either or situation! The very brief section on breastfeeding also included the questionable and disappointing statement, “you can even get better eye contact with your baby with a bottle in its mouth instead of being squished face-first into your breast.”

Each of these sections is small, but my concerns about them are large. Despite these critiques however, I would still recommend Pregnant on Prozac to birth professionals and parents seeking information about treatment options for depression during pregnancy with the caution not to rely on it as your only resource and certainly not to count on it for advice on exercise, nutrition, or breastfeeding.

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

Becoming an Informed Birth Consumer

Mar26

Though it may not often seem so, birth is a consumer issue. When speaking about their experiences with labor and birth, it is very common to hear women say, “they won’t let you do that here” (such as regarding active birth–moving during labor). They seem to have forgotten that they are customers receiving a service, hiring a service provider not a “boss.” If you went to a grocery store and were told at the entrance that you couldn’t bring your list in with you, that the expert shopping professional would choose your items for you, would you continue to shop in that store? No! If you hired a plumber to fix your toilet and he refused and said he was just going to work on your shower instead, would you pay him, or hire him to work for you again? No! In birth as in the rest of life, YOU are the expert on your own life. In this case, the expert on your body, your labor, your birth, and your baby. The rest are “paid consultants,” not experts whose opinions, ideas, and preferences override your own.

There are several helpful ways to become an informed birth consumer:

Read great books such as Henci Goer’s The Thinking Woman’s Guide to a Better Birth or Pushed by Jennifer Block.
Hire an Independent Childbirth Educator (someone who works independently and is hired by you, not by a hospital). Some organizations that certify childbirth educators are Childbirth and Postpartum Professionals Association (CAPPA), BirthWorks, Bradley, Birthing From Within, Lamaze, and Childbirth International. Regardless of the certifying organization, it is important to take classes from an independent educator who does not teach in a hospital. (I’m sure there are lots of great educators who work in hospitals, but in order to make sure you are not getting a “co-opted” class that is based on “hospital obedience training” rather than informed choice, an independent educator is a good bet.)
Consider hiring a doula—a doula is an experienced non-medical labor support provider who offers her continuous emotional and physical presence during your labor and birth. Organizations that train doulas include CAPPA, DONA, and Birth Arts.
Join birth organizations specifically for consumers such as Citizens for Midwifery or Birth Network National.
Talk to other women in your community. Ask them what they liked about their births and about their care providers. Ask them what they wish had been different.
Ask your provider questions. Ask lots of questions. Make sure your philosophies align. If it isn’t a match, switch care providers. This is not the time for misplaced loyalty. Your baby will only be born once, don’t dismiss concerns your may have over the care you receive or decide that you can make different choices “next time.”
Find a care provider that supports Lamaze’s Six Healthy Birth Practices and is willing to speak with you seriously about them:

Remember that birth is YOURS—it is not the exclusive territory of the doctor, the hospital, the nurse, the midwife, the doula, or the childbirth educator. These people are all paid consultants—hired by you to help you (and what helps you, helps your baby!).

Rolla Area Doula Recommendation

Mar3

Summer Eyberg has been a colleague and friend of mine for many years. Late last year, I was privileged to received Summer’s skills as a doula during my third pregnancy and also postpartum when that pregnancy ended unexpectedly during the fourth month. Summer has an amazing gift of presence—she is open and receptive and listens without judgment. She is also skilled at always returning decision-making power to the hands of the mother (where it belongs!). I have always been impressed with Summer’s ability to notice when something needs to be done and how she quickly and graciously moves to do it without fanfare. Summer is also friendly, passionate, and easy to trust and she has a natural gift in celebrating and honoring pregnant women.

Summer’s compassionate attention and sensitive listening have blessed me beyond measure and I am lucky to call her my doula and my friend!

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Summer can be contacted via Peaceful Beginnings Doula Services or via Facebook