Posts Tagged ‘breastfeeding’

What’s in the job?

Wednesday, July 6th, 2011

 

 

 

 

I wonder if most of us really know what the scopes of practice are for the providers we may choose  for pregnancy, birth, postpartum, and for the baby.  Keep reading to see if you really know what the jobs encompass.

As you go through the list I would like you to think about the language used, descriptors, and purpose of each type of provider. When we are approaching health care decisions especially who will care for us from pregnancy through birth, postpartum and for our babies, we need to make sure we are choosing the appropriate care for our individual needs and situation.

If anything strikes you or you would like me to add any provider types, please leave me a comment!

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OBSTETRICS AND GYNECOLOGY (OB/GYN)

Obstetrics and gynecology is a discipline dedicated to the broad, integrated medical and surgical care of women’s health throughout their lifespan. The combined discipline of obstetrics and gynecology requires extensive study and understanding of reproductive physiology, including the physiologic, social, cultural, environmental and genetic factors that influence disease in women. This study and understanding of the reproductive physiology of women gives obstetricians and gynecologists a unique perspective in addressing gender-specific health care issues.

Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages.

Obstetricians and gynecologists may choose a scope of practice ranging from primary ambulatory health care to concentration in a focused area of specialization.   – from ACOG

Certified Nurse-Midwife

Midwifery as practiced by Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) encompasses primary care for women across the lifespan from adolescence beyond menopause, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. Midwives perform comprehensive physical exams, prescribe medications including contraceptive methods, order laboratory and other diagnostic tests, and provide health and wellness education and counseling. The scope of practice for CNMs and CMs also includes treatment of male partners for sexually transmitted infections, and care of the normal newborn during the first 28 days of life. -from ACNM

Certified Professional Midwife

Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other health care providers when necessary. The key elements of this education, monitoring, and decision making process are based onEvidenced-Based Practice and Informed Consent. – from MANA

Direct Entry Midwife (including Licensed Midwife)

  • Not required to be nurses.
  • Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
  • May or may not have a college degree.
  • May or may not be certified by a state or national organization.
  • Legal status varies according to state.
  • Licensed or regulated in 21 states.
  • In most states licensed midwives are not required to have any practice agreement with a doctor.
  • Educational background requirements and licensing requirements vary by state.
  • By and large maintain autonomous practices outside of institutions.
  • Train and practice most often in home or out-of-hospital birth center settings.

To learn more detail about all types of midwives go to Citizens For Midwifery

Nurse Practitioner

Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages. Today, NPs complete graduate-level education preparation that leads to a master’s degree. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.

NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. Nurse practitioners perform services as authorized by a state’s nurse practice act.  These nurse practice acts vary state-to-state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician. -from ACNP

Family Practitioner

AAFP defines a family physician as, “a physician who is educated and trained in family medicine–a broadly encompassing medical specialty.”

Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. – from AAFP

Labor Doula

The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.

During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.

During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.

During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed. – from CAPPA

Postpartum Doula

The postpartum doula provides informational and educational information to the family. Medical advice is not given; referrals to appropriate studies and published books are within the postpartum doula’s scope. The postpartum doula will determine ahead of time what duties she feels comfortable with performing for the postpartum family and she will share this information with the family prior to accepting a position with them.

CAPPA members do not perform clinical or medical care on mother or baby such as taking blood pressure or temperature, vaginal exams or postpartum clinical care. CAPPA standards and certification apply to emotional, physical and informational support only. CAPPA members who are also health care professionals may provide these services within the scope and standard of their professions but only after making it clear that they are not functioning as a labor doula, postpartum doula, or childbirth educator at the time of the care. For needs beyond the scope of the postpartum doula’s expertise, referrals are made to the appropriate resources.

CAPPA strongly recommends that members do not drive mother or baby unless there is a life-threatening emergency and an ambulance could not get to the family quick enough. – from CAPPA

Lactation Educator

Lactation educators fill an important function in educating and supporting families interested in learning about breastfeeding. This education may take place in the public, hospital, clinical or private setting. Lactation educators provide informational, emotional and practical support of breastfeeding. They may provide this service exclusively as breastfeeding educators, or may use their training to augment their support in other professions, in the cases of doulas, childbirth educators, nurses, dieticians, and postnatal or parenting educators. In addition to providing breastfeeding information, lactation educators offer encouragement, companionship, an experienced point of view, and foster confidence and a commitment to breastfeeding.

Breastfeeding education is not restricted to new families, but applies to the general public and medical staff as well. Due to the limited breastfeeding information given in standard medical and nursing training, and the rampant misinformation about breastfeeding that is so prevalent in our society, the breastfeeding educator serves as a resource for accurate, evidence-based information to the public and health care providers, as well as to childbearing families.

CAPPA does not issue Certified Lactation Consultant status, nor does the lactation educator program qualify a member to dispense medical advice, diagnose or prescribe medication. However, lactation educators provide a wealth of information about how and why to breastfeed; establishing a breastfeeding-friendly environment; basic breastfeeding anatomy and physiology; the normal process of lactation; deviations from normal; physical, emotional and sociological barriers to breastfeeding; overcoming challenges; and resources available (including medical referrals) for the breastfeeding family. They can also be a source of vital support, guidance and encouragement throughout the duration of breastfeeding. -from CAPPA

IBCLC (Lactation Consultant)

International Board Certified Lactation Consultants (IBCLCs) have demonstrated specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).

This Scope of Practice encompasses the activities for which IBCLCs are educated and in which they are authorized to engage. The aim of this Scope of Practice is to protect the public by ensuring that all IBCLCs provide safe, competent and evidence-based care. As this is an international credential, this Scope of Practice is applicable in any country or setting where IBCLCs practice.

IBCLCs have the duty to uphold the standards of the IBCLC profession by:
• working within the framework defined by the IBLCE Code of Ethics, the Clinical Competencies for IBCLC Practice, and the International Lactation Consultant Association (ILCA) Standards of Practice for IBCLCs
• integrating knowledge and evidence when providing care for breastfeeding families from the disciplines defined in the IBLCE Exam Blueprint
• working within the legal framework of the respective geopolitical regions or settings
• maintaining knowledge and skills through regular continuing education

IBCLCs have the duty to protect, promote and support breastfeeding by:
• educating women, families, health professionals and the community about breastfeeding and human lactation
• facilitating the development of policies which protect, promote and support breastfeeding
• acting as an advocate for breastfeeding as the child-feeding norm
• providing holistic, evidence-based breastfeeding support and care, from preconception to weaning, for women and their families
• using principles of adult education when teaching clients, health care providers and others in the community
• complying with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolution -from IBCLE

Pediatrician

A pediatrician is a child’s physician who provides:

  • preventive health maintenance for healthy children.
  • medical care for children who are acutely or chronically ill.

Pediatricians manage the physical, mental, and emotional well-being of their patients, in every stage of development — in good health or in illness.

Generally, pediatricians focus on babies, children, adolescents, and young adults from birth to age 21 years to:

  • reduce infant and child mortality
  • control infectious disease
  • foster healthy lifestyles
  • ease the difficulties of children and adolescents with chronic conditions

Click here for more information about the Physicians and Staff at the University of Maryland Children’s Hospital.

Pediatricians diagnose and treat:

  • infections
  • injuries
  • genetic defects
  • malignancies
  • organic diseases and dysfunctions

But, pediatricians are concerned with more than physical well-being. They also are involved with the prevention, early detection, and management of other problems that affect children and adolescents, including:

  • behavioral difficulties
  • developmental disorders
  • functional problems
  • social stresses
  • depression or anxiety disorders

Pediatrics is a collaborative specialty — pediatricians work with other medical specialists and healthcare professionals to provide for the health and emotional needs of children. – from UMM (I could find no concise scope of practice definition on the AAP website but here is their Scope of Practice Issues in the Delivery of Pediatric Health Care)

Doctors of Chiropractic

Defining Chiropractic Scope

Since human function is neurologically integrated, Doctors of Chiropractic evaluate and facilitate biomechanical and neuro-biological function and integrity through the use of appropriate conservative, diagnostic and chiropractic care procedures.

Therefore, direct access chiropractic care is integral to everyone’s health care regimen.

Defining Chiropractic Practice

A. DIAGNOSTIC

Doctors of Chiropractic, as primary contact health care providers, employ the education, knowledge, diagnostic skill, and clinical judgment necessary to determine appropriate chiropractic care and management.

Doctors of Chiropractic have access to diagnostic procedures and /or referral resources as required.

B. CASE MANAGEMENT

Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to other health care providers.

C. HEALTH PROMOTION

Doctors of Chiropractic advise and educate patients and communities in structural and spinal hygiene and healthful living practices.

-from ACC

 

Lactation Training Colorado Springs – Register now.

Thursday, May 5th, 2011

Transform your understanding about what breastfeeding/breastmilk really is:

• An irreplaceable relationship
• A brain developer

• An immune system
• An organ system
• A living tissue

Transform your professional skills

• Increase your doula competencies in the first hours after birth
• Hone your postpartum doula skills
• Learn unique strategies for teaching breastfeeding to families
• Explore adult learning styles
• Enhance your communication skills

Transform yourself

• Take the leap to explore new ways to work with families
• Connect with other women who love working with moms and babies
• Open your mind about new concepts surrounding breastfeeding
• Take the first step to becoming certified as a lactation
educator with CAPPA

Concepts covered over the three days include: Lactation Professionals, History
of Breastfeeding, Group Process, Learning Styles, Anatomy and Physiology of
Breastfeeding, The Importance of Breastmilk and Breastfeeding, Prenatal Support
and Breastfeeding issues, Birth’s Impact on Breastfeeding, the Hospital
Experience, Latch and the Breast Crawl, Skin To Skin, Signs of Successful
Feeding, Maternal and Infant Challenges, Medications and Breastmilk, Fathers and
Partners, and Curriculum Development.

LAST DAYS TO REGISTER!!!! Must register before 5pm, May 9th MST.

June 3-5, 2011, 8:30am-5:30pm, $425

Colorado Springs, CO at Prep for Birth

To register www.motherjourney.com

Ready to become more proficient when offering breastfeeding education? This
course is designed to improve the skill base, knowledge and perspectives on
breastfeeding and supporting both the Baby Friendly Hospital Initiative and
Mother Friendly practices.

This course satisfies the following:

*The Core Competencies in Breastfeeding Care and Services for All Health
Professionals as outlined by the United States Breastfeeding Committee (no
endorsement by the USBC is implied).
http://www.usbreastfeeding.org/Portals/0/Publications/Core-Competencies-2010-rev.pdf

*The 20 Hour World Health Organization Curriculum to support the baby Friendly
Hospital Initiative.

http://www.who.int/nutrition/topics/bfhi/en/index.html

*The CAPPA Lactation Educator certification step for workshop attendance.

http://www.cappa.net/get-certified.php?lactation-educator

Why become a certified lactation educator?

Certified Lactation Educators (CLEs) provide evidence based information to the
community, families and professionals to encourage an increase in breastfeeding
initiation, duration and support. CLEs are found teaching community and hospital
based breastfeeding classes, as peer breastfeeding counselors in hospital and
public health setting, facilitation support groups, running pump rental stations
and providing phone support.

The CAPPA CLE does not prescribe, treat, nor diagnose breastfeeding related
conditions and is trained to refer clients facing circumstances that require
this degree of intervention to a qualified professional. The CAPPA 20 Hour CLE
course is not an IBCLC exam prep course, nor does the CAPPA CLE training prepare
a student to become an IBCLC.

Your faculty:

Laurel Wilson, BS, IBCLC, CCCE, CLE, CLD, CPPFE, CPPI owns and manages
MotherJourney in Centennial, Colorado. She has her degree in Maternal and Child
Health-Lactation Consulting. With over sixteen years experience working with
women in the childbearing year, Laurel takes a creative approach to working with
the pregnant family. So is co-author of forthcoming book, The Greatest
Pregnancy Ever: The Keys to the MotherBaby Connection. Using journaling, birth
art, visualization and experiential exercises, women connect with their inner
resources to discover their true beliefs about themselves, their relationships,
and their abilities to birth and parent their children.

Laurel is certified as a lactation consultant/counselor and educator, childbirth
educator, labor doula, Prenatal Parenting Instructor, and Pre and Postpartum
fitness educator and prenatal yoga teacher. She serves as the CAPPA Executive
Director of Lactation Programs and trains Childbirth Educators and Lactation
Educators for CAPPA certification. Offering education and movement classes to
families in private and hospital settings, Laurel has created teaching
strategies that facilitate better understanding of the change processes during
the childbearing year. Laurel has been joyfully married to her husband for
almost 20 years and has two beautiful teenagers, whose difficult births led her
on a path towards helping emerging families create positive experiences. She
believes that the journey towards and into motherhood is a life changing rite of
passage that should be deeply honored and celebrated.

In light,
Laurel Wilson, BS, IBCLC, CLE, CCCE, CLD
Co-Author of forthcoming book, The Greatest Pregnancy Ever: The Keys to The
Mother-Baby Bond
MotherJourney Childbirth Services
CAPPA Executive Director and Faculty for Lactation Programs
Customer Advocate for InJoy Birth and Parenting
linfinitee@aol.com, www.motherjourney.com
720-291-9115

Connect with CAPPA:

Our website

On Facebook

A Road to Placental Encapsulation

Saturday, January 22nd, 2011

The below post is written by a mother of 3 wee ones. She graciously accepted my request to share her journey to placental encapsulation. I have personally witnessed a significant in Kailah’s postpartum between baby 2 and three overall along with her milk supply increase. I am truly amazed by the differences.

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My Experience With Placenta Encapsulation by Kailah Brost

Not all crunchy people are born that way. In fact, the more blogs I read the more I realize that that becoming “crunchy” is a process for most people.

Since my first birth I have considered myself to be “semi-crunchy”, but I think that my last birth experience officially graduated me into full fledged crunchiness. I mean, not only did I have a homebirth, but I (gasp!) had my placenta encapsulated so I could ingest it!

I had heard about placenta encapsulation some here and there, but hadn’t thought about it as something I would do. The first time I gave it consideration was when I lost my milk supply with my second baby at 5 months – just like it had happened with my first baby. I worked with a Lactation Consultant with both, and tried just about everything, but we couldn’t get it back up and had no idea why it had gone in the first place.

So when I found out I was pregnant with baby number 3, I knew I was going to give placenta encapsulation a chance. Couldn’t hurt right? And as fate would have it, the new leader of our local ICAN chapter was a Placenta Encapsulation Specialist. One of our meetings I was the only one who showed up, so I got to pick her brain. She also sent me to www.PlacentaBenefits.info and gave me a study on the placenta and hormones and I was amazed at the what the research had to say.

We all know that with the birth of a baby our hormones come crashing down around us. Well, all those hormones we lose – thyroid, progesterone, prolactin, etc – are in the placenta and ingesting it gives us doses of those hormones that help keep us from crashing so hard. Thus Postpartum Mood Disorders are much less likely, milk supply is boosted and can come in faster, and energy is increased. After looking at that, I was sold. Who wouldn’t want all that while introducing a baby into the family, especially with 2 other very small children?

Right after my son was born, one of my first calls was to the Placenta Encapsulation Specialist. The baby was born at 5pm, so she came up the next morning and started on the 2 day process. Day one was preparing, cutting it up and putting it on a dehydrator. Day 2 was grinding it up and putting into capsules for me. I had an average sized placenta and ended up with 117 capsules.

We had decided I would take enough for just a couple weeks so I could save some for the time when my supply traditionally decreased. I took 2 3x/day for 2 days, 2x/day for a week, and 1x per day for a week. I could not believe how I felt! I wasn’t sleeping continually, I didn’t mind getting up in the night with the baby, and I felt so calm and at peace with the world. The night I started taking them, almost 3 days post partum, my milk supply came in with a BANG! I was actually on facebook chatting with my doula for help I was so engorged. It rapidly resolved itself, however, and an awesome breastfeeding relationship was established. Three weeks postpartum my mother-in-law came to visit, and she stressed me out so badly that half way through her visit I started taking them once a day again. Amazingly, it worked! She was still driving me nuts, but suddenly I was calmer about it and able to focus and make it through the week.

The best thing for me was how it affected my breastfeeding. My supply was much stronger than it had been with my other two. I LOVED watching my baby get so beautifully chunky! However, a couple of weeks ago at 4 ½ months postpartum, my supply again dipped. I immediately took out my reserved placenta capsules and while we work on figuring out why my body does this, I am using them to keep my supply at a good level.

It’s fun for me to see the journey to crunchy I’ve taken. I was sick in November and saw the PA in my Dr.’s office. While going over my history I noted I’d done placenta encapsulation and he was really fascinated. The Dr.’s wife is a nurse in the office and a friend of mine. She told me later that the PA came to her and asked if she’d ever heard of ingesting the placenta. “Oh,” she replied, “you must have met Kailah.”

Bio:

Kailah is wife to an amazing man, and babywearing, cloth diapering, co-sleeping, breastfeeding, stay at home mountain mama to 3 kids under 3 whose births turned her into a crunchy birth geek, and VBAC and homebirth advocate.

Email – zarikailah@yahoo.com

twitter – @klabrost

facebook – http://www.facebook.com/klabrost

Wish List In 2011

Sunday, January 2nd, 2011

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.

Posptartum and the Great Abyss

Monday, November 29th, 2010

The postpartum period is a critical time for the health, attachment and emotional adjustment for both mother and baby.

It has become the expected norm that women are left with very little medical or care provider support/assistance in handling the many norms, transitions and stumbling blocks that present in the first 6 weeks postpartum with her and her baby.

The general exception to this rule are women who birth at home with a midwife or in a free standing birth center where the rest of the perinatal period has several (approximately 6 visits) scheduled for follow-up care for both mother and baby. In this case, a family practitioner or pediatrician is unnecessary unless a need outside the norm arises.

Sadly with the majority of American women birthing within the hospital environment, she will leave the hospital with a stack of papers, a resource list, perhaps after viewing a newborn video and be left to her own devices until that 6 week appointment with her  care provider (yes, some hospitals offer a visiting nurse once or maybe twice after birth, but is not the norm).

This is so stunning to me. Absolutely hair raising the lack of care women get. It is akin to entering the open sea with a poorly written map and expected to find the “New World” successfully and without setback.

As a doula and educator, I field emails, texts and calls from my clients and students asking questions, needing breastfeeding feedback and help navigating life.  WHERE ARE THE hospital care providers in this time?  Even without being able to offer home visits (except there could be a staff nurse, PA or NP to fill that roll), why are OB’s and hospital CNM’s not having their patients come in to the office at regular intervals post birth? For example, days 3, 7, 14, 21, 30 and then at 6 weeks? This sort of practice could address both emotional, physical needs and very well catch many other things BEFORE they become issues.

The longer I am in the birth professional, I am simply appalled by what passes as good care. No wonder so many women have recovery needs, postpartum mood disorders missed and breastfeeding problems. After months of constant contact and appointments (albeit not usually comprehensive), a woman is dropped into the abyss of postpartum without a safety net.

One practical solution is for a mother to secure a labor doula who would work with her prenatally through the early postpartum period and then hire a postpartum doula to continue care and assist in the rest of the perinatal period.

Another is for the mother to have a trusted, knowledgeable and skilled family member or friend come and stay with in her home from the birth through at least 6 weeks post birth. This person would help the mother learn to mother and not be “nannying” the baby similar to that of a postpartum doula.

Lastly, for truly comprehensive care, there is always the option to switch to a provider that offers it or one never knows what would happen if it is simply requested as part of the maternity care package of her hospital-based provider.

I hope you found this food for thought invigorating! I look forward to your comments.

The Best isn’t Better. Usual is where It is at.

Thursday, September 16th, 2010

There has been much ado surrounding the language of breastfeeding being normal and usual versus the best for baby and mother in great thanks to Diane Weissinger. It is so valuable to recognize that while we all desire to be the best, we often hit the normal everyday averages in life. We are comfortable reaching a goal that seems more attainable. Best or better can feel so far out of reach where average and usual seem quite in reach most of the time. None of us generally want to be below the average or usual. Thus the language of the risks of NOT breastfeeding is so vital.

I would like to see the same type of language revolving around pregnancy and birth as well.

In the overall picture here is the usual occurrence: Ovulation leads to heightened sexual desire, which leads to sexual activity, which leads to pregnancy, which leads to labor, which leads to birth, which leads to breastfeeding…..

So how do we look at language as an important part of our social fabric and belief systems surrounding this process?

Let us look at contrasting statements of what is often heard and how a positive point of view can be adapted.

Pregnancy is: a burden, an illness, an affliction, a mistake, something to be tolerated……

Pregnancy is: a gift, wonderful, amazing, part of the design, someone to grow…..

Labor is: scary, worth fearing, the unknown, unpredictable, painful, to be avoided, to be numbed from, to be medicated, to be induced, out of control, unfeminine…..

Labor is: what happens at the end of pregnancy, hard work but worth it, manageable by our own endorphins and oxytocin, an adventure, not bigger than the woman creating it, to be worked with, worth be present for, is what baby expects……..

Pushing and Birth are: terrifying, physically too difficult, only works for women who are not too small, short, skinny, big, fat, young or old, responsible for pelvic floor problems, out of control, horrible……..

Pushing and Birth are: what happens after dilation completes, to help baby prepare for breathing, bonding and feeding, sometimes pleasurable, sometimes fast, sometimes slow, able to occur in water, standing, laying down, squatting, on hands and knees, often most effective when a woman is given the opportunity to spontaneously work with her baby and body, not always responsible for pelvic floor issues, amazing, hard work, worthwhile, sets the finals hormonal shifts in motion for mother and baby……

Is it really BETTER? I say no. It is usual and normal.

  • Spontaneous labor is not better – it is the expected usual occurrence at the end of pregnancy.
  • Unmedicated labor and birth is not better – it is what the body mechanisms and baby expect to perform at normal levels.
  • Unrestricted access to movement, support and safety in response to labor progression is not better – it is the usual expectation to facilitate a normal process.
  • Spontaneous physiologic pushing is not better – it is what a woman will just do, in her way.
  • Spontaneous birth is not better – it is what a mother and baby do.
  • Keeping mother and baby together without separation is not better – it is what both the mother and baby are expecting to facilitate bonding, breastfeeding, and normal newborn health.

Denying the norms and adding in unnecessary interventions, medications and separation is creating a risky environment for mothers and babies. Thus increasing fear, worry,and even a desire to be fixed at all costs.

Perhaps even worse, an atmosphere has been created where the abnormal has become the expected norm and the normal has become the problem to be eradicated.

Bottom line, our language matters and will help shape for the positive or negative the future of birth.

Preparing For Birth – Online Breastfeeding Class resource

Wednesday, October 7th, 2009

Busy? Only have time to attend a class during the day or in the late evenings? Below is a link for a fantastic online breastfeeding class? Only $20.

This class is suitable for mothers and birth professionals.

Follow-up can be provided via phone, chat room or in-person (Colorado Springs, CO area).

http://alliancebreastfeeding.com/services/simply-breastfeeding/

The Doula Seed

Sunday, July 26th, 2009

Whenever I am asked why I am a doula, I need to stop and think for a moment.  My response every time is that as a doula I am filling the gap (along with others)  that is missing in today’s transient and autonomous society. When I respond, I am thinking of the days when girls and young women learned the ways of pregnancy to all things postpartum at the feet of their grandmothers, aunts, sisters, cousins, and other women in their community.  What a beautiful and age old scene that is.

Then that scene brings me to my own journey in becoming a doula.  Here is my “why” story.

Living without my own mother since I was 10 years old, I yearned for the mentoring and teaching that I am called to act upon in my life’s work.   Even without my mother, I was blessed to grow up around some other women who modeled breastfeeding, cloth diapering, and natural birth for me.

I also think of the journey that brought me to being a doula for real.

I had an epiphany one day almost 25 years ago when a close friend and I were waiting for the bus to get home from work.  She described her birth – left by her partner during pregnancy, her mother refused to come since she was unwed, and she was at an overtaxed county hospital where the staff was barely in the room to support her.  She was utterly alone and scared.  My heart broke for her and her daughter. No woman should ever be alone to fend for herself under those circumstances.  EVER.  In looking back, I can say at that moment my doula heart seed was planted though it would be years before the seed came to full bloom.

Fast forward a couple of years and I had a knack for mamas and babies.  I could help a baby latch and mom grow confidence in breastfeeding.  I knew how to calm a mama when she was tired and at her wit’s end. I understood the pregnant mama and could easily encourage.  I was invited to attend a birth of a family member I was very close to.  She delivered in a freestanding birth center.  It was an amazing natural birth with very little requirement of her except to labor and birth.  An atmosphere of encouragement, freedom, and calm. I will say it was one of the most comfortable places I have ever been in my skin supporting her.  I didn’t understand the job I had done with her, but it was good.  I think I was on a birth high for weeks.  The doula seed was beginning to ferment.

I attended birth along the way for friends and other family, assisted in breastfeeding and talking through general pregnancy issues. Mind you I hadn’t had my own children, was educated and worked in fields that had nothing to do with birth.  I loved the mamas and families that I knew.  When I started having my own family, it seems the mojo went into high gear.  I was asked questions all the time about many things pregnancy, birth and breastfeeding related, no matter where the place or situation.  Even my husband began fielding calls when I wasn’t home from friends who needed baby help.  The doula seed was slowly sprouting.

When my dear youngest boy weaned himself, I began wondering OKAY now what am I going to do while maintaining being a SAHM? My sister-friend “J” found the CAPPA website and told me I needed to take the trainings and then I could really support the families in my community as an extension of what I was already doing.  Get the education she said.  I went to the site, spoke to my husband at length and took the leap.   Three trainings in 5 months.  Then I began to to seek out clients, put together curriculum, and found a local doula group to join.  The doula seed exploded into a blossom of great fragrance about me.

I ill not say the work is easy. Anything worth any value is not.  From the prenatal meeting, to the birth while looking into a mother’s eyes encouraging her down the path so many have walked before, to the early postpartum time in assisting with breastfeeding, attachment and family health, I am honored and blessed doubly.  Participating in the most intimate time possible, witnessing the transformation that so often occurs in a woman (and her huband/partner/family), and hearing that first sound of life when her baby “speaks” is beyond description.  A miracle takes place each and every time.

The doula blossom has deep roots now.  On occasion it needs some pruning, soil treatment, and large doses of sunshine as all beautiful plants need to maintain health and well-being.  Still it is very good.

Preparing for Post Birth –

Saturday, July 25th, 2009

Putting effort into the initial postpartum period is in my opinion equally as important as preparing for pregnancy and birth.  Sometimes it is even more important due to circumstance or birth outcome.  Too many focus solely on the labor, delivery and perhaps the “stuff” that goes with having a baby while completely forgetting to look at all incredible change that occurs with having a new baby 24 hours a day, 7 days per week.

Below is a listing of important information to think about, investigate, understand and/or plan for.  Make a note of people in your immediate life that can be a resource as you go through the list.

Look carefully at class descriptions you may take in your local area, some are very thorough and others do not go into information you need in detail.

Here’s to postpartum preparedness!

Common Physical Changes for the Mother

Uterine Change and Bleeding

Breast Expectations and Breastfeeding Norms

Hormones and Symptoms

Recovery Requiring Attention

Vaginal Tearing, Episiotomy, Cesarean, Extreme Soreness or Swelling, Hemorrhoids

Nutrition

Common Psychological Changes

Mother and Father/Partner Changes

Processing the Birth Experience

Processing Becoming a Family

Postpartum Mood Disorders

Peer and Professional Support Resources

Understanding Your New Baby

Babymoon

How Baby’s Feed

Attachment

Infant Development

New Family Dynamic

Coping with Sleep Deprivation and Exhaustion

Managing Stress

Grieving the Changes

Siblings and Pets

Knowing How to Get the Right Support

Postpartum Doulas and Practical Support

Making Your Best Decisions

Defining Parental Roles – Financial, Baby Care, Changing the Status Quo

Choosing a Health Care Provider for your Baby

Early Infant Health Care Decisions – Vaccinations, Circumcision, etc.

Parenting Philosophies

Developing Your Parenting Style

Where Baby Will Sleep

Boundaries with Family and Friends

When to Seek Professional Help

Relationship Care

Realistic Expectations

Sexual Intimacy

Practicalities of Life

“Dating”

Priorities

Single Parenting

Arranging Practical Support

Making a Community

Parenting Needs

Unexpected Outcomes

Processing a Difficult Birth

Babies with Medical Needs, Coping and Advocating

Dealing with Loss, Grief, and Trauma

I offer a Postpartum Strategies class privately in the Colorado Springs area that goes into more detail on many of these topics.  My Bookstore lists several helpful books as well.