Wednesday, 30 March 2011

Handing back the keys

This week I finished working with one of my twin mums.  I had been with her about nine weeks in total.  I started working with her three days a week, then we slipped down to two and eventually to one.  She had given me a set of her house keys in case I arrived when she had gone back to bed with the girls.

Of course to ensure her love and devotion I started my time off with a lemon drizzle cake and a homemade cheesecake.  I made a couple of lovely vegetarian meals (she had no meat in the fridge) and made sure that she had lunch and supper every day that I was with her.

In this time she would go back to bed with her girls and sleep.  Wonderful!  Just what the Doula ordered.  Eventually she began arriving downstairs before lunch and we would chat or she would do a couple of bits.  Then I would arrive and she would be awake having had a decent(ish) night's sleep.  Of course this would be the time that her three year old suddenly decided that sleep wasn't really an option.  Then she began popping out for a swim, or to get in some shopping because they wanted an extra large lasagna or a lamb tagine for supper.

At the beginning her lovely husband would leave me notes.  Simple notes showing his priorities.

Dear Mars
A and the girls had a rough night.  Could you make sure she has a good breakfast and one of your lovely lunches?  Have bought ingredients for a fish pie.  Could you make a chorizo and lentil stew?  Oh and if you have time, one of your delicious lemon cakes.
Have a good day.

I knew that she was ready to say goodbye to me before she did.  We both knew, however, that her husband was not.  So we decided that the following week would be my last and that I would bake a farewell chocolate and banana cake (favourite of the three year old).  As I finished I handed back the keys.  Such a lovely family but I was glad to say goodbye.  Not because I didn't like them, or want to work with them anymore, but simply because it was time for her to take back the keys and continue her transition into Mother of three.  I feel so satisfied when I know my ladies are good to go.  I work to make myself obsolete and when I am, well I smile.

And as that door closed I began working with another family.  Singleton baby.  Dad has gone abroad with his work for a week.  And so for another lady I am feeding and watering her and sending her back to bed.  I'll put a wash on, hang a wash out, take down and fold the laundry.  We'll talk about cluster feeding and whether or not it is normal for a baby to wake and look at you like it's party central at 3am in the morning.

I take the keys and go to the butcher's, the supermarket, the chemist.  I will mother my mothers.

Here's a little something by Gloria Lemay

Sunday, 20 March 2011

Crossing a new threshold

It's funny the things that trigger my trains of thought.  I was just reading through blog posts and article shares on Facebook when I came across a great share by Invisible Midwives, Broken Birth and Developing Doulas.  The article was a from The Daily Mail. Imagine that, the Daily Mail with a positive birth story.

It was a lovely story.  I love hearing about birth in all her glory, but hearing a simple birth story is wonderful.  And it made me think about the things that women have said to me about birth.  I've met with women who have told me that they have low pain thresholds so they won't be able to birth without drugs.  What makes me smile is that in the five years I've been a Doula, those are the women who seem to "breeze" through it.

I have been blessed to witness what I can only call "silent" births.  Ladies who have gone down into themselves as they labour.  They turn off their thinking brain, they shut out the outward stimuli and they become one with their bodies.  Now I'm no hippy by anyone's standards, but I can and do testify to the amazing power of their births.  One of my ladies, whose story is on my website was keen to have a normal, natural birth.  She went into labour and was calm and serene, gently contracting away.  We arrived at the hospital birthing centre to be told that she was only a few cms dilated and that she should go home.  Fortunately the birth centre was very quiet and I managed to persuade the Midwife to let us hang around a bit.  I sent my lady and her husband for a walk.  She was soon back as the contractions had built.  She either walked about the room or stood in the corner as the surges washed over her.  She listened to and trusted her body.  Then she made three long, low, bovine noises and the Midwife said "Yep.  Things are happening". And within a short wee a gorgeous baby boy was born.

Another of my ladies used gas n air throughout her labour.  She fell asleep between contractions.  She was sure that she would want an epidural and so it was rather wonderful to watch her snooze her way through labour.  Her husband had a huge grin on his face the whole time.  At one point the Midwife said "she's really going to have to wake up to have this baby you know".   She had a beautiful daughter.

One of my ladies whose birth ended with a caesarean section also laboured quietly through.  The labour was long and hard, but she breathed her way through it and had the caesarean when it was clear that this baby wasn't making an entrance any time soon.  She feels (in common with another of my section ladies) that hospital was the reason why her contractions were ineffective and kept stalling.  She had contracted pretty well at home.  She's due a second baby soon and has elected to have a Homebirth (HBAC) and yes, I'll be there for that one too.

Most of my ladies that labour silently don't believe me when I tell them afterwards.  They are mostly convinced that they were screaming like banshees.  Often a Midwife will not believe that they are in labour because of their lack of noise.  It's why I think that it is important to look at the whole woman when she's in labour.  Her mouth may say nothing, but her body speaks volumes.  I love the Midwives that quietly watch the Mum and gently put things in place for her.  It's a special skill to be able to sit on ones hands and wait.  Some people have a real need to be doing something, anything all the time.  Pregnancy, birth, breastfeeding, child-rearing... it's all about waiting.

Thursday, 17 March 2011

Doubly blessed

Happiness is mine today!

This weekend I was off call.  Oh how lovely to be off call.  I've been really busy for the past fortnight supporting three mums of twins.  The first mum was doing brilliantly.  Breastfeeding was (and still is) going well.  The second has one twin who is feeding like a champion and the second has had problems latching on and taking her milk from a bottle.  The third is my mum with the boys born twelve weeks early.  One of her sons came home and was having some difficulty feeding, the second fed well in the hospital but it didn't work out once they were home.

With each of my visits I have tried to encourage and support to the best of my ability.  I have cooked, sent them to bed, kept their spirits up when breastfeeding seemed to be going awry.

What each of these twin mums have in common is the negative opinions of many others.  They have been told at various times during their pregnancies and postnatal periods that breastfeeding twins is going to be at best difficult but more likely, impossible.  And so the first barrier to successful twin breastfeeding is formed.

Now why do people do that?  I mean we have two breasts and with two babies it seems simple.  Perhaps it is their own experiences of breastfeeding or their own perceptions.  Whatever the reasons, it is a barrier that needs to be broken down.

The second twin mum I've been supporting has plenty of milk.  All she has to do is to look at one of her babies and her milk flies across the room.  You may think that I exaggerate, but (for a wee change) I do not.  As second baby girl is not as good at the breast as her sister she gets some of her feeds from a bottle.  Mum puts the pump to her breasts and in less than 5 minutes has filled two containers with milk.  Honestly, she could feed an entire neonatal wing on her own.  When I first started with them a few weeks ago Baby girl 2 did not go to the breast.  Her sucking action with both breast and bottle was not good.  I suggested Cranial Osteopathy because it was clear that the issue was not a lack of supply and so it had to be another reason.  The lovely Miranda Clayton visited her at home and discerned that there was a weak muscle issue with the baby and wondered if it might be to do with the fact the babies were born at 38 weeks and perhaps Baby girl 2 needed a little longer.  Whatever the reason, with some treatment from Miranda and encouragement from me, Mum has had success with breastfeeding Baby girl 2.  Baby girl 1 feeds beautifully and needs no encouragement.

My third lady has struggled from the beginning.  First the boys were born 12 weeks early, then she was told that one of the placentas had been left inside her after the birth.  Now the progesterone levels are high during pregnancy to maintain it and when the placenta has been retained (or left inside), lactation is delayed because of the powerful inhibiting influence of progesterone.  In short, breastfeeding is difficult to establish, or in her case, expressing was rather soul destroyingly minimal.  As the boys were tiny and premature and the objective was to get them big enough there was plenty of supplementing.  When the placenta was discovered her milk production increased but her confidence in her ability to produce enough milk for two was shot.

My role with her was one of faith.  She didn't have enough faith in herself so I held it for her and she leaned in my direction.  Little by little the milk production increased and the babies' ability to suckle and feed increased.  Now the amount of artificial milk is rapidly decreasing and she is beginning to feed them both almost exclusively from the breast.

So, the reason for my happiness?  I got two texts over the weekend.   The first from lady 3 which read "I did it!  Can't believe it myself... I breastfed both together, all by myself, J still asleep :D they r sleeping like angels now...".  The second, from lady 2's husband, said "Lady 2 is feeding both babies together for the first time".

So like my ladies, I am doubly blessed.

When the Wee Weapons were tiny

Being part of the Village

My lovely friend Maddie Mahon is a sister Doula.  She recently blogged about why she does what she does and that has inspired me to copy her (best form of flattery apparently!)

The best way that I can tell you why I do what I do is with stories of my ladies.  Yes I know this whole blog is full of stories of my ladies, but what you gonna do?  You know I'll tell you anyway.

After the first Doula birth I attended Dad said "I only agreed because you are a friend, but I don't know how we did the first birth without you."  Proof I was in the right job.

Another birth: I was called to a client's induction.  She was 8cm.  She had had an epidural.  The male midwife (and before you say "here we go" my favourite midwife is a man... hmm... that smacks of "some of my best friends are [insert group you are insulting]) looked me up and down and said "Why do we need you here?  How many births have you done?".  At that point I'd done 50.  He said "Oh I had to do that many to qualify.  I've done over 200 now".  I realised that this man felt threatened by me and my presence.  My lady wanted to change positions and he told her it was impossible.  I asked why.  He replied "Who is delivering this baby? Me or you?".  I couldn't help myself I said "I thought Mum was birthing her baby".  At 10cm he began to direct her pushing.  He never looked at her once.  He began to count.  She began pushing, but it wasn't to his count so he got cross, told her off and started again.  Suddenly it was shift change time and he left.  He had destroyed her confidence in herself, her body and her ability to birth.  Talking to him, asking questions, trying to shield my lady simply made him more stubborn and actually the best thing for my lady was for me to be silent and hold her hand.  The new midwife was lovely but the damage was done.  The most brutal forceps delivery I've ever seen followed and consequently the baby had real breastfeeding issues.  I spent days afterwards with Mum and baby working on the feeding.  Finally they were good to go it alone and my time with them ended.  A year later I got an email from her.  She said "You may not remember me but you were with me at the birth of my son.  I just wanted to thank you for your support and to let you know that I'm still breastfeeding a year on."

Twin birth: My lady wanted to have a vaginal birth as normally as possible.  The hospital told her why it would be impossible.  They were insistent that she gave birth with an epidural and that she laboured and birthed in theatre with quite a contingent of staff.  She knew what she wanted and she refused.  In the end a compromise was reached, she was allowed (you really should hear what Mary Cronk thinks of the word allow/ed) to labour in a birthing room but had to transfer to theatre for the birth.  She was allowed (there's that word again) to use gas n air only as long as she realised the risk of needing a general anaesthetic should the second twin go into distress and she was allowed (and again with that word) to have a minimum number of staff at the birth.  She laboured beautifully and quickly.  She mentioned labour had started (early) and that she was in hospital.  I wandered over slowly because she said that there was no rush and within the hour (minutes before I arrived) she was 10cm.  I met her as she was transferring to theatre.  The wonderful Consultant put sheets up against the windows to stop the students peering in and turned off a very annoying machine that was continually beeping. My lady gave birth to two gorgeous boys using only gas n air and got a standing ovation from the staff.  They were amazed and hadn't thought it at all possible.  My lady booked me for the birth of her daughter a couple of years later.

One of my favourite postnatal jobs was with a second time mum.  She needed someone to take care of her and maybe watch the baby whilst she slept.  Her older son was at nursery.  I would arrive and we would chat whilst I began cooking.  She was a wine buyer so there were plenty of wines to be used in the cooking... oh how I loved the cooking.  She would take the baby upstairs, feed him and go to sleep.  I would listen to the radio and sing whilst cooking.  When my time with her came to an end her husband promised to buy an aga for me to work on if I would stay.  We're still in touch.  No aga yet though.

My twin mum with boys born 12 weeks early had breastfeeding difficulties and just a few days ago managed to breastfeed them both at the same time with no help.  She thanked me for having faith in her.

I could go on... but there are many stories.  Some with beautifully easy births, some with horrendous births.  Some with postnatal needs that were simply about being fed and sent back to bed, others with breastfeeding issues.  The end result is always the same.  Happy ladies, happy babies, happy me!

Why do I do what I do?  I love people and if I can help make things a little easier and leave happy ladies and babies (and partners) in my wake... well do I really need another reason?

Saturday, 12 March 2011

Sister in the house

I spent Wednesday working with a mum to be who is suffering from Pelvic Girdle Pain (PGP).  The poor darling has been on crutches since the beginning of January and the baby is not due for a few weeks yet.  I cooked up a storm.  It was so lovely to open a fridge full of food and a store cupboard full of spices.  Wonderful.  But I digress...

It had been a long week to date (long fortnight really) and I was getting to be beyond tired.  So I made my first mistake... I planned an early night.  I should never plan an early night.  As soon as I do it is bound to fail.  

I had a call from my early March client (a repeat client) to say that she was having erratic contractions.  So an early night was a good plan in theory.  I'm convinced she saw me lay my head on my pillow because as soon as my eyes closed... the phone began to ring.   Her husband was on the line.  The contractions were getting worse and they didn't feel safe with their midwives.  Could I go immediately?  Of course.  I jumped out of bed with a fond "farewell pillow" glance.  I grabbed my book, a bottle of water, my ipod, my keys and my homeopathy kit (in case she wanted to use it).  I called the cab and was off.  It was 11.30pm.

When I arrived at the house F, her husband, welcomed me with a big hug and kiss and a whispered "Thank God".  I hugged her mother and immediately introduced myself to the two midwives, one of whom was a Sister/Nun belonging to a religious order (I forgot to ask which order... daft Doula).  I explained who I was and they looked at me as though I had interrupted something.  Mum was upstairs on the bed contracting away.  The MWs had been unable to give her a vaginal exam because the pain was too much.  This meant that MW1 wouldn't let her get into the birth pool because in her words "protocol says you have to be 5cm or I can't allow you in the water".  MWSister meanwhile, was trying to find the foetal heartrate by continually prodding Mum with the handheld sonicaid.  She did not turn it off when she was finished so the calm, quiet room was filled with the hissing and the hum of her electrical aid.

I could tell that the dynamic was wrong and that Mum was fearful of giving birth.  Dad told me later that the MWs hadn't introduced themselves and that both he and his wife had hoped they would leave.  So my job at this birth was to calm the "troubled waters" and provide a sense of safety for Mum and Dad.  Dad was no retiring wallflower.  His protective stance was one to behold (and stay the right side of).

Mum was breathing through her contractions nicely.  Dad was breathing with her and reminding her to relax and to keep doing the wonderful work she was doing.  Grandma was going in to settle their 3 year old son periodically.  MWSister kept attempting to get the foetal heartrate and calm was restored each time she had.  Me, I was re-reading Pride and Prejudice (which is on the Kindle app on my phone) and waiting.

After a while I suggested to Mum that she might like to use the toilet to empty her bladder a little.  My main thought was that a little mobilisation would be good for both her and the baby.  She had been rocking on on fours on her bed for a while.  Getting up was really good for her.  She didn't manage to empty her bladder but she did feel the benefit of the short walk and went downstairs to the birth pool.  MW1 still wasn't happy about her getting into the pool so Mum and Dad stood beside it and the contractions continued to build apace.

Mum decided (with some gentle persuasion from me) to let MW1 attempt to check her progress.  I have to confess I wasn't sure why MW1 needed to as many of the community and homebirth MWs I've worked with are pretty fantastic at looking at their ladies and knowing roughly where their labour is at.  So, we moved over to the couch but Mum refused to get on her back for the exam and told us... "she's moving down.  She's almost here."  At this point evidence of her pushing began to be seen and a discreet wiping up of debris prompted MW1 to say she might as well get in the water.

Oh the looks on MWSister and MW1's faces as Dad whipped his kit off (leaving a fetching pair of cloth boxers on for our modesty) and got into the pool with Mum.  She held on to him and breathed.  Oh it was such a beautiful sight.  Neither MW knew quite what to do, but there was nothing that needed doing.  They were simply having a baby.  Just thinking back on it fills me with shivers.  It was amazing. This was a husband and father's love in action.  Dad said "I can feel her coming".  The  MWs and I reminded Mum to keep her bottom in the water for the birth.  It wasn't long before a wee girl slipped into the world at 2.23am.  MW1 had been shouting "Don't touch the baby as it comes out, you'll stimulate it!" then when she arrived she shouted "Grab the baby.  Bring the baby up".  I leant in to Mum and said "Take your daughter.  Bring her up into the world".  MW1 reached in to look at the baby and to look at the cord.  Dad asked her to stay back as he was unwrapping the cord from around his daughter.  Mum put her new daughter to her breast where she almost instantly began to nurse.

Eventually Mum and Dad got out of the water to await the arrival of the placenta.  MW1 wanted Mum to hand the baby on to someone else, but Mum held her tight and with Dad's support they went upstairs to the bathroom.  A bowl was popped into the toilet and we waited for the placenta whilst Baby Girl fed.  The MWs stayed downstairs having asked us to let them know when the placenta came. After about an hour MW1 called up the stairs to say that she would have to give the syntometrin injection because it had been more than an hour.  I looked at Mum who said "It's coming now" and with a loud whoosh, the placenta dropped into the bowl.  It was huge!

Mum and Dad went back to their bedroom where MWSister did the quick baby checks and weighed Baby Girl.  Mum, Dad and Grandma all cuddled in bed as the MWs gathered their equipment and left.

What I love about homebirths (apart from the miracle that is birth of course) is Mum, Dad and Baby curled up around each other in bed.

When I left the house was full of wonder and joy.  Another beautiful birth and a Baby Girl with no set name.  I was thinking Mars!

Saturday, 5 March 2011

Pre-natal to Paternal.

This evening I've been thinking a lot about breastfeeding.  Nothing new there I know.  I spent the day in Rex The Great British Cafe.  The gorgeous poached eggs on muffins and smoked salmon with the delicious hollandaise sauce was not the only reason for my visit.  I find that I study better when I'm not at home.  Funny how appealing cleaning the oven/fridge/Wee Weapon's room becomes when there's studying to be done.  I was reading about the trends in Breastfeeding and the Tides of practice <frantically looks at study book to check that that was indeed today's topic of study> and then I checked in on my facebook business page.  I had commented on How Breastfeeding Works' link about male perceptions of breastfeeding.  She suggested I wrote something about how antenatal knowledge helps Dad in supporting their partner with breastfeeding.

So... here are my thoughts (of course it's a blog so the majority of the thoughts will be mine).

I run antenatal sessions with the lovely Rebecca.  We specialise in private antenatal sessions in people's homes.  We cover breastfeeding in great depth and we feel that it's important that Dad/the Partner knows how breastfeeding works as well as Mum.  Let's face it, in the middle of the night - and it's always the middle of the night - when Mum is exhausted and breastfeeding seems harder than it's ever been, Dad wants to rescue the situation.  "Darling, it's enough.  You've tried hard, this isn't easy.  I'm going to go out and get you a bottle.  This can't go on."  If, however, Dad understands how breastfeeding works, he might take a different tack.  Perhaps he'll remind her not to make decisions late at night.  It's always worse at night.  Perhaps he might rub her shoulders, bring her a drink, tell her how wonderfully she's doing, arrange to call an IBCLC in the morning.  Don't be fooled by those with celebrity endorsements, get the real thing, not an imposter.  He will support her wish to breastfeed and, using the knowledge he's gleaned antenatally, may be the reason she breastfeeds for one more day.

I confess to finding it strange that often men are excluded from the breastfeeding portion of antenatal classes, perhaps that has changed and the exclusion is less common than I think.  Mum's partner is her chief Gatekeeper, or the harbinger of doom.  A good partner will know when to encourage and when to gently steer Grandma, Mother In Law, Sister, Friend, Father of "recent baby who has done this all before so listen to me" away from her and encourage her to find her way with feeding.  If he has been present at the breastfeeding sessions he will know the importance of stimulating the milk supply and the intensity of those first few weeks.  He won't be so quick to rush to the shop.

Too many times I've heard people say "but it's not fair on Dad for Mum to be the only one to feed the baby".  Really?  It's not fair?  Has Dad become redundant suddenly?  There are so many things that Dad can do to encourage and increase his bond with the baby.  All those nappy changes, baths, massages etc encourage skin to skin time and allow Dad to know his baby.  I know that they just want to be supportive, but sometimes that is counterproductive.  

It's all about the knowledge really.  Dad needs more than glancing knowledge at how it all works.  Sadly we don't live in a society where breastfeeding is the cultural norm.  We are beginning to see more and more women breastfeeding and it's so lovely when men look on appreciating the art of breastfeeding rather than ogling the breasts.  As the Fathers learn about breastfeeding, so will the sons.  As they support their partners through pregnancy, birth and the postnatal period we'll see breastfeeding return to its rightful place.  Bogstandard and normal.

Wednesday, 2 March 2011

Happy World IBCLC Day!


Happy World IBCLC Day!

What on earth is an IBCLC?  An IBCLC is an Internationally Board Certified Lactation Consultant.  

An IBCLC is the person you want should you find any bumps in your breastfeeding road.  This is also the person you might want to speak to antenatally if you've heard how hard breastfeeding is going to be.  Maybe you've found out that you're having multiples and you want to speak to someone who knows about feeding multiples or any one of her colleagues.  You can find IBCLCs across the world.

I was talking to a Postnatal client today.  She's from Norway and has beautiful twin daughters.  She told me that in Norway breastfeeding is the cultural norm and therefore it wasn't until she came to England that she realised people had issues with breastfeeding.  What a wonderful way to live, assuming that breastfeeding just happens and problems are rare.  Much preferable to our society's determination to make it seem more difficult than it ought to be.  Don't get me wrong, I know that there are reasons why some women can't breastfeed.  This I fully accept.  I work with these women.  I've seen the baby that wouldn't suckle and nurse for 12 weeks, the allergic twin, the "nope, I don't get it...wait (2.5 weeks on)... I get it now" baby.  I've seen mastitis, engorgement, low supply, over supply and breast abscesses (I won't link that one.  If you don't have it, don't google it.  NOT pretty!)

In an ideal world there would be no need for a Doula nor a Lactation Consultant (International or not).  However, this world is not ideal and therefore I am able to have a career that I love and adore.  In July I will sit the 6 hour IBCLC exam and if I've done enough work, revision etc and not gone into meltdown on the day, I will join the honoured ranks of the IBCLC.

For now though lift a glass with me and give thanks for that person that helps smooth the bumps in the road.