Love On Top: Celebrating Black Breastfeeding Week

Many women may ask, "Why do we need a Black Breastfeeding Week?  Isn't it enough to be celebrating Breastfeeding Month in August?"  The simple answer is, no.  It is not enough.

Women of Color face unique challenges and hardships when it comes to breastfeeding.  The cultural barriers alone make the initiation and continuation of breastfeeding for Black mothers much more difficult than for White or Hispanic mothers.  Some of the barriers specific to the Black community are:

• There are fewer lactation professionals that serve areas with higher populations of Black mothers
• There are significantly fewer lactation professionals that are Women of Color vs. White or Hispanic
• Since fewer women of the previous generation breastfed, it is harder to have the much needed familial support to initiate and continue breastfeeding
• There are fewer breastfeeding role models within the Black community
• In some communities, breastfeeding is viewed as a "White thing", leading to ridicule of Black mothers who do breastfeed
• There are still deep-rooted cultural barriers stemming from the days of slavery where Black women were forced to wet-nurse White babies 

So why does it matter if women of color are breastfeeding or not?  Simply put, breastfeeding saves lives.  

In a study published by the CDC, it was found that Black mothers were 17.2% LESS LIKELY to initiate breastfeeding than White mothers.  Those that did, were 8.5% less likely to still be breastfeeding at 6 months postpartum and 13.7% less likely at 12 months postpartum.

Black babies who were breastfeed for less than 6 months are at an increased risk for:

• Necrotizing entercolotis a deadly disease that attacks the intestine of premature infants (3.3 times more likely)
• Child death (2.2 times more likely)
• SIDS (1.9 times more likely)
• Ear infection (1.7 times more likely)
• G.I. infection (1.3 times more likely)

Black mothers who breastfeed for less than 6 months are at a 1.4 times more likely to develop Type 2 Diabetes during their lifetime, and had higher risks for developing chronic high blood pressure.

How can White and Hispanic mothers help support Women of Color during Black Breastfeeding Week?

LISTEN TO THEIR BREASTFEEDING STORY. Empathize with their struggles, provide encouragement and support, and celebrate in their victories!

How To Set Yourself Up For Breastfeeding Success:

Ask that hospital staff allow you and your baby immediate skin-to-skin for at least an hour after delivering.  

Follow you baby’s hunger cues - rooting, smacking lips, sucking on hands/fists - and allow them to nurse on-demand vs on the clock.

Ask to have the hospital’s Lactation Consultant evaluate your baby’s latch before you are discharged, even if you are not having any issues.  If you are struggling to get your baby to latch properly, ask that the LC on staff be called immediately to come assist you.

Consider hiring a doula for your birth - mothers who have doulas in attendance of their births have much higher rates of successfully initiating breastfeeding immediately postpartum, as well as higher rates of continued breastfeeding success 6 months postpartum.  

Have good postpartum support in place before delivering.  Mothers who have good support when they are released to go home with their babies have higher breastfeeding success rates.

Become involved in your local Mom or breastfeeding groups, like Le Leche League.  

Breastfeeding can be challenging for some women, it is ok if you do not enjoy your nursing experience at first.  Find someone who you can talk with openly about how you feel about breastfeeding and the challenges of being a new mother (like a Le Leche League Leader, a breastfeeding professional, or a postpartum doula).  

Normal Stool and Urine Patterns For Breastfed Babies

Stool

Day 1:  Meconium, black/tarry (1)

Day 2: Black/green (2)

Day 3: Green, more frequent, looser, smaller quantity, lighter colored (3-4)

Day4: Brownish green to mustard-yellow, loose small-curd (4-5)

Day 5: Mustard-yellow, loose small-curd (3 or more)

Urine

Days 1-3: Few wet diapers, increasing daily

Days 4-5: Heavy, wet diapers (4-5)

Day 6: Heavy, wet diapers daily (6)

When to look for help:

• If your baby is very sleepy and regularly feeds less than 8 times in 24 hours and does not provide enough wet or soiled diapers daily.
• If you baby is very fussy after feedings. 
• If your baby is not gaining the appropriate amount of weight (4 -7 ounces weekly) or experiences a large drop in weight.
• If your baby regularly takes an hour or longer each feeding.
• If your baby has no consistent swallowing rhythm.  
• If your baby is inconsistent at the breast/latching or suckles less than five minutes per breast.
• If you experience extreme engorgement.  
• If your baby was premature, has a birth defect (eg. cleft palate), was ill, or had a difficult birth.
• If your baby has jaundice.  
• If you had multiples.  
• If your baby is showing signs of nipple confusion (will accept a bottle or a pacifier but refuses the breast).  
• If you experience cracked or bleeding nipples, or extreme pain when nursing lasting beyond one week.  
• If you have inverted or flat nipples.  
• If you experience flu-like symptoms, have a fever, or have painful, bright-red, engorged breasts which may or may not have hard lumps or knots in them.

Resources

Recommended Reading

The Nursing Mother’s Companion, by Kathleen Huggins

Dr. Jack Newman’s Guide To Breastfeeding, by Jack Newman & Teresa Pitman

The Womanly Art Of Breastfeeding, by Diane Wessinger, Diana West, & Teresa Pitman

Online Resources

Breastfeeding

Kellymom.com

Ibconline.ca

LLLusa.org

Milkymamas.org

Exclusivepumping.com

Toxnet.nlm.nih.gov/newtoxnet/lactmed.htm (National database of drugs and their impact on breastfeeding mothers and their infants)

Finding a Doula

Beltanebirthservices.com (I offer birth and postpartum services to the women and families of Hampton Roads, Isle of Wight County and Surry in Southeastern Virginia)

Peninsuladoulas.com (Hampton Roads area of Southern Virginia)

Dona.org

Doulamatch.net

Birth Plans 101

K.I.S.S.

The K.I.S.S. method is always the way to go when formulating your birth plan.  Keeping things clear and simple helps your providers work with you in the delivery room.  Complicated or convoluted birth plans generally end up in the trash bin.  Nurses, doctors, and even midwives begin to dread - and ignore - mothers who show up with a lengthy list of requests (or ones that are simply not achievable in the birth space).  While it is a good idea to write out an extended version of your ideal birth to help you narrow down what is most important for your delivery, it is not advisable to hand this draft out to staff on the day you actually deliver.  Being realistic about your expectations in the delivery room as well as sticking to the basic points will help ensure your providers actually take the time to read, and honor, your birth plan.  

Do Your Homework

The key to being able to advocate for your ideal birth (and stick to the most important aspects of your birth plan) is to do your research.  Being informed about the risks and the benefits of possible interventions during your birth allows you to feel confident in advocating for yourself when a provider may offer - or worse, insist - upon something you aren't comfortable with.  It is also worth looking into taking a real childbirth education course, even if this is your 2nd (or your 12th) baby.  By real, I mean a class that is not offered by the hospital you are delivering at.  Look into childbirth educators in your area who offer private or group classes.  This type of class really explains all of your options during hospital births, the nitty gritty of the natural birth process, and almost always provides hands-on practice for labor positions and physical comfort measures.  Think you won't need those comfort measures because you plan on getting your epidural the instant you walk in the Labor & Delivery Ward?  Think again.  Most providers and hospital policies require that the mother be a minimum of 4 to 5cm dilated before getting the drugs, so you are looking at several hours of labor before finding relief through modern medicine.

CLIFF Notes

In a hospital setting staff rarely has the time to sit down and read over a lengthy birth plan.  Most providers and nurses are serving several laboring mothers at once and handing them a three page birth plan is likely to have them glance at page one, set it down, and forget about it.  As mentioned before, I encourage mothers to write out an extended version of their ideal birth for the purposes of getting all of your thoughts down on paper.  Once this has been written, make two or three copies; one to keep for your records, one to hand to your birth partner, and one for your doula.  Now it is time to "trim the fat" and focus on the three to four most important things for each stage of your labor.  Once you have narrowed it down to three things for each stage (active labor, delivery, immediate postpartum/newborn care), list them in order of importance to you.  This is the birth plan you should hand to every nurse and provider that walks into your room.

A Picture Is Worth A Thousand Words

Consider using a pictographic birth plan instead of a written one.  Using icons instead of a list (or a novel) will help keep your birth plan clear and easy to follow.  This also allows you to tape a copy to the door or even around the room for quick reference.  It is easier for a provider to "forget" a list of wishes they read a few hours ago than it is for them to ignore a clear visual aid posted in plain sight.  Additionally, this allows your partner or doula to "gently remind" staff by asking them to refer to your birth plan if you become unable to give a verbal response.   

Example Birth Plans:

Extended Version*

Hello and allow me to introduce myself.  My name is Sally and my husband is Ron.  We are expecting our first child, Regina, and are very excited to meet her!  It is really important to me to have as natural a birth as possible.  Ideally I would labor and deliver on the beach, as I feel very connected to the ocean.  I plan on taking a long walk on the beach when my labor starts and having Ron at my side as we talk about our love for one another and our excitement at meeting Regina.  When my contractions become closer together and harder to manage on my own, I will call my doula, Terri, and ask her to meet me at the hospital.  I want to refuse all vaginal exams at check in and ask that the staff trust me to know when I am in active labor and ready for admittance into the Labor and Delivery Ward.   Once in the room, I want all of the lights dimmed and to have ocean sounds playing on my portable speaker.  I want minimal talking in the room and request that the staff keep their voices down.  I would like the option of using a diffuser in my room and aromatherapy.  I want the ability to labor in whatever position my body tells me to be in, including on all fours on the floor or in the shower/tub.  I do not want to me on the monitors continuously.  I will work with my body to manage my labor without the use of pain medication, while Ron and Terri help guide me and keep me focused.  I do not want to be offered any pain medication at all, no matter what I say or how I am sounding.  My bag of waters will be left intact until they break on their own, either during active labor or delivery.  When it is time to deliver, I want the ability to push in any position I desire without prompting from staff and I want to deliver squatting or standing up.  I would like Ron to catch Regina and place her on my chest.  I want her cord to stop pulsing and to become limp and white before the doctor clamps it.  Ron is to cut the cord.  My placenta will be allowed to deliver naturally with no traction on the cord and no pitocin administered.  Meanwhile, Regina will be left on my chest and we will try to initiate breastfeeding while the nurse preforms all necessary screenings.   Regina will be left with me skin-to-skin until I am ready to hand her over to be weighed.  I do not want her bathed until she is 24hrs old.  I do not want her to receive the eye ointment or the vitamin K shot until she has successfully latched and nursed.  Thank you for honoring our wishes!  We appreciate you taking the time to read this and are looking forward to working with you!

*While this is a great reference for you and your partner, I do not recommend handing an extended version like this to your nurse(s) or care provider.  Some of "Sally's" wishes may seem outlandish or impossible for a hospital delivery - that's OK.  When writing this version out, write about what is a truly ideal birth for you without concern about what is/is not feasible wherever you plan to deliver.  

Simple Birth Plan 

Mothers Name: Sally
Father's Name: Ron
Baby Girl's Name: Regina
Doula's Name: Terri

Sally's Birth Plan

Thank you for helping us welcome our daughter, Regina, into the world today!  Here are the things that are most important to me for my birth experience.  I appreciate you taking the time to read this and in honoring my wishes today.  

Labor:

• Limit vaginal exams 

• Intermittent fetal monitoring or wireless monitoring so I may labor freely

• Allowed to labor freely, to include in the shower or the birth tub (if available)

Delivery:

• Allowed to push with my body's natural urges

• Allowed to push in any position 

• Allowed to deliver in a squat

Immediate Postpartum:

• Immediate skin-to-skin

• Delayed cord clamping - please allow Ron to cut the cord!

• Do not use cord-traction to speed delivery of placenta

Newborn Care:

• All screening to be done on my chest

• Allowed to initiate breastfeeding naturally

• Delayed bath, eye ointment, and vaccines

• Do not give formula

Sample Pictographic/Visual Birth Plan:

This image was developed by Mama Natural (mamanatural.com).  The following link will take you to their website, where you can develop a visual birth plan similar to this one.  https://www.mamanatural.com/visual-birth-plan/.  I am not affiliated with Mama Natural and do not receive any incentives for "clicks" or services. 

Preparing For Postpartum: Not Your Typical Baby Registry

We all know the scene; a room full of women - some young, some old - gathered in celebration over the new life that is growing in the mother-to-be's bulging belly.  There are normally soft pastel decorations, and cake, and lots of talk of babies and labor and pregnancy.  With slight variations in decor and guest lists, this is what you'd expect to see at a typical baby shower anywhere in the country.

One of the exciting things about expecting your first baby is being turned loose in the baby store with your scanner gun.  Armed and ready, you and your partner will troll the isles ready to add ALL things baby to your registry.  This way, you can be prepared for when your baby arrives.  The question is, however, how beneficial is it really to be gifted 6lbs of burp cloths and 1,000 newborn onesies?

The postpartum period is often the most overlooked hardship new parents face.  The excitement of the impending birth is over.  Friends and relatives have "showered" you with all the odds and ends of baby supplies, leaving you with heaps of clothes and diapers and gear to wash and sort through.  Your family has come to see the new baby and have since left.  Now, you and your partner are left alone to work out how to care for this new, tiny, perfect ... screaming being on your own.

So how can you best prepare for this time in your lives where you will need the most support, and yet where the majority of new parents are found most lacking in it?  The solution is simple; change up your registry.  Instead of asking for outfits and teethers, have guests sign up for postpartum help like vacuuming or laundry days.  Request a simple meal that can be easily frozen and then re-heated in lieu of a cute card.  Register for a birth and/or postpartum doula and ask guests to consider donating the amount they would have spent on a baby gift towards their fee(s).  Instead of games, set up a meal-prep station where guests can help you fill ziplock bags full of healthy meals and snacks that you can fill your freezer with.

The purpose of a Baby Shower is to "shower" the expecting mother with love and support and to help prepare the parents for their new addition.  What better way to do that than to ensure the mother is supported just as much after  her new baby comes home as when she is expecting?

Postpartum Registry/Game Suggestions:

Baby Snuggle Coupons

Need It:
Construction Paper
Scissors
Sharpie
Clothes Line/KitchenTwine
Clothes Pins

Make It:

Using brightly colored construction or card paper, cut out rectangles about the size and shape of a dollar bill.  On one side on the 'coupon' write, "Good For One Baby Cuddle!".  On the other, write a simple task the person 'redeeming' the coupon needs to complete before getting to hold the baby.  (Examples: vacuuming, let Mommy take a shower, do the dishes etc.)  Hang the coupons on the clothes line using the pins and let guests pick and choose how they would like to "use" their coupon!

Meals In Lieu Of Cards

When sending out the invitations, ask guests to consider bringing a simple meal that is easily frozen/reheated instead of a card.  Be sure to provide important nutritional details, if needed (like dairy-free or vegetarian) and to have a list of quick and easy recipes available for guests who ask for suggestions!

Postpartum Sign-Up Sheet

Need It:
Poster-board or Large Sheet of Construction Paper
Ruler
Marker

Make It:
Using a ruler, mark evenly-spaced horizontal lines across your paper.  Number them.  Let guests know that there is a Sign-Up sheet hanging up for those willing to volunteer to help with household tasks once the baby is home.  Provide a list of suggestions either on the sign-up sheet or on a separate paper. (Examples: make a meal, let Mommy take a nap, scrub bottles, do a grocery run etc.)

Register For A Postpartum Doula

Instead of registering at a baby store, register with a doula!  Provide the doula's name/business name and ask her if she would be willing to create "Gift Cards" for your guests if they contact her directly.  If she would prefer you handle all of the details, ask guests to consider gifting the amount they would have spent on a baby item towards the cost of your doula services.  You can provide a link on your invitations to your favorite online article explaining all of the benefits of having a postpartum doula (or tell your guests directly if they ask).  

Meal Prep Assembly Line

Need It:
Gallon-Sized Freezer Ziploc Bags
All The Ingredients For Several Big Recipes
Mixing Bowls/Kitchen Tools

Make It:
Instead of your typical baby shower games, make a meal prep train!  Find one or two simple recipes that can be thrown in a ziploc bag and put directly into the freezer, then thawed or thrown right into the oven when you're ready to cook them.  Plan on purchasing enough ingredients to double or triple each recipe.  Print out several copies of the recipe(s) in a large, legible type.  Set up prep stations where guests can perform one or two steps of the recipe with ingredients, tools, and a copy of the recipe with the step they are to complete highlighted.  (Example: Station 1 the guest chops all of the veggies, Station 2 the guest measures out all the spices/liquids, etc.)*.  Have one guest in charge of labeling the ziploc bags and ensuring all the appropriate ingredients get into each one.  You if you doubled or tripled your recipes, you could have up to 8 meals ready to freeze by the end of the party!
*NOTE: For really simple recipes, you could devote one prep station per meal and then just let guests take turns at each station.  

For Cloth Diaper Moms

- Instead of a game, set up a few stations where guests can stuff and fold your cloth diapers and other baby clothes/blankets.
- Register for a diaper services.  Ask guests to consider gifting one month of diaper services in lieu of a baby item  

The Crash Course Guide On Doulas For Expecting Fathers

What is it that the doula do?

Simply put a birth doula is professional labor coach.  A doula attends the mother during her labor and delivery, offering emotional and physical support.  She has specialized training and experience with the entire labor and delivery process (natural and medicalized), and is devoted to serving new mothers and their families to achieve the birth experience they desire.  

We promise we will NOT replace you.

Your doula is not interested in replacing you in the delivery room.  Your partner is going to need reassurance, comfort, and love from you to make it through her labor and delivery and the doula's job is to step aside and help you do what you do best; being there for her when she needs you.  Your doula will be your guide, and like a good jock strap she is going to provide you with enough support to get you through this!  She may take the lead for a bit now and again when she sees you need a break or are unsure what to do, but a large part of her role is to show you what to do and how to do it so that your partner remembers how amazing you  were in helping her have an incredible birth.  

We're like the "Phone A Friend" option, only better.

We all know you have been there for your partner the past nine months, helping her rub coco butter on her swelling belly and massaging her aching feet.  We know you went with her and cringed through watching that infamous video; the grainy one that has emotionally scarred so many men in childbirth ed classes across the nation.  You've also likely read every book on pregnancy and childbirth and babies that your wife handed to you over the past year in preparation for this very moment, so when those first contractions hit and you instantly forget everything we promise we will not judge you.  Your doula is going to be right there by your side gently reminding you about how to time contractions, what it means when a care provider murmurs your wife is "at 0 station and 60% effaced", that it is in fact normal for an incredible amount of fluid to gush out when the sac finally ruptures, and will calmly guide you over to help "hold a leg" when the moment of truth arrives.  

Here's your hall pass.

The one thing expecting fathers tend to appreciate most about their doula is the fact that they can take breaks during their partner's labor.  Having a doula allows you to be able to go to the bathroom, take a quick nap, go grab a bite to eat, or simply take a break from the excitement in those long hours leading up to delivery.  A doula also offers peace of mind to those who like to have a plan laid out if there is an emergency - fathers can safely and guilt-free leave their partners in the trusted care of their doula while they are able to go with the baby after delivery if an issue arises.  

We'll hold your hand, too. 

It may seem like all the focus is on your partner (because it is), but your doula is aware that you are going through a big life event as well.  Don't be shy about letting her know if you have any concerns about what's going on in the labor and delivery room.  She understands what you're going through and will be happy to help make sure your are getting the same answers and reassurance your partner needs to make informed choices during her labor.  Your doula is also acutely aware that not every guy is going to be able to put on a brave face through all of the more graphic parts of the labor process.  It isn't easy to suddenly see the person you love most in this world go through what can only be described as one of the hardest (but also one of the most incredible) things of her life.  Your doula is there to help reassure you that even though things may look and feel scary, it is all part of the normal birth process.  

We will not burn sage or start a drum circle in the delivery room (unless you ask us to).

While TV and social media have pegged doulas as all being the stereotypical New Age Flakes, most of us are actually pretty "normal" individuals.  Just like everyone else, doulas come from various backgrounds and have differing life-styles and values.  It is true almost all birth workers (individuals who work within the birth community) tend to have a more holistic and natural approach to things but the beauty of a doula is that she sets all of her personal beliefs aside and supports her clients choices and decisions 100%.  Hiring a doula does not mean you suddenly need to start drinking home-made kombucha and listen to Peruvian pan-flutes set to whale song during your morning commute to work, it simply ensures you have someone devoted to making sure your and your partner's wishes are honored as you bring your child into the world. 

The buck stops here. 

Your doula works for you and you only.  She does not answer to your care provider, nor is she an employee at the hospital or birth center who has to adhere to their rules.  Her sole focus is on your partner and you.  This is important as it allows your partner to know without a doubt that your doula is there supporting and honoring her wishes no matter what.  You can trust that your doula will give you honest, open answers regarding care options and will always list the pros and cons of any intervention offered.  She will not become frustrated with your questions and will not judge any decision made.  Your doula has made a commitment to your partner (and to you) that she will honor and respect your preferences, provider suggestions and hospital policies be damned.  

5 Things Your Doula Would Like You To Know

1. Ask us where WE would want to deliver.

Doulas are placed in a unique position in the birth world.  We often get to stand silent witness as different obstetricians, nurses, hospitals, and yes even midwives question (or worse, flat out ignore) a mother's choices in the delivery room.  We have seen it all, from beautifully supported births down to horror stories where the mother's consent is violated repeatedly.  Doulas have to be careful about how and what they say in regard to hospital and care-giver practices when speaking with their clients, however if your doula says she will not attend births with a specific provider or at a specific location there is probably good reason for that.  The same goes if she tells you that she would deliver her own baby with a specific provider or hospital/birth center.  

2. Pictures, or it didn't happen.  (Does your doula really want to see your mucous plug?)

We all know how excited you are for something to indicate you're approaching the start of labor.  It's been a long ten (yes, it's actually technically ten) months waiting for that first contraction to hit, marking the moment when you finally  get to meet that precious little bundle.  Trust me when I say your doula is just as excited as you are.  We live and breathe birth and we LOVE it when our clients go into labor!  However, a picture mail in the middle of the night showing what you think may or may not be your mucous plug cradled lovingly in a wad-full of T.P. is not always the best way for us to share in your enthusiasm.  Certainly let your doula know if you think you passed your plug - she may even request a pic! - but consider saving the image for your pregnancy scrap book unless she asks you to send it her way.  

3. There is a doula out there for every individual, and we want you to find the right one for YOU.

Take your time interviewing doulas before making your final decision.  Just as you are a unique woman with specific life style choices and preferences, doulas come from all walks of life as well.  You should feel a kinship with the doula that you choose - a "click".  While it is true that you do not have to even have met your doula before labor for her to positively impact your birth (studies have shown that just having a doula sit in the room with you greatly impacts birth outcomes), for you to get the best experience possible it is worth holding out until you find the perfect doula for you!  As doulas, we want you to have the best birth possible and we know that means that we are not always the perfect fit with potential clients.  We will not be offended if you ask us for referrals so you can interview other doulas in your area!  

4. No, we won't deliver your baby.  No, not even 'accidentally'.  No, really.

Seriously.  This is a big no-no.  The role of your doula is to provide informational, emotional, and physical support for you during your labor and delivery process.  A doula DOES NOT perform any medical tasks and is not properly trained (or prepared) to deal with emergent situations that could potentially occur during a normal birth.  Yes, doulas have a great deal of knowledge and training about the birth process.  And yes, we trust the body's natural ability to have uncomplicated deliveries 99.9% of the time.  However, we do not have the training or skillset to handle medical emergencies.  If your doula tells you she is comfortable delivering your baby for you, please understand that she has over-stepped the bounds of her profession and is no longer acting as a 'doula', but as an unlicensed midwife.  

5. "Student" and "In-Training" doulas have value, too.  

There seems to be a popular thought out there that women can get a "steal of a deal" by hiring a student doula or doula in training for their births.  So what exactly is a student doula?  This is a term often used to describe an uncertified doula who is working towards certifying with a particular organization.  There are many  certifying organizations available for doulas to choose from, all with different requirements for certification and guidelines they expect their doulas to adhere to.  It needs to be mentioned that doulas are not required to be certified.  A doula who is going through her certification process may have attended zero birth prior to starting or may have been attending births for 20+ years and decided it was worth affiliating herself with an organization.  Generally speaking, a student doula has completed her "hands-on" training requirement prior to seeking clients, but that is not always the case.  So, what does this mean in regards to the overall "value" of your doula's services?  Experience, of course, does count and certainly has it's value which is why most doulas who are certified and/or who have attended more births charge more.  However, a student doula also has value.  Consider the fact that your doula, whether she has 700 births or 2 births under her belt, is devoting her time to you for the entire length of your active labor through your immediate postpartum period (up to three hours after you deliver).  For some women, this means upwards of 18hrs total of labor support.  This does not include the time your doula will spend with you prior to labor, being on-call for your delivery (which means they are unable to make any other commitments or solid plans during that time-frame), or the time spent with you during any postpartum appointments.  Regardless of whether a doula is certified or not, she can have a very positive impact on your delivery (as mentioned before, studies have shown the benefits of just having a doula in the room with you). Please keep all of these factors in mind before you start "bargain hunting" for doula services.  Normally the fee your doula charges has been agonized over - doulas do this work from the heart and are not out there trying to rip anyone off - and she is charging what she needs to be able to stay in business.   

Placenta Encapsulation: You're Going To Eat Your What Now?

Natural birth methods and techniques are becoming more and more popular amongst women who are choosing to have hospital deliveries.  As women become more educated and aware of their choices regarding pain management, interventions and delivery, they are also learning more about their postpartum care options as well.  Placentophagia, or the act of consuming one's placenta after delivery, is starting to be less of a fringe activity and more mainstream for mothers who are looking for natural alternatives for hormone, mood and physical recovery in the postpartum period.  

What exactly is placentophagia?

Simply put placentophagia is the act of mammals eating their placentas after the birth of their young.  Almost all species of mammals, with the exception of humans, routinely practice placentophagia.  There are hormones present in the placenta, namely prostaglandin and oxytocin, that may help shrink the uterus down to it's pre-pregnancy size.  This combined with the need to hide anything that may attract predators near a new mother and their young is why most mammals engage in this activity.  Humans have little to no fear of predation while recovering from birth, which is one of the speculated reasons that we no longer have the urge to consume our placentas right after delivery.  

Why would I want to eat my placenta?

While there have been no studies showing the benefits of placentophagia in humans there is an overwhelming amount of anecdotal evidence to be found from women who have ingested their placentas in the form of capsules, tinctures, edibles or even raw.  The most commonly reported benefits of placentophagia are:

• Increased milk production
• Shortened recovery time postpartum
• Decreased postpartum bleeding
• Anxiety and stress relief
• Increased energy
• Decreased Baby Blues symptoms
• Decreased Postpartum Depression symptoms  

How does placenta encapsulation work?

Most women are put off by the thought of even looking at their placenta, let alone blending it in to a postpartum smoothie.  That is where placenta encapsulation comes in.  A professional with special training or experience will come and collect your placenta shortly after you deliver.  They will then transport it to their home or office where they have set up a hygienic space to process and encapsulate placentas.  Alternatively if you have a home birth they may even process it in your own home if you so desire.  After transportation, they will prepare the placenta for dehydration, dehydrate it and then grind it into a fine powder.  The powder is then placed in to capsules which are ready for you to take as needed for postpartum symptom support and relief.  

What are the risks?

The CDC (Centers For Disease Control) and ACOG (American College of Obstetricians and Gynecologists) do not recommend the practice of placentophagia in the form of placenta encapsulation (or any other form, for that matter).   Why is this when there have been few to no studies showing risks to the practice?  

As of now, there are NO REGULATIONS for those who offer placenta encapsulation or processing services.  That means that there are no safety or hygiene standards that they must adhere to when handling your placenta.  This is a problem because the placenta is a blood-rich organ - if health and safety standards are not practiced where placentas from multiple women are processed the risk for blood-borne and food illness increases significantly.  It is vital if you are considering having your placenta encapsulated that the professional you hire practices safety and hygiene protocols to help minimize this risk.  Things to ask the professional who is encapsulating your placenta are:

• Do you thoroughly disinfect all of your bowls, tools, equipment and workspace after each placenta?  *Note: This does not mean using warm water and an antibacterial dish soap!  A proper bleach solution or something similar must be used.  
• How soon after my delivery can you come and retrieve my placenta?  **Note:  Most hospitals require that if you are taking your placenta home, you must have it picked up no more than between 1 and 4 hours after delivery.  Check with your hospital regarding their policies.  
• Where and how do you store placentas for transport and/or placentas waiting to be processed?  ***Note: Like any sort of organ intended for consumption, your placenta must be stored in a cool, dry and clean container or frozen if not used right away.  If the person transporting your placenta is bringing their own cooler, make sure they disinfect the cooler with a bleach solution between each client.  

It is important to note that you should never ingest placenta capsules, tinctures or edibles derived from another woman's placenta.  This greatly increases your and your baby's risk for blood-borne illness.  

Other risks include unwanted side effects.  Again, there are no studies showing adverse side effects from placentophagia.  Anecdotal evidence suggests some women may feel very jittery or have anxious or racing thoughts while taking placenta capsules.  It is recommended if you experience any adverse reactions to stop taking or reduce the amount of capsules you consume in a day.  

If you are interested in placenta encapsulation or have questions regarding the practice of placentophagia, please feel free to contact me at meagan@beltanebirthservices.com!  

Have you encapsulated your placenta?  Or used a tincture?  Made a placenta smoothie?  I'd love to hear your experiences with placentophagia in the comments below!  

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Breast Engorgement

Breast engorgement is a common issue that many women experience while lactating.  Besides being very uncomfortable engorgement can lead to other complications, some of which can be serious.  Here I will explore why breast engorgement happens, what to do about it when it does, and what symptoms may point to a more serious issue that requires professional evaluation.

What is breast engorgement?

Engorgement occurs when there is an overabundance of milk in the breasts.  Most women experience engorgement for the first time within the first few days postpartum when the colostrum, that their breasts have been producing since approximately the fourth month of pregnancy, transitions to mature breastmilk.  Breastmilk production is triggered by delivery, so even women who don't plan to breastfeed may experience some engorgement while suppressing lactation.  Breast engorgement is characterized by the breasts becoming heavy, swollen and very firm or hard.  You may even experience lumpiness in the breast tissue and some redness.  Generally engorgement is quite uncomfortable, and can range from moderate tenderness to extreme pain.

What complications can arise from breast engorgement?

Besides being very uncomfortable, engorgement can lead to clogged ducts.  A clogged duct is a milk duct that has become blocked in some way generally by the swollen tissues surrounding it.  When a milk duct becomes clogged a hard, painful lump will appear on the breast.  Clogged ducts can occur with or without engorgement.  Due to the swelling and inflammation, clogged ducts generally go hand-in-hand with engorgement if the issue is not quickly resolved.

If a clogged duct is not properly released and drained it can soon lead to a very serious infection called mastitis.  Mastitis can cause; fever, chills, a warm or 'hot' spot, redness of the breast tissue, and can be extremely painful.  It is very important if you experience any of these symptoms or suspect an infection that you contact your care provider immediately so you can be assessed and placed on antibiotics that are safe for breastfeeding.  If not treated appropriately, mastitis can turn into a breast abscess that must be surgically drained.

Engorgement also poses nursing challenges.  Due to the swelling and inflammation of the breasts the nipple and areola may change shape or become very hard.  This can make it difficult or impossible for a baby to latch and nurse effectively.  A poor, ineffective latch can cause damage to the nipple, pain when nursing above and beyond what is already being experienced with engorgement, and frustration from the baby as they are not able to get an adequate supply of milk.  A poor latch also means that the baby is unable to express and empty the breast fully during a feeding leading to more engorgement, clogged ducts, and possibly result in diminished milk supply.

How do you resolve breast engorgement?

The best way to resolve engorgement is to empty and soften the breast by nursing, pumping or manually expressing your breastmilk.  Nursing frequently and on-demand can help resolve moderate engorgement fairly quickly.  If the engorgement is moderate or the baby is having trouble latching, manually expressing some milk into a towel or a burp cloth, will help to soften the areola and nipple area.  If you are exclusively pumping, simply try pumping more often.  You should be pumping as frequently as your baby would be nursing, so every two to four hours within the first few weeks of life.

Any clogged ducts need to be broken up and released as well.  If you are nursing, position your baby's chin towards the duct.  This allows them to help unclog the duct by using the suction created during nursing.  While your baby is latched and actively nursing, use the ball of your thumb to massage or rub the lump.  This can be painful but it is important to stick with it and go until the duct is clear.  This should be done while you are pumping or manually expressing your milk as well.

If your engorgement is due to weaning, or because you are suppressing lactation, do not fully empty the breast when manually expressing or pumping.  Milk production is a supply and demand system, so the more you empty your breasts the more milk your body will make.  Just express enough milk to soften the breast tissue a bit and relive the pressure.  If you are weaning and you decided to go cold turkey, it may be beneficial to consider weaning down over a few days vs stopping all together if that is an option.  Just decrease the length and amount of nursings daily and watch for engorgement.

Here are some tips and techniques to try to help soothe engorged breasts and achieve a better latch:

1. Choose The Right Bra

A tight or ill-fitted bra with an underwire may be exacerbating the issue.  Find a comfortable nursing bra that provides support without being too snug, preferably without an underwire.  

2. Cabbage Leaves

Applying cool cabbage leaves over your breasts, held in place by a well-fitted nursing bra, can help reduce the inflammation and redness as well as soothe the ache associated with mild to moderate engorgement.  Because cabbage leaves are also used help dry up milk supply you do not want to wear them all the time.  Leave them on for about 20 minutes 2 times a day until the engorgement begins to go away.    

3. Epsom Salts

Some lactation consultants recommend soaking the breasts in a warm water and epsom salt solution to help provide relief.  You can use a basin, sink or anything deep enough for you to be able to fully submerge your breasts.  Fill with warm water and add one to two handfuls of Epsom Salts.  Do not use salts that have essential oils or fragrances added to them as these can be too strong to expose your newborn to.  Submerge and soak your breasts until the water cools or for five to ten minutes.  If you have cracked or bleeding nipples, apply a thin coat of lanolin over them before submerging the breasts so that it does not sting.  After soaking, rinse breasts with cool, clean water.  You can soak your breasts before each feeding or as often as you wish during the day for up to three days.  Most women feel relief within 24 hours of treating with Epsom Salts.  

4. Manual Expression/Pumping

While you do not want to express or pump your breasts so frequently or fully that you end up increasing your supply unintentionally, expressing enough milk to soften your nipple or your breast tissue will not only relieve some of the discomfort of engorgement but also allow your baby to achieve a better and more efficient latch.  This could also help if you have a very forceful let down that causes your baby to choke, sputter, or unlatch and become fussy at the breast.  Keep a small washcloth, towel or burp cloth handy to express your milk into right before latching your baby if you are manually expressing.  Alternatively, you can use a clean container or bottle to catch and store any expressed milk for later.  This video published by Stanford Medicine with material developed by Jane Morton, M.D. demonstrates an excellent method for hand expressing breastmilk.   

5. Reverse Pressure Softening

If your nipple and areola have become so flat or hard that your baby is unable to latch or is struggling to achieve a good latch, reverse pressure softening can help resolve that issue.  First, wash your hands as you are going to want to nurse immediately following this technique.   With one hand, gently cup the underside of your breast.  Using two fingers on your free hand, apply steady, firm pressure on the areola right by the nipple.  Hold for five to ten seconds and then release.  Repeat in a circular motion around the nipple until the areola is softened.  The following short video created by LittleBearLactation shows how to perform this technique.  

Little Bear Lactation, "Relieving Breast Pressure With Reverse Pressure Softening", YouTube, September 28, 2018, youtube.com/watch?v=NMzR_X13Mc8

If you have tried the techniques listed above but are still experiencing engorgement issues or suspect your baby is not latching correctly due to fussiness or your breasts not being fully expressed during feedings, please contact a lactation consultant to evaluate you.  

How do you resolve engorgement while suppressing lactation?

If you are trying to suppress lactation altogether,  wear a firm, supportive bra or bind your breasts with a wide, soft ace bandage.  Keeping them compressed will help them to produce less milk and will also keep milk production from being stimulated by touch or movement.  Keeping cool cabbage leaves on your breasts may help to relieve your engorgement and can help diminish your supply faster.  Ice or cold gel packs placed in your bra can also provide relief from pain and swelling. You may have to manually express very small amounts of milk, just enough to soften the breast and keep lumps from forming, when in the shower or if your breasts become very swollen, hard or lumpy.  Remember that your milk production is a supply and demand system so if you fully empty your breasts or go beyond expressing just enough to relieve some pressure your body will likely increase its production.  Avoid soaking your breasts in warm water, such as in the tub, or prolonged spray from a hot shower as heat can stimulate milk production.  Keep a close eye on possible clogged ducts or mastitis and tell your care provider right away if you develop a fever, redness or signs of infection.

Breastfeeding Resources:

Kellymom.com provides evidence-based research and information regarding breastfeeding and lactation.

ibconline.ca provides educational videos, guidance, information and support for breastfeeding developed by Dr. Jack Newman, a physician specializing in breastfeeding support and advocacy.

Le Leche League U.S.A. provides information and support for breastfeeding families.  Click on the link for more information or to find a local LLL group near you.

Recommended Reading:

Dr. Jack Newman's Guide To Breastfeeding, Dr. Jack Newman & Teresa Pitman
The Nursing Mother's Companion - 7th Edition, Kathleen Huggins, R.N., M.S.

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Questions about pregnancy, birth or postpartum life?

Interested in hiring a doula?

Please feel free to contact me

meagan@beltanebirthservices.com

or check out my website!

Beltane Birth Services