Meghan Markle has hired a doula, what is that? Part 1

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 1.

There are two main types of doula. A Birth Doula and a Postpartum Doula. There are also Doulas who specialise in supporting families through loss and other niche areas

In this blog we will focus on Birth Doula support. 

A Birth Doula begins work with their client during pregnancy. Supporting them throughout pregnancy, labour and birth. We don’t clock out at 8pm. We are there by our clients side every step of the way. Offering continuity of care throughout pregnancy, labour, birth and postpartum. We then visit our clients at home, offering support with all those early parenting questions.. We offer knowledge, encouragement, information and hands on tips and tricks of the trade. 

Knowledge: We help our clients to understand their chosen place of birth (most commonly a hospital) policies.We compare the different hospitals policies, statistics and what the National Clinical Guidelines say. We also chat about International Guidelines and help our clients to make informed decisions about their care. We also cover the physical process of labour and birth and common things that come up. We can assist our clients to create their birth preferences for their unique journey. After baby arrives we share all the latest evidence on infant care, recovery after birth and anything else you’re wondering about too!

Encouragement: We build up our clients. A huge part of our role is to help our clients (the birthing mother and her partner) to feel confident. We are like their coach or cheerleader from the sidelines, reminding them of all the skills they have gained throughout their pregnancy and the strength they have within. This does not stop once baby arrives. We build you up again after birth and remind you of that strength and knowledge.

Information: Apart from the mentioned topics, doulas also answer any questions that happen to arise with each client. It may be they read an article online and wonder does that happen in Ireland? Or they are told they have a condition (such as gestational diabetes GD) and would like information to help them feel informed and confident on how best to manage it.

Hands on tips and tricks: Doulas are not afraid to get in there and help out. During pregnancy we show our clients different massages, counter pressure and comfort measure to help during labour. We teach these skills to the birth partner so they feel fully involved in the process. On the day of labour often doulas and partners work really well together - tagging in and out (counter pressure can be really tiring after a few hours!) This support continues on into parenting. From showing you how to change and dress a newborn (which is surprisingly tricky at first) to helping you find a comfortable position to feed in - your doula will be right there. 

Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. Partners often say things like “I didn’t know what to do to help my wife” or “I felt like a spare tool in a scary unknown setting” but with a Doula supporting them - they have a full tool kit to draw from. They also get encouragement and a helping hand along the way. After they become a Dad/Mam we are still there. Helping them to adjust to their new role and offering guidance on how best to support you.

With DoulaCare Ireland you have a full team of support. Each client is matched with two doulas. You have your primary doula and your back up doula. You have the opportunity to meet both. Both doulas will know your birth preferences and wishes. This means that if for any reason your doula needs to take a break (such as a long birth, where your doula may need to grab some sleep), you have the option of your back up doula joining you so you are never alone! Our co-owners Jen and Mary are always on hand too. We offer phone and email support to our clients and our doulas so no question is ever left unanswered.

In next weeks blog we will discuss Postpartum Doula support.

Until then… Doula Jen x

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How do I know my baby is getting enough milk?

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You will be learning together. Breastfeeding is a skill that can be learned, so take that time in the early days to relax and focus on getting to know your new baby. Your job is solely to cuddle and feed him, everyone around you needs to care for you! So snuggle up in bed, snooze, smell the top of his gorgeous head, cuddle, study his adorable face and tiny little finger nails. Savour every moment. Follow your instincts, you are his mam you will know if he is getting enough milk. Granted, you will be flooded with hormones and perhaps haven’t slept for a while so here are some basics to get you off to a great start! 

How does your baby appear? A baby who is getting enough milk will be alert and active during wakeful times. He will appear bright and healthy. He will have a good colour (not too jaundiced or pale) and have moist lips. He will be gradually growing in length and head circumference, your PHN & GP with keep track of this.

How often should my baby feed? A new born tummy is tiny, only the size of a marble. A full feed is 5-7mls (a tea spoon) this gradually increases to the size of a hens egg by one month old, about 80-150mls. Because they can only take in these tiny amounts, they need to feed often. Most new babies feed 10-12 times in 24 hours, some feed more! Follow your baby’s feeding cues. Don’t watch the clock thinking “It has only been an hour, he can’t be hungry again!” Those first few days and weeks are all about learning. Your baby has never breastfed before so he needs to find his rhythm (along with learning to breathe, smell, taste, see and process his new world) Offer encouragement and support as you both learn this new skill together!

How long should feeds last? A feed can last from 5-30 minutes on one side, once you can audibly hear your baby swallowing – he is still extracting milk from that breast. So leave him to work away! Once the rhythm slows to about one swallow every 7 sucks it is a good idea to switch sides. When he is finished that side you can change his nappy, wind him a little (most breastfed babies don’t suffer from much wind) and then offer the second breast. He may not be interested, take a small feed or sometimes feed on that side for 30 minutes again! Trust that your baby knows what he is doing. Relax and enjoy those new baby snuggles. 

What goes in must come out! If your baby is having lots of wet and dirty nappies then there must be milk going in to create it. You are looking for about 5 or 6 wet nappies per day and one dirty per day of life (ie one dirty on day one, two dirty nappies on day two and so on up to day 4) Your baby’s poo should change from the black sticky meconium to a greenish colour and then mustard colour by around day 5. Some breastfed babies have a poo after every feed!

Weight gain. Many new parents can become obsessed with their baby’s weight. Don’t worry too much about it, however it can be a good guide as to how your baby is doing. Weight loss of 5-10% is normal after birth. This can be higher if you had a lot of IV fluids during your labour and birth. You would be looking for your baby to regain his birth weight by about 2-3 weeks old. A rough guide is for your baby to gain about 5-7oz (or 150-220 grams) per week. Remember weight is just one part of the picture, it is not the sole focus. 

Remember breastfeeding can be tender for some in the early days but it should NEVER hurt. If nursing your baby is painful there is something wrong. Remember it is a skill that can be learned together so seek support. Ask your nurse to assist you, reach out to supports around you (listed below) or of course, have a Postpartum Doula by your side!

Doula Jen x

Jen Crawford

Co Owner & Founder of DoulaCare Ireland 

Further reading & helpful resources: 

http://kellymom.com/hot-topics/newborn-nursing/ Tips for the early days breastfeeding your baby. 

http://www.breastfeedinginc.ca/content.php?pagename=vid-reallygood Great video clip from Dr Jack Newman & IBCLC Edith Kernerman page ‘Breastfeeding Inc’. This clip shows what a good latch & drinking looking like. 

https://www.breastfeeding.ie/First-few-weeks/Guidelines-for-mothers/ Great chart with guidelines for first few weeks. 

Breastfeeding Supports:

Association of Lactation Consultants Ireland http://www.alcireland.ie/find-a-consultant/ 

Cuidiu, Irish Childbirth Trust http://www.cuidiu-ict.ie/supports_breastfeeding_counsellors

Le Leche League Ireland https://www.lalecheleagueireland.com/groups/

Friends of Breastfeeding http://www.friendsofbreastfeeding.ie/wp/support-2/

National HSE Breastfeeding support https://www.breastfeeding.ie/ 

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Power Pumping

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Increasing Breast Milk Supply-Power Pumping

If you are exclusively expressing for your baby, for any reason it is important to replicate normal infant growth spurts. Baby’s who feed at the breast will naturally increase their feeds when they are due a developmental leap or growth spurt. However, a pump cannot recognise these millstones, so you will need to mimic your baby. This triggers an increased release of prolactin from the pituitary gland – the ‘make more milk!’ message.

Because breasts work on the principle of supply and demand, using a breast pump is often recommended once your milk has come in (around day 2 or 3 after birth). Before this it is best to use hand expression, as colostrum is made is small quantities and is thicker – thus harder to bring out with the manual pump. Regular pumping delivers to the brain a ‘make more milk!’ message and can be very effective in increasing supply. However despite regular pumping sessions many women do not see results as quickly or as effectively as they had hoped. Enter power pumping!

How do I power pump?

Firstly it is important to set yourself up with the right equipment. Ensure you are using a hospital grade, double breast pump. Most Irish hospitals use the Medela Symphony. Ask a member of staff to check that the flange (bit that goes over your nipple) is the correct fit. The standard size is 24 but many Irish women will need the 27. Get into a comfortable position, with your bottle of water, a snack and items from your baby (like photos, or something that smells of them)

Power pumping is not a replacement for regular breast pumping to increase supply. Instead, power pumping is intended to boost your progress by replacing one regular pumping session with a strategically designed alternative. It works by repeatedly emptying the breast, signalling the body to make more milk, more quickly. This is mimicking a baby’s ‘cluster feeding’, many do this in the evening time.

To power pump, pick one hour each day or night (eg. 8pm every night) and use the following pumping pattern:

Always begin with a good breast massage. Some coconut oil can help to minimise friction.

1. Pump for 20 minutes; then rest 10 minutes, massaging again.

2. Pump for another 10 minutes; rest for 10 minutes, massaging again.

3. Pump again for 10 minutes; finish.

This means you will have 40 minutes of active pumping in a 60 minute period. During the rest phase, massage your breast, look at photographs of your baby, smell an item that has been with your baby and relax.

You can watch a movie or read a book if it helps you to relax, do not focus on the pump and how much milk is coming out. This is not the aim. You are trying to trigger your body to make more milk tomorrow. You are not aiming for increased milk volume today. Try to view it as an hour each evening for you to put your feet up, have a nice treat and cup of tea and maybe watch a TV show. 

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Where do pumping mothers fit in?

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Anyone following my story over the last year knows my gorgeous baby Kayla Rose was born in March with an undiagnosed cleft palate. She has a very severe cleft, missing all of the roof of her mouth, hard and soft palate. This meant separation at birth, a SCBU stay and set me on a new journey of full time pumping. (You can find my blogs and videos on DoulaCare Ireland social media & on our website under Jen's Pregnancy Diary

I am 3 months into my pumping journey now and while I have gotten over my loathing of the pump, I am still struggling to find my “place” in mothering labels. Many a nurse and doctor have been made to feel awkward when they ask how Kaylas feeding is going, as I erupt into a blubbering mess about not being able to breastfeed. Paul has started to put his arm around me when they start running through the questions, in anticipation of the dreaded question.

At all of Kayla's hospital appointments I am asked “breast or bottle fed?” I mean, after my first few emotional break downs I would have thought they’d have it written on her file not to ask me this any more...but alas they break it out each time. I can now calmly say “she is breast milk fed in a bottle” (I tend to follow it up with a “she can’t feed at the breast because of her cleft” like I am making excuses to them or something. Just so they know it’s not that I don’t want to breastfeed, because I really really do.)

“It has me thinking where do pumping mothers fit in? Are we breast feeders or bottle feeders? Or do we occupy a status all on our own in some kind of middle ground? ”

Anyway, I digress. It has me thinking where do pumping mothers fit in? Are we breast feeders or bottle feeders? Or do we occupy a status all on our own in some kind of middle ground? 

I have worked with many mothers who chosen to pump for different reasons and were 100% happy with that choice and thrived on the set up. I am pumping out of necessity (if you haven’t already got that) so perhaps that is why I am writing this blog. To hear others point of view on the topic and open the discussion.

I have always been a breastfeeder. I am proud of that and enjoyed every aspect and the beautiful bond. I now find I am not sure of my identity any more. I almost want to write “containing breast milk” on Kaylas bottles for fear of breastfeeding mothers judging me. This is of course ridiculous as I never once think anything bad of mothers who bottle feed (formula or breast milk) as it is their choice for their baby. It is a totally idiotic thought process and yet a real one for me right now.

One thing I will say is that pumping is a full time job, the washing and sterilising is unreal and you still have to feed baby the milk in the bottle too. It is no joke. I have supported hundreds of pumping mothers over the years and have always admired them for their dedication and hard work but living it has opened my eyes to the incredible emotional journey and physical exhaustion that comes with it. I am so proud of myself (cringe I know) for getting this far and giving Kayla 100% breast milk to date. While it is not the feeding journey I longed for, it is ours - and we are finding our way. My heart still longs to breast feed but I love cuddling her into me and gazing into her eyes while she has her bottle. Feeling her little body tucked into mine and knowing she is getting all the goodness of my milk – that is tailored to her needs. 

So I open up the discussion. Where do us pumping mothers fit in? Remember to be kind to all feeding choices – you never know the journey that family is on or why they chose their feeding method. 

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