Mothering a baby who has Down Syndrome

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My name is Gillian Phelan. I was invited by Doulacare Ireland to talk a little bit about my daughter Elliah who was born with Down Syndrome and my experience with all that comes with it, and also what we are doing to help her develop at as normal a rate as possible.

Firstly a little back story... Elliah is my first child, born thanks to IVF (after many failed attempts and surgeries) in October 2018. I had an excellent pregnancy up to 34 weeks when my placenta rather suddenly shut down leading to a real emergency c-section. A movie-worthy dramatic scene. But that’s a story for another time.

NICU baby special care

Baby had to be taken to Special Care because she was small (4lbs), but breathing on her own and otherwise doing pretty well. As soon as I saw her I said to myself that her eyes looked ‘Down Syndromey’... Tests went off and we waited and waited and waited... Every day the consultants were hopeful that the results would be back “tomorrow”, or “ by the end of the week”. There really was a doubt in our minds. Some of our nurses said they didn’t think she had it. Others were less sure. Her eyes were literally the only tell tale - she didn’t have any of the other signs on the checklist. It took 17 days for the diagnosis to come back from Crumlin - 10 minutes up the road from The Coombe where we were. It was confirmed that Elliah has Trisomy 21 - which means that she has a third copy of her 21st chromosome. Nobody knows why it happens, but in 1 out of 800 births it just does.

So we were told what is to be expected of our daughter, and quite honestly, from the get-go it seemed very limited. We were being told not to expect much. That there isn’t much hope that she be independent or have a fulfilling life in the usual sense. Well, I absolutely reject that. Their limitations, not ours. Putting a child in a box labeled ‘limited’ will only encourage them to be just that. This is not acceptable for me. Additional needs or not, each child develops at a different rate, and faces their own individual challenges.

mother and baby who has downs syndrome

Needless to say, once the initial settling in period had passed, we looked into alternative therapies to help ‘wake up’ her senses so to speak. Basically we were interested in anything that would help bridge the gap between herself and other babies of the same age. Our goal will always be that she be as close as possible to doing the things that her peers are doing. Whether that be sitting up unassisted, crawling, walking, talking and all those other key achievements down the line. We are linked up with St Michaels House in Ballymun now and everyone is great. They do a fantastic job, they really do. But relying on that one Physio or Speech therapist visit a month and going one morning a week to the pool just isn’t enough. Physical and mental development go hand in hand, and we have now found a set of daily stimulation exercises that work for us and are giving good results.

We travelled to France to meet with an ex Montessori teacher who has a 5 year old daughter with DS. She has become an alternative consultant on all things DS, and sees families to build a personalised program for their children. Her daughters name is Marie, and she is quite exceptional. Her speech and motor skills are pretty much those of an average child of her age. She is at the same level as all her friends and attending mainstream school without a Special Needs Assistant. Emmanuelle started out with her solid Montessori background and has done extensive research and training to complement that. She saw Elliah over 2 days and gave us a program to follow based on her particular strengths and weaknesses.

We were highly recommended to read Glenn Domans (horribly entitled) book ‘How smart is your baby?’ Domans research stretched over 40 years and he worked with thousands of children and their families - for the most part the babies and children in his studies had brain damage, not DS. Specific exercises and hyper-stimulation techniques are used to override the problem and wake up the affected senses. Now I’m not going to lie, some of this stuff is totally counter intuitive for the mother of a small baby, but his results really do speak for themselves. So after reading the book, and seeing Emmanuelle in France, we had a specially adapted exercise and stimulation plan for our baby.

baby special needs crawling mat

We have built her a crawling ramp to encourage as much movement on her tummy as possible. Children with DS tend to have issues with their muscle tone, so strengthening those all important neck and back muscles is vital.

We also had to ditch the traditional play mat which was not at all adapted to her needs. It has been replaced with a large gym mat - exactly like the ones we used to have in school (the navy blue yokes).

We also have a Dayvia light which is on constantly during her sessions. The very bright light is recommended for sensory stimulation of course, but also for helping with the distinction between day and night. Not to mention luminotherapy in our dark winter months.


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The last ‘big’ thing we invested in after reading the research is an electromagnetic machine called an Earth Pulse. Designed to help athletes and Racehorses recuperate better, it emits a field adapted to the individuals needs so their rest is optimised and thus their performance enhanced. During their testing process they realised that all of the people partaking in the trial who had thyroid issues gradually stopped needing to take their medication. This is a key factor in DS. Our expert in France insists that ALL children with Down Syndrome have an issue with their thyroid. Even if a blood test says it’s functioning, ie producing satisfactory levels of thyroxin, there are no further tests done to check if that thyroxin is doing its job as it should in the cells. It really is one of those things where you believe it or you don’t. We thought that we have nothing to lose and a whole lot to gain. It’s been a few weeks now and Elliah is definitely more alert, more interested in her surroundings, more of a sparkle in her eye. She’s even sitting up in her highchair which is a big milestone and around the same time as an averagely developing baby.

Emmanuelle has been using the machine under Maries bed for a couple of years now and she insists that she started to see a difference in her capacities after a few weeks. Since we seem to have a similar timeline, I’m certainly inclined to agree.

It’s a lot. It’s very time consuming. But seeing Elliah improve every day is all the motivation I need

(I’ll have a shower when she’s 2 🤪) I’m also exclusively pumping which doesn’t help time-wise, but that’s my choice. It’s not a chore though. Elliah is not a burden. We feel as much love, and pride as any other parents. DS comes with the innate capacity to truly be oneself. To find joy in the simplest of things and to love without conditions or judgement. She is funny and sassy and an absolute ray of sunshine. I simply cannot imagine life without her smile.

Hopefully we are putting in place a foundation that will help our daughter be her best self and have more choices in her future. We will at least know that we gave it everything we had.

Well done if you’ve gotten to the end of this post 😂

What we wouldn’t do for our kids.

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So Meghan Markle hired a Doula? What is that? Part 2

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 2.

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 Postpartum Doula support.

In times past (and indeed today in many cultures around the world) parents were not sent home from hospital with a new baby and expected to know what to do and manage on their own. We would have had the support of families, neighbours, friends - minding us, feeding us, helping us adjust to the changes in our lives and allowing the new Mum to rest and recover from birth and support her during the first few weeks of life with a small baby. Today we are often lacking this support and just expected to cope. People do call in to visit but don’t think to bring a cooked meal for the Mum, let her rest, load the dishwasher or ask how she is doing. The focus is often on the baby and the Mum is just expected to get on with it. However, we are not hardwired to manage in this way. We need the support of others in those first few weeks and months and in lieu of support from our community the postpartum doula can step in and offer this support.

A Postpartum Doula begins work with their client as soon as they book in. For some, this is during pregnancy (the forward planners!) and for others this is after baby is born. If it is during pregnancy, your doula will help you to prepare for your new arrival and the huge shift your life will take. If it is after birth, your doula will slot right in to your new routine (even if you don’t think there is any form of routine) As with Birth Doula support, your Postpartum Doula comes with many layers of support. We help you to debrief and process your birth experience. We nurture you while you recover from birth and find your new normal. We help your older children adjust to having a new dynamic in the family. We support your partner, adjusting to their new role and debriefing their own experiences. We offer knowledge, encouragement, information and support every step of the way - as each new day brings new challenges. Above all, we help you to savour the good moments between the chaos :)

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Knowledge: Doulas are information junkies. We love reading, attending study days and growing our knowledge base. In DoulaCare Ireland all our Doulas must attend at least three CPD days per year. - which ensures the building of knowledge as evidence changes and new research is undertaken. We also learn from every interaction, with each individual client. We bring that knowledge base to you when you come home with your new baby. No matter what comes up, with your recovery after birth or your babies needs - chances are we have seen it before (or we know who to call if not).

Encouragement: Anyone who has had a baby, knows that surreal feeling of being left in charge of this new tiny human. Many parents feel “they are not seriously letting me home alone with this baby? I don’t even know how to bath him or tell if he is hungry” Don’t fear. It is normal to feel that way. The truth is no parent has the answers. Babies don’t come out with an instruction manual. We all learn on the job! The great thing is, with your Postpartum Doula by your side - you have a calm presence helping you every step of the way. So nothing feels overwhelming. You and your baby learn together, with a helping hand from your Doula.

Information: To new parents this is invaluable. The number one question we get asked… “Is this normal?” Rest assured, your Doula will have all the latest evidence and research at hand to help you make informed decisions when the fog of parenting clouds your brain. It can be hard to process information when you are recovering from birth and haven’t slept more than an hour in 2 weeks. Your Doula will give you the information you need in bite sized chunks so you can fully process it as required. She would also be delighted to tuck you up in bed, with clean sheets, after a hot shower and home cooked meal - and after a nice nap it is easier to think more clearly and have perspective on the changes in your life!

Hands-on tips and tricks: A Postpartum Doula passes on all the parenting tips and tricks they have picked up through their training and working experience. They help you to simplify your daily life. Sometimes it’s a gentle suggestion on where to keep the changing table, that you hadn’t thought of (like having a second one in that corner downstairs to save you running up and down the stairs 20 times a day) Sometimes it is demonstrating different methods of helping baby to get wind up - which can be a tricky skill to master.

Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. In parenting, it can be helping them to figure out how to put a baby grow on baby (which way is up? Are these the arms? We all know how hard it can be to get a new baby dressed!) It can be explaining the hormonal rollercoaster women ride after giving birth and to expect highs and lows. It can be a listening ear for them to debrief or to gush about their beautiful new son or daughter. Sometimes it is offering gentle suggestions to help them adjust to their new role and see what part they can play in supporting their partner and adjusting to their own new role.

With DoulaCare Ireland you have a full team of support. Each client is matched with the perfect doula for their needs. In the bigger contracts (100+ hours) you will usually have two doulas offering support. You have the opportunity to meet both beforehand. Both doulas will know your parenting style and wishes. This means that if for any reason your doula needs to change your scheduled hours you have the option of your second doula covering 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.

We know from neuroscience that our brains are not hardwired to manage on our own in those first few weeks of adjusting to life with a new baby. All so often when we arrive at a new Mums house, they disclose that they feel they are doing something wrong as they struggle to cope. So few of us talk about how hard it is, that many are left feeling not good enough. The postpartum doula steps in to fill the gap. We are there to build confidence and make those first few weeks a positive memory for years to come - in other words to help a family thrive and not just survive the early days of parenting


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VBAC Mothers are real!



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Hi I am here…a real life, breathing VBAC mum :) 

So many of our DoulaCare Ireland clients do not believe that VBAC’s actually happen in Ireland. Well as a doula I have supported them, as an antenatal educator I have taught parents about them and earlier this year I experienced a VBAC personally.

My beautiful baby daughter Kayla Rose (a bit of a social media celebrity now) arrived in a whirlwind on 25th March 2018. I had an intervention free VBAC, supported by my husband, doula and midwife (an obstetrician was there also but I have very vague memories of her as she was not my focus) 

As Kayla’s birthday starts to draw closer, I have started to write my birth story. I will upload it in two parts (its a long story even though the birth itself was fast) That will give you all a full run through of my VBAC.

Before labour began I was admitted to hospital at 38 weeks for polyhydraminos (too much amniotic fluid) and baby in an unstable lie. Kayla was lying diagonally across my tummy. This meant there was a high risk of cord prolapse if my waters released. So after weighing up all my options, the pros & cons I decided to stay in hospital. (see my pregnancy blogs and our social media posts during March 2018 for videos/updates etc) You can also look back through my weekly pregnancy blogs ;)

There was lots of talk about elective caesarean but I held firm that I would like to try for a VBAC. I was confident in my body’s ability to birth my baby. There was a lot of negotiation and I found being informed about my options really helped in these situations. I knew the benefits and risks and studies that were done around vaginal birth after caesarean and also repeat caesareans. I was never against caesarean. I knew it was one option and if that ended up being the case I was ok with it, once I was listened to. My main priority was always to have a safe birth BUT I also wanted to have a positive experience. I found having doula support a great advantage as I had someone that I could bounce my thoughts and feelings off, who was non-judgemental and impartial and made a great sounding board for me. They supported me as I mourned the birth I wanted (to labour at home before going into hospital), and help prepare me for my change in circumstances. The brain training techniques in the GentleBirth app also helped me keep my focus and stay calm as things changed for me.

During my pregnancy I did all I could to empower myself. I worked on my physical and mental health. Over the 9 months I worked on building a positive mindset. preparing my husband to be my advocate. I armed myself with great support, in the shape of my informed husband and my wonderful Doula. I took time for self care. I had regular reflexology, used aromatherapy, had shiatsu, realigned my pelvis with chiropractic treatments, listened to daily affirmations, GentleBirth tracks and had a vision board. I knew my VBAC wasn’t going to just land in my lap. I had to take ownership and prepare for it.

I stayed really positive and used my time on the antenatal ward to focus my mind and prepare my body. I went into spontaneous labour just as I was going to bed on the 24th of March. I did consent to having the CTG, even though I had originally felt I did not want it (more detail to come in my birth story) However I was clear that I chose my own position and moved with my body.

Kayla Rose entered the world at 4.17am, the night the clocks went forward. So my labour lasted less than 3 hours. She was 8lbs 2oz, at 38+6 gestation. 

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I escaped with only a small 1st degree tear and no abnormal blood loss. 

I did it!




Jen with baby kayla enjoying skin to skin,surrounded by love with (hubby paul taking the photo), midwife jo (rotunda) and doula mim.

Jen with baby kayla enjoying skin to skin,surrounded by love with (hubby paul taking the photo), midwife jo (rotunda) and doula mim.

It was such a high and I was so proud of myself. I haven’t really spoken about that high much. There was complications after, as Kayla was born with an undiagnosed cleft palate and Pierre Robin Sequence but that was not connected to our VBAC. My moment of euphoria only lasted a second before we realised something was wrong with our baby.

So after a bit of my story…. I experienced a VBAC in an Irish maternity hospital. Yes at times during my pregnancy I felt like there was a huge spotlight over my head. Yes I had to negotiate and be firm at times. Yes I had a wobble myself during labour, when I had a burning sensation across my scar but I did it. The evidence says many more woman can safely do it too. 

Preparing for a VBAC can definitely be a rollercoaster and support is crucial. Most people (including health care providers) just assumed I would be having a repeat Caesarean. I knew VBAC was safe, I was aware of the evidence and for me it was the option I hoped for.

There is a lot of misinformation out there about VBAC birth. You will hear care providers tell people that they can have a VBAC but only labour for so many hours as it is dangerous for the scar (not evidence based), or they cannot go over 40 weeks in case the scar ruptures (not evidence based), or because it has only been 2 years since their last baby their scar may be too weak (not evidence based)…you get the picture!!! So in order to have a successful VBAC you do need to prepare yourself. Below I have listed some of my top tips for anyone hoping for a VBAC.


What are my top tips?

Empower yourself with knowledge and the latest evidence.

Educate yourself and your partner so they are also aware and can advocate for you if needed.

Get yourself a Doula!

Take an independent childbirth class - a Cuidiu antenatal class or a GentleBirth workshop, or a VBAC specific workshop (also given by an independent provider).

Try to be under midwifery led care if possible.

Peer support is hugely helpful. The VBAC in Ireland Facebook group is a great support network of Mums who have tried for a VBAC, or are trying (LINK)

Don’t be afraid to ask questions at appointments (bring a notebook if it helps)

Know you have the right to decline any option of care once you understand the benefits and risks (a caesarean, a CTG trace, an induction and so on)

Remember to use BRAIN as a tool when discussing your options (both for you and your baby)

Example:

What are the BENEFITS of a repeat caesarean?

What are the RISKS of a repeat caesarean?

What are the ALTERNATIVES?

What does my gut INSTINCT say? Need more INFORMATION?

What happens if I do NOTHING for now and wait to make a decision?

Remember DoulaCare Ireland are here to support you through your VBAC. Ask us questions, gain information & support but above all, gain the skills to make informed decisions for your individual situation. 

I wish you luck on your journey. Whatever the outcome, what is important is that you have a positive experience - at the centre of that is making informed decisions and feeling supported. 



Doula Jen x



Some Further reading :

http://aimsireland.ie/vaginal-birth-after-caesarean-vbac/

https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/cavanmonaghan/maternity-services/consultant-led-care/maternityvaginalbirth%20aftercaesarean.pdf

https://www.rcm.org.uk/tags/vbac

https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf

https://evidencebasedbirth.com/topfive/

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Expressing Love

A Poem for all Pumping Mothers.

Hmmmm hmmmm goes the pump through the night,

Reminding myself it will all be alright.

The chafing and blisters won't last,

Counting each drop as they fall becomes a thing of the past,

Watching my baby sleep soundly,

The sound of the pump rings out all around me.

Hmmmm hmmmm goes the pump through the night,

Reminding myself it will all be alright.

I'm giving my baby every drop that I can,

Even though things are not quite how I planned.

I'm pouring my love into every single drop,

Telling myself "keep going, don't stop"

Hmmmm hmmmm goes the pump through the night,

Reminding myself it will all be alright,

Skin to skin, and slings,

Are our new bonding things.

As I nourish her tummy,

With my tailor made milk (that's so yummy!)

As drops turn to sprays,

And hours into days,

As mls turn to ounces,

And days into weeks,

The lowest moments fade and we experience more peaks.

Hmmmm hmmmm goes the pump through the night,

Reminding myself it will all be alright,

The grief begins to pass,

As we find our own way.

The pumping becomes part of life

As we grow day by day.

A poem by Jen Crawford. Exclusively pumping for her daughter Kayla who was born with a complete cleft palette and Pierre Robin Sequence.

What's the story with Kaylas Cleft?

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Anyone following my journey over the past year will know Kayla was born with a cleft palate (but not lip) Many people don’t quite understand what that means, and to be honest I struggled a bit at the beginning too! So I thought a blog would help :)

 

There are many different types of clefts and no two are the same. A baby can be born with a cleft lip, a cleft palate or both a cleft lip and cleft palate. Essentially what a cleft is, is a hole or gap in the area. 

The following stats are taken from (http://www.cleft.ie/?page_id=25) The incidence of cleft lip and/or palate in Ireland is between 1 in 700 and 1 in 1,000 births. Incidence of cleft palate occuring alone is about 1 in 2000 births. More than 70% of babies with cleft lip also have cleft palate. 

Parents who have a child born with a cleft, have a 5% chance of the next born also having a cleft (so a 1 in 20 chance). If a second child is born with a cleft, the likelihood increases further for any subsequent child. 

The chances of a parent who was born with a cleft having a cleft baby is approximately 7 in 100. So Kayla will have roughly a 7% chance of having a baby with a cleft (of course if she chooses to be a parent but we would love lots of grandchildren!). 

 

Types of Cleft Lip

  • Forme fruste unilateral cleft lip
    A subtle cleft on one side of the upper lip, which may appear as a small indentation.

  • Incomplete unilateral cleft lip
    A cleft on one side of the upper lip, which does not extend into the nose.

  • Complete unilateral cleft lip
    A cleft on one side of the upper lip, which extends into the nose.

  • Incomplete bilateral cleft lip
    Clefts on both sides of the upper lip, not extending to the nose.

  • Complete bilateral cleft lip
    Clefts on both sides of the upper lip, extending into the nose.

Types of Cleft Palate

  • Incomplete cleft palate
    A cleft in the back of the mouth in the soft palate.

  • Complete cleft palate
    A cleft affecting the hard and soft parts of the palate. The mouth and nose cavities are exposed to each other.

  • Submucous cleft palate
    A cleft involving the hard and/or soft palate, covered by the mucous membrane lining the roof of the mouth. May be difficult to visualize.

Kayla is linked in with the cleft team in Temple Street. They have been amazing. Big shout out to Jane the cleft nurse specialist who takes families under her wing and walks the journey with them. She gives us so much time to ask any questions we may have and checks in regularly to see how Kayla is doing.


 

In Ireland, the cleft teams grade the palate or lip cleft from 0-3. 0 being very mild and 3 the most sever. Kayla has a grade 3 cleft palate. She has a complete cleft palate, but instead of just being a gap or a hole Kayla is missing all of her palate (hard and soft)

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Kayla also has a condition called Pierre Robin sequence (or syndrome) PRS for short. This is a condition in which babies are born with a smaller than normal lower jaw, a tongue that is small and bunched which often falls back in the throat, and difficulty breathing. It is present at birth but not always detected in pregnancy ultrasounds. Most babies with PRS have a U shaped cleft palate like Kayla. Again the team will grade PRS 0-3 and Kayla scored a 0, as luckily she does not have many issues with her airways. Kayla does well once she is on her side or raised. Another positive is that nature gave her a helping hand with a tight posterior and anterior tongue tie to hold her tongue in place, so her tongue does not flop back to block her airways (who would have thought it? A helpful tongue tie!!)


 

Other common issues in babies/children with PRS are problems with their eyes (Stickler Syndrome), problems with their inner ears and dental issues. Kayla will be under different teams for each and so far they have been wonderful.


 

Kayla will have her first surgery to create a soft palate when she is around 9 months. This will hopefully help with her speech development. She will most likely be 3 years old before her palate is completely closed but for now it seems the only long term issue she will have is a speech delay – which she will catch up on by the time she is 10 years or so. So while her first few years of life will be hard, with surgeries and hospital appointments it is something that won’t hold her back and she can put behind her!

 

I hope this blog helps to explain things a little? Please feel free to ask questions :)

Again thank you to everyone for the love and support since Kayla was born xx

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If you or someone you know has a baby with a cleft or PRS these are helpful resources:

Websites:

http://www.cleft.ie/

https://www.clapa.com/

www.cleftlipandpalatebreastfeeding.com

https://www.breastfeeding.ie/Resources/Publications/ The booklet I co created "Breastfeeding and Expressing for your preterm or sick baby" has lots of information on getting off to a good start, maintaining your milk supply, storing milk, skin to skin and more. It is available free to download or order. All Irish maternity units should have copies also. 

The Australian Breastfeeding Association (ABA) has two booklets (both e-booklet -released during 2017 and hard copy)  The cleft breastfeeding booklet: https://goo.gl/ZnoFqc has information about breastfeeding - and expressed breast milk feeding, lactation aids, type of feeding methods including - cup/spoon/supply lines/ bottles/teats. As well as some of the experiences surrounding feeding from families.  The second booklet is all about expressing and storing breastmilk: https://goo.gl/ft7gDp

 

Facebook pages: 

cleft lip & palate association of ireland

Cleft Lip And Palate Association

Cleft Lip and Palate Breastfeeding Support Group

 

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