Thursday, March 25, 2010
Approximately five weeks ago, Zachary joined our family. He was very accommodating: Contractions intensified after I finished with my nail and hair appointments, stayed steady through a delicious pizza dinner (the last we would ever have as a family of three), and active labor began a few minutes after Hallie went to bed for the night. Zachary was even born just a few minutes after midnight, thus ensuring his parents got a few hours of sleep before Hallie awoke for the day and demanded attention.
Immediately following Zachary's birth, I nursed him for a while and continued to do so throughout the night. By the next morning, a mere 6 hours later, my breasts were sore and my nipples feeling chapped. Ugh. I watched throughout the next day and attempted to analyze the latch and see where we were going wrong. Starting nose to nipple? Check. Wait for wide gape before bringing nipple into mouth? No problem. Upper lip flanged? Yes. Still, as a Certified Lactation Counselor (CLC), I know that most breastfeeding pain is a result of poor latch. Still, no matter what I did, I couldn't get an read on the problem.
By the next day, my nipples were cracked and bleeding. The pain was so intense that I dreaded my son's plaintive cries of hunger. Nursing my daughter had been successful from the start and such a joy, that I was devastated not to feel the same about my son. And worse...I help other women with their latch issues for a living. How could I not solve my own?
I was too embarrassed and proud to ask for help. As the days went by, it was getting worse and worse. I had my husband hold up a mirror while I fed our son in order to attempt to watch the feed from another angle. I still couldn't see the problem (well, I couldn't see much of anything as my husband kept moving the mirror), I tried to videotape a feed, but we ran into the same issue with the camera that we did with the mirror.
Finally, out of desperation and because I *knew* my nursing relationship with my son should be better, I called a colleague to come over and help me out. I showed her how I was nursing Zachary and after less than 30 seconds of my demonstration, she told me that his lower lip was not in the proper position. Of course! The one spot I could not see myself from any angle. We readjusted the latch and I felt immediate relief as Zachary gulped hungrily as the newly increased flow. My colleague and I spent the next hour catching up and she told me how impressed she was that I called since so many CLCs and Doulas end up with nursing issues simply because they were too embarrassed to ask for help.
By the next day, my nipples had healed and I no longer dreaded nursing. In some cases, I looked forward to it since it was a great excuse to sit back on the couch and rest while other people watched Hallie, folded laundry or made dinner. Bliss.
And so, my brand new son was able to teach me an important lesson within the first week of his life: Asking for help - even when you are supposed to be an expert - is perfectly okay. No one thinks less of you and in some cases, they even think more.
Sunday, January 31, 2010
Recently, I went to an event sponsored by folks in the NYC birthing community. There were a variety of experts on topics relating to birth and infants and I was asked to speak on CRP/first Aid Instruction. I love attending these sort of events in any capacity, not just for the ability to outreach to pregnant New Yorkers, but also because these events allow me to meet other doulas, midwives and assorted people involved in a similar line of work to me.
It was with great expectations that I listened as one of the midwives spoke about how to choose a provider, learn about hospital protocols and give a summary of the ins and outs of birth. Toward the end of her talk, however, she said something that hit a wrong chord with me.
“No woman needs a doula during her birth or postpartum experience,” claimed the midwife. “All you need is a trusted friend who is not afraid of infants or birth”
With all due respect, I completely disagree. During the birth of my daughter, my birth doula was the person who assured me that everything was progressing normally. She had witnessed enough births that she was not colored by her own experiences the way a friend may be. She had seen all sorts of birthing scenarios and could confidently and accurately tell me what was happening throughout the process. As a postpartum doula, I am trained to screen for postpartum depression. I have assisted enough women with breastfeeding issues that I can instantly assess and correct most problems without referring to the way I did it. And, I have seen enough newborns at this point that I can confidently tell a parent when everything is normal – and when its not.
In my role as a postpartum doula, I am available to my clients 24 hours a day, 7 days a week. It is not unusual for the phone to ring at 4am with questions ranging from nipple pain during breastfeeding to a how to remove baby poop from white upholstery. Sure, many of these new moms have mothers, sisters and friends who say “call me anytime,” but they aren’t comfortable calling at 4am with what might be a trivial questions and feel bad bothering a friend. But I make it clear that its my job to answer the phone and the moms while the without support need it, the ones with a solid support system are grateful to have it.
Moreover, I have no agenda. I do not care if you vaccinate your child, circumcise your son or refuse to dress your daughter in pink. My job is to create confident and capable parents and help new parents to find their own way. Rarely do my clients know whether or not my daughter is vaccinated, how I feel about my babysitter or if I plan on having a bris for my not-yet born son. The only time I offer an opinion about a new parent’s style is if that parent is doing something dangerous – and even then I try and make my corrections as gentle as possible. “You know, using plastic wrap to protect the sheets could increase the suffocation rates. You may want to try a simple mattress protector instead”
Thankfully, I spoke after the midwife who told the audience that there was no need for doulas and after my talk, I found many people nodding in agreement with me. Seems everyone has a pushy mother-in-law/sister/friend who insists that any form of parenting other than the one they used is incorrect and its nice to have an “expert” to call for back-up when you lack the confidence to do it on your own.
Tuesday, June 2, 2009
“It’s cold, you should put a jacket on that baby”
“Why is that baby dressed so warm in June? Don’t you know babies overheat?”
I got both of these comments within a 10-minute span while shopping yesterday. For the record, it was approximately 75 degrees and my daughter, who was being worn in a sling against my body, was wearing jeans, a light shirt and was barefoot, having lost her shoes and socks somewhere along Broadway. Trust me, had she been uncomfortable with the temperature, she would have let me know. Hallie does not suffer silently.
To the old grannies at Fairway, I am quite capable of politely thanking them for their interest while giving them a glare that keeps them from offering any other “help.” Strangers on the street would never think I am anything but utterly confident as a mother.
While working with a family last week (one of 4 babies born in under a week!) I was doing a home visit while some of the family’s friends stopped by to visit. The mom was having trouble breastfeeding and we were working on latch and helping to maintain a comfortable position for mom and baby when the friend piped up with her own advise.
“Just have your doula give him some formula and hang out with us for a while,” the friend offered.
The new mom hesitated and looked at me. I explained that, because of existing supply issues and problems with the baby’s latch, giving bottles this early could disrupt the ability of the mom to properly feed and was likely ill advised.
“Ugh. You’re not going to be one of those breastmilk is best people, are you?” the friend chided the new mom. “That is so annoying. I was formula fed and turned out fine. Don’t be ridiculous.”
With great reluctance, the mom handed me the baby and went to join her friends.
As a doula, sometimes my job is to keep my mouth shut. I did not want to start an argument between friends and fed the baby. After the friends left, the new mom apologized for her friend. I told her that I supported whatever decisions she made, but felt concerned that she had felt pressured by her friend.
“I don’t know what it is,” the mom explained. “I have no problem telling the hospital staff when I don’t like what they are doing, but friends are harder to deal with.”
I counseled her as to polite ways to handle friends, but as I did so, I flashed back to a dinner party I attended recently. Four couples, all with young children sat around a dinner table on a rare child-free evening talking with the hosts who were expecting a baby this fall. The expectant parents were asking me about cloth vs. disposable diapers. While my family uses cloth diapers, I understand they are not the proper choice from everyone and ran through the pros and cons of both choices. I did tell her, however, that my family loves our cloth diapers and would never go back to disposables.
One of the other woman at the table overhead the conversation and chimed in with her opinion.
“With all due respect, Sara,” she began. With that opening, the other woman began a statement that in no way could have been considered respectful and began to criticize my use of cloth diapers.
“Well,” I countered cautiously, “we are really happy with our choice and if we ever have another baby, we are going to continue to cloth diaper.”
“Oh, don’t listen to Sara.” The other woman turned to the expectant mom. “I mean, she still breastfeeds.”
I sat there in stunned silence. I could have countered with the fact that my baby, like all the other babies of couples at the party, is less than a year old and that the World Health Organization recommends “infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond” and that “the American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months.”
I did none of those things and my eyes welled with tears. I composed myself and the evening continued. As we went home, my husband looked at me and questioned why I did not give the woman at the dinner party the same treatment as I do the strangers at Fairway. And the answer is, I don’t know. It’s easier to politely tell strangers to mind their own business than it is to tell friends for some reason.
So, as I counseled the new mom whose friend complained of her breastfeeding, I realized that while I am able to give advice about how to handle such situations, it’s not something that is easily resolved, even when you are a doula, a mom to a not-quite one-year old and able to yell with woman at Fairway.
Sunday, March 22, 2009
I am a big believer of the benefits of breastfeeding. I really do think that breastmilk provides babies the best possible start in life. In fact, I so support breastfeeding, that I helped create an informal milk bank for women who are unable to produce their own milk, regularly donate my milk to families in need and am working toward becoming a certified lactation consultant.
All that being said, even more than I advocate breastfeeding, I advocate healthy babies and well-rested mothers. Currently, I am working with a family with a 12-day old baby. For the last twelve days, the mother has been actively trying to breastfeed her daughter. But, no matter how often she put her daughter to her breast, her daughter was not gaining weight and the pediatrician (not to mention the parents) were getting worried.
Part of the work of a doula is to assist with basic breastfeeding issues. I watched the mother attempt to feed her baby and saw her wince in pain. We worked together to adjust the baby’s latch and used pillows to support the baby, but no matter what we tried, the mother would cry in pain (literally, her eyes would well with tears) whenever she put the baby to her breast. We adjusted the way the mother held the baby, but that did not offer relief either. The baby’s father admitted that when the baby cried at night, the mother would offer the baby a pacifier rather than deal with the pain of breastfeeding.
The introduction of a pacifier worried me: Newborn babies nurse every 90 minutes or so and skipping night feedings not only affects the mother’s milk supply, it also means the baby was not getting the proper nutrition. Part of the work of a doula is to know when you are in over your head and I referred the family to a Board Certified Lactation Consultant. By the time the mother met with the lactation consultant, mastitis (an infection of the breast) had developed and the mother was in extreme pain.
Normally, one of the remedies for mastitis is to have the baby nurse as long as possible on the infected breast. This does not harm the infant and the flowing milk often relieves the mother’s pain. But in this case, the lactation consultant and I came to the same conclusion – the emotional issues surrounding breastfeeding were too much for this mom to handle. Instead of finding the act of breastfeeding to be a bonding experience, the mom would come up with excuses to avoid having to feed her baby and dreaded even holding her baby for fear that she would need to nurse.
This morning, the lactation consultant recommended that the mother begin to offer her baby formula. This would eliminate the mother’s pain (both physical and emotional) and allow the father to assist with some feedings and give mom a needed break. I was not present when this recommendation was made and the mother called me in a panic after the lactation consultant left. She was consumed with guilt over what she perceived to be a parenting failure.
Some reassurances can be done over the phone and some require face-to-face interaction. Given the mother’s fragile emotional state, I decided to drop by for an hour or so. We spoke to length about the importance of just holding and bonding with the baby and, more importantly, how the baby’s lack of weight gain signified a potentially serious underlying problem that had to be remedied. I told the mother that offering her baby formula did not make her a bad parent and that the healthiest and happiest babies came from parents who were themselves happy and healthy. Tonight, the mom’s mission was to go to bed at 8pm and not wake up until she felt ready. Tonight, Dad would handle all feedings (with a bottle and formula).
I really do hope that the mother gets the rest she needs and realizes that by not breastfeeding she is not causing any kind of lasting harm to her baby. In fact in a situation like this, it may be the best parenting decision she can make because it will be one that will allow her to spend time holding and just getting to know her baby without fear.
And all babies really need to be healthy, smart, happy people is (to steal from Hallie’s Development Movement instructor, Dionne) is good nutrition (in whatever its form) and a loving caretaker. Here’s hoping that the mom understands that for her, formula will help her to offer both of these things.
Tuesday, March 17, 2009
Just yesterday, I had an argument with my daughter during dinner. I had served her chicken and peas and after taking one bite, Hallie announced that she finished. I told her that she was not finished and that she needed to eat more. Again, she informed me that she was finished and promptly clamped her mouth shut. I tried again, alternating between pleading and sternness, but no matter what I said, Hallie just shook her head and repeated that she was finished.
The most amazing this about this entire exchange is that Hallie is only nine months old. The only words I have ever heard her say are “Dada,” “doggie,” and “duck.” But, I have seen her say and express complete thoughts for several months. Starting almost at birth, Justin and I began using American Sign Language when speaking to Hallie. At first, we would sign words like “milk,” and “more,” but as time went on, I got into the habit of signing in real time as I was speaking. And, while Hallie lacks the ability to verbalize the words she wants to use, she can sign them.
To date, I have seen Hallie properly sign the following words: Milk, finished, cereal, no, and tired. The words that she understands are far more extensive: Mommy, Daddy, potty, more, yes, bath, dinner, eat, water, cookie, frustrated, angry, touch, favorite, play, duck, good, work, try, happy, see you later and so many more that I can’t list them.
While in college, American Sign Language (“ASL”) was my minor concentration. But there were so many words that I could not remember (after all, no matter how much ASL I had used as a labor lawyer, words such as doll and pacifier just did not come up very often) so Hallie and I enrolled in a Babyfngers class (check them out on the web at www.mybabyfingers.com) During the classes, ASL was practiced through songs such as “If You’re Happy and You Know It” or “Rubber Ducky.” I learned new words and Hallie had a great time listening to the music and would intently watch a room full of people signing in unison.
There are the detractors who tell me that ASL delays verbal speech, but Hallie babbles non-stop (really, just stop by our apartment at 4am and you are guaranteed to hear her loudly calling for the dogs). There are folks who tell me that ASL eliminates temper tantrums, but that is not true either (note the first paragraph regarding last night’s dinner). But, the thing that teaching ASL to Hallie has done is provide us a wonderful activity to do together (sort of a secret language that is just for us and about 500,000 other people) and allows us to have actual conversations.
It’s just too bad that as soon as she learned to “talk”, she also learned to talk back.
Tuesday, February 10, 2009
Last weekend I attended a DONA (Doulas of North America) workshop in Yonkers, NY. The workshop ran all day Friday, Saturday and Sunday and was approximately 30 minutes from my home. There was nowhere for a babysitter to go with the baby so Justin, my husband, took Friday off from work and spent the weekend as the primary caretaker.
My daughter, Hallie, is currently 8 months old and in all that time, she has never been alone with her father for an entire day. Sure, they go for walks and hang out together but it is always for short periods of time. The one time they spent an entire day together, my husband brought the baby to visit his parents. There was no such safety net this weekend.
I left detailed instructions for Friday. Nap times, general feeding times, music and sign language classes. The day was structured and busy. Hallie was a superstar most of the day. She napped at the appropriate times, ate according to the schedule and was generally very easy-going. Then at 6:45pm, Hallie had a breakdown. She cried, she screamed and she was otherwise inconsolable. When I got home Friday evening, Justin was pacing back and forth in Hallie’s room trying to lull her to sleep in his arms. Scattered around the room were a pacifier (she has never liked them), a bottle of expressed milk, teething toys, a favorite blanket and Sophie the Giraffe. Clearly, Justin had used every tool at his disposal without success. I picked up the baby and she instantly put her head on my chest, her thumb in her mouth and fell asleep.
Anxious to avoid a repeat performance, Justin invited his parents to spend the day with him and the baby on Saturday. Again, the day went by without incident, but around bath time, Hallie began to cry and was inconsolable. At around this time, I happened to call and check in and could hear Hallie crying in the background. The frustration in Justin’s voice came clearly through the phone.
“I did everything you said and she won’t stop crying,” he complained.
“I am not sure what to tell you,” I retorted. “She never does this for me. Generally bath time is the best part of the day.”
Justin hung up the phone and I drove just a little faster in order to get back. When I walked in the apartment, Hallie was wide awake and relaxing in her grandmother’s arms. Justin had taken the dogs for a walk and was not home. He mentioned that he felt defeated because he was unable to calm the baby and had passed her off to his mother and taken a walk to clear his head.
I reassured Justin that knowing when to walk away from a crying baby was as important a skill as being able to calm the baby. When a caretaker gets frustrated about not being able to calm the baby, they often tense and inadvertently make things worse than they were before. He again expressed frustration that my instructions did not work for him.
The next morning was the last day of the workshop and Justin’s parents had left the night before. There was no schedule as there had been on Friday and no support as there had been on Saturday. It would just be Hallie and her Daddy all day. I admit to being a little nervous.
I called several times to check in on Justin and kept getting voice mail. Part of me hoped that they were out enjoying the unseasonable weather and part of me wondered if the crying was drowning out the ringing phone. I finally got in touch around 6:30pm. I heard the unmistakable sound of a baby’s giggle in the background.
“Sorry,” Justin was out of breath when he answered. “We are in the middle of a game of peek-a-boo and I can’t talk right now.”
When I arrived home, the baby was fed, bathed and ready for bed. Both father and daughter was making faces at each other and laughing. They barely glanced at me as I walked in the door.
When I asked Justin about how his day had gone, he excitedly told me about the long walk he had taken with the baby and the dogs, the nap on the bed he had taken with the baby in his arms and the dinner they had shared. What was different? It turns out that not having a schedule or someone else there to tell him how to care for the baby had freed him up to do things his own way. Nap time happened because Justin was snuggling Hallie on the bed and both fell asleep. Dinner for Hallie were just bites of Justin’s delivery from the local diner and she was awake at 7:30 because, “she did not seem sleepy” to him.
When Justin had the flexibility to read the baby’s cues, he really was able to get to know her. She responded by being happy and adjusting to the new routine with ease. It was precisely the same was I developed the original schedule: I wrote down what had organically developed for me.
This weekend was a good reminder that it is okay to parent differently. Schedules and routines are fine as long as they work. Don’t be afraid to try new things or mix it up once in a while. And, if you are having fun, the rewards can be endless. In Justin’s case, Hallie rewarded him on Sunday with her first word.
I picked up Hallie and asked her if she had a nice day. She just pointed at Justin, grinned and said, “Dada.”
Monday, January 12, 2009
As a doula, I have found that sometimes it takes a while for someone to tell you what is really bothering them - they may not even know themselves - and just listening is all you can do. In this particular case, I listened to Kelly for over an hour. She kept repeating how she knew childbirth should be a joyous event, but she was anxious. Finally, she confessed that she wished she had never gotten pregnant because the thought of losing Jack broke her heart.
Aha! I grasped at that last statement. Was Jack a friend who did not like children? Was he someone who had helped her throughout pregnancy and was now leaving her life? No. Jack was her beloved Rottweiler and companion for eight years. As Kelly explained it, she had adopted Jack from a local shelter when he was a puppy and they had been together ever since. Kelly had been with Jack for longer than she had been with her husband and was now terrified that the presence of children in the home meant that there was no place for Jack.
In the three weeks since the twins had been born, Jack had suddenly developed all sorts of undesirable behaviors. He had become destructive when left alone and even growled when Kelly or her husband held one of the babies in front of his face. The turning point really came however, when Jack snapped at one of the twins earlier that morning. Now Kelly's husband was insisting that the dog find a new home before one of the babies was injured.
I came over at 10am the next day to see if I could help. It was clear from the moment I walked in that Jack was feeling neglected and resentful. Like any new parents, Kelly and her husband had their hands full with their new babies and little time for anything else. When I inquired as to when Jack had last been walked, both Kelly and her husband looked sheepish. His normal walk was 7am, but on this particular morning, there had not yet been time to go out.
Kelly then showed me what had happened just before Jack had snapped at one of the twins. She had been holding one of the babies, trying to get the dog used to the scent. The dog has walked away during this exercise and gone into his crate. Kelly followed and tried again. The dog tried to leave the crate and Kelly crouched in front of the entrance, mistaking the dog's desire to leave as curiosity. As she stood up, she readjusted the baby in her arms so that the baby's face was right over the dog's head. The dog interpreted this as a threatening act and it was then that the dog snapped (but did not bite).
I began to understand the problem. First, Jack's needs were being pushed aside for the new babies. If the twins had a human older sibling who needed to be fed and helped to the potty, Kelly and her husband would have to accommodate those needs. It is no different with a dog. Jack's 7am walk could not be consistently forgotten and his lack of exercise was likely making him act poorly. (After all, an exhausted dog is too tired to destroy the house when left alone). I recommended a dog walking service in the area who could help take over the walks while Kelly and her husband developed a new routine.
More importantly, Kelly and her husband did not understand some of the basics of canine behavior. Jack's crate was his safe space. When presented with a situation that made him uncomfortable (a newborn baby being pressed against him), Jack had responded the only way that made sense. He had gone into his crate. This is the doggie equivalent of going into a room and shutting the door. And yet, Kelly had followed him and taken away Jack's one refuge in the apartment. Then, when Jack tried to find a new space to rest, Kelly had (in Jack's mind) blocked his exit and trapped him. Jack felt frightened and cornered and had snapped in a fear reaction.
I spent the rest of my visit helping Kelly and her husband learn safe ways to introduce the twins to Jack and providing them with local resources for dog owners and parents of multiples. I watched the twins for a bit so that Kelly could take Jack for a walk and some one-on-one time and her husband could nap. And I left them with tips on how to correct and prevent problem behavior in Jack. We scheduled my follow-up visit for a couple of days later.
This evening I called Kelly to check in and see how things were going. I was especially concerned about how Jack had been reacting to the twins. When Kelly answered, she was a completely different person than the woman I originally spoke to on the phone. She and her husband had hired a dog walker and started taking Jack to play at a local Doggie Day Care facility. They had stopped forcing interactions between Jack and the babies and, while Jack did not seem particuarly interested in the babies, he no longer reacted aggressively to them. Kelly's husband had agreed that Jack could remain in the home.
During the call, I asked Kelly what she was doing, as it seemed very quiet on the other end of the phone. "Oh," she replied. "I am snuggling with my baby on the couch."
"Which one?" I asked.
"Jack," she replied, happily.