When parenting isn't all sunshine and joy.
The birth of a child is a major life change! Every part of your life is touched; physical, emotional, spiritual and mental. It is important for women and their support network to understand postpartum mood changes and disorders before they happen so that if a new mother experiences some of the feelings and physical symptoms associated with the various postpartum mood disorders she can be treated promptly, as quick intervention has been proven to reduce the length and severity of the issue.*
No one knows if a new mother will develop a mood disorder. It can happen to anyone and it is important to acknowledge that it is not the mother's fault. Postpartum mood disorders can happen anytime during the postpartum period. The length of a woman's postpartum period depends on many things, including how fast she heals physically, how long she breastfeeds for, how long it takes the baby to sleep through the night, etc. While medical text books tend to consider the first 6 weeks the postpartum period, most mothers would agree that it is a lot longer than that.
There are certain situations that increase a woman's risk of developing a mood disorder, but often women with no “red flags” can be affected.
Mild Mood Disorders:
The most common cause of mild, postpartum mood disorders in women with no previous mental health issues, are hormones* and lack of sleep.
There are 3 times in the postpartum period where mood changes can be caused by fluctuating hormones
The first week when all those pregnancy hormones drop really quickly, and when other hormones increase to produce breast milk
A) Anytime you reduce the number of feeds/day. For example, when baby stops waking at 2 am and you move from 8 feeds/day to 7 feeds/day.
B) When you wean completely. Baby lead weaning reduces hormone fluctuations as weaning is gradual. Weaning quickly, or stopping “cold-turkey” greatly increases a mother's chances of developing a mood disorder.
2-4 weeks before your period returns
How does sleep deprivation cause/worsen mood disorders?
Everything seems worse when you are tired.
Focus and concentration problems (chronic sleep deprivation is linked to ADD/ADHD)
You react quicker and out of proportion to situations
Increased anxiety, feeling overwhelmed
Increased irritability and anger
What can you do to heal yourself?**
Identify what you are feeling
Identify what might be triggering your feelings
Decide what you can do to feel better about the cause of each feeling and make a plan
Follow through with your plan, this may mean enlisting help of someone you trust or reaching out to a therapist
Know when you need medical help and get it sooner rather than later.
Avoid caffeine and sugar! Studies have shown that ingesting caffeine and sugar makes PPMD symptoms worse.*
This printable worksheet is something that I developed** to help myself and clients focus our thoughts and feelings in order to identify the cause of those feelings and actions we can take to feel better. If you find that your symptoms are not going away or are getting worse talk to your doula, doctor or a therapist, all of whom have referrals that may help you. There is a lot of help available don't be afraid to ask for it.
Other tips for healing from postpartum mood challenges can be found in my pathway to healing visual guide. This guide is an adaptation of the Steps to Wellness found in Jane Honikman's book I'm Listening.
Dads, partners and adoptive parents can also struggle with postpartum mood disorders. Don't be afraid to reach out for help and support!
Books and Online Resources
I'm Listening, Honikman
Overcoming Postpartum Depression & Anxiety: Sebastian
This Isn't What I Expected: Kleinman
The Postpartum Husband: Kleinman
Down Came the Rain: Brooke Shields
www.postpartumstress.com – self assessment tools, information
If you struggle or have struggled with any of the following consider taking a proactive approach to postpartum mental health and set your self up for success by creating a support network before baby arrives. That circle of support may include understanding and trusted family and friends, a doula, a public health nurse, counselor, doctor or therapist. Finding support before the birth of your child helps reduce the panic of trying to find someone trusted and available after.
If you are struggling with postpartum mood disorders and have experienced any of the following finding quality supportive help that understands your situation may help you heal and move forward in a positive way.
It is important to recognize the symptoms of postpartum mood disorders so you can identify and seek help quickly should you or your partner experience any of them.
History of Bipolar Disorder in self or family
History of Depression in self or family
History of Postpartum Depression in self or family
History of Anxiety Disorder in self or family
History of PMS
History of eating disorders
History of insomnia or not receiving at least 2 blocks of 3 hours of REM sleep in the postpartum period
Traumatic or disappointing childbirth experience
Unresolved losses (especially reproductive in nature- i.e., miscarriage, infertility, abortion)
History of sexual or physical abuse or neglect
Recent stresses (i.e., an illness in self or family; divorce; a move; a change in jobs; death. change in financial status, etc.)
Perfectionist personality; very task oriented; inflexible
Isolated (lives far from family, few if any friends or peers with children)
Relationship struggles with partner
Relationship struggles with mother
Relationship struggles with the baby (i.e., colicky, high needs, temperament differences, illness/injury, developmental delays)
Source: DONA International Postpartum Doula Workshop Manual 2013
If you find you are suffering from any of the following it is important for your health and that of your whole family that you seek appropriate help. That may be simply talking to a trusted friend, doula or doctor or it may mean finding a therapist that can help you work through your postpartum journey. Postpartum mood disorders happen to more women than report it and there is nothing to be ashamed about. It takes a village to raise a healthy family!
Feelings of despair/hopelessness
Anger and irritability
Sleep disturbances (too much/little)
Loss of energy and interest
Physical symptoms (clumsiness, slowed speech, etc.)
Frightening thoughts about self or baby or other family members
Weight loss or gain
Feelings of guilt, shame, inadequacy
Hypochondria; excessive worries
Mania (part of bipolar disorders)
Feel great/high energy
Decreased need for sleep/insomnia
Mind racing; cannot shut thoughts off
Pressured, fast speech
Muscle tension; chest pain
Shortness of breath; choking sensation
Fear of dying
Fear of going crazy
Fear of being alone; fears of baby's health; agoraphobia
Feeling trapped, immobilizing guilt
Recurring, persistent and disturbing thoughts, ideas or images (scary images of accidents, abuse, harm to baby)
Ritual behaviours done to avoid harming baby (e.g., put away knives) or to create protection for baby (e.g., only wear white, don't ;eave the house) constantly checking the baby, house, etc.
Intrusive thoughts, fears and images
Person cannot control thoughts
Person understands that to act on these thoughts would be wrong
Hyper vigilant (e.g., can't sleep for fear that something will happen to baby; constant “fight or flight” mode)
Post-traumatic Stress Disorder
(usually occurs quickly after birth)
Previous trauma (recent or in the past- abuse, accident, etc.)
Feeling of anxiety when exposed to situations similar to the trauma
Sensations of “being in the trauma” now
Psychosis (very rare)*
Delusions (about baby)
Refusal to eat
Break in reality
Higher risk if bipolar disorder in self or family
Missing moral compass
*Requires immediate treatment often including hospitalization and medication
Source: DONA International Postpartum Doula Workshop Manual 2013
Let's talk about the postpartum belly. Good golly is it a squishy mess! There is no other feeling in the world than pressing on your belly right after you have a baby. So weird. Kind of like a souffle that has fallen in.
Here are the things that I have found the most helpful to promote healing and reduce discomfort in the first week postpartum.
1. FIBER and WATER: After months of being shoved out of the way and compressed, your internal organs, especially your digestive tract, will be out of sorts for the first few weeks as they settle back into place. Being mindful of your diet can help reduce digestive discomfort. Drink plenty of water!! You need 1/2oz – 1oz per pound of body weight of water (coffee, soda, black tea and juices don't count) daily and more if you are breastfeeding. That's a lot of fluid! But it helps with milk production, weight loss, skin elasticity, sleep deprivation and mood, so drink up!
Along with that you are going to want to eat fibrous foods because you don't want anything sitting in your gut. It needs to move through you while your insides reposition themselves. Definitely avoid constipation! (See the post on bottoms).
Best postpartum foods are:
- hearty soups
- tea (try Steeped Tea's Neetle Greek Mountain, it promotes healing and milk production!)
- low acid fruits and vegetables
- whole grains
- limited dairy (hard to digest)
- iron rich foods to help replace iron lost through growing a human and postpartum bleeding
Generally you don't experience after pains with your first baby. Thank you Mother Nature for tricking us into more children. However, once it's not your first trip to the fair you are gifted with cramps that will make you double over, grit your teeth, maybe mutter a few swear words. And with each baby they tend to get a bit worse. Yay!! So great.
While they are totally not fun, they are important as they are bringing your uterus back down to it's pre-pregnancy size and reducing the about of blood loss. The release of oxytocin when you breastfeed kicks the shrinking up a notch and can cause more cramping while baby eats. I found taking some form of pain meds about a 1/2 hour before nursing helped to take the edge off. Slow steady breathing, similar to your labour breathing also helps. You can add some heat with a hot water bottle or heating pad too. Just be careful that baby doesn't get too hot if you apply the heat while nursing. And don't worry they only tend to last a few days.
3. Compression: shorts, shirts, belly bind. Love them all. Love, love, love my compression shorts. They helped hold my hips and pelvis together, kept my stupid pad from shifting and irritating an already irritated area and helped hold my stretched out belly firm. I also found the counter pressure helped with the cramping.
Since I am a large chested woman, made with the capability to feed an army of starving infants, I like a snug bra. I found my breasts felt better when supported especially when my milk came in. However, lots of women I've worked with like the opposite…to go braless or topless for the first week. Whatever works.
I also, with my last baby, discovered the art of belly binding. There are a few different ways to do it. You can wrap your belly with a tensor, or a long strip of cloth. You can purchase an elasticized band that goes from your boobs to your hips to suck it all in. Or you can go the traditional route with a Bengkung Belly bind, which are beautiful and work great, but a bit time consuming to put on.
The point of binding or wrapping your belly in the postpartum period is to help your uterus shrink and encourage your internal organs to return to their original location after being displaced for the past few months. A bind adds core stability so you can let your muscles heal without slouching into bad posture and potentially causing yourself issues down the road. There is a tendency when we feed our babies and hold are babies to round forward and not maintain proper posture and a bind helps hold us up when our muscles need a break. They also help your skin shrink by reducing the pull of gravity. Just try not to wear it over a long period of time (weeks to months) as binding can lead to muscle deterioration.
4. Core Strength: Time to strengthen those deep core muscles. It is really important when you are schlepping a car seat around, bending over cribs and breast or bottle feeding to get those core muscles back to at least a functioning-properly-capacity if not toned and swelt. The nice thing is that there are a few exercises you can do starting soon after delivery.
1. Posture: The weight and size of the baby that was just inside you causes your spine to shift to accommodate it throughout pregnancy. By the end your spine's natural s bend is exaggerated. This stresses your hips, shoulders and lower legs as they adjust your centre of gravity to keep you from falling forward. Once baby is out and the muscles are called back to the front lines they have lost a lot of their strength and this can cause your spine to stay in the exaggerated s curve, which can cause all sorts of problems with your hips, shoulders, neck, calves, shins, etc. So after baby is born focus on regaining proper posture.
Relearning proper posture after giving birth takes time! There is a tendency to lean forward at the hips as there is often tension in the lower back and cramping in the front right after delivery. Slowly this gets better throughout the first few weeks and practicing proper posture for a little each day will help. Remember when you are nursing or holding your baby to keep your shoulders back and down and your core muscles as tight as possible. Bring baby to breast not breast to baby. You may need a stack of pillows. Put baby in a wrap if possible. They hold baby centred on your torso and aid in better posture.
2. Belly Breathing: Lay on your back on a flat surface with your knees bend at a 90 degree angle and feet flat on the floor. Breathe in deeply and as you exhale contract your abdominal muscles. Focus on pulling your belly button towards your spine, drawing you pelvic floor in and tightening the muscles between you belly button and pubic bone. Hold for as long as you can or a count of 10 and release. Repeat 10 times 3-4 times throughout the day. You can do this one while in bed!
Did I miss something? Let me know in the comments below!
Check out the other two installments in this series; breasts and bottoms!
October is Pregnancy and Infant loss Awareness Month and in honour of breaking the silence on pregnancy loss I have written about my first experience with miscarriage. Early miscarriage is not often talked about as often times friends, family and co-workers aren't aware of the pregnancy let alone the loss. There are times when early loss is perceived as less traumatic than loosing a child later in pregnancy or after birth. However, loosing a child at any stage is hard and all life deserves respect and validation, acknowledgement that a life that was there is no more. With early miscarriage you just begin to dream about your child and suddenly it's gone.
While I am quite comfortable talking about my experiences with early pregnancy loss, I did find sharing this post difficult and, to be honest, I'm not sure why. I am sharing my experience because when I lost my second pregnancy near the end of the first trimester I felt very alone and while I can't take the hurt away from another mother who has lost her baby, I can do a little bit to let her know she's not alone and that things will get better.
It has been just over 17 years since I had my first miscarriage and I still remember it as clear as if it was happening now. I close my eyes and my brain replays it clear as a sunny day. I close my eyes and they still fill with hot, stinging tears. I remember the phone call from the doctor. The way my heart sort of stopped and I had to sit down. The tingling numbness that seemed to spread through my body. While my mother's intuition had been bothering me for weeks that something was wrong, I clung to the hope that I was wrong and just being paranoid and the results from my ultrasound would be fine.
"Mrs. Lindquist, I'm so sorry to tell you this." Pause, "But the ultrasound showed that your baby has passed away. We are not sure why. Your baby was 10 weeks and 5 days, perfectly formed with no heartbeat." Pause. "We'll need you to come in for an appointment to discuss what you would like to do." I sure she said more, about being sorry for our loss, but my brain didn't register anything else.
I knew before that conversation, though, that this little one was going to be gone too soon. One night I just had a sense of unease come over me and I couldn't shake it. I knew that feeling. I had had it before. When I thought I might be pregnant the first time and really didn't want to be, the same sense of unease had made my stomach drop. This time, I prayed hard that I was wrong.
I was so excited to be pregnant this time and had determined to share my excitement with those around me because I had kept my first pregnancy a secret for as long as possible and then felt that because others were not happy about it that I should keep my (eventual) joy about it to myself.
We started sharing our good news within a few weeks of confirming the pregnancy. We were met with some reluctant congratulations, but overall our friends were happy for us. I was excited. This experience was going to be different from the last one.
Around two months I started to spot, and that sense of unease grew in leaps and bounds. I researched, spotting was normal. I search my brain for a memory of spotting with my first and it was there, I had. I had hope that this would pass and all would be well. But I kept spotting, nothing major, just a little everyday. I went to the doctor, "It's normal." She said. Maybe see could see my anxiety, or thought the placenta was low, but she sent me for an ultrasound just to check things out.
I can still bring up the waiting room of the ultrasound clinic in my minds eye. I only went there once. In my later pregnancies I couldn't bring myself to step into that office again and always chose a different clinic for my ultrasounds. I remember laying on the exam bed, the paper crinkling under my bare back. I remember the clinicians face and when she excused herself to go and get the radiologist, I knew it was not good. I remember how they refused to tell me, or show me my baby on the screen and just said my doctor would have the results the next day. I remember driving home in a numb kind of trance, wanting time to slow to give a miracle time to work. I remember crying, curled up on my bed, alone.
I just wanted my baby to be alive and okay.
I wasn't to be. After the doctor called, I walked down the hall to my husband and just stared at him, the words just wouldn't come. Eventually, they did, "It's gone. Our baby's dead." He held me, tight, while I cried and cried. I still remember the feel of his strong arms holding me up, the warmth of his lips on the top of my head, the steadiness of his voice when he told me everything would be okay.
I almost wished there had been something wrong, so that it would make sense that the baby wouldn't be able to survive and it was kinder to pass early, but it was perfectly formed with no heartbeat.
Later that night, and many nights after, as I laid in bed staring into the dark trying to understand and feeling unbelievably helpless, I tried to find the good. If I can just find the good in this, I'll be ok. God doesn't send trials that have no good. I just have to find it. Became my mantra. It took years before I finally found it.
In the days that followed I met with my doctor to discuss what I wanted to do. As my miscarriage was incomplete, meaning the baby died but didn't spontaneously pass from my body, I could either wait and let nature take are of it or go to the hospital and have a D&C. If I waited, it could take months and the child would deteriorate and possibly pass in pieces or all at once, the doctor couldn't tell me for sure. The thought of walking around with my dead child in me for months broke my heart. I couldn't do it. I needed to make my peace and start to heal. I felt I couldn't emotionally and mentally handle dragging it out for weeks or months.
We made an appointment for a D&C. I don't remember much. I don't remember driving to the hospital. I don't remember waiting my turn. I don't remember going into the operating room. I remember laying on the bed talking to the obstetrician on call. I remember she was kind. I remember she double checked that the baby was dead. I remember she did the ultrasound herself and showed us. I wish I had asked for a picture.
I was not awake for the procedure and I am thankful for it. I knew what was involved with a D&C and I didn't want to be awake, it was too much.
After we went home. I felt physically fine. I didn't cramp. I didn't even bleed much. I wished I had, focusing on the physical pain would have freed my mind for a bit longer.
Part of me now wishes I had of asked to deliver, to induce labour, to see my child and say good bye. But it was too much for me back then, and I didn't know it might have been an option. Now I can picture my baby as I want, beautiful and whole.
The weeks following were hard. My hormones were a mess, my heart was broken, I didn't have anyone to talk to about it. I was only 21 and none of my friends had a clue what being pregnant was like, let alone what loosing a baby felt like. My husband was great but admitted he didn't feel as bad because the pregnancy wasn't real to him yet. I'm glad he told me that. I was angry that he wasn't as sad as I was. Then I understood. It's different. We all grieve differently and I needed to let him do his own.
Two weeks to the day after the D&C my older sister got married. It was great. Sunny day, ugly dresses, good times. Unfortunately family had heard that we were expecting and not that we had lost the baby, so I spent the reception being congratulated and having to say actually we lost it a couple weeks ago. Awkward. We left early. I needed to go home and cuddle my daughter.
Very few people know what to say to a women who has had an early miscarriage. We got the standard; You're young, you can have more. There must have been something wrong. At least it was early. You'll be fine soon. It wasn't meant to be. While I remained polite and thanked them for there concern inside my brain was screaming Shut up! SHUT UP! I don't care that I can have more kids, I don't care that there was most likely a reason, I don't care that it was early. I WANT MY BABY! My brain understands this, it's my heart that doesn't. My heart is broken.
But there were other things said about our miscarriage, things that were hurtful and I'm sure never meant to reach my ears. But whispers have a way of floating around and getting back to the person they are about. There were those that thought I deserved it, because I had gotten pregnant with my first child before I was married. There were those that thought it was for the best, heaven forbid we have two children when we were still so young! Then there were those that thought it would have been better if we had lost our first pregnancy. They thought it would have been better if my daughter had never been born…if my then 2.5 year old never existed.
It's funny I can forgive the people who thought I deserved it, that's just ignorance and misplaced righteousness that is not worth my time, but I still struggle with the fact that there were people that actually thought it would have been better if my daughter had died. How could someone say that about a beautiful little 2 year old. And we were doing a good job parenting and for the love of Pete, we were already beating the odds for teen marriages.
Physical healing came quickly. We were told that as soon as my cycle had come around once we were good to try again if we wanted. My doctor recommended waiting a few months to allow for emotional healing. We thought that was a good idea.
Emotional healing was harder. I felt that that baby was a boy. I never knew for sure, but my gut told me it was a boy. I named him. It helped. Giving my baby a named validated the life and was one of the most helpful things I did.
When we decided to try again it was scary. All I wanted was to be pregnant by the time my due date from my lost baby came around. I didn't know how I would deal mentally and emotionally on that day if my womb was still empty. I have always been thankful to God that our second daughter was conceived shortly before that date. While I was sad for what would never be, I had hope for the future. It was a nervous and cautious hope, that needed to be nurtured daily, but it was hope none the less.
The first trimester has remained scary for me since this experience. I was never again simply overjoyed about finding out I was pregnant. There was always a little piece of my heart that I held back. We never again shared our news with anyone until we made it safely through those first 12 weeks. While I know friends would have been supportive and loving and wonderful if we had of told them early, I still remember the hurt and in order to protect myself I held my news close.
I've had 3 other early miscarriages since this one and it was easier to heal, make peace with my loss and move on when only my husband and I knew. I am an internal processor and need to deal with situations on my own before sharing with others. It's the way I'm wired. I admire those that are social processors and need to share their experience in order to cope, it's just not me.
I have found the good in all this. I have an understanding of how precious and tenuous life is. How one day it's here and the next, gone. I am immensely thankful for all my children and love them deeply because I know the hurt of loosing four that I never even met and I can't imagine the pain of loosing an older child. My heart breaks for parents that loose babies further in pregnancy, shortly after birth or anytime really.
I learned to have courage to try again. I learned to be kind to others who find themselves in a similar situation. I learned to forgive those that say hurtful things, although this took along time. I learned that life goes on and hope is renewed and there is still good in the world.
I learned that what you say to a woman who has lost a baby, at any stage of pregnancy, has a lasting effect, good or bad. I have strived to choose my words carefully, to validate the life, respect the hurt and loss, and reduce the sense of isolation.
Experiencing miscarriage at a young age, one that everyone knew about, has enabled me to support other woman who walked that same path of loss. There is not very much support for early miscarriage. It isn't talked about too much. I've never been uncomfortable talking about my experience once I took the time to process it. Talking is therapeutic. Sharing helps with healing. I'll never forget how alone I felt when I lost my first and if there is a way that I can lessen that feeling for someone else I will.
I am sad for my little ones that were never born. I'll never forget where I was or how I felt when I knew I had lost them. I will always have a special spot in my heart for them. But I can see the good. God never gives us trials that don't have good in them. We just have to find it. Sometimes it takes years, but it's there. There is good and hope even in the darkest times. We just have to keep looking for the good.
Earlier this month, on Sunday June 7, 2015, I had the opportunity volunteer at the PAIL Network's (Parent And Infant Loss Network) annual family picnic and butterfly release. This event is a chance for families to gather in rememberance of their babies that have passed away too soon.
This year the weather was absolutely perfect! The sun was shining, a gentle breeze was blowing, soft clouds floated high in the sky. There couldn't be better conditions for the butterflies to released and take flight.
This was my first time attending an event like this. I decided to volunteer after seeing a I saw on facebook. After a quick consultation with the giant family calendar that runs the house, I signed on. I had no idea what I would be doing. I figured they would have something for me to do!
I wanted to serve at an event and with an organization that really validates and honour babies that have passed prenatally or shortly after birth.
A bit about the day: This event is an opportunity for families that have lost a child prenatally or shortly after birth to take a moment with family and friends to remember and honour the little life that has passed away. It is a chance to take a time out and remember. To feel supported and less alone.
My own experience with miscarriage was quite lonely. It is something that is not often talked about and people rarely know what to say to help a grieving mother, or father or siblings. Finding positive support in different forms, such as group counseling, one-on-one counseling, peer counseling, or private reflection, or quite often a combination of all, is very important to healing and being able to face another day. The PAIL Network provides such resources for parents.
This event was great. From a weather stand point it was perfect, not too hot, not too cool, and barely a cloud in the sky. There were games and activities for the kids that came. There was plenty of space for families to spread out a picnic blanket and enjoy the day. There was a raffle and silent auction with the proceeds benefiting the PAIL Network so they can keep supporting families.
But the most beautiful part of the day happen just past noon when everyone gathered at the top of the meadow, by the silver coloured windmill to release their butterflies. There was a poem read by a mother in memory of her daughter, words shared by one of the organizers and a gentle rendition of Angel Eyes (by Jim Brickman) played on the guitar as families let their butterflies go.
The day was special to me as I had the opportunity to not only give back to my community and support families from across the province (there were families from Ottawa to London), I also was able to watch my girls give back too. When I volunteered to help, the organizer asked if I knew anyone would would be able to help out with the kids' station. Turns out I have 2 teeange daughters who would be great at that! So they got signed up too. I must say I am extremely proud of my young ladies for their willingness to serve and the gentle way they interacted with the children and parents.
In addition to being awesome helpers, my girls did a very special thing for me, that makes me tear up as I write this. They, without my knowing, got a butterfly from the organizer for me to release in memory of the four little angels I lost prenatally. I was not planning on taking part in the release, I was there to help ensure that my small contribution was taken care of. I had not even thought of joining in. I have made peace with my loss. My experience has allowed me to comfort other women and walk with them through one of the hardest parts of being a mother. That being said, I feel blessed to have had the opportunity to let that little Monarch fly in memory of the little ones I only barely knew. I am humbled by the thoughtfulness of my daughters. I am truly glad I went.
Nothing compares to the loss of a child. Nothing fills the hole left in your heart. Nothing takes the memory away. All we can do is focus on the good, remember the moments that filled us and treasure our little ones here on earth and in heaven. One day I'll get to hold my angels in heaven, until then I am comforted that the first face they saw was Jesus'. Which is what my insightful nephew told his parents when they suffered a loss prenatally.
One of the most important things I learned after my first miscarriage was that my husband grieved differently than me and that it was okay. Seems like a simple thing now, but at the time I was angry and hurt that he didn't seem as upset as I was, that he wasn't a sobbing mess like me. I learned that it didn't mean he wasn't sad, he just dealt in a different way and that it was important for me to let him.
I have to say that this event was a mix of happy and sad. Everyone who attended has been touched by a loss that hits you in the gut. It's so hard to carry on, but carry on we must. Events like this are beautiful, not only on the day of, to gather and feel like there are other people who understand, really the wealth of emotions and stages of grief that parents and family members go through, but also, because in the days, weeks and months after everytime you see a butterfly flutter through the air you remember your child with joy.
If you have lost a child you are not alone. Miscarriage is more common than anyone wishes. Infants pass away more often than we talk about because it's hurts so much. Reach out, find a group or a friend or a therapist that is right for you. It might not be the first place you try. Group support might not be your thing, or it might not be your thing at that time. Keep looking, don't go through it alone. We are a village in good times and in hard times.
For local (Markham) and on line resources for prenatal and infant loss support click here.
After having 6 babies I like to think I've learned some tips on how to survive the first week postpartum. Each of my babies has brought a new challenge and a new discovery on how to make that first week more comfortable. I was still learning new things with number 6!
Here are my top tips for making that first week more comfortable. I've divided them into categories because that's how my mind organizes pretty much everything, I might just colour code them too 🙂
I'll be covering things in this order: breasts, bellies, bottoms and other.
This post is all about breasts. As a breastfeeding advocate and a successful breastfeeder I think it is important for moms to hear from other moms about what to expect, books are great but there is no replacement for knowledge handed from one mother to another. This isn't a how to guide on breastfeeding, just some things I've learned about nursing.
2. Engorgement: Day 3-4 is when the milk comes in, and when it comes, it comes! There's a good chance your breasts are bigger than they have ever been, sore and probably shooting milk out in all directions! Nothing says "Hot Mama" like rock hard boobs shooting milk all over!
What's the best way to deal with this? Nurse baby, often. Our bodies are so amazing! Our milk comes in just as our baby has his/her first growth spurt.
Even with increased feeds often times there is still more milk than baby can drink and it is important to empty your breasts frequently or you can end up with blocked milk ducts (ouch!) or an infected milk duct (super ouch!) I found that if I had more milk than my baby could drink (and I did, I could have easily fed a village!) the best thing for me to do was pump the extra after nursing and toss it in the freezer for a day in the future… like when I desperately needed to get out of the house and away from the crazy little housemates I lovingly call children.
If pumping doesn't work for you you can try hand expressing to relieve some of the pressure and to encourage those high milk ducts to empty. There are lots of people who don't think pumping is a good idea, but when done after baby has nursed it is pretty effective in reducing engorgement, discouraging blocked ducts and it can help establish a good supply because breast milk is a supply and demand system. If your body thinks baby is finishing a breast it will keep producing. So if you don't need or want to freeze milk then each day you would pump a little less and let your body adjust.
Another thing besides frequent nursing and expression that can help ease the discomfort is applying heat. Standing in a hot shower with a towel wrapped around your breasts, or soaking in a hot bath helps to reduce discomfort, it also feels nice on your other sore bits as I will talk about in part 2 and 3 of this series.
Compression, like wearing a sports bra also helps. This helps reduce how much milk you make, so be careful not to compress your breasts to the point that you are no longer making enough for baby.
The other thing that can help is massage, especially in the auxiliary breast tissue. It is common for the milk ducts up by the arm pits to get blocked, massaging in a downward motion, toward your nipple, can help encourage the milk in the outlaying milk ducts to exit, especially if you do it while baby is nursing or while you are expressing.
Not every mother has the overwhelming engorgement when her milk comes in and that's o.k.! It doesn't necessarily mean that mommy isn't making enough milk. It may just be that that mother and newborn are in perfect sync and they have sorted out the supply and demand process of breastfeeding quickly. As long as baby is peeing and pooping frequently there is enough milk.
It is also common for baby to spit up if your breasts are engorged because the milk flows quickly and they can get more than their little tummy's can handle. Be prepared 🙂 They can also have a bit of trouble breathing and swallowing at the same time when your milk lets down and the flood gates open. They can take in air if that happens so make sure they have a burp after or they might be grumpy about 20 minutes after eating because they have an air bubble in their belly that is bothering them.
3. Nipples: The first few times you nurse can be uncomfortable, but it shouldn't last. The most important thing is to make sure baby has a good latch. A good latch doesn't hurt. It can be a bit uncomfortable for the first little bit as your nipples get used to the sensation, but if pain or discomfort lasts longer than the first few sucks take baby off and adjust the latch. If pain is persisting get help ASAP, there is nothing worse than getting a blister on your nipple because it's going to hurt to nurse until that sucker heals (haha see what I did there) and it could get infected which really hurts! If it ever feels like your nipples are on fire, especially between feedings, get them checked, there is a good chance they are infected. Deal with it quickly.
Sometimes it can be hard for newborns to latch onto an engorged breast. There are a couple of things you can do to help. The first is to press areola down so your nipple "pops" up. With your fingers and thumb form a circle around your nipple and press the areola down. This just pushes all that milk back a bit and elongates the nipple to help baby latch.
You can express some milk by hand to reduce the pressure, or if you are finding that you are really engorged you can pump off some milk. This helps reduce the pressure, elongate your nipples, and start the milk flowing which can make it easier for baby to latch, especially if you have a sleepy baby.
Try different positions to help baby get a good latch.
A good tip for keeping your nipples in good form is to express a few drops of milk when you are done nursing, rub it into your nipple and let them air dry. Seriously, motherhood is ridiculously glamorous!
4. Bras: Invest in a good quality nursing bra that fits properly! Seriously, the girls deserve it. If you need to be fitted wait for your milk to come in and get fitted. This is probably not something you'll do in the first week since it is actually better to just go free and let baby nurse, but plan on getting a good bra soon!
In the same area is breast pads. There are a lot of different types out there. Stay away from any that have a plastic back or layer as they trap moisture which can lead to infection. There are some nice washable ones that are soft, and cheap, since you only buy them once. Just keep them clean and handy. Although when your milk comes in you may just want to wear a towel!
5. Set up a nursing station or 2 or more around your house. Include a water bottle and snack for you, clean nursing pads, burb cloth, book/magazine/remote, anything else you might need while nursing so you don't have to get up. Click here for a list of one-handed snacks perfect for breastfeeding.
6. Set up a sibling basket or 2 around your house. If you have older children put together a little basket that is just for them for when you breastfeed. Include items such as books, small toys, a baby doll and blanket so they can feed their baby too, and maybe a little snack. Biggies might like to cuddle while you nurse too, or help by going and getting items for you, like a receiving blanket or diaper. Of course there is a good chance they will simply ignore you too!
I think that's all I've got about boobs. Did I miss something? Let me know in the comments below!
Cartoon was found on pinterst.com
Since becoming a doula a lot of people have asked me what a doula is and why they would need or want one involved in their pregnancy, labour and delivery or postpartum period. Even though doulas have been around for thousands of years it is still a fairly new profession in modern times and there is a fair amount of confusion about what doulas do and what their role in birth and the early postpartum period is.
In the past few years the number of professional doulas has grown and the practice of having a doula has increased. The word doula comes from the ancient Greek and means "woman who serves", and that is still basically what a doula does. Nowadays, the role of a doula has been tailored and specified to mean a woman who serves as a birth companion or helper in the prenatal and/or early postpartum period, providing non-medical emotional, physical, and educational support to mothers and their families. It is important to note that no one can predict the path a labour and delivery will take and doulas can not guarantee that your birth experience will go the way you want it to or be without complications. No one can. Doulas do their best to educate you so you can make informed decisions, support your choices, provide emotional and physical support during labour and delivery and support you in the early postpartum period.
I recently got together with my sister-in-law, Elle Lindquist, and filmed a Q&A about what a doula is and does.
Here are some of the questions that I have been asked about what I do as a doula, what the role of a doula is compared to other birth support persons, and why a mother may or may not choose to have a doula at her birth or involved in her early postpartum period.
1. Why would I need a doula, I have a midwife? Don't they basically do the same thing?
Midwives are great. I loved my midwife attended births and I love working with the midwives. They are usually very woman-centred and provide more continuous care than obstetricians or GP's are able to. While doulas and midwives often have similar approaches to care there are a few very important differences.
Midwives are specialized medical professionals. Their job is to ensure that the mother has a successful pregnancy and birth, which means at it's most basic level a living mother and child. They are very good a making mothers feel great during the process, but if anything medically needs to be assessed, consulted about and/or preformed it is the midwife's responsibility to do that and sometimes that trumps everything else.
Also once baby is here, you only see your midwife a few times for a check up. You may have more questions about parenting then they have time to answer or knowledge about. Their focus is on pregnancy and labour an delivery.
Doulas are non-medical professionals hired by the mother to help her in non-medical ways. Our only job is to provide continuous care for the mother. We make sure mommy knows what is happening, what her options are, how to advocate for herself, and help her with physical and emotional comfort measures. We stay with the mother while the midwives are attending to the medical aspects of birth. For example, as the time for the actual birth of the baby approaches midwives have to prepare their equipment and items for the baby. They are not usually fully focused on helping the mother through the increasingly intense contractions because they have medical responsibilities that must be taken care of. Doulas by contrast do not have anything medical to prepare and are free to stay with the mother, helping her focus, move to whatever position she feels she needs to be in, encouraging her and keeping her informed the entire time.
You may find that once your baby has arrived you have a boat load of questions or are feeling overwhelmed. Postpartum doulas come to your home to help you and your family make the transition to parenthood or to parenting multiple children easier. They are also trained to recognize the signs of postpartum mood disorders and can intervene early thorough education, recommendations for help and supporting you if needed.
2. Time availability:
When you have a midwife appointment you are generally allotted 15-20 minutes and in that time you do the regular physical checks to make sure everything is tickety-boo with baby and you, plus ask any questions that you might have and discuss anything that has come up with the pregnancy. Sometimes that is not enough time to feel like you really understand what is going on and what is coming up.
Doulas are able to spend more time with the you and your family. I often sit with mothers for a few hours at a time explaining various aspects of pregnancy, labour, delivery or the postpartum period. If I don't visit at home, we call, text or email back and forth until she feels like she has been listened to, had her questions answered and has a plan in place if needed. This becomes more important in the last few weeks of a woman's pregnancy as she often has a lot of questions or something might come up at an appointment that she would like more information about. Doulas provide information, options and a listening ear and we generally have more time to spend with the mother.
3. Number of patients/clients:
Midwives have many women that they care for. Which means that they have to balance their time between their patients. If two women go into labour on the same day the midwife has to attend to each one in some way. That may be with home visits early in labour, phone consultations or arranging for their backup midwife to take over. Sometimes they are able to come to your home and assess your labour and support you physically and emotionally, but sometimes that isn't possible. They could be with another patient or your home is at the edge of their catchment area and they may not have enough time to go between all the places they need to be. In which case they will give you instructions about when to come to the hospital or when they will be able to come to your home. You are left to labour on your own until that time.
Doulas come to you when you want them to and stay with you providing continuous care until a few hours after the baby is born. When you are in labour and you want your doula to come and help you, they come. You are the only person that they care for at a time. Their focus is on doing whatever needs to be done to help you feel comfortable, confident, informed and encouraged.
Note: When interviewing a doula be sure to ask how many clients she takes at a time. If you would be the only client due during your "on-call" period.
2. I'm just going to get the epidural as soon as I can so why would I need a doula?
I feel it's pretty safe to say that most hospitals and birth centres don't admit labouring women after the first couple of contractions. General rule of thumb for heading to the hospital is when contractions are occurring every 4-5 minutes, lasting 60 seconds and have been doing so for at least an hour. They also have to have some intensity to them, mommy needs to focus to get through them. At some hospitals they won't admit a woman until she is at least 4cm dilated either. Getting to that point can take a while. Then you need to be admitted, they have to locate the anesthetist, and he/she has to actually be available. Then they prep everything and hopefully there isn't an emergency that pulls the doctor away. Doula's help you get to the point where the meds kick in without loosing your mind. After the meds are working doulas help you reposition periodically to help labour progress. Moving within the confines of the bed helps your cervix dilate evenly which, in turn, helps labour progress quicker. Movement and massage also helps reduce muscle and joint aching after delivery and the epidural wears off. Doulas also help when it comes to pushing. Epidurals make it harder to work with your body and push in different positions. Doulas help keep you focused, and encourage you to try different positions if needed. Doulas also help you establish breastfeeding, which can be a bit more difficult for babies that react to the epidural (sleepy, less able to latch).
While epidurals take away all or most of the pain they do not relieve any anxiety a woman may be feeling, especially if she was not originally planning to have an epidural. Doulas can help with relaxation and help you process why the epidural was needed if it wasn't planned.
Sometimes by the time mommy is ready to be admitted she dilates so quickly that there is no time to get an epidural and while the medical staff are rushing around trying to get everything ready for delivery mom is just left to deal with the most intense part of labour. Doulas are with mom early in labour and stay with her and focus on helping her. We also help keep partners calm and helpful.
3. This hospital has really good nurses how would a doula be helpful?
Nurses are medical professionals that are assigned to more than one patient at a time. While they provide good care, it is not usually continuous, they don't always respect your birth plan and desires, they don't come to your house and care for you in early labour before you are eligible for admission, and they don't know you. They also work shifts. So depending on how your labour progresses and when you are admitted you could go through a series of nurses and have to go through your birth plan/wishes each time. Doulas, by contrast, provide continuous care at your home and at the hospital, respect your wishes and care for you while you partner updates the new staff about where your at, how your doing and what you'd like for your labour and delivery. Some nurses are great, some are not and there is no way to guarantee that when you go into labour the awesome ones will be assigned to you. Having a doula that knows you, has been with you for the whole labour, knows what is working for you in labour, knows what you'd like to happen and is there to care for just you helps protect your space. Protecting your space means that you are able to focus on the task at hand and not worry about anything else.
4. My partner will be there. I don't know why I would need a doula.
Partners are awesome and you may very well not need a doula. Your partner may remember everything learned in prenatal classes, keep a calm head if anything unexpected happens and meet and surpass all of your emotional and physical needs. Which is amazing!
For those of you that are not sure, or have partners that are nervous about knowing what to do and how and when to do it and/or have never experienced birth or experienced birth with you or in the fashion (ie home birth) that you want, a doula may be helpful. It is important to note that doulas do not replace partners. Doulas and partners generally make a great team. Here's why:
- Doulas make partners look awesome. We help your partner know what to do and when to do it to provide awesome care to you.
- Doulas remember what we learned in prenatal classes and we help partners remember too.
- Doulas have experience that your partner may not have. Is this your partner's first baby? Will your partner want support to feel confident and helpful?
- Doulas know what questions to ask if unexpected things happen during labour and help you and your partner stay calm so you can get the information you need to make informed choices. Often times if the unexpected happens, partners can feel panicked, helpless or confused. Doulas support them to help them feel better, more informed, and helpful in whatever the situation may be.
- Doulas and partners can spell each other. Partners need to use the washroom, eat and sleep. I have gone to clients who are experiencing long early labours and taken care of mom while her partner sleeps so that he is able to make it to delivery.
- Doulas let partners know what is normal. Birth can be scary for people who love you. Women make sounds that they have maybe never made before and most partners feel relieved to have someone tell them that not only is it normal, but it's great! We also show partners how to help mamas make the sounds that are helpful in labour.
- Some partners want to be hands on after delivery with skin to skin, diapering etc. and doulas encourage, help and guide partners so that they feel confident in their parenting ability right from the start. Some doulas will take photos too, which frees up your partner to be more hands on with labour, delivery, cord cutting, skin to skin and more.
5. My mother/mother-in-law/sister/aunt will be with me. What else can a doula do?
There are a few ways to look at this:
1. Your family members are awesome and respect your wishes and want to do whatever they can to make your birth a wonderful experience. In this case doulas help them do that. Sometimes we model comfort measures, or breathing techniques, we encourage your support persons, we spell them, same as partners they need to eat, sleep and use the washroom, we keep them informed, calm and comfortable with whatever happens.
If you have an awesome family you may not need a doula to be there, and that's awesome. There is no replacement for respectful and caring family support. One option to enhance your family's support skills is to use a prenatal doula who will meet with you and your family prenatally to help you all feel prepared and educated, show comfort measures and breathing techniques that your extended family can use to help you and then wish you the best for your labour. Prenatal doulas are available for phone/text/email, but do not attend your birth.
2. Your family members are a bit more set in their ways and feel like your birth experience should be a certain way. In this case, as always, doulas provide un-biased support. We support what you want. We keep your space so you are free to handle labour in the way you want or the way your body needs you to. We don't get upset if you are in pain, because we know it's all part of the process and you'll either deliver or ask for meds when you want them because you feel you need them, not just because your family members are stressed out at seeing you in pain. Or if you want meds and your family thinks that's not what you should do, doulas help you get what you need and keep the relatives informed and in line. Doulas understand that your labour is your labour, not your mother's or sister's or aunt's and you may need support from a non-family member to ensure that your desires are understood and respected.
3. Family members want to be supportive but are outside their comfort zone. Doulas help them be apart of the birth while respecting their boundaries and filling in the gaps so mom still gets the care she needs and the other family members feel good about their role.
6. I'm going to be induced.
In the case of inductions doulas provide information about why you would need one, the different methods available, the benefits and risks accosiated with each one, and are able to spend more time answering your questions. Yes, medical persons do this also, but you may find that you would like more time to go over things then you are allotted at your appointment. We support you through your choosen method just like we would if labour started on it's own.
7. This is not my first baby, I know what to expect, so I don't see what a doula could do to help me.
Every birth is different. Doulas often work with mothers who have had negative experiences and would like the opportunity to have a try for better birth experience. Doulas work with women who will be doing a VBAC. Doulas work with women who want to try something else. Often when it is not your first baby you have a better idea what you like and what you do not. Doulas help you advocate for yourself so you can have the birth experience that you want. It is important to understand that no one can guarantee that your labour will go the way you want it and in the case that something unexpected happens doulas can help you stay as close to your desires as medically possible. Usually just having someone explain things to you and care for your physical, emotional and spiritual (if desired) needs increases your enjoyment and satisfaction.
Doulas also help with siblings. If you are planning on having older siblings present at the birth, doulas help prepare them for the experience and support them through the birth if that's what's needed. Postpartum doulas come to your home and take care of light housekeeping, food preparation, baby's laundry, infant care, breast and bottle feeding support and help with siblings, which may include entertaining them so mom can rest or attend to baby, explaining things about newborns at their level, or modeling ways they can help care for baby with out accidentally hurting them.
8. Labour and delivery are an intimate time I don't want a stranger in my birth room.
This is very true. There are a lot of women who do not want anyone else in their birth room and that's great. Doulas respect the fact that our services are not for anyone. Women need to be free to do labour in a way that relaxes them and makes them feel comfortable and confident and if that means no strangers then there shouldn't be any strangers in the room.
For those of you on the fence about if you want a stranger in the room I'll go over the most common reasons women are unsure about having someone they barely know involved in such an personal and intimate time.
- I don't want anyone to see my private areas. Doulas honestly don't care what your bits look like, and we are not the ones all up in your lady place…that's for your doctor, nurse or midwife. We are up at your head whispering encouragement, instructions, or breathing with you to help you focus and stay in control.
- What if I pee or poop or sound like a lunatic? Again, doulas don't care. We are usually encouraging you to make certain noises because they help labour progress. We also get excited when you pee or poop because we know it has to get out of the way for baby to come out. If you pee in the middle of a contraction we get really excited because it means you are relaxing your pelvic floor which is awesome!
- I want to be the one to tell my story. Doulas don't tell your story. It is not our story to tell. We don't go home and tell our families what happened, other than "baby's here, everyone is good", we don't post your news. It's your story, we respect that.
- I don't want someone I don't know at my birth. Doulas get to know you during your pregnancy, the earlier we're hired the longer we have to get to know you. By the time baby is ready to be born moms generally feel pretty comfortable with their doula. If they don't, that's a red flag and they should reconsider having that person attend them. Trust your instincts. The doula you hire has a lot to do with personality and connection. Often times you know pretty quickly which doula is right for you. I always recommend that you interview a few and pick the one that knows what she is doing and you feel comfortable with. Each doula has different skills to offer and you choose the one that matches up with you. The doula that was great for your friend may not be the one for you. Interview a few doulas, check their references, policies, certifying bodies and do your research. Another thing to note is that if you are with an OB you will most likely not know the nurses that will attend to you, and possibly the doctor as a lot of obstetricians work in teams and you get whoever is on call when you are in labour. In that case, your doula is one of the only people you do know.
The thing to remember is what happens in birth stays in birth. The only person who can bring it up in all it's glorious detail is the mother!
If you like the idea of having a doula help you prenatally and in the postpartum period, but would rather not have someone attend your birth, look for a prenatal doula or a doula on call. They provide all the same care prenatally and in the early postpartum period, including phone support during labour but they do not attend your birth.
9. The fee for doula services seems really high, why?
Doula services are not cheap and in most cases they are not covered by insurance. Doulas spend a lot of time with each client and because most only have one client due at one time they are limited in how many clients they can work with each month. Doulas come to your home prenatally, are on call for you 2 weeks before your due date and 2 weeks after, they research for you if needed, provide information and resources, answer questions, and attend your birth from the moment you ask them to come until 2-3 hours after delivery. That can end up being quite a long time. Doulas pay their own transportation, childcare if they need it in order to care for you, food expenses, parking at hospitals and birth centres, insurance and other professional fees. All of that is considered when setting the cost for service.
There are however different ways to afford doula services.
- Some doulas volunteer their services or reduce their fees if they need families for certification purposes.
- Some doulas volunteer their services or reduce their fees for low income families or single mothers.
- Some doulas offer different service packages at different price points.
- Some doulas let you pay in installments.
- Some doulas negotiate their fees to make their services affordable or trade services, just keep in mind how many hours your doula will be working for and with you.
- Some insurance providers will cover the cost of a doula in full or in part. If you have a Health Spending Account with Sunlife Financial, they will reimburse the fee of DONA doulas. Always double check that you are covered and what the requirements for approval are.
- If you are not sure if your insurance provider covers the cost of a doula, submit a request for coverage explaining how it is beneficial to have a doula attended birth, the cost involved, the service provided and the amount you would like covered. You may be turned down, but you never know, you might get some of the cost covered. Also, by submitting written requests you help make insurers aware that the service is wanted and beneficial. Working together mothers can change policies.
If your doula, for whatever reason, is unable to attend your birth it should state in your contract what the refund will be, if any, and any conditions involved. For example, if you cancel because you changed your mind you will most likely be out the entire fee especially if your doula has turned down other clients because you were booked in. If the doula misses the birth at her fault (illness, family emergency) most will refund a portion of the fee.
Those are the most common questions that I get asked about being a doula. If I have missed something, just let me know and I'll add it to the list.
Doulas are not for everyone. They cannot guarantee your birth and postpartum period will be smooth sailing, but we do our best to support mothers educationally, emotionally and physically in the way that she needs and that she responds to best, which has been shown to decrease the length of labour and interventions and increase satisfaction with the experience.