Postpartum Mood Changes

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.

 

Hormones:

There are 3 times in the postpartum period where mood changes can be caused by fluctuating hormones

  1. The first week when all those pregnancy hormones drop really quickly, and when other hormones increase to produce breast milk

  2. Weaning:

    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.

  3. 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

 

Healing Yourself:

 

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

 

Books:

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

 

Online:

www.postpartumstress.com – self assessment tools, information

www.mooddisorders.ca/faq/postpartum-depression

 

 

PPMD Banner 1

Mothering the New Mother, Sally Placksin
** Please note I am not a doctor, therapist or counsellor.  The suggestions I give have been deleveoped from experience, reading and self education.  If you are struggling with any postpartum mood issues please seek appropriate support.

 

Postpartum Mood Disorders: Risk Factors

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

  • Thyroid disease

  • Multiple births

  • 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)

 

 

Printable PPMD risk factors

 

 

 

Source: DONA International  Postpartum Doula Workshop Manual 2013

Postpartum Mood Disorders: Symptoms

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!

 

Printable List of PPMD Symptoms

 

Depression:

  • Feelings of despair/hopelessness

  • Crying, tearfulness

  • Anger and irritability

  • Sleep disturbances (too much/little)

  • Loss of energy and interest

  • Physical symptoms (clumsiness, slowed speech, etc.)

  • Suicidal thoughts

  • 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

  • Irritability

  • Decreased need for sleep/insomnia

  • Feeling “speedy”

  • Easily Distracted

  • Mind racing; cannot shut thoughts off

  • Pressured, fast speech

Anxiety

  • Muscle tension; chest pain

  • Shortness of breath; choking sensation

  • Hot/cold flashes

  • Tingling hand/feet

  • Agitation/restless

  • Fear of dying

  • Fear of going crazy

  • Faintness

  • Irritability

  • Anger/rage

  • Fear of being alone; fears of baby's health; agoraphobia

  • Feeling trapped, immobilizing guilt

  • Racing heartbeat

  • Hyperventilating

  • Nausea/vomiting

  • Diarrhea

  • Dizziness

Obsessive-Compulsive

  • 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

  • Emotional numbing/detachment

Psychosis (very rare)*

  • Paranoia

  • Delusions (about baby)

  • Hallucinations

  • Irrational thoughts

  • Impulsivity

  • Refusal to eat

  • Poor judgement

  • Lack decision-making

  • Break in reality

  • Severe insomnia

  • Confusion

  • 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

Postpartum Survival Guide: The First Week Part 2

Bellies:

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
  • smoothies 
  • 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

2. Afterpains:  

So.

Not.

Awesome.

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.  

Try this activity:
Stand with your feet hip width apart and your knees soft (not locked straight).
Slowly rock forward so your weight is supported in your toes.  
Slowly rock backwards so your weight is support in your heels.  Repeat and focus on how hard your body has to work to remain upright.
Balance your weight on your feet so that it is evenly distributed between your toes and your heels.
Lift your shoulders up, pull them back and drop them down. This opens up your chest.
Pretend there is a string coming out of the crown of your head and pull it up.
Tuck your chin in slightly.
Pretend there is another string coming from your chest on a 45 degree angle and pull it out.
Pull in your core muscles.
Tilt your pelvis forward slightly.
 

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!

 

Butterfly Release

IMG_0948Earlier 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.  

IMG_0964My 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.

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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. 

IMG_0953

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.

IMG_20150607_131841If 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.

Postpartum Survival Guide; The First Week, Part 1

 

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.

Breasts:  

1. Milk supply:  It is pretty common for new mothers to worry about their milk supply, about whether or not they are or will make enough milk to feed their babies.  I have talked to a lot of moms who are freaking out on the first day or two postpartum because they don't have enough milk.  Well, here's the thing, we are not supposed to have milk until day 3 or 4.  So step one to making milk is to relax!  The first couple of days we produce colostrum, or "liquid gold" as the NICU nurse that was caring for baby #5 liked to call it.  It is exactly what our baby's need, full of proteins, vitamins and nutrients.  It also contains antibodies from the mother which is good as baby's are not born with their immune systems running at full strength and the colostrum, and later mature breast milk, is what helps them fight off infections. Colostrum also has a laxative effect which allows baby to pass meconium more effectively and more quickly, which helps prevent newborn jaundice.  Colostrum is slowly replaced by mature milk in the first two weeks.  The quantity may seem small, but the quality is amazing and just what baby needs.  
 
The other thing to remember is that baby's tummy is really small and what your breasts produce is the perfect amount to slowly stretch your baby's tummy and get him or her ready for when your milk comes in.  The best thing to do to encourage your milk to come in is to relax, let baby suckle, and stay hydrated. Your milk will come just in time for baby's first growth spurt on day 3 or 4. If it's your first baby your milk may come in a day later.
 
DSC04243If you are still worried about your milk supply there are some teas that help bring it in and boost up the volume.  My favourite is Nettle Greek Mountain by the Canadian company Steeped Tea.  If you are interested in ordering this tea to try click here. (Canadian shoppers only)
 

2. Engorgement:  Day 3-4 is when the milk comes in, and when it comes, it comes!  There's a good 5007513c65392d4ab07e1cbfd108c30dchance 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.

DSC045973. 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 DSC04599washable 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.

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DSC046006. 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!

Check out part 2…all about bellies.

Cartoon was found on pinterst.com

  

Why would I need a Doula?

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.

1. Responsibilities

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:

  1. Doulas make partners look awesome.  We help your partner know what to do and when to do it to provide awesome care to you.
  2. Doulas remember what we learned in prenatal classes and we help partners remember too.
  3. 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?
  4. 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. 
  5. 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.
  6. 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.
  7. 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.  

  1. 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.
  2. 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!  
  3. 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.
  4. 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.

  1. Some doulas volunteer their services or reduce their fees if they need families for certification purposes.
  2. Some doulas volunteer their services or reduce their fees for low income families or single mothers.
  3. Some doulas offer different service packages at different price points.
  4. Some doulas let you pay in installments.
  5. 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.
  6. 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.  
  7. 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.