Breastfeeding

            My experience in the early childhood field is deeply rooted in my experience as a birth and postpartum doula, as well as my years of experience leading new mom support groups. I have witnessed over a thousand mothers’ early journeys into motherhood, and have seen the emotional and physical benefits of breastfeeding first hand in both mothers and babies. So, when we were asked to pick a public health issue that affects child development to discuss in our blogs, breastfeeding was an easy choice. I have seen countless moms and babies in love with each other, gazing into each other’s eyes, connected in every way by their breastfeeding connection. I have seen mother driven nearly to madness as they try to increase their milk supply, work through nipple pain caused by a bad latch, or struggle through recurrent thrush or clogged ducts and mastitis.  I have seen breast milk squirted on clogged tear ducts, scratches from thin baby fingernails, and sore nipples, and seen the almost magical healing affect that it has. Too many of the tough stories I see and hear are rooted in poor postpartum support, misinformation, or lack of education in general… All too much of that poor information is still coming from hospitals and pediatricians, and all too often this misinformation leads to moms giving up on breastfeeding. To add insult to injury, the sense of guilt and defeat that these women carry for giving up is overwhelming.

            In my work as a doula, both pre and post partum, one of my main go-to books is Dr Jack Newman’s Guide to Breastfeeding. Dr. Newman wasn’t always a breastfeeding activist. In fact, he bumped into the field almost by accident. In  1981, after finishing his residency as a pediatrician, Dr. Newman went to Africa and witnessed how devastating bottle feeding was in a culture that was suffering with issues of starvation, contaminated water, poverty, low immunization rates, and a tuberculosis epidemic, amongst other things (Newman, 2003).  Dr. Newman didn’t really understand the intricacies and challenges that breastfeeding could present at that time, but he did realize that breast milk didn’t require mixing contaminated water into it like formula did, that breast milk was made to be exactly what babies need, and that it was free . He also saw the babies were being admitted into the hospital daily for starvation because their mothers weren’t breastfeeding them, but were, instead, struggling to afford to give them formula. So, Dr. Newman became a breastfeeding advocate for the first time (Newman, 2003).

             Upon his return to Canada, Dr. Newman then went on to start several breastfeeding clinics in hospitals in his area and began to realize that breastfeeding is a major public health issue (Newman, 2003). He began to notice that the information being given to new moms in many hospitals was (and is in my experience) quite poor and often illogical. As he put it, “Once I started examining it, I realized the whole system works against mothers and babies breastfeeding. We have stacks of research to show that breastfeeding is important for the health and optimal development of babies, and yet it is too often seen as expendable and unimportant” (Newman, 2003, p.5).  My experience definitely aligns with Dr. Newman’s experience. Few people realize that breastfeeding is not always easy and when women encounter difficulties and have no support, far too many professionals, friends, and family encourage them to quite. I can’t count the number of times that I have heard someone say, “Well, I was raised on formula and I’m fine!” as an excuse for not supporting women and babies who are learning to breastfeed. Formula has its place, but it should be considered a last resort, in my opinion (Newman, 2003).

            Dr. Newman also points out that a pack of cigarettes comes with a label that says the ingredients are known to cause cancer, but when people speak about giving babies formula versus breast milk, they say that breast milk offers benefits for mom and baby that formula does not provide. Dr. Newman says then goes on to say, “If women who were breastfed as infants show (as they did in a recent study) a decrease of 25 percent in breast cancer rates when compared to women fed formula as infants, this can- more accurately- be restated this way: Women who were fed formula as infants had a 33.3 percent increase in breast cancer rates” (Newman, 2003, p.9).  Why is it that this public health issue is always presented in a way that downplays its significance? In fact, the benefits that breastfeeding provides (and formula doesn’t) are vast. Children who were breastfed as babies score higher, on average, on tests of intelligence and development. Babies are less likely to develop diabetes is they are not introduced to cow’s milk until after one year of age. Some researchers have found links between formula and SIDS. Breastfeeding has been shown to decrease chances of developing allergies, asthma, and ear infections. Immunity is also boosted by breastfeeding, and increases the efficacy of vaccines (Newman, 2003). I, myself, breastfed my youngest daughter until she was nearly three years old. During that time, she had very mild eczema that we never thought much of. After I weaned her, she developed severe eczema, respiratory problems, and a huge gamut of food allergies became apparent. While breastfeeding didn’t keep those problems from happening all together, the immune boosting qualities of the breast milk, were what kept her from developing those ailments for her first three years. I am so grateful that I was able to nurse her as long as I did and that she didn’t have to spend those formative years itching horribly and in and out of the hospital.

            The incredible gift that breastfeeding is really came into focus for Dr. Newman when he worked in Africa in the early 1980’s.  A look at breastfeeding in Africa continues to shine a light on the power of breastfeeding today. According to Unicef, three million children under the age of five die each year. Of those, Unicef estimates that hundreds of thousands of lives could be saved if their mother’s were to exclusively breastfeed (2014).  Some of the highest rates of mortality and malnutrition in the world are present in Central and West Africa. 56% of deaths of children under the age of five are due to malnourishment.  Unicef says, “Protecting, promoting, and supporting breastfeeding could be the single most important child survival intervention in the region. Exclusive breastfeeding alone has the potential to avert 13 per cent of all under-five deaths in the region” (2014). While breastfeeding is a part of the culture in all of the regions of West and Central Africa, Unicef estimates that only 20% of babies exclusively breastfeed for the first six months of life. Indeed, the rates of breastfeeding are amongst the lowest in the world. Unicef’s goal is to make breastfeeding education and direct support available to all breastfeeding women through implementation of community support. “This means promoting the benefits of breastfeeding at the community level to ensure that each and every mother is supported.  This includes the creation of community structures such as mother to mother groups, health system support to breastfeeding mothers, health worker, community health worker and lay counselor training, workplace support and assisting breastfeeding mothers affected by emergencies, HIV and other crises” (Unicef, 2014). (I’ve left the links in above, so that you could check out more individual stories on Unicef’s website).

            The story that Unicef paints about breastfeeding in Central and West Africa really speaks to the reality of how tough breastfeeding can be without support. In my experience, many people mistakenly believe that breastfeeding comes easily and naturally and takes no education. For some, that is true, but for so many it takes vigilance, commitment, and lots of support. Even in San Francisco, one of the most liberal areas of the United States, where many moms feel pressure to breastfeed and are embarrassed to bottle-feed in certain circles, the medical world is filled with mixed messages about breastfeeding.  When I was in the hospital six years ago after the birth of my oldest daughter, for example, some nurses would not let me have a breast pump when I couldn’t be with my daughter in order to stimulate my milk coming in. Nurses on other shifts would ask me if I had been pumping and be horrified that I hadn’t. One Neonatal ICU doctor even chastised my wife, telling her she was being “negligent” by not giving our daughter a glucose drip or formula before she was even twenty-four hours old! Even a cursory understanding of lactation would teach you that that is unnecessary! This is not an unusual story. I hear stories like this nearly every day. This is a huge part of the reason that I do what I do. I work to support, normalize, and connect together new moms, so that they don’t feel isolated, have the information and connection that they need to learn and thrive, and so that what they are going through is very common. Breast milk and the experience of breastfeeding are some of the most magical, powerful gifts that a mother and baby can have, and the benefits are vast. If you have a breastfeeding story that you would like to share here, I would love to hear it! Thanks!

All the best,

Lauren

References

Newman, J. and Pitman, T.. (2003) Dr. jack newman’s guide to breastfeeding: the Canadian expert offers the most uo-to-date advice on every aspect of breastfeeding. Toronto, Ontario: Harper Collins.

           

Unicef. (2014) Promoting and protecting breastfeeding. [Website]. Retrieved from http://www.unicef.org/wcaro/english/4501_5055.html.

Birth Stories

Tell you a story about birth?!...

Well, twist my arm! I have been given an assignment to write about birth!! For this birth and postpartum doula, homebirth mother of two, infant sleep consultant, and mommy coach, this is really a dream assignment. I’ve been thinking all week about which birth story I would like to tell, and I decided that I would have to tell two, the two most important birth stories of my life, those of my two daughters.

            My oldest daughter, V, came into the world with a fair amount of drama. I was quite large and everyone had been telling me I was going to pop any day for months. I had a knowing she would come early and at 39 weeks, it felt as though she was never going to come. It turned out I was just waiting for my mom to come into town. My mom had rented a little house to stay in around my due date and we went out to dinner that night. I ate lobster, and my wife drank just a little bit too much wine.

            I went to bed that night expecting nothing, but apparently all I had needed to give my little one the sense that it was time to make her appearance was the comfort of knowing that my mommy was near. I woke up that night around 2am in child’s pose and very crampy. I was tired and didn’t think too much of it, other than, “Well, that ‘s odd! I don’t usually do yoga in my sleep!” I went back to sleep and woke up two hours later in child’s pose again. This time I was getting the feeling that something was happening, but knowing that early labor can be long and the best thing that I could do was rest, I went back to sleep. I woke up at 7:00 in child’s pose again, but having some mild contractions. I woke up my wife, Joan, and let her know about my nocturnal yoga posing and let her know that it was probably the big day.

            My wife was just slightly hung over, as I mentioned, and we knew that I needed to get some good food in my body, so we decided to go out to breakfast. We gave the midwife a head’s up phone call and went about our business. I had contractions as we were getting ready and was really intimidated by how tough they were, but I knew that this was only the tip of the iceberg, so I did my best to keep going. I felt a wave of intensity and a desire to escape my body. We soon got in the car and drove out of our little canyon. By the time we reached the highway (about three minutes) I had had two contractions. We thought it a fluke and kept going, but contractions continued to grow in intensity and length, as well as frequency. We turned the car around. Joan drove us to Starbuck’s instead because she knew she was going to need coffee, at least.  I was not willing to be alone and went with her into Starbucks! I had a contraction against a pole outside, as well as one that started in line and ended in the bathroom. We went home after that.

            The whirlwind that follows from this point is hard for me to retell in any sort of linear fashion. I was in active labor, for sure. My acupuncturist, midwife, mom, sister, and the assistant midwife were soon there with us. I remember trying to get away from the pain and thinking my doula/assistant midwife was crazy when she told me to “move towards the pain.” I remember trying to sit on the toilet and it being too excruciating to bear.  I don’t remember how I ended up naked, but mamas always seem to, and I was no exception. I remember my midwife having me walk the stairs and vomiting on the stairs and knowing somewhere in my far away doula brain that I was in transition. I remember the shower- the glorious shower! It was in the shower that I was able to get in front of the pain, if that makes sense. It was then that I decided that I could do this and, if I was going to do it, I was going to do it with gusto.  I started doing deep squats and then standing up and pulling one leg at a time up into my armpit. I’m a dancer, so I’m pretty flexible and it was a very big range of motion. In my head, each squat and leg lift was pulling my cervix open around the baby’s head like a turtle neck sweater. The water made it tolerable and I felt powerful for the first time. And then the hot water ran out.

            I then remember hours of being on all fours on a blue tarp in my bedroom with so much pain in my back. I remember my mom pushing on my back, my wife everywhere at once (in a good way), and my acupuncturist putting needles in to keep labor moving. It seemed unfathomable that the pain would not kill me and that I had to face it again as each wave came into me. But the waves came and I survived, and after a few hours, I learned to open to it. I learned the art of sweet surrender. All the time I knew that I was well taken care of.

             I tried to get in the birth tub, but immediately wanted to push. My midwife checked me and I was only at 7cm and could not, so I got out and went back to laboring on the ground.  Later I got back in the tub and felt some relief and release. I was checked again and was fully dilated. I squatted in my wife’s arms and pushed for what seemed like an eternity. I was really tired. Really tired. Really, really tired. I was far away, too. It was like I was watching myself from another universe. My wife wanted to catch the baby, so she switched places with my mom. My mom held me as, after about forty minutes of pushing, my daughter arrived into my wife’s capable hands. Everyone was joyous as the moment approached. I was far away. I wanted to feel joy and I even had the presence of mind to feel guilty about not feeling joy, but the best emotion available to me was relief. I was just not really in the room, if that makes any sense. Well, read on, and it will.

            Just as V emerged and was handed to me, the umbilical cord spontaneously snapped, spraying blood like a firehouse all over everyone. The midwife got very intense- she sort of calmly panicked, letting the word, “fuck,” slip out of her mouth. The assistant midwife handed her the clamps and all was well quickly. It left a feeling of panic in the room, though. By now a third midwife, a less experienced midwife, had arrived.  She worried that V was not okay, though she was only slightly purplish and pinked up quickly. In retrospect, I think that she was panicked due to the unexpected and very unusual snapping of the cord. I think she expected something to go wrong.

            Meanwhile, we waited for the placenta. After what seemed like an hour of being far away and trying to nurse and sitting in bed disoriented and drunk on my wife and my daughter, my midwife gave me herbs to make the placenta come. It didn’t. She then gave me Pitocin to make the placenta come. No contractions or placenta at all! My body knew better somehow and blocked that Pitocin’s affects for a very long time. At this point our midwife gave us some choices. We could do a manual extraction at home or in the hospital. The risk was hemorrhaging either way, which, of course, is much safer to do in the hospital. So we transported. We left the baby with my mother, which makes me sad now, but we didn’t have enough room in the car for everyone and I needed my wife more than my daughter at that point.

            We drove to the hospital- 12 minutes. I laid in the backseat and the Pitocin finally kicked in. I was ready for drugs now. The baby was out and I felt that I shouldn’t have to be feeling huge contractions anymore! When we got there, they were waiting for us with a wheelchair outside and a team holding doors and elevators for me as they rushed me in. When I stood up to get out of the car I passed a blood clot so big that I thought that I had passed the placenta. No such luck. They attempted to extract the placenta, but it didn’t work and I started to bleed out. I went unconscious and they wheeled me away to do D & C. While all this was happening, our midwife got a call from the 3^rd midwife saying that V is on the way to the hospital in an ambulance because she had had a seizure.  This was before I was unconscious and my midwife and I just looked at each other and knew somewhere deep that it wasn’t true. My wife, on the other hand, thought she was going to lose everything.

            V arrived in the hospital and was monitored for three days. The official diagnosis was “overly concerned grandmother,” which was rude, but very far from a health problem. We later put together that V had an extraordinarily strong Moro reflex. My mom and I both have had seizures in our lives, though I hadn’t been medicated or had any problems with it in many years. But the midwife was new and a bit green and was scared by the snapping cord and she panicked as they were putting V in the car seat and a cold gust of wind came up and she stiffened and startled so dramatically. I believe our history of seizure disorder came into her mind. At least that’s the best I can piece it together. My family’s reaction to this news likely escalated the whole thing and we were off to the races. Regardless, it’s always better to be cautious with homebirth and I can’t be upset with the midwife for doing everything she could to take care of my daughter.

            I came out of surgery fine, but had lost half my blood volume. They wheeled me to the NICU, where I saw V and she actually smiled when she saw me. But I felt like a human anvil and it was hard to even lift my arms. The nurses told me I needed to rest and couldn’t go see my V again until I could stand up. After crying with my wife and swearing we’d never have another baby, I fell asleep. When I woke up, I decided I would see my baby NOW, and attempted to stand up. I stood up for a moment and then toppled. They then gave me a blood transfusion, thank goodness!
            Over the next few days, we found our breastfeeding relationship, despite all of the roadblocks and were lucky enough to take to it quite well. It took me more than a month to feel relatively normal after the blood loss, despite two blood transfusions. V and I bonded quickly, though, and we were inseparable. Our forced separation really affected our early months. I wouldn’t let her out of my sight and she would scream if I left hers. It was a rocky beginning, but, as I’ve gotten to know her, it all makes a lot of sense. Her first word was, “Space!” She is a fiercely independent person and she expressed her need for space the moment she came into this world and magically snapped that cord! Then she needed to get to me, so she found a way to get to that hospital, too. She is an extremely capable, happy, and healthy girl. Incidentally, it only took about three or four days for the oxytocin amnesia to hit and I wanted to have another. ;)

            My youngest daughter’s birth was in every way more gentle and peaceful than her older sister’s. W came ten days early and was born in four hours of gentle labor. And, yes, I did have her at home even after that harrowing first birth experience. I believe mothers should give birth where they feel the safest and having seen what I have, the hospital is not that place for me. There is an increased risk of repeated retained placenta if you have had it once, but my midwife felt the retained placenta was related to the cord snapping and the cord snapping is considered a rare fluke.  So, with a lot of extra precautions, I gave birth at home. I woke up at 3am in labor with W, and, like her sister, it took off quickly. Our midwife was a few hours away at a conference and was about to come back to trade places with her back up so that the back up could go to the conference. They later told me that they could tell that I was in transition at the initial call by the sound of my moans, so the back up came right over. When she arrived she found me sitting on the floor rocking back and forth in our office. “Are we having a baby in here?” she asked. We went upstairs and, to my shock, she said I could already get in the tub. So I sat in the water and rocked, pressing on the inguinal ligament and moaning a low moan, waiting for the real pain to start. It never did. They checked me and I was just shy of fully dilated. A few more minutes and I was ready to go, but didn’t feel ready. My midwife suggested to me that sometimes moms have to decide when it’s time for the baby to come with second babies, which I mistakenly took as a cue that I needed to do that NOW. So I got out, sat on the birthing stool and PUSHED despite not having the urge. In retrospect, I wish I had just waited until the urge came, I suspect it would have been easier. Anyway, I pushed for a half an hour harder than I’ve ever done anything in my life. The bag of water was still intact, so the baby and the bag would come bulging out with each contraction and then go back in. Everyone thought the baby would be born in the caul (with the bag of waters intact). Instead, I finally broke the bag of water, soaking my entire birth team in amniotic fluid! I then said, “I need to take a nap,” and lay down and slept. My wife nudged me and got me to eat a honey stick to bring my blood sugar back up. After a half an hour, the contractions had built back up and woke me up. I promptly kicked most of my birth team out of the room and took my wife’s hands. Just then, V woke up and my mom went down to get her.  I squatted and pushed W out in one push. My wife caught her as the midwife was running to get gloves, while hollering “Catch the baby, Joan!”.

            W let out a little cry, which was the only one we heard for several weeks. She was a mellow thing. V and my mom came upstairs and, after the cord had pulsed out, V cut the cord (with help) at age 2 ½. She then said, “NOW can I get in the birth tub?!”. The placenta emerged within a few minutes gracefully and intact. There were no complications. Just bliss. I got a message from my doula just the other day that someone had asked her what her favorite birth that she had ever attended was. She had promptly said W’s. It really was magical. My wife and I were so connected through the whole thing. There was laughter throughout, and never any sense of heaviness or emergency. W and I were completely in sink. I talked to her throughout.

          I could not be happier that I had two homebirths. As different as they were, they were both filled with just the right lessons that I needed at just the right times. And the joy... Oh, the joy was unprecedented!

Birth In Haiti

            My midwife is a hero of mine. Besides being an incredible midwife and person, she is also an activist working in the United States and in Haiti. Her blog postings, stories, and photos of her work with Midwives for Haiti have been very inspiring to me. So, when I was asked to research birth in another region of the world, I decided to research Haiti.  I have been pretty blown away by what I have found.

            Haiti is a rough place to give birth to say the least. While poverty, sanitation issues, and issues of infectious disease were significant issues in Haiti before the massive earthquake in 2010, they are even worse now (New York Times, 2010). An article in the New York Times from late January 2010 discussed the bleak reality that pregnant Haitian women were facing. According to the times, the United Nations estimated that 15% of pregnant women in areas of Haiti that were affected by the earthquake were likely to face complications that could cost the baby and/or the mother’s life/lives (2010). But even before the earthquake, infant and maternal mortality rates were extremely high in Haiti coming in as the highest in the Western Hemisphere. According the United Nations, in 2010, for every 100,000 women who give birth, 670 die (New York Times, 2010)!! Hepatitis, typhoid fever, and HIV are also large problems in the region (www.indexmundi.com, 2013). Problems with sanitation in both urban and rural areas and many areas don’t have access to clean water. In 2006, child labor rates were at 21% and literacy at 48.7%. Haiti is a country grappling with extreme poverty.

            Birth in Haiti is dangerous and prenatal care is difficult to find, especially in rural areas. The additional blow of the earthquake made things worse for birthing mothers, as well. The high rates of infant and maternal mortality are not surprising given the lack of care, high risk of infectious disease, lack of education, poor sanitation, and lack of access to good quality food and water. Organizations like Midwives For Haiti are working to train men and women as skilled birth attendants so that they may help bring information and care to pregnant women in both urban and rural parts of Haiti. In addition to training midwives, these skilled midwives and birth attendants travel through rural parts of Haiti as a mobile clinic, providing care and information to hundreds of women. Without access to midwives or OB care, many women give birth literally in the dirt. One woman, Ms. Antoine, who gave birth in a crowded, hot hospital tent in 2010 after losing her husband to the quake, said “The street where I live, it’s so dirty; there isn’t enough food or water… I’m scared to bring a baby into this awful situation” (New York Times, 2010).

            Reading these statistics and stories, and hearing from my midwife first hand about the incredible spirit of the Haitian people and the amazing work that her organization is doing, I realize how lucky I am. Not only to be giving birth in a privileged part of the world, but also with the privilege of empowering education and experience that allowed me to make good choices about how and where I would give birth. To have birth options in the first place makes me very fortunate indeed. There may be some similarities between the way that I gave birth at home and the way that many Haitian women give birth at home… Indeed, the process of birth has basic similarities for all women. We squat, walk, moan, yell, cry, hum, and deal with pain in whatever ways we can. At some point, we all learn surrender. But what are the differences? Well, for starters, I had a very skilled attendant and a hospital very close by. I knew that I was being taken care of and was safe. I can barely fathom what it would feel like to give birth knowing that both you and your baby could easily die. And, in my case, if I had given birth at home in Haiti with my first daughter, I would have died, and, perhaps, without me to care for her, she would have, too. Perhaps, more important, is the question of how her development after birth would have been affected by living in Haiti rather than here? If I had lived in Haiti would I have been exposed to typhoid or rubella when I was pregnant? Would V have been born healthy? Would I have had sufficient food to feed her? Would sanitation problems have caused her to fall ill? If she had made it through the early years and months, would she have had the opportunity to learn to read, as she now knows? It is possible, but very unlikely. Relationships protect our children from a lot, but they can’t protect them from everything.

            There are a lot of problems with health care in this country and certainly a lot of birth practices that are sub par in this country, but, overall, we are extraordinarily privileged. I am grateful to women like my midwife, who put their money where their mouths are, and do something to really make some change for people in places that don’t have what we do. My wife and I often talked about volunteering for Midwives for Haiti and travelling to Haiti when our children are grown. I hope that that happens. I would love to share what I know and learn from the incredible midwives and women of Haiti.

Sources:

New York Times article:

http://www.nytimes.com/slideshow/2010/01/29/world/0129BIRTH_index.html

Midwives for Haiti: www.midwivesforhaiti.com

Statistics about Haiti found at: http://www.indexmundi.com/haiti/demographics_profile.html