The Unsolicited Advice Show, The Doula Edition

Host: We have a very special guest today on “Unsolicited Advice!”  We are happy to welcome Leslie, who had a baby three months ago.  Leslie’s here to talk about her doula.  Leslie, what on Earth is a doula?

Leslie: According to Ina May’s Guide to Childbirth, “...doulas are sympathetic and knowledgeable labor companions who typically provide some form of prenatal preparation and stay at your side once labor begins until your baby is born.” (location 4100).  Our doula, Kelly, met with us several times before I went into labor to discuss our goals for birth and make plans for how we would achieve them.  I worried that, because she had delivered all three of her children at home, she would judge our decision to have a hospital birth.  My worries couldn’t have been more unfounded.  She cared deeply about helping us reach our goal of having as few medical interventions as possible in a hospital setting, so she spent plenty of time teaching us pain management and relaxation techniques.  She also provided some prenatal tutelage in breastfeeding, as I wished my baby to be exclusively breastfed for the first 6 months.

Host: But surely with such clear goals in mind, you could have done just as well researching and carrying out a plan on your own.

Leslie: On the contrary.  Let me read you an excerpt from Vital Touch by Sharon Heller, page 19.

Her impact? Powerful!- a 50% reduction in c-sections; 25% reduction in length of labor; 40% reduction in use of oxytocin to increase contractions; 30 percent reduction in need for pain medication; 40 percent reduction in use of forceps; 60 percent reduction in requests for epidural and less pain during labor.

Host: Couldn’t your husband have provided ample support to achieve all these things?  

Leslie: Don’t get me wrong.  Dan supported me in everything I wanted for Alice’s birth, but he was no more experienced than I was!  The expectations for husbands during labor and delivery are really laughable, if you think about it.  We don’t even expect future doctors to be able to handle new situations so well at first.  Ina May’s Guide to Childbirth puts it this way in location 4117:

...medical students are expected to get pale and sweaty when first exposed to new medical situations, they note there are no consequences when they must leave.  On the other hand, no such allowances are made for first-time fathers.  When they must leave, the mother is left alone and often resents her partner’s absence.

Dan supported me, as I said, but when I told him I had decided to try to forgo an epidural, you should have seen his face!  The possibility of watching me go through all that pain didn’t thrill him at all.  When Kelly began to show him what he could do to help, he felt a lot better.  She further ameliorated the situation by assuring him that she would be there the whole time, so he wouldn’t have to remember everything on his own.  (She wasn’t kidding, by the way.  She never slept during my whole 35-hour labor!  She was by my side the whole way.)  

Host: So your husband just needed a little extra help.

Leslie:  His feelings were not uncommon.  Ina May wrote, “Fathers often have significant fears and anxieties surrounding birth-giving.  The calming influence the doula can have on expectant fathers is often as significant as her effect on the laboring woman.” (Ina May’s Guide to Childbirth, location 4107).  Dan blessed me by being perfectly calm and cool during the whole birth process, even holding a leg up while I was pushing!  But Kelly’s presence and expertise took the pressure off of him to be my only support.  She held my other leg up, by the way!

Host:  Wow!  It seems like Kelly really made a difference in your birth experience!  But is it really worth the expense of hiring a doula?

Leslie: Without question!  To again quote Vital Touch, page 19, “The doula’s power doesn’t stop with birth.  Mothers who had a doula feel better about their delivery, have far less postpartum blues, and show increased self-esteem six weeks postpartum.”  This was true for me.  Most women, when asked about the birth of their children, will tell you a horror story.  When someone asks me how Alice’s birth was, my unhesitating and truthful answer is always, “So wonderful!”  Kelly, Dan, and I laughed, we played, we worked hard, and we stuck it out together.  Even though I still think of the pain and shudder, and even though I was unsuccessful when it came to resisting pain relief (read my birth story here), I feel very positive about my labor and delivery.  This positivity has helped me see my body as a powerful instrument of life, instead of focusing on the stretch marks and extra weight that pregnancy left behind.  Truly, I’d say a doula, or more specifically, a terrific doula like Kelly, makes having a baby a cool, fascinating, and even fun experience instead of a scary and painful one.

Host: Any parting wisdom to impart on our audience?

Leslie:  Yes.  I would just like to wrap it all up by saying that a doula is really essential.  Don’t weigh the pros and cons, just do it!  You won’t find any cons anyway.  Your doula will become a part of your heart forever because of her love and care during this special moment in the life of your family.  Please message me if you would live near me and want to contact my doula.  You won’t find anyone better!

Trim Healthy Mama

When I tell people I’ve struggled with my weight since college, I often get a big eye roll.  Back then I struggled to maintain a body that was at least 15lbs lighter than was healthy, going so far as to binge and purge for several years in its pursuit.  I got over that only to gain about 20lbs in my twenties due to some unhealthy and borderline addictive habits.  Then I settled into a comfortable marriage (and a 2-glass-a-night Pinot habit) and gained 20 more.  Finally, I started a stressful new job and 9 more creeped up on me.  That put my 5’ almost 4” frame at a solid 169lbs for those of you who’ve been counting along!  I carried them well (hence the eye rolling), packing most of them into my breasts and hips, but I knew that they weren’t doing me any good, so I endeavored to lose them before I got pregnant.  Imagine my surprise when those two pink lines showed up just two weeks after we started trying!  I shed the 24lbs I gained during pregnancy within a couple of weeks, then another 10 or so dropped off because I never resumed my wine habit.  That’s where I find myself now.  I know I shouldn’t do a hardcore diet while breastfeeding, but my supply is more than adequate and I feel like I can stand to make a few healthier (skinnier) choices, which is why I’m starting Trim Healthy Mama.

Originally, I planned to do Weight Watchers, as I lost quite a bit of weight with them a few years ago.  However, after using Weston A. Price Foundation’s (WAPF) protocol to easily get pregnant, I am aware that Weight Watchers promotes a diet that would leave me deficient in some essential fats and nutrients.  Instead, I decided to try to adhere to WAPF recommendations for pregnant and nursing women (the following is copied and pasted straight from the WAPF website):

• Cod Liver Oil to supply 20,000 IU vitamin A and 2000 IU vitamin D per day, which is provided by 2 teaspoons high vitamin cod liver oil (Green Pasture brand).
• 1 quart (or 32 ounces) whole milk daily, preferably raw and from pasture-fed cows (learn more about raw milk on our website, A Campaign for Real Milk, www.realmilk.com)
• 4 tablespoons butter daily, preferably from pasture-fed cows
• 2 or more eggs daily, preferably from pastured chickens
• Additional egg yolks daily, added to smoothies, salad dressings, scrambled eggs, etc.
• 3-4 ounces fresh liver, once or twice per week (If you have been told to avoid liver for fear of getting “too much Vitamin A,” be sure to read Vitamin A Saga)
• Fresh seafood, 2-4 times per week, particularly wild salmon, shellfish and fish eggs
• Fresh beef or lamb daily, always consumed with the fat
• Oily fish or lard daily, for vitamin D
• 2 tablespoons coconut oil daily, used in cooking or smoothies, etc.
• Lacto-fermented condiments and beverages
• Bone broths used in soups, stews and sauces
• Soaked whole grains
• Fresh vegetables and fruits

AVOID:

• Trans fatty acids (e.g., hydrogenated oils)
• Junk foods
• Commercial fried foods
• Sugar
• White flour
• Soft drinks
• Caffeine
• Alcohol
• Cigarettes
• Drugs (even prescription drugs)

IMPORTANT WARNING: Cod liver oil contains substantial levels of omega-3 EPA, which can cause numerous health problems, such as hemorrhaging during the birth process, if not balanced by arachidonic acid (ARA), an omega-6 fatty acid found in liver, egg yolks and meat fats.  Please do not add cod liver oil to a diet that is deficient in these important animal foods. It is important to follow our diet for pregnant mothers in its entirety, not just selected parts of it, which is provided by 2 teaspoons high vitamin cod liver oil (Green Pasture brand).

As you can see, it is a tremendous amount of food!!  I wanted to find a way to temper the massive calorie count that comes with such a list, so I started watching YouTube videos on WAPF to see if I could come up with anything.  It was while doing this that I came across one mom’s testimonial on Trim Healthy Mama.  

At first glance, the Trim Healthy Mama plan seemed to give me the freedom to eat the foods I needed to adequately feed Alice, so I decided to look into it further.  I learned that the main idea was to combine food fuels in a way that would help my body burn its fat stores.  Satisfying, or S, meals use fats as their main fuel while eschewing carbohydrates.  Energizing, or E, meals are full of carbs and exclude fats.  The idea is to eat only one kind of fuel at a time.  This, along with all kinds of other complicated protocols that I haven’t learned yet, will give my body a chance to burn away excess fat, while I still eat all the nourishing foods on the WAPF diet.  

If I have any success, I plan to write more about it!  Maybe I’ll do a weekly post or post of my menu plans or food logs or whatever.  Would you read about it if I did?

My Birth Story

You’ll notice that I’ve written this post a bit like a journal entry.  As you may have guessed, I didn’t actually write it as it was happening!  I just found myself remembering it in this way, and I thought it might be fun to record it for myself and for Alice this way.

I’ve also included an episode that occurred 2 weeks after I gave birth because it was very much a part of the special story of how Alice got here.  Sorry for the length!

The Best Laid Plans

I would like to have as natural a labor and birth as possible in a hospital setting.  My friend, Kelly, is my doula, and she’s been working with Dan and I for months on pain management strategies.  All 3 of her children were at-home water births, so she knows what she’s doing.  She is going to help us implement a 3 positions, 3 contractions plan.  If I’m losing my cool, Dan will suggest that I try another position for 3 contractions.  We’ll do that 3 times and reassess my need for medication.  I like this plan, as it keeps me in control and prevents me from acting on impulse.  I’m also hopeful that my physical strength from continuing karate training will help me.  I’ve always been an athlete, beginning with hard core competitive swimming when I was a kid, so I know how to push my body.  I’m also told that exercise at least 4 days a week can shorten labor to 10 hours or less, so that’s a plus!  Finally, if I don’t have to have Pitocin, I think I can handle labor, that’s where our last strategy comes in.  I wish to labor at home as long as I can to avoid as much medical intervention as possible.  I think I have a good chance of making it!

Troubled Waters

I am calling the doctor because I have noticed some discharge that wasn’t there before.  Yuck.  Pregnancy isn’t glamourous.  The doctor says that I may have broken my water and that I should go ahead and get checked at the hospital.  Apparently a person can break her water without having a dramatic gush follow.  The baby’s head could be blocking the flow, causing very little release of fluid.  I don’t want to go, because if my water is broken, they’ll admit me and make me do my whole labor there.  That’s not part of the plan!

Checking Out, Checking In

Kelly convinced me to get checked out, so we reluctantly grabbed the bags and headed in.  Right up until now I thought we would be turning around and heading straight back home.  The doctors weren’t able to agree on whether or not I’d ruptured my membranes, so they’ve checked me out over and over.  The third Ob is finally affirming that the water bag is broken.  We’ll now be checking into our Labor and Delivery room which, if all goes according to plan, will be our home for the next 10 or less hours.  However, I’m concerned because my contractions are far apart and not painful at all.  Labor hasn’t really started.

Pump Up the Jam

The doctors have given me 18 hours to get labor really going before the chance of infection increases dramatically from my water being broken.  When my time is up, it’s the Pitocin for me.  Dan, Kelly, and I are now running around trying every labor-starting strategy we can think of, which is to say that Dan and I are following Kelly’s instructions!  I’ve walked up and down the hallway, bounced on a birth ball, and pumped with the hospital’s breast pump.  When Kelly suggested squats, I convinced her to do karate stances down the hall in front of the nurse’s station with me.  I think it’s working!

Lots of Pain, No Gain

I’m trying my best to hold still as the nurse checks my progress.  I started having real contractions about 8 hours ago, but I still feel like I’m handling them pretty well.  I’ve agreed to let them hook me up to a Pitocin drip because I’m starting to get tired with no sleep since yesterday afternoon’s short nap, and no food since yesterday’s lunch.  I’m 19 hours in, and even I’m starting to worry about infection.

Enough is Enough

I’m praying (loudly) through contractions as I wait for the anesthesiologist.  Before the Pitocin I was at a 2.5 (which is what I checked in at as well).  Once it kicked in my contractions went through the roof.   Kelly told me I was probably experiencing them as they would be in transition.  I was able to do 3 hours, the last of which I tried being in the tub.  Everyone said that this would help a lot, but I didn’t find it helpful at all.  I pulled myself into a squatting position through each contraction, trying to make some progress.  Finally, I had had enough.  I wanted the drugs.  They were about to check me anyway, so I said that if I was an 8 or a 9 I would keep going.  I wasn’t I was...wait for it...a 2.5.  No progress at all.  Time for a little help!

The Best Thing in the World

Whenever an epidural came up in conversation with other moms, it was always described as “the best thing in the world.”  Now I can confirm that this is an accurate description!  The process wasn’t nearly as scary as I thought it would be, and 3 contractions later, the pain was gone.  Dan was able to lay down on the couch to catch some rest, and Kelly and I are just sitting and chatting as if I’m not lying naked in a hospital bed waiting to push a human out of my hoo-ha!  My sense of humor has returned and I’m joking around with the nurses.  Now we wait.

Push It Real Good

They told me for 5 hours that it was almost time to push.  Now it really is!  My delivery nurse, Lee, is really funny!  She says that most new mothers take about 3 hours to push, but she’s too old for that, so we’re going to do it in 2!  I have no intention of pushing for 2 hours.  All the working out didn’t help this labor go any quicker, I’m determined to use it to my advantage while pushing.  

The whole NICU team is here because there is meconium in the womb, but I’m not concerned for some reason.  I know the baby is going to be ok.  I’m a bit disappointed that they won’t be able to put her right on my belly and delay cord-clamping, but as long as she is healthy I don’t mind so much.

Moving

Lee is pushing Alice and me down the hallway to our new Mom and Baby room.  Dan is by our side.  Kelly prayed with us, then went home a few minutes ago to be with her own babies.  

I pushed for just over half an hour before my baby was delivered.  Lying on my back with my legs up didn’t feel good to me, so I had Kelly and Lee help me turn over and lean over the back of the bed in a kneeling position.  I was able to move Alice down pretty quickly that way.  Then they made me turn back over for the last few pushes to get her out.  With my nature being very low oxytocin, I worried that I wouldn’t connect right away with my baby.  But as soon as she slid out, I was Momma.  I couldn’t see her for a few minutes while they took her to the other side of the room to help her breathe, so I sent Dan to keep watch.  She hadn’t aspirated meconium, so they were able to give her back to me pretty quickly.  I cuddled her against my chest for only a few minutes before she started trying to get down to nurse.  Kelly showed us how, and she nursed for a good, long time.  

During all this, my doctor was having a terrible time.  My placenta had to be delivered in pieces, so she was up to her elbows in my uterus making sure it was all out.  I caught a glimpse of the long, thick surgical twine she used to stitch me up, but I really didn’t pay any attention.  It was just me, my husband, and my baby.  

Return to the Scene of the Crime

Here I am, back in the hospital.  I’ll be discharged later on today, but it’s been an eventful 2 weeks!

Alice and I were discharged with a clean bill of health 2 days after her birth, though we worried that we wouldn’t be, since I was running a slight fever and recording highish blood pressure.  I began my maternity leave feeling well, fully able to do the sleepless nights.  However, as I went along, I began feeling sick; it was a bit like having a mild flu.  My stitches didn’t seem to be healing either.  I had never had a baby before, so I didn’t know what was normal.  By about 10 days postpartum, however, I knew something was really wrong.  I made an appointment with my Ob-gyn and endured an excruciating internal examination.  Even just pushing on my abdomen was painful!  My doctor told me that I needed to be re-admitted immediately.  I had an infection in my uterus that she suspected was spreading to my bladder.  She was aware that I had delivered my placenta in pieces and worried that I may have placental matter left in my uterus.  She felt it was imperative that I check back in right away, but I was hesitant.

I was panicked that I would have to leave Alice!  We were still perfecting breastfeeding and I didn’t want to mess with our success.  Ergo, my doctor admitted us back into the Mom and Baby ward so that I could bring her with me.  Thank God!  Dan also accompanied me because I would have to leave my room for tests and procedures and someone would have to take care of Alice in the meantime.  

It turned out that they only required me to leave the room once, in the end, for an trans-vaginal ultrasound to check for placental matter.  I pride myself on my toughness, but tears ran down the sides of my face as the technician moved the wand around the infection.  It was not my finest half hour, but blessedly, she found nothing.  Heavy duty antibiotics would take care of me...they thought.

Sadly, they were wrong.  I had to stay an extra night because the infection had somehow caused postpartum eclampsia and they feared my high blood pressure would cause a seizure.  They prescribed a blood pressure mitigator and observed me overnight to make sure I’d be alright.  What a scary experience, but it looks like everything is alright now.  Even with this little blip, I count bringing Alice into the world one of the best experiences of my life!

Cloth Diapering

One of my big “causes” is the landfill problem.  I could get onto my soapbox right now and start preaching away about the amount of waste we produce and what it’s doing to our planet… but don’t worry, that’s for another post.  I only mention it because I’m writing about cloth diapering for my beautiful friend, Abby.  She and her husband are about to welcome their first baby and they have decided to cloth diaper her.  As usual, I’ve offered unsolicited advice, even though I’m no expert.  I thought I’d just lay out the routine we do with Alice and hope it helps.

Most of my stash (collection of cloth diapers and paraphernalia) came from a Facebook garage sale!  The woman who sold it to me had the process down to a science, so I didn’t have to think much about how many of this or that I needed.  She gave me about 20 pockets (waterproof diaper covers that can be stuffed with absorbent inserts and used much like disposables)

and 30 microfiber inserts (insert: an absorbent something that you stuff into a pocket diaper.  It can be bamboo, charcoal, hemp, cotton, or microfiber).

A friend from church also gave me about 20 prefolds (a flat piece of cloth that has been folded into a rectangle and sewn into layers to use as a diaper- see this video for folding techniques),

2 snappies (a stretchy holder thingy for fastening prefolds (see the above video)),

and 4 covers (a waterproof  layer that goes over a prefold or insert so that baby’s clothes don’t get soaked).

If you’d like to build your stash for even less money, you could choose to purchase flats (just a large square of fabric that can be folded into a diaper or used as a pocket insert)

or even FSTs (flour sack towel.  You can fold it just like a flat or use it as a pocket insert)

instead of prefolds and do the folding for yourself!  

When Alice was a newborn, we used the nb sized prefolds with covers and snappies.  We didn’t have many that were small enough, so we did supplement our routine with disposables when I couldn’t keep up with the laundry.  As she got bigger, we had the option of using the larger prefolds with covers, or stuffing our pocket diapers and using those.  We do both.  If we choose the pockets, we stuff them with 1 prefold and 1 microfiber insert.  It’s a little bulky, but it keeps her from soaking through. Update: We have been doing only a prefold OR two microfiber inserts, not one of each, and it's much less bulky.

There are countless books, articles, and online support groups geared toward helping cloth mommas diaper their children because finding a routine that works can be difficult!  I, blessedly, have yet to have major trouble with my routine.  I use a diaper pail with a wet bag (basically a trash bag made out of polyurethane laminate that can be washed with your diapers) to keep Alice’s dirties until washing day.  I wash every 2 or 3 days depending on my schedule.  There’s no need to spray poo off before washing yet because we still have that liquid, ebf (exclusively breastfed) poo that can go straight into the wash, but we have a sprayer attached to the toilet for when we start solids.  I run a heavy duty wash with a prewash and extra rinse.  Though there are several schools of thought on the subject, I choose to add detergent to both the prewash and main wash.  Update: I was getting detergent stains on my clothes from the extra, undissolved soap in the machine. I ran a tub clean cycle and did some more research. I now use only about a teaspoon of powdered soap only in the main wash. It not only works fine, but my diapers seem more absorbent, maybe because the soap was building up before. My dryer uses dehumidifying technology instead of heat, so I have no problem throwing everything in.  If you have something different, however, you may want to be careful with your PUL and elastic.  Don’t stretch them when they’re warm from the dryer or they’ll lose their shape and elasticity, then you have leak problems.

Just a couple more things.  Don’t ever use fabric softener on your cloth.  It makes moisture repel instead of absorb.  Same thing goes for standard diaper cream.  They make special, cloth safe creams, or you can try coconut oil, but if you’re like me, you’ll find that you never need it.  Cloth is so gentle on the baby bum!  There is a footnote on this, but it merits a mention here, too: DO NOT USE MICROFIBER AGAINST BABY’S SKIN.  It will draw all the moisture out and leave an angry red rash.  Finally, I recommend using cloth wipes in tandem with cloth diapers.  It’s pretty easy to throw them in the same wet bag/wash with everything else, you’ll save more money, and you’ll decrease your waste even more!

Was this helpful?  Have some ideas I missed?  Leave me a comment below!

Road Trip with Baby Pt. 2

*In this post, I recommend using a pump and bottle to feed on a trip.  I know many of you will be opposed to this.  That’s ok!  Alice is an excellent eater and has never had any problems with taking a nuk, paci, bottle, anything.  She is normally breastfed, and I avoid the bottle as much as I can, but I’m not religious about it.  I would never recommend you do something that doesn’t work in your own breastfeeding relationship, I just want to share what works for us.  Thanks!

This is the second part of a 2-part entry on traveling with a newborn.  My husband and I made the 22-hour drive from Denver to Los Angeles for Christmas this year with our 10-week-old.  The first part of this entry was about what we did to prepare for the trip and how we planned for it to go.  You can read about it here.  This installment is a recount of how the trip went and what I would do differently.

We travelled for 10 days total, including 4 days in the car and 1 overnight motel stay each way.  Alice had her own backpack packed with 10 Ziplock bags.  Each bag carried an outfit for the day.  It worked out well because I could just grab a bag when I was ready to dress her in the morning, instead of trying to root around for pants, then a shirt, etc.  I wish I could have thought of a better way to organize it than Ziplocks, though.  I had a lot of used bags to either toss or try to reuse by the end of the trip.  In the end, it seemed wasteful.  If you have a better idea, I’d love to read about it in the comments!

Feeding Alice on the road was a learning experience.  I brought my pump and some bottles so we wouldn’t have to stop to nurse.  On the way out, I only pumped enough for each next feeding.  This meant that I was having to find a microwave every other time she ate to sterilize my 2 pump bottles.  I wised up on the way back.  My research revealed that breastmilk is generally good for 4-8 hours at room temperature.  Using the 20-minute-per-side rule, I pumped as much as I could and used it for the next few feedings. Thus I only had to sterilize the pump once.  This worked incredibly well!  We chose Dr. Brown’s Natural Flow bottles to prevent gas and were pleased with the results.  Alice was expectedly gassy, but not so much that it made her fussy.  In fact, she slept for about 90% of the time!

Because of all her sleeping, we didn’t end up using her toy or nuk very much.  The Boppy pillow was endlessly valuable to the success of the trip.  Alice nursed, slept, and did tummy time on it.  It was most handy, though, when her cousin shared his cold and she couldn’t breathe well on her back.  We draped her over it to sleep on her tummy.

So, now that I’m a total expert (haha), here are my top tips for traveling with a newborn:

1. Your baby will probably sleep most of the way.  Bring a small toy, just in case, but there shouldn’t be any need to pack piles of stuff.
2. Organize your baby’s bag in a way that allows you to pull outfits easily.  You never know where you’ll be changing him/her or what accommodations you’ll have.
3. Pump and bottle feed if you can.  Milk lasts longer than you’d think, sterilization has become easier with the advent of the microwave sterilization bag, and you’ll save a lot of time.
4. Bring a Boppy pillow or the like.  It has many uses!