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Triple Feeding

Here is a made-up, but very typical, case-study.

Jo and her partner Sky had their baby a couple of weeks early, by cesarean. Because of the cesarean, Jo’s milk took a few days to “come in”. It’s very common, after the extra stress of surgery, for the body to take a little extra time to start producing mature milk.

And the baby, named Louis, has had trouble getting on the breast well, and emptying the breast effectively, because he’s a couple of weeks early, also a common problem. So he lost a little more than 10% of his birth weight in the first three days.

The maternity doctor recommended that Louis receive some formula to supplement his feeds at the breast. In order to make sure he was getting all the breastmilk possible, Jo would put him to the breast first, at each feed, and then top him up with 1-2 ounces of formula. And in order to make sure her breasts were completely emptied, Jo would pump after each feed for 10-15 minutes.

So Jo and Louis left the hospital on Day 3 and went home Triple Feeding

1. Baby to breast
2. Supplement baby with bottle
3. Pump to empty breasts

Jo found that every feed took over an hour, even if her partner Sky fed Louis the bottle while she pumped. Then Louis would sleep for a couple of hours and then wake up to start all over again. It was exhausting.

At Louis’ one-week doctor visit, he had gained only two ounces since leaving the hospital. Just barely enough. (Babies are supposed to gain an ounce a day, or about half-a-pound a week.) The doctor suggested Jo give him at least 2 ounces of supplement after every feed. Jo and her partner Sky went home determined to get Louis to gain weight well. And they did! The following week, Louis had gained 9 ounces! The doctor was happy and told them to keep doing what they were doing – it was clearly working.

But it wasn’t working. Jo and Sky were on a treadmill of feeding, pumping, and washing bottles, with little naps in between. It was taking both of them to manage and Sky had to go back to work in a couple of weeks. Jo broke down sobbing at the thought of coping with this all day alone. This was when they made an appointment to see a lactation specialist.

Reach out for help!

I see many little families like this one. They have overcome the hurdle of getting their baby to gain weight, but they are stuck in an unsustainable pattern of feeding. Much of what I do when I meet with them is help them figure out a way to feed their baby more sustainably, while making sure their baby continues to gain weight at a good rate.

For some families, I can help them wean from pumping and supplementing. Some will have to continue supplementing, but can stop pumping, and some may decide to pump exclusively. Some may decide to move to exclusive formula feeding. There are as many solutions to the problem of feeding a baby as there are families. It’s a matter of  helping them identify their goals, and helping them understand the pros and cons of various strategies.

What is true for everyone who goes through a period of Triple Feeding, is that they need support and guidance finding a sustainable way to feed their baby. If you are in the situation I described above, please ask your care provider for more help, and perhaps see a lactation professional as well. La Leche League also provides excellent help. The Victoria Breastfeeding Cafe on Facebook is a great way to get peer support.

Remember that, no matter how small the amount of human milk your baby gets, it is always of value. But your own mental health and comfort are also tremendously important. Feeding your baby, no matter how you do it, can be comfortable, manageable, and, dare I say it, even enjoyable!

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Is your baby a room-mate or a house-guest?

Curious Baby

Many years ago, a client told me about how she and her partner had felt about caring for their baby in the middle of the night: “Everytime he woke up and needed a diaper change we behaved as though a GOD had landed, and we both had to get up to worship him and cater to him.” After a few weeks of this, they decided they were “over-staffing the diaper changes” and did not need both parents to get up each time.

Many new parents in the baby groups I facilitate have told me that they don’t know what to DO with the baby, when, after a few weeks, the baby starts to stay awake for longer stretches and seems to be looking for something to happen. The parents say they don’t know what to do to “entertain” or “stimulate” the baby. The braver ones confess that they find it boring, to talk to a small baby and rattle toys in the air.

It makes me think of the difference between a house-guest and a room-mate.

When a friend or family-member comes to stay at my house for a few days, or even a week or two, I tend to focus on them. I cook special meals. I make them cups of tea. I might take a few days off work to spend with them or make sure I come home early from work. If they go off to their room for a nap, I might relax and go do the dishes, but when they come out of their room, I feel I should give them my attention, and offer them a drink.

Once someone has lived with me for several weeks, though, they become a room-mate. We might plan to have dinner together, but I don’t have to rush home from work. I can do the dishes while they sit in the kitchen drinking their tea. We might even sit in the living room together reading the paper, and be quietly companionable.

You might feel about you new baby as though they are a very special houseguest at first. But that’s not sustainable for more than a few weeks. Eventually, you have to acknowledge that your baby is your long-term room-mate, who’s going to stick around for the next 18-25 years!

Of course, you should give your baby attention.

You should talk to your baby, and play little tickle games, and rattle toys, and read books, and sing songs. But it’s also ok to hang out in the living room together sometimes, and read your book, or answer your email, or listen to a podcast while baby kicks and rolls around on the floor and looks at the ceiling or out the window. You will look over once in a while and check in with baby, make sure baby know you are still there, still available. But you don’t have to stare into your baby’s eyes every minute of the time they are awake!

Remember that your baby did not come here to “play.” You baby’s goal is to learn to be like you! So you can help your baby by showing them what a happy busy grown-up looks like. Let your baby see you doing chores. Fold the laundry on the floor while the baby lies next to you. Put your baby in the bouncy-chair to watch you while you empty the dish-washer, or vacuum. When your baby can sit in the highchair, put them in there to watch you do the dishes or peel the carrots.

I hope your life is not only made up of chores though!

Let your baby watch you doing things that make you happy. Dance around the living room, do some yoga. A friend of mine decided to learn the banjo during her mat-leave. Her son loved listening to her play. An artist I know used to paint big colourful canvases with her baby watching, fascinated, from the baby seat.

But you also want your baby to learn to kick back and chill out. So model that behaviour. Go lie on a blanket under a tree with your baby and just be peaceful.

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Lactation – A desert trek or a river hike?

How we think about lactation makes a big difference to how we feed our babies.

Bags or glands?

If we think about breasts/chests as bags that fill up with milk, and then are drained by the baby, and then take x-amount of time to refill, we are going to believe that we MUST wait a certain amount of time before putting the baby to the breast again. And if the baby gets fussy in the middle of that time, we believe are “out of milk” and have to give something from a bottle (expressed human milk or formula).

But breasts/chests are not passive “bags”. They are glands that make milk in response to being emptied. An empty gland makes milk faster than a full gland. And much of the milk is made DURING the feed in response to the baby’s suckling (and cuddling, and little massaging hands, and lovely smell…). So there is ALWAYS some milk available.

Desert Trek – Oasis Model

One way to think about breast/chestfeeding goes like this. The day is like a long gruelling trek across a desert. Every 2-3 hours you come to an oasis, and there you have to drink as much as you can, because then there is no more water for 2-3 more hours, across this arid terrain, and the baby might not make it to the next oasis.

If we think about feeding this way, we get anxious about how much the baby gets at each feed. We may encourage the baby to take more from a bottle, after some time at the breast/chest. And we are in a rush to get the feed “done”, so that we can move on the next chore, move on to trekking across that desert. And if the baby shows signs of hunger before 2-3 hours have gone by, we may think “I’m not good at this. I can’t make enough milk. I’m inadequate.”

River Side Hike Model

Another way to think about chest/breastfeeding goes like this. The day is like a pleasant, easy hike along a beautiful, clean, free-flowing river. Anytime we are thirsty we can walk down to the bank and take a sip, or a gulp, or a great big cupful. Sometimes we stop and drink for a long time, sometimes, we just take a quip nip, and then keep on going.

If we think about feeding this way, we don’t need to worry about how much milk the baby gets at any one feed. Some feeds will be long and some short. Some feeds will be leisurely and cuddly, others more business-like. And we don’t need to think about how to tell if the feed is “done” because we know we can always put the baby back to the breast. If we’ve been sitting on the couch, feeding for half-an-hour and suddenly get really hungry, we can say “I’m going to get myself a snack now. We can come back and give you more milk in a bit if you still want it then.” We don’t have to sit there feeling trapped and desperate.

What if there’s not enough milk?

I know, of course, that there are some parents who cannot (for whatever reason) make enough milk in 24 hours to completely satisfy their baby’s needs. That may be sad, and frustrating, and if that’s where you are sitting, my talking about walks along beautiful rivers doesn’t help at all. But even if that is the case, we don’t have to go to a “desert-oasis” model of feeding.

If we have to supplement, maybe we can think about it like this. The walk along the river sometime leads us up onto a cliff where we can’t get at the water easily. And so we have to carry a bottle of water for those bits of the trip. We don’t need to drink from the river AND from the bottle every time. Sometimes we can use one and sometimes the other.

When we supplement our babies from a bottle, we have to think a little further ahead than a parent who is exclusively breast/chestfeeding. But we still don’t have to do exactly the same thing at each feed. Some feeds (typically between midnight and noon – the AM hours) may be ones where there is a lot of milk, and the baby needs no supplement. Others (typically between noon and midnight – the PM hours), may be times when the baby needs two or three or four ounces of supplement. You are the one who knows your baby and your body best. You will figure out the best way to proceed, in a way that works for you, your baby and the rest of your family.

Relaxed and confident

But please, let’s all leave the desert trek model of breast/chestfeeding behind us. It doesn’t help us feel relaxed. And if we feel relaxed and confident, our baby can relax and trust in us. And that makes life so much easier!

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A Breast/Chest Field Trip

Many changes occur in a person’s breast/chest tissue during their pregnancy and after the baby is born. When new parents come to me with breast/chestfeeding difficulties, and I ask them if their nipples are “cracked”, they sometimes are not sure. “I don’t know what my nipples looked like before the baby started to suck on them. Do they look normal now?”

To get a sense of what equipment you are starting out with on your breast/chestfeeding journey, it might be a good idea for you to go on a “Breast/Chest Field Trip” at the end of pregnancy.

(Please note: If you have concerns about your breast health, or if you have had breast surgery or top surgery, some of this may not be relevant to you. Please see your doctor or midwife and consider setting up a prenatal appointment with a Lactation Consultant (IBCLC) to prepare for any challenges you may encounter when breast/chestfeeding your baby.)

1. Take your top and/or bra off and stand in front of a mirror with good lighting.

2. Look at your chest. You may notice:

• Your breasts/chest tissue are bigger than before you got pregnant. Most of the glandular tissue you need to make milk grows during pregnancy. And all the little ducts that are needed to transport the milk grow then too. Some chest/breast tissue grows a lot, and some grows only a little, but they almost all grow some.
• One side is larger that the other. As breasts/chests grow, the difference in size between them (and there is almost always a difference in size) becomes more apparent.
• Your sides are not symmetrical. One nipple may be lower than the other. One may point more to the left, or more to the right. Knowing that your breasts are not symmetrical may help you figure out how to position your baby on your body

3. Look at your nipples. You may notice:

• Your areola (brown or pink part of  around the nipple) has become bigger and darker.
• You may have more visible or darker bumps on the areola. These are sometimes called “Montgomery’s tubercles” but they are more descriptively called Sebaceous Glands of the Areola. They secrete an oily substance that keeps the nipple and areola supple and smells attractive for the baby. The smell helps the baby find the nipple.
• Your nipples may be bigger and darker than before. They may stick out more. The skin may be crinkly (the anatomical term for the crinkles is “rugae”) (These crinkles are not “cracks.” When a baby attaches to the breast too shallowly, and the nipple get pinched, a blood blister may form and then a wound may develop. That is what people mean when they talk about “cracked nipples.”)
• Your nipples may only stick out if they are touched, massaged or get cold. If that is the case, you may have “flat nipples.”
• If your nipples retreat when you compress the areola, you may have “inverted nipples.” This is caused by short connective tissue within the nipple. Check with your doctor or midwife to make sure.
• Inverted or flat nipples make people feel worried about being able to feed their baby. Don’t worry! Babies use the nipple as a guide to tell them where to latch on. Flat and inverted nipples make it a little more difficult for the baby to FIND the nipple, but you are going to be there to help! The baby is supposed to take a big mouthful of tissue, including the nipple and much of the areola, so the size of the nipple or invertedness of the nipple should not matter. Many parents find that after they have been feeding for a few weeks, their nipples stick out and become easy for the baby to find.
• There are gadgets and exercises out there to “fix” inverted nipples. There is no scientific evidence that those gadgets and exercises work. The best way to deal with flat or inverted nipples is to get expert breast/chestfeeding help after your baby is born.

4. Pull gently on your nipples and see how far out they stretch.

• When a baby is connected properly to the breast/chest, the tip of the nipple is all the way at the back of the baby’s mouth – at the soft palate. When I tell pregnant parents this, they imagine that their own little nipple could never reach that far. But nipples and areolas are very stretchy! Check it out!
• A generation or two ago, mothers-to-be were told to “prepare” their nipples by scrubbing them with a rough towel or rubbing them with alcohol! This is no longer recommended. It does nothing to prevent sore nipples, in fact it may damage the skin of the nipples and make them more tender.

5. Try to express a little colostrum. (These directions are given for your right side. Try your left side first if you are left handed!)

• Hold your right breast or chest tissue in your right hand.
• Have your little finger all the way back at your chest wall and your other fingers supporting the weight of the tissue.
• Have your thumb on top. Move your finger and thumb back towards your chest, away from the areola, and then slide them forward, compressing the tissue.
• When you get to the base of the nipple, stop and maintain the pressure for a few seconds.
• Don’t pull on the nipple – that just pinches the ducts closed.
• Imagine there little “grapes” under the skin and you have coax the “juice” out of them!
• Move your hand around so you try all different angles – all different points of the compass.
• You may need to try for several minutes before you see a few drops of colostrum. It takes some time to get the knack.
• Some people see little beads of yellow colostrum on their nipples during the second half of pregnancy. Some see little yellow crusts of dried colostrum. Others don’t see colostrum at all. But almost every pregnant person makes colostrum after about 20 weeks.
• Expressing or leaking a little colostrum does not “waste” any, because you will continue to make it until about 10 days after the baby is born.
• The purpose of expressing colostrum here is just for you to develop a better understanding of how your milk producing glands work. You don’t have to do it. If you express colostrum now, it does not mean that you will make more (or less) colostrum later. If you can’t, it doesn’t mean there isn’t any. It probably just means you haven’t figured out how to do it yet. Try again later, or wait for your baby to figure it out.

6. Look at your breasts/chest again and think about what wonderful “equipment”, what beautiful “packaging” they are for making and delivering milk to your baby!

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Resource List on Systemic Racism in Perinatal Health in Canada

My motivation in compiling this list was to find Canadian resources for participants in my birth doula workshop.

My motivation was to find Canadian resources for participants in my birth doula workshop. As a White Canadian, I do not have lived experience of the effects of racism within our institutions. American or British resources do not help me confront these issues, because I can reassure myself that “it’s not so bad here.” So I set out to find specifically Canadian resources to help me come face to face with the racist past and present of our country. I also wanted to focus on health care, and particularly perinatal care, because these are the issues I am called to work on in my profession as a doula, childbirth educator, and doula trainer.

I have only included items that can be freely and easily accessed (no scholarly articles behind pay-walls), and I have chosen shorter items, because they are more likely to get read!

I welcome comments about anything from this list that you watch/read. This list is not final – I hope to continue to add to it and update it. I welcome contributions to the list, if you know of articles or videos you would like to share. Send them along!

Eva Bild, CD(DONA) BDT(DONA) LCCE
Victoria, BC
eva@motheringtouch.ca

 

 

Institutional/Systemic Racism in Hospitals in Canada

https://www.ohchr.org/Documents/Issues/IPeoples/EMRIP/Health/UniversityManitoba.pdf

Episode from CBC radio – White Coat Black Art: https://www.cbc.ca/radio/whitecoat/i-am-a-white-settler-why-that-matters-in-health-care-1.4545454/it-s-the-hardest-conversation-we-can-have-confronting-racism-in-health-care-1.4545477

https://portal.cfpc.ca/ResourcesDocs/uploadedFiles/Resources/_PDFs/SystemicRacism_ENG.pdf

http://www.wellesleyinstitute.com/wp-content/uploads/2012/02/Colour-Coded-Health-Care.pdf

 

Indian Hospitals (This is the term that was used for these now historical institutions.)

https://www.youtube.com/watch?v=ZUOuUo79zU8

https://www.youtube.com/watch?v=ZLiyhvZTXXo

https://www.ictinc.ca/blog/a-brief-look-at-indian-hospitals-in-canada-0

https://www.canadashistory.ca/explore/books/separate-beds

 

Perinatal Care – Indigenous Families

https://diversityhealthcare.imedpub.com/canadian-indigenous-womens-perspectives-ofmaternal-health-and-health-care-services-asystematic-review.pdf

https://www.nccih.ca/docs/health/FS-AboriginalMaternalHealth-Smylie-EN.pdf

https://www.jogc.com/article/S1701-2163(16)34325-0/pdf

https://openpress.usask.ca/northernhealthcare/chapter/chapter-5-indigenous-birth/

https://www.researchgate.net/publication/324574736_Indigenous_Birth_in_Canada_Reconciliation_and_Reproductive_Justice_in_the_Settler_State

 

Forced Sterilization – Canada

https://www.cbc.ca/radio/thecurrent/the-current-for-november-13-2018-1.4902679/indigenous-women-kept-from-seeing-their-newborn-babies-until-agreeing-to-sterilization-says-lawyer-1.4902693

https://www.youtube.com/watch?v=aasDnMQcSvI

 

Perinatal Care – Black Canadians

https://www.chatelaine.com/living/black-birthing-experience-canada/

https://www.huffingtonpost.ca/entry/black-maternal-health-canada_ca_5ed90ae3c5b685164f2eab93

https://www.sciencedirect.com/science/article/pii/S0738399118309601?via%3Dihub

https://www.mcgill.ca/newsroom/channels/news/black-women-canada-higher-risk-preterm-births-256639

 

Anti-Black Racism in Canada – History

“Anti-Black racism is a particularly pernicious, borderless, and unique form of racism that has its roots in the Transatlantic slave trade. Slavery evolved into what Saidiya Hartman terms the “afterlife of slavery,” the modern-day, virulent, enduring forms of structural racial injustice and the different forms of structural inequalities that African descended people here in Canada and in other parts of the world continue to experience today.”

http://spacing.ca/toronto/2020/06/09/if-black-lives-truly-matter-in-canada-an-apology-for-slavery-is-only-a-first-step/

https://podcasts.apple.com/ca/podcast/the-erasure-of-canadas-history-of-anti-black-racism/id1462438248?i=1000477236535

https://podcasts.apple.com/ca/podcast/ep-01-policing-black-lives-by-robyn-maynard-ft-natasha/id1517728687?i=1000487997076

https://www.cbc.ca/listen/live-radio/1-63-the-current/clip/15781363-anti-black-racism-canada

Anti-Black Racism Reading List

https://onesearch.library.utoronto.ca/anti-black-racism-reading-list

 

CMAJ (Canadian Medical Association Journal) – Open Access

Time to dismantle systemic anti-Black racism in medicine in Canada

https://www.cmaj.ca/content/193/2/E55?fbclid=IwAR12nm56JtsRA6_MknvDDd5t_SVFc1n_OGRRONfR51_BvwahZZ9reHlfujE&utm_source=TrendMD&utm_medium=cpc&utm_campaign=CMAJ_TrendMD_0

About William Osler – (in)famous Canadian doctor – and his place in our racist history

https://www.cmaj.ca/content/192/45/E1414?utm_source=TrendMD&utm_medium=cpc&utm_campaign=CMAJ_TrendMD_0

Is your hospital culturally safe?

https://www.cmaj.ca/content/187/1/E13.full?utm_source=TrendMD&utm_medium=cpc&utm_campaign=CMAJ_TrendMD_0

 

The Secret Life of Canada

A podcast about the country you know and the stories you don’t.

The Secret Life of Canada highlights the people, places and stories that probably didn’t make it into your high school textbook. Join hosts Leah and Falen as they explore the unauthorized history of a complicated country.

The podcasts include stories about the wide variety of marginalized people in Canada – from Indigenous people, to Black Canadians and People of Colour, to LGBTQ people.

https://www.cbc.ca/listen/cbc-podcasts/203-the-secret-life-of-canada

Webinars

From the Canadian Public Health Association: Transforming our Response: Practical Tips on Providing Trauma Informed, Culturally Safe Care

Part 1 – https://www.youtube.com/watch?v=lttfFKqT3yQ&feature=youtu.be

Part 2 – https://www.youtube.com/watch?v=IVcg5-DH9mk

Part 3 – https://www.youtube.com/watch?v=em3Gc4ggO2c

 

Indigenous Cultural Safety Collaborative Learning Series

http://www.icscollaborative.com/webinars

 

San’yas Indigenous Cultural Safety Training

This course costs $300 for anyone who is not employed by a BC health authority. But it is very highly recommended.

http://www.sanyas.ca/training/british-columbia/core-ics-health

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Virtual Bra Sizing!

With or without COVID, life goes on. Folks keep having babies. Mothers still choose to breastfeed those babies. Mothers still want nursing bras.

But how do you get a well-fitted nursing bra in times to social isolation and physical distancing? Well, you could follow the instructions on the Bravado website . But right now, we can’t accept returns of bras (or anything else, really.) So it’s a bit riskier than usual to order a bra.

At Mothering Touch we have always prided ourselves on providing personalized service, to support parents through every stage of pregnancy, childbirth and the postpartum period. So how can we help with the bra fitting dilemma? Online, of course!

Call us at the shop (250-595-4905) between 10am and 2pm, and we will make an appointment for you to meet with Eva, via Zoom, free of charge!

All you need is to have a measuring tape and be wearing your favourite bra. Eva will guide you through measuring yourself, and together, you can decide on the best bra, and the best size for you at this moment. And, if you are in late pregnancy (37-40 weeks) Eva can make an estimate of what size bra you will need after your baby arrives.

(Eva has been supporting parents in breastfeeding since 1996 and fitting bras since 2004. She brings a whole lot of experience to this situation.)

Then you can order the bra online, secure in the knowledge that it will fit well. (And when this whole episode in world history is over, you will have a funny story to tell, of how you had an online bra fitting!)

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To our Valued Childbirth Class Participants

Dear Parents-to-be

Welcome to the brave new world of online childbirth and parenting classes! The Mothering Touch childbirth educators and I have been working very hard to create new materials and effective activities which work with this new platform. And we are continuing to provide evidence-based, up-to-date, locally informed, interactive, live, personal (and fun!) classes.

While we would SO much rather be sitting in the room with you (which is absolutely NOT an option anymore), we are finding that we can have a good give-and-take and discussion online. Parents are getting their concerns addressed and their questions answered.

One mother-to-be who took our classes recently said: “My partner and I have very much enjoyed both of the online classes we’ve been taking at Mothering Touch. We’re about to be first-time parents, and feel so much better having some down-to-earth discussion and hands-on practice lead by the Mothering Touch teachers. I’d recommend these classes for all new parents for sure!” We have been getting excellent feedback and most parents are very grateful to be offered this online option.

Some parents, however, have been wanting to cancel. They say this online situation is not what they signed up for (fair!) and they are wanting refunds. I absolutely sympathize with these requests, and I know many are coming from a situation in which money is tight because of lay-offs. So we are still honouring our Class Cancellation Policy.

However, I beg you to consider that, as a small, family-owned business, we will not be able to continue to function if everyone asks for a refund. As it is, we operate on a very tight budget, and this quarantine situation is affecting us very deeply, as it is affecting all the other small local businesses that make Victoria such a vibrant, livable city.

I ask you to reflect on the fact that your baby is still going to be born, that the amount of support you are going to have in labour may be less that you expected, and that you are still in need of good, locally-informed preparation for childbirth. Mothering Touch is here for you, as it has been for over 16 years. We want to help. Help us to help you.

If you are truly unable to afford childbirth classes at this moment, our Bursary Fund is still available. All you need to do is contact us by phone to discuss your financial situation. And if you are in a position to help, you can Pay-It-Forward here.

If you want to try Zoom out, so that you have a sense of how it works, join me for our daily Parents-and-Babies Zoom chat from 1-2pm. https://zoom.us/j/157409600 Pregnant parents are welcome too! All questions are valid, all input is valued.

I wish you all health, and patience, and good humour as we go through these challenging times. I am full of hope that we will emerge into the sun this summer, having defeated this virus through cooperation and mutual support.

Wishing you all good things,

~ Eva

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Childbirth Classes – An essential Service?

Well, of course they are not. Babies will come out whether or not their parents are prepared. But in the midst of a pandemic, when a state of emergency has been declared and the cities are shutting down, when hospitals are restricting access to support people in labour and postpartum units, it becomes even more important for your birth helper (who may also be your life partner) to be well prepared to support you.

At Mothering Touch, our childbirth and parenting educators are devoted to providing you with the information and practice and support that you need to feel confident going into labour. We want to train every birth helper to be the very best support that they can be. We want the two of you to feel like a team, who can take labour on and make it a good, life-affirming experience for your new little family.

We are streaming all our our classes on Zoom. Although there are many on-line options for childbirth preparation, in the midst of this emergency it is as important as ever to get information about local resource and practices. Taking an on-line class that was recorded in Tallahassee (nothing against Florida!), won’t serve your purposes as much as a live, interactive class would, given by local childbirth teachers who have worked and supported parents in the very hospital where you are going to give birth!

We are in touch with the hospital administration who are keeping us informed of changes that may occur with regards to who is allowed in the hospital, and what services are available.  You can read the letter the Hospital sent out about this here. Our teachers will continue to pass on up-to-date information in our on-line classes, and to take you through information about the layout of the facilities (which we used to cover in hospital tours.)

We started out the week offering the option of coming in-person or streaming the class on the Zoom platform , because we believe strongly in people’s right to make their own decisions about their care. However, as the week has progressed, it seems clear that we must ask everyone to use the online streaming, and not to come in to the store for classes.

Do reach out and contact us by email or phone if you have any questions about classes. We want to help!

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Look at us in People Magazine!

Look at Mothering Touch being mentioned in People Magazine as one of the hot spots on Vancouver Island, in a list of places Harry and Meghan might like to frequent, as they settle in here. How exciting!

You can be sure though, that if the Duke and Duchess of Sussex dropped in to Baby Group, or Motherhood circle, or Baby Yoga, we would protect their privacy, just like we do for all our clients! Everyone has to have a safe place to go with their baby. We might even be able to help with the baby carrier Meghan was having trouble with a few weeks ago! 😉

We are tickled pink!

 

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Becoming a Doula

Learning comfrot measures

What are your plans for this year? Are you up for learning something new? Developing some new skills? Starting a new career? Finding a new passion? Why not take a Birth Doula Workshop?

What is a Birth Doula?

A Birth Doula is a person who accompanies pregnant families through late pregnancy, childbirth and early parenting. The doula’s role is to provide informational, emotional and physical support. The doula helps the parent or parents to find the information they need to make decisions about their care. The doula provides a listening ear, a compassionate voice, and holds space for the parents to process their experience. The doula holds a hand, wipes a brow, provides a cup of tea or sips of gingerale, rubs a back or massage a foot, suggests positions and movements to ease a long labour.

The doula’s focus is on the parents’ emotional well-being. Doulas do not diagnose, prescribe or recommend. Knowing that the midwife, doctor or nurse is taking care of the safety of the parent and baby, the doula is available continuously, throughout the childbirth experience, to ensure that the family feels safe and supported.

What do you learn in a Birth Doula Workshop?

I LOVE teaching Birth Doula Workshops! It’s a wonderful opportunity to meet with a group of people who are passionate about helping, who honour and respect the power of childbearing parents, who are curious about the process of labour and birth, who are compassionate and caring.

We talk about the anatomy and physiology of pregnancy and birth. We talk about the process of birth, both the physical and the emotional unfolding that happens. We try out and practice many different pain-relieving comfort measures – breathing, massage, visualization, positioning, movement. We discuss medical interventions, pros and cons, indications, how to help clients cope with them.

We also discuss starting a doula business, how to create a referral network, how to find clients, how to interview clients.  We help you plan your startup. A panel of practicing doulas comes in to meet with you and share tricks of the trade.

We discuss the emotional aspects of doula work, how to support clients through disappointment, or depression, or loss, how to find resources, and how and when to refer, so that it’s not all on us. And we talk about the postpartum period, and breastfeeding, and the new baby, and how to say goodbye at the end of the relationship.

We spend four days together, immersed in all this juicy, subtantial stuff. It is SO satisfying!

Who can be a doula?

Anyone! Anyone who is prepared to be compassionate, respectful, open-minded, open-hearted. Anyone who is ready to be on call for weeks, and ready to stay up all night, and press on a sacrum until your wrists and thumbs ache. You don’t need to be any particular age, or gender, or to have any particular education. You do not need to have had children. People of all sorts become pregnant, and they need people of all sorts to support them.

Are there laws restricting who can practice as a doula?

No. Not in Canada. Anyone can call themselves a doula. But I encourage you to get proper training and to become certified. Do your research. Make sure that the organization training you and certifying you is credible. Consider: is it an associaton of doulas which works for its members, or is it a privately-owned business trying to turn a profit? Is it an organization whose training and certification will be recognized in other provinces, states or countries?

Does the trainer you are going to learn from provide any mentoring or support after the workshop? Will they help you find clients? Will they support you through certification? Do they run meetings for doulas to meet and connect and network? (Yup. I do those things…)

DONA International

The doula organization I have been certified with for over 20 years, and for which I train doulas, is DONA International. DONA was the first international doula organization. DONA developed the Standards of Practice for doulas which have been studied, determined to safe and beneficial, and which have become the industry standard. DONA has certified thousands of doulas in over 50 countries around the world.

How can I find a Doula Workshop?

Funny thing that. I happen to be teaching a doula workshop in Victoria from March 6-9, 2020. You can read all about it here.  

I offer one bursary (full and partial) in each workshop to folks in financial need. As part of my efforts towards Reconciliation, I offer one full bursary in each of my workshops, to an Indigenous person. Please contact me directly – eva@motheringtouch.ca

If you can’t be in Victoria that weekend (too bad, it’s a great time of year to visit), you can find a DONA International Birth Doula Workshop here. 

I have so many more questions!

If so, contact me. I love to answer questions about being a doula.

 

In the Doula Spirit,

                 Eva

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How to bottle-feed a baby – Paced Bottle-Feeding

bottle-feeding

Whether we are exclusively bottle-feeding, breastfeeding-with-occasional-bottles, or doing-half-and-half, it makes sense to feed the baby in the most physiologic, relaxing, pleasant way possible, which helps parent and baby develop a comfortable attachment. This process is sometimes called Paced Bottle Feeding. It involves mimicking the flow that the baby might get at the breast, and allowing the baby to have control of their experience, the way they would at the breast.

This information is intended for babies from birth to six months or so. After that, the baby will be better able to communicate their needs.

General guidelines:

1. Feed your baby based on the baby’s cues, not on a schedule. Hunger cues are:

a. Lip-smacking
b. Tongue darting
c. Squirming
d. Rooting – looking for something to suck on with their mouth
e. Hands to mouth
f. “Barking”
g. Crying is a very late cue – really more a sign of distress than hunger.

2. In the first three months or so, a bottle-fed baby will need small amounts of milk, 2-3 ounces, about 8-10 times per day (24 hours). Gradually they will start to take more milk at a time and feed less often.

3. Hold and cuddle the baby a lot. Even when you are not feeding them. We often over-interpret baby’s crying as meaning hunger when really the baby is asking for physical contact, movement, stimulation.

4. Don’t change the baby before the feed (unless absolutely necessary.) It just makes a hungry baby angry to be changed when they want to eat. It’s better to take a little break in the middle of a feed to change a diaper. And babies often poop when eating anyway!

5. Have your baby skin-to-skin when feeding, if you like, and if it’s convenient. Do not swaddle the baby when feeding them. Let the baby’s hands be free to explore and participate.

6. Use a slow-flow nipple – this is a nipple which, when held upside-down with milk in it, will release one drop of milk per second. This makes sure the baby does not eat too much, too fast.

7. Plan to take 10-20 minutes to complete the feed. Every feed does not need to be the same length. We all have some long meals and some short ones. Taking a longer time to feed allows the baby to recognize the feeling of being full before they become over-full. This reduces “colicky” crying.

Step-by-step Bottle-Feeding:

1. Make sure you, the parent, are comfortable. Make sure you are not hungry yourself, and can sit and focus on the baby for the next 20 minutes or so without interruption. Find a cosy place to sit, with good support for your back and arms. Make sure you have the bottle and a burp cloth and maybe a box of tissues nearby, as well as a water-bottle for yourself, and perhaps your phone, so you don’t have to jump up if it rings.

2. Make the baby comfortable in the crook of your arm. Your elbow should be supported, and the baby’s head is resting against your forearm. The baby’s head should be higher than their stomach. The baby does not have to sit absolutely upright, but being on an incline is better than flat on the back. (Babies fed while lying flat are at more risk for dental caries and ear infections.) Being upright means the baby is able to release air they might swallow.

3. Touch the baby’s upper lip with the nipple and draw the nipple downwards over the bottom lip. When the baby opens their mouth, put the nipple in slowly, letting the baby draw it in. Do not force the nipple into the baby’s mouth.

4. Keep the bottle tilted so most the nipple is full of milk. But don’t worry if the baby sucks in a little air – this is quite normal.

5. Count the baby’s sucks and swallows. If the baby does not take a breath by the fourth or fifth suck, remove the nipple and allow the baby to have a break in the flow to swallow and breathe. Keep the nipple right there, by the mouth, so the baby can latch on again when ready.

6. The baby may be upset when you remove the nipple. Talk to them and tell them it’s coming back. They just need a little break. After you have done this a few times, and they know it always comes back, they will be calmer.

7. Other signs a baby needs a break are:

a. Opening eyes wide
b. Pulling the head back, or turning it to the side
c. Arching the back
d. Pursing the lips
e. Letting go of the nipple

8. Take the nipple out right away and sit baby upright or put baby up on your shoulder if you see these signs of mild distress:

a. Milk spilling from the mouth
b. Opening eyes widely
c. Stiffening of arms and legs
d. Flaring nostrils
e. Grimacing
f. Lips turning blue

9. Talk to your baby. Tell them a story. Talk about your plans for the rest of the day, or about what you did this morning. Make it clear that you are focusing your attention on them in a loving and relaxed way, and that you enjoy their company. Develop a habit of pleasant meal-time conversation that will last a life-time!

10. Switch sides halfway through the feed. If you were holding the bottle in your right hand to start with, switch so you are now holding it in your left hand, and the baby is resting on your right arm. This provides for symmetrical eye stimulation and development.

11. Let the baby decide when the feed is done. Signs of being finished are:

a. Falling a sleep
b. Turning head aside or back from the nipple
c. No longer sucking
d. Letting go of the nipple

12. Resist the urge to encourage the baby to finish the last bit of milk in the bottle. The baby is in charge of their body and their stomach. Letting the baby feel satiation cues and responding to them is a good way to set up good eating habits for later life.

13. Put the baby up on your shoulder to burp. Pat their back gently.

14. A baby will often fall asleep for a few minutes, and then decide they could use a little more milk. Take advantage of that little break to change the diaper. Then be prepared to give the baby a little more milk. That’s okay.

15. If the baby still seems to root around even when they have had a large amount of milk, consider that they might just need to do a little more sucking. Offer a pacifier and a cuddle and see if baby falls asleep.

Resources:

HealthyFamiliesBC.ca is a good website on family health – lots of information there on formula feeding and bottle preparation.

HealthLinkBC.ca is another source of British Columbian health information.

www.inspq.qc.ca/ is a Quebec resource with good, detailed information – in English.

Many of the ideas I have shared here are influenced by:
https://www.peelregion.ca/
https://kellymom.com/

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Pay it Forward

I find myself having to do something I always dread. I have to raise our prices. I always resist doing this – so years go by and our prices stay fixed. I really wanted to keep our Childbirth Classes, especially, affordable, because I know most expectant parents don’t have a lot of spare cash. But it has to be done. We will be raising the prices of our Childbirth Classes, and our Parenting the Newborn Classes on August 1. (So you might want to let your friends, who have not yet registered, know that this month is a great time to do so!)

At Mothering Touch we have always given bursaries to families who are in financial difficulties. These families are referred to us by their midwives, or family docs, or public health nurses. We negotiate a fee they can reasonably afford – sometimes that means $20.

As we raise our prices, I want to make more people aware of our Bursaries, and I would like to make more bursaries available. So we have come up with a plan. When folks register for their classes, they will be given the option of contributing $5 or $10 to our Bursary Fund. As they pay for the classes that help them to prepare for parenthood, they can support another family, who might not be as well off. They can pay it forward.

We’re going to put a Pay it Forward button on our front page too. So that families who have already taken their classes can make a contribution.

When you contribute to our Bursary Fund, you are giving a pregnant parent and their partner or support person the opportunity to get evidence-based information about childbirth, breastfeeding and early parenting, to go on a tour of the hospital where they may be birthing, and to attend two free prenatal yoga classes. You help connect them with Mothering Touch, and resources that will support them all the way through the first years of their baby’s life.

We hope many of you will consider donating to our Bursary Fund, and will pass the word along to families who may be able to benefit from it.
Have a great summer!