World Breastfeeding Awareness Month

It's world breastfeeding awareness month! In honor of this, my next several posts will be focusing on breastfeeding information, resources, research, best practices, stories, and photos. I of course understand and respect that not all families I work with are breastfeeding, whether by choice or not, and there is of course some that fall in between. As a birth doula, I am always happy to support my doula clients any way they choose, however I find that most often, my clients are worried about and are asking me about breastfeeding -- usually right after birth and the postpartum visit. I had the great pleasure this year of becoming a Certified Breastfeeding Counselor, and am loving that I am able to provide a greater depth of support to my clients around breastfeeding.

To kick off the week, I want to share an awesome blog post from Lamaze's Science and Sensibility blog, which has excellent resources for breastfeeding or soon-to-be breastfeeding families.

Read the blog post here.

Beautiful Birth Photos

These photos are beautiful! Whether it's a home birth, hospital birth, natural birth, cesarean birth, midwife birth, water birth, OB birth, breastfeeding or formula feeding, or it's a first or second or third child... there's no one right way to do it. Take a look here.

Folic Acid/Folate in Pregnancy: New Research on Potential Risks

Folic Acid (otherwise known as Folate, in it's non-synthetic form) : we know it's important for a developing fetus, but should everyone be taking folate?? This article contains groundbreaking information on folic acid and an uncommon, but not rare, genetic condition.

"There’s no solid consensus, but some reports state that anywhere from 10 to 15 percent of Caucasians and more than 25 percent of Hispanics are unable to metabolize folic acid. Called methylenetetrahydrofolate reductase, or MTHFR for short, this defect refers to the MTHFR gene, which produces the enzyme responsible for converting synthetic folic acid (what’s found in prenatal vitamins and fortified grains) to methylated folate (the metabolized nutrient that protects against NTDs)."

Read the full article here.

The Cesarean Rate Epidemic

This article looks at the current rates, state, and climate of Cesarean Births in the U.S. It provides statistics and rates, reasons for Cesareans, as well as the associated risks. 

“Cesarean delivery may be a safe alternative to vaginal delivery but its use in 1 of 3 women giving birth in the US seems to high.”

— contemporaryobgyn.modernmedicine.com

An excerpt discussing the rising rates and unusual number of Cesarean rates below:

"One possible reason for the rise in the cesarean delivery rate may be that there has simply been a rise in the need for cesarean. The most common indication for a primary cesarean is cephalo-pelvic disproportion, or arrest of progress in labor. It is unlikely that maternal pelvis size has changed over the past 3 decades, but it is possible that birth weight has increased. In fact, evidence suggests that rates of macrosomia have increased over the past 2 decades.8 Other issues that contribute to increasing rates of cesarean delivery, possibly through the mechanism of birth weight, are maternal obesity and gestational weight gain.9,10 Without question, the proportion of obese women has increased over the past decade and higher weight classes are associated with even higher rates of cesarean.11,12 In addition, increased gestational weight gain has been associated with cesarean delivery and is commonly above standard guidelines.13

Another reason for increasing cesarean rates may be a rise in elective cesarean delivery, also known as cesarean delivery by maternal request (CDMR). Because there was no ICD-9 code for CDMR, it is unclear what proportion of cesareans are due to it. One recent study, however, estimated the proportion as high as 4% in the United States.14 Interestingly, CDMR is more common in other countries, such as Brazil, Taiwan, and Chile. A study in Chile comparing women receiving private care (cesarean rate >40%) to women receiving public care (cesarean rate <20%) found that 8% of those receiving private care and 11% of those receiving public care stated a preference for cesarean delivery, with the vast majority preferring to deliver vaginally.15 Thus, even in this setting, it is unclear that maternal preferences are driving the increase in cesarean delivery rate."

Full article can be read here: http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/cesarean-epidemic-are-we-too-quick-cut?cfcache=true

Why delay cord clamping?

Science and Sensibility, the research blog from Lamaze, has an excellently evidence based article on the practice of delayed cord clamping. The article is structured by listing objections, which is a great way to go about learning the benefits, as well as to be prepared to answer to someone's concerns about this practice. Delayed cord clamping is becoming so much better understood and common place. Many Ob and midwife practices in Brooklyn and NYC do this as a matter of protocol. 

Read the full article here. 

VBACs are more likely successful if you call the midwife

A new study shows that VBACs (Vaginal Birth After Cesarean) are more likely to be successful if a midwife provides the care instead of an obstetrician. 

You can read a portion of the abstract of the study here, and an excerpt is below:

Background

Research is yet to identify effective and safe interventions to increase the vaginal birth after cesarean (VBAC) rate. This research aimed to compare intended and actual VBAC rates before and after implementation of midwife-led antenatal care for women with one previous cesarean birth and no other risk factors in a large, tertiary maternity hospital in England.

Conclusions

Implementation of midwife-led antenatal care for women with one previous cesarean offers a safe and effective alternative to traditional obstetrician-led antenatal care, and is associated with increased rates of intended and actual VBAC.

Breastmilk Storage

This is not about storage in terms of how to store your pumped milk. This is about how much milk your body can store. I love this infographic below from Nancy Mohrbacher. It explains, in part, why babies may have such varied feeding patterns, even babies from the same mother :)

Mothering The Mother: Postpartum Support for Women

During prenatal sessions with my doula clients, I always make a point to discuss postpartum plans. In the way in which every woman usually has some sort of birth preferences (hospital birth, home birth, birthing center birth, midwife, doctor or OB, natural birth, epidural birth, and so forth...) it is important to develop some ideas around what the plan is for postpartum care. 

Some of the questions I encourage my pregnant couples to ask themselves are: what is our sleeping arrangement and what are our beliefs in infant sleep? Where is our healthy food coming from? Who's around if we need support? Would we like a postpartum doula? How much time can we take off? Who is in charge of feeding? Who is in charge of feeding? Who will do the laundry and the chores?

Mothering the Mother: New Mothers Need a Focused Period of Rest and Recovery

An excerpt:

The postpartum period is considered to be the roughly six-week period when a woman recovers from the magnitude of pregnancy and birth. It is also the wild, messy, tender, achy, exhilarating time when a woman begins the process of shedding one way of being for an entirely new identity. It is a fleeting, essential moment, a powerful pause before the full initiation of the next chapter of her life. But in a society that encourages a new mother to "bounce back," right after birth, a woman is pushed to do the opposite of resting and recovering; she is encouraged to get back to a version of her body and her life that is gone forever. She has been forever transformed by the profound act of making another human being and requires care and attention before hurtling forward.

More reasons to breastfeed: Antibodies

As if we need another god reason to breastfeed newborns, but here you go anyway... excerpted from "Antibodies in Breastmilk Prime the Baby's Gut to Handle Mom's Invading Microbes."

“… the breast milk is also loaded with microbes, which means a brand-new baby’s gut is subject to a full-on invasion of tiny, foreign animals from the moment he or she starts feeding. The infant’s immune system, rather than attack these foreign organisms like an immune system is designed to do, instead sits back and lets them invade. And now we know a bit more about why: In a study published Thursday in the journal Cell, researchers from the University of California Berkeley found that in addition to all those microbes, mother’s milk is loaded up with antibodies to the very same microbes it contains. In other words, the milk contains both the beneficial microbes and what the body needs to be able to accept them.”

What to expect with your baby's weight after birth

This is an excellent article, with very wise advice on baby's weight loss within a the first couple of weeks of life. If you have concerns or questions about your newborn's weight loss and milk intake, you are of course advised to seek support from a Lactation Consultant (IBCLC), a Certified Breastfeeding Counselor (CBC), or a Certified Lactation Counselor (CLC). Any of these lactation professionals should be able to support you or point you in the right direction.

An excerpt is below and the full article can be read here.

"This weight loss has nothing whatsoever to do with breastfeeding and milk intake.  In fact, the authors suggest that if clinicians want to use weight loss as a gauge of milk intake, they calculate baby’s weight loss not from birth weight, but from their weight at 24 hours.  According to their findings, this could neutralize the effect of the mother’s IV fluids on newborn weight loss.

This is one more reason weight loss alone should not be used to determine when newborns need formula supplements.   The Academy of Breastfeeding Medicine put this well in one of its protocols: “Weight loss in the range of 8-10% may be within normal limits….If all else is going well and the physical exam is normal, it is an indication for careful assessment and possible breastfeeding assistance.”

Let Babies Figure it Out On Their Own

This is a great piece on infant physical development. When my first son was 3 months old, I had the wonderful opportunity to take an infant developmental movement class at a nearby yoga studio. My teacher taught me so many wonderful things that I would never have otherwise learned about supporting my son's physical development. Even as someone who is quite physically attuned, with my background as a dancer and my current yoga practice, I just had no idea how many of the things that I was doing were not helpful, and potentially detrimental, to my kid's budding physicality. This article explains some of what I learned in my class.

"When an infant is propped or placed in sitting and standing before they have developed adequate upper body strength to move their own body into sitting and standing, their spinal curves will be develop out of sequence. The result, which I have seen over the years in my work with infants, children, athletes and adults, can become organ, glandular and/or spinal challenges such as scoliosis and lordosis because the cervical and lumbar curves have become dominant.

When a newborn or an infant is “propped” in a sitting position or placed into equipment by a caregiver, they will either stiffen or flop over. When a young infant is consistently sat and stood up, they will usually extend their limbs and stiffen throughout their entire body (a fear response) in an effort to support the weight of their head. This stiffening is easily felt when holding them and will not only disrupt the integration of their arms and legs with their torso but also delay their ability to roll over."

What A Doula Does

I adore this blog post written by my dear doula colleague, Yiska Obadia. You can read an excerpt below, and the full article here.

"Doulas are there to serve their clients. You want to birth naturally? I will support you. You want an epidural? I will support you. You want an epidural and to avoid a c-section? I will do my best to help you achieve that. Doulas serve our clients in helping them to achieve the birth THEY want as well as supporting them wholeheartedly with the birth they get."

A cervix in labor

What does it look like? Check out this handy guide to understanding how your cervix will change in the late third trimester and in labor. Maybe you followed your pregnancy by reading about your baby's size being compared to fruit... and now you get to read about your cervix in relation to fruit :)

What to pack in your hospital bag for birth... around the world photos

I love this photo essay! Our things that we might pack in our hospital to-go bag are truly a reflection of our culture's practices and beliefs around birth.

Have a look here: Essentials of Giving Birth Around the World

From Spinning Babies... The Sacrotuberous Ligament: Key to Unlocking a Long Labor

This article is definitely worth a read if you are pregnant and preparing for labor. And especially if you are interested in anatomy! According to the article, it may be particularly applicable if any of the following are present:

• A long and difficult labor in which normal remedies (Rebozo Sifting, Position Changes, Spinning Babies Maneuvers) are not fully effective

• Persistently malpositioned baby

• Highly athletic mother (especially those who are highly athletic into their pregnancy)

• History of any trauma in which the ligaments of the pelvis could have been affected (accidents, falls, etc.)

• A visible Pelvic Upslip: One (usually left) iliac crest superior to the other, one leg (usually left) functionally shorter than the other.

NYC's Newest Birthing Center at LOMA

Finally, earlier this year, New York City unveiled a new in-hospital birthing center. Until recently, our only in-hospital birthing center was the Birthing Center at Mt. Sinai West (formerly known as St. Luke's Roosevelt). As of this winter, women have another in-hospital birthing center option: The Birthing Center at New York Presbyterian/ Lower Manhattan Hospital. I had the pleasure of attending a birth there as a doula just a few weeks ago, and the facilities are beautiful! (Not to mention the birth, too, of course!!)

Hopefully this trend will continue in NYC. There are so many women looking for low intervention birth settings, with the option to labor in a tub amongst other great options available in the birthing center. NYC residents also have the option to give birth at the Brooklyn Birthing Center, an out-of-hospital freestanding birthing center, and New York City's only independent birthing center.

Read more about the opening of Lower Manhattan's Birthing Center here.

Postpartum & Breastfeeding Nutrition For the New Mother

Postpartum nutrition! Many women aren't aware that for breastfeeding a newborn (or older baby), that often women need to eat more than they did when when they were pregnant! Of course, quality is important as well, as it's not just about getting enough calories.  The amount a breastfeeding mother should eat also depends on level of exercise, overall caloric needs, and other variables, or course. The best rule of thumb is to eat to your hunger, being mindful of making healthy choices whenever possible. Through recent research, we know that a mother's varied diet will encourage her child to enjoy a wide palette of flavors - all the more encouraging to eat well while breastfeeding! Check out the links below for more info on postpartum eating and nourishing the new mother:

Recovery From Childbirth: Postpartum Foods

Do Breastfeeding Mothers Need Extra Food or Fluids?

Nourishing the New Mom

Maternal Nutrition During Breastfeeding

Premature Birth & Air Quality: New Findings

This is heartbreaking. As if there are enough terrible effects on our environment and our health... now we are (not surprisingly) learning about the consequences of air pollution on newborn infants and what it costs our economy. It's obviously not just a financial issue. This affects all of us and our futures.

Read the full article here:

http://www.techtimes.com/articles/145548/20160331/premature-birth-linked-to-air-pollution-costs-us-4-3-billion-per-year.htm

Zika! Being pregnant in NYC/Brooklyn this summer.

Ah, Zika and NYC and Brooklyn and being pregnant this summer. Or maybe you've traveled recently to somewhere where it's prevelant. Regardless, ah, it's a bit of a stress. Here's an article with some practical info:

http://www.democratandchronicle.com/story/news/2016/04/12/zika-virus-an-unlikely-threat-in-upstate/82926754/

Natural Hospital Birth

As a birth doula serving clients who live primarily in Brooklyn and Manhattan, I work with many women who see both OBs (often low intervention practices) and midwives in the hospital setting. However, many of my clients are looking for a holistic birth experience, or a natural birth experience, within a setting that typically is not set up to accommodate un-medicated births. The odds are generally stacked against women hoping to have intervention-free births in a hospital. BUT, as a doula, I have witnessed many women successfully do this! Here are a few resources on how to work towards, or achieve some version of, a natural hospital birth:

Video

Book