Save your milk! Use paced feeding.

One of the biggest concerns for moms going back to work is that they won’t have enough milk for their baby while they are away. This needs to be tackled in two parts. Part 1 is about making sure to use the pumped milk wisely and not putting extra pressure on mom to pump more. Part 2 on how to maximize pumping at work is coming soon!First let’s talk about the person caring for the baby. Above all, don’t let them waste your milk!

The First Hour "Swaddle"

Why the FIRST HOUR SWADDLE? Well, it really isn’t a swaddle, but it is what we teach as the first way you can wrap a baby in a blanket. Don’t shoot me down yet…we are basically wrapping baby up in mom’s skin with the blanket over both. Nothing between mom and baby but maybe the diaper. Baby has unrestricted access to the breast, mom’s warmth, smell, skin, etc. All the wonderful regulatory behavior that babies need in those early days (and beyond) gets to happen regardless of the room’s contents.

The last 5 minutes says a lot

One thing I have learned is to really make sure those last 5 minutes count towards building confidence in my clients. Not that I don’t focus on building them up the entire time I am with them, but specifically those last 5 minutes before I go, I make sure they know that overall things are going better than they feel like they are, and that I have great hopes that things will improve very quickly. Which is true, but of course families can’t see it in the midst of their chaos.

Client favorite: Refrigerator Quiche

This is a quick doula meal I can make just about anywhere. Most families have eggs, and an assortment of tired looking veggies that were meant for something but got overlooked by a new baby in the house. This is a great way to build a whole meal out of a rag tag team of odds and ends, and give a new family something beautiful to eat that lasts beyond one meal.

On the Edge...

As doulas who offer overnight care, gentle sleep consults, and of course a host of handy mom-helping services, we often hear the worst stories. (Like the moms who freeze their purses and call us because they can't find their keys! True story--and not just one!) But lately I am hearing stories aboutmoms who put off their need for sleep long enough to really feel like they are having a breakdown. Like losing their mind, and not just for that moment when you 'forget' you had a baby and then suddenly realize you have been a mother for 3 months (not uncommon!). But the kind that feels desperate, clinging to any kind of support they can possibly trust.

Top 10 Things I Learned from Moms Group

The long awaited top 10 is here! Jordann graduated recently with a twist: a top 10 list of all the things she acquired on her journey through the first 6 months (coming to moms group almost every week). She is our guest blogger, and shares some good stuff! I am going to take them 3 at a time (not to make you wait, but otherwise it might be a bit too long to read in one sitting with a squirmy baby).

Small packages

This week I was with a client who has to take a certain medication with food at intervals throughout the day strategically to reduce the affect on her nursing baby. After making her food this week, she said something I just loved. "Every time I go to take my medication, I think to myself, 'I need a little snack.' Then I look in my fridge and I say, 'Yay, a little snack my doula left for me!'"

It made me think of how often we need a little something, but don't take the time to nourish ourselves. We don't feel like a big meal, and don't want the hassle of chopping and slicing, heating, or creating more dishes for ourselves to have to manage while we are managing a tiny little one's various needs. So we grab a bar or some other packaged food to tide us over. But how often have you found yourself nearing dinner and all you have consumed all day is a bar or packaged item, a few drinks and maybe a handful of almonds?

I can tell you that as a doula I find a lot of neglected fruit and veggies in the fridge that my clients are thrilled to eat; they just don't have the time to prepare it for themselves. All it takes is chopping it up, slicing it and serving it to them to perk up their energy and their spirits. So of course we do (sometimes every time we visit!).

However, I think spreading the word to other helpers would be great as well. Moms need food. They don't take the time to serve themselves, and I think there is this sense that they don't want to go to so much trouble for just them. So I have a solution. Small packages.

When I am with a family, I often take the time just to wash the grapes and put them in separate serving sizes ready to grab. Yep, grapes. Those wonderful bags of sweetness that mold in the bottom of your fridge because no one got to them in time. (You know you have done this.)

I also make snack size bowls of all kinds of dishes. Roasted veggies, rice or pasta dishes, snack plates with hummus dip, even plating up that casserole that someone else brought that is covered in foil (that no one has opened in a few days). Just taking the time to get out the serving dishes and putting the food in easily accessible places--that you see when you open the fridge--allows a mom to get the nourishment she needs without having to live off an energy bar.

So dads, partners, grandmas, friends...think small packages. Because moms rarely refuse a little bit of something, especially nursing moms. The result might be a more energetic, positive outlook from the new mama, and that makes everyone happy, right?

(I will admit that this uses more plastic wrap that some families are used to, so please let me know if anyone has a solution for small packages of food that you can see when you open the fridge...)

Summer is coming...Grill Bread season!

Have you ever grilled bread along with that meat or veggies? It is a yummy addition to anything grilled...and usually there are few leftovers when these come warm from the grill.

We like to use whatever dough we have on hand. There are many recipes online for this, and you can use purchased dough too (a lot of people like Rhodes frozen dinner roll dough).

Today I made the dough from:

1 pckg yeast

1 c warm water

1 c ww flour 

 1+ c white flour (more for rolling out or if the dough is too sticky)

2 T olive oil

3 T brown sugar

1 t salt

I like to get the yeast going in the water before adding everything else, but I usually just throw all the rest in the Kitchen Aid to mix for a few minutes and then let it rise for about an hour.

I piece the dough into golf ball sized pieces and roll them out on floured board to about 1/4 inch. They need a few minutes to rise a bit;  then you can throw them right onto a hot grill for about 90 seconds on the first side once they puff a bit), and 30 seconds on the 2nd. The thinner they are, the faster they cook (thicker is yummy too, you just get less surface area to put yumminess on).

Usually we just stack them in a folded kitchen towel as they cook and then serve them right away with butter, or to scoop up something fantastic with the meal. But you can make them into little pizzas, use focaccia toppings, make into tacos, or tear pieces off for an Indian style dish. (Gotta love the versatility.)

So if the kitchen is too hot to bake bread, but you want that fresh from the oven taste, give grill bread a shot. It might become your new favorite...

Human milk update

I love calling breastmilk human milk, and cow's milk bovine milk. Makes so much sense. It doesn't need to make mothers feel guilty about feeding their baby formula, as we are doing what we need to do to feed our baby: offering baby the safest milk that is readily available, even though it is from a different species. Just one little tidbit I learned at the Breastfeeding Coalition conference at OHSU. Dr. Jae Kim and Dr. Lisa Stellwagen gave multiple presentations on the use and research on our tiniest preemies and their feeding options. Here are some more of the things I learned:

The amount a 150 lb adult would have to gain to grow similarly to a preemie would average about 3lbs a day! That makes feeding a preemie essentially a nutritional emergency. (And preemie parents feel that!)

Vit D deficiency seems not just to be the vitamine de jour, but a very needed factor for pregnant moms to ensure that their baby gets a adequate amount (and even more crucial for preemies). Supplementing with Vit D is done at much higher doses in European countries with no ill effects, and it also takes weeks to build up the stores just to get back to normal when you are deficient. It is not just important for infants, but mommies too!

There are no studies reflecting the quality of diet in relation to the quality of human milk, other than the studies on fatty acids. So the kind of  fat that you eat does matter...choose the best options available.

A normal milk production is 800 mls in 24 hrs (that is just shy of 27 oz for the non metric world). However, even moms of preemies who make 300 mls can fully feed their baby, at least during their stay in the NICU (when it is most crucial).

There are 250 compounds in breastmilk, and that is just the known ones! There is a lot of research currently being done on oligosaccarides, just one  in the growing list of known compounds. For formula companies to make even a few of these in a lab somewhere and then try to market them would be in the millions, billions if they were to address all of them.

Gassy, fussy baby question

Gassy, fussy baby

This is a question I received a while back, and also get asked about  a lot. Thought some of you might find it helpful. (Beth Yohalem-Ilsley also adds her expertise to this one.)

My baby is 3 weeks old, and as of this past Monday evening she started grunting through the night, consistently. She sounds like she is trying to push out a poo or gas. I have since started giving her gas drops (Little Tummies), colic calm, and gripe water, none seems to be doing the trick. She gets relief, at least for a short while, when she has a big release of gas or poo, but it doesn’t last long.

She is no longer sleeping peacefully.  When I lay her down, she grunts, and moans herself to sleep, even though she was sleeping peacefully in my arms. She is restless and gets her arms out of her swaddle while sleeping. When feeding (BF) she gets over amped up and white knuckles her fists, kicks her feet, and grunts. I have to stop her every 3-5 minutes to burp her because she is sucking too much air.

I have been able to get good burps out of her, but she still remains fussy. I am finding that she is throwing up about 1 meal a day… and its not from her gut because its not curdled, it still the milk she just ate.

I went to a naturopath yesterday and they tested me and found that I am sensitive to dairy, gluten, chocolate, and coffee, so I have eliminated those. My ped recommended the Mylicon gas drops, which we have tried, but with little success..

I have been putting her on her tummy, laying across my lap, and massaging her back, which is also massaging her belly on my legs.. I would get a little bit of relaxation from her at times, but in most, it just irritated her more.

Any suggestions or thoughts would be greatly appreciated.

Answer

Dear Mama,

Your experience sounds similar to others that I have heard from. Babies around 3 weeks of age often start to become more gassy and fussy, and parents often are mystified by this. However there are a few things you could try to ease this time for her.

You mention the feedings being difficult for her to manage. Sometimes a lactation visit can help with this, as you could work with some positioning that might help (and it is hard to think of new positions when you are brand new to nursing!). You might try a position that uses gravity to slow the flow of milk to your baby (often when they white knuckle like that they are struggling with the flow being too fast, and just trying to hang on and get what they need—kind of like drinking from a garden hose!). They suck air because they are trying to suck, swallow and breathe (in that order, usually) and they are just getting hit with milk too fast to breathe slowly. So they gulp, and in turn it causes burps and gas that need a lot of management afterward. (There are other things it could be as well, like reflux, but I think your Ped would be a good person to take a look at that, and there are so many ways to work on the breastfeeding first before we start to diagnose anything else. You can find a lot of different nursing positions on http://www.kellymom.com.)

It might take up to 3 weeks to get the allergens out of your system (and hers) completely, so sometimes there is just the waiting period. In the meantime, try using the baby yoga hold with her, either in arms or in the sling/wrap. This can be done by placing her back to your chest and holding her legs in a flexed position at the hip level. Keep her back straight, but allow her legs to be bunched up. You will be surprised how much easier it is to get gas or burps out in that position.

You can also use some baby massage to ease her digestion. Baby massage is wonderful for so many things (including good sleep patterns and weight gain!) but can be done with just some tummy strokes to relieve some gas. There is too many details to go into here, but there are baby massage vides everywhere, as well as classes around PDX that would go into more detail with communicating with your child as well as easing her body discomforts.

Regarding the sleep grunting, I would say that many babies this age do a lot of grunting while asleep. Ask at a local moms group about this and a huge show of hands will illustrate how many babies start really grunting at 3 weeks. (I host 2 of these per week in the Providence system, all new mamas with babies under 6 mo old are welcome; http://www.providence.org/classes for more info.) Swaddling can make a big difference with this, but you might have to use the bat wings to keep the arms tucked in (arms out really doesn’t help much with swaddling until they are much older, and can suck on their hands for comfort). If you don’t have a source to teach you the ‘bat wing’ technique (we teach it at Providence so many new mamas know how to execute this technique) consider getting a postpartum doula or other professional to show you. (There is a you tube clip on the bat wings now.) You might also try having her sleep at an angle or use some movement at night to ease the grunting. (Many moms use a bouncy seat/vibration chair or use a vibration unit on the baby’s bed to allow the parents to get some sleep while baby is still being “moved.”)

It sounds like you are trying many things already that will help, and hopefully some of these suggestions can ease her way as well as yours! I do think you would benefit from the help of a postpartum doula, as they are specialists in this early age and transition into parenthood when you are learning how to interpret your newborn’s behavior. There are many wonderful postpartum doulas in PDX, and they can really make a big difference when you are learning so many new things all at once.

Congrats on welcoming your little one and I hope things resolve for you soon!

Kimberly Bepler ABC Doula Service

Dear Mama,

Sometimes little ones who seem so calm and peaceful for the first 2 weeks start showing signs of soft tissue injury right about then and the next few weeks. The “injury” is caused from the crazy process of being born but it take a few weeks before the soft tissue forms enough to show signs of damage (even slight amounts). I’m not sure what the birth story of your baby is but the manifestations usually show up as discomfort in certain positions, difficulty in eating comfortably, vomiting after eating and some signs of general discomfort. Infant craniosacral therapy is a wonderful and gentle way to relieve areas of muscle and fascia tension and can be done at any point.

There are also some more specific treatments if the vomiting is due to food sensitivity from your milk and affecting your baby’s digestive tract (since you mentioned learning about your own food sensitivities and it is possible your baby will be affected by what is in your milk). Hopefully your new knowledge about that will help. Another option for you is Shonishin. This is an excellent non-invasive technique that involves tapping and rubbing along the skin of acupuncture points and meridians with small metal tools. There are also Chinese and western herbs that can be given to babies 1 month old and older to assist with digestion. There are a few of us here in Portland that practice eastern medicine for children and also several practitioners who do infant craniosacral therapy. Best of luck in getting through this very difficult transition.

Beth Yohalem-Ilsley Mississippi Health Center

Choosing a Birth Doula?

Many families ask me the following questions about choosing a birth doula: Do we need one? How do we pick one? And who do you recommend?  I suppose as we are a postpartum doula group that doesn’t offer labor support, we are in the category of being fans without being biased towards our own offerings.

Here are some of my guidelines for answering the birth doula questions:

Do we need one?

The biggest question here is what you really want from your birth. Are you birthing at home, in a birth center, or in a hospital?

Homebirth and birth center midwives often have assistants or apprentices that can sometimes act as your doula and many of them do births in teams, so a labor doula isn’t always needed. However, some of them welcome doulas at the birth and appreciate the emotional support that doulas can provide as they care for more of the physical/clinical concerns around the birth. If you birth in the hospital, even though you often have one nurse assigned to one patient during labor, the role of a nurse and a doula are very different. Nurses used to provide many aspects of doula care, but now their time is buried between charting, running all the equipment used in a hospital birth, and carrying out the orders from the doctors or midwives. Certainly nurses can be a huge source of emotional support, but their work also runs in 12 hour shifts, and you are likely to get a few different nurses during your labor process—this usually is not a good continuum of care for the laboring mother.

Do you have women in your family that have experienced birth who can be present with you to meet your needs during labor? Sometimes mothers, sisters, and other female relatives or friends can be great doulas, trained or not. It is important that they know your desires for your birth and are operating on your agenda, not their past experiences or biases.

The main reason I see a lot of women hiring birth doulas is to avoid some of the interventions that make birth more difficult and often surgical. Yes, the Cesarean rate is still way too high by anthropological standards (over 30% in some hospitals in PDX) and having a doula at your birth reduces the chance of a cesarean by 50%. It also reduces many other often unnecessary interventions. Unless you have the doula role covered by other professionals (not your doctor or midwife, they rarely will sit with you throughout labor) or other family members/friends who you confidently feel can meet your needs in a calm way, I would recommend you look into getting a birth doula. I have had one birth with a doula, and one birth without a doula, and I will tell you it does make a big difference!

How do I pick one?

Here again, the question to you is: what do you want from your birth? Are you looking for a medication/intervention free birth? Do you have a Cesarean planned where your partner might be torn in different directions as you and the baby could be separated after surgery? Are you looking to delay an epidural for as long as possible? Are there concerns about your family members wanting to help but your gut tells you that they might not be the best person for the job?

All of these are great reasons to have a birth doula, but I would recommend different people based on the circumstances!

The beauty of the doula is that she should be there for you. Your needs/desires should be at the top of her list. If your doula has an agenda about “saving birth” or “changing the system,” you also need to feel strongly about this before going into labor as you don’t want to be caught in the middle of a conflict between your healthcare team and your doula. The best recommendation I have for choosing a doula is to talk to several on the phone, get a feel for their care, and then interview at least 3. You should follow your instincts when making decisions about who to have at your birth. You will likely be naked with this person, and make funny sounds and have this strange primal behavior—you need to feel VERY comfortable with whomever you chose. If you have a twinge of hesitation, move on. There are hundreds of birth doulas just in the Portland, Ore. area, and you are bound to find one that meets your needs perfectly.

Do you want a student doula (one with less experience but also charges little to nothing) or an experienced doula (where the fees can range from $300 to $800, depending on the package that your doula has to offer)?

Is this your first birth? I would probably recommend an experienced doula that can reassure you when you have questions (as there are MANY the first time around). If this is a subsequent birth, then it depends on your first experience and what you are looking for this time. The studies on doulas report that having a woman quietly staying with you throughout labor can reduce interventions and empower you in many ways, even when she doesn’t have a bag full of tricks that help you cope with labor and work together with your partner. I have met many women who want to be “good patients” who prefer to follow what the doctor decides about their birth. These women would benefit from a quiet doula that can help fill in the gaps of knowledge when the primary caregiver is busy doing other things.

Families who are looking for more of an advocate to their care will want a doula with a lot of experience, a strong knowledge base, and a good ability to read you in stressful situations.

And finally, whom do I recommend?

Yes, I do have a favorites list, but even within that list, there are variations based on the client’s needs. And there are so many wonderful doulas that aren’t listed as well. I would probably recommend looking at http://bsnnorthwest.org/ first for their list of caring doulas. There are many doulas listed there who have received rave reviews for the past several years and some new doulas who are getting involved with the community of birth supporters and can offer services for low or no cost.

You can also contact http://www.birthingway.edu and look for their list of trained and/or certified birth doulas, as they are a local midwifery college and have a long list of women looking to do births at low cost for experience. Many women check out http://www.dona.org, http://www.cappa.net, or http://www.icea.org to find their list of certified or trained doulas. This does insure that your doula has gone through the initial training requirements, but these are often overwhelming lists to work from with the numerous options.

Most women tell me that their birth doula was invaluable during their birth. I have heard a few stories reporting otherwise though, and I would want to caution you against compromising your goals.  Also make sure to budget for help after the baby arrives. Many women tell me that the help of a lactation consultant, postpartum doula, home-chef or a postpartum massage was as helpful, or even more helpful, as the services a birth doula provides.

I hope this has helped you figure out what would be best for you as you plan for your birth. As I am certainly a fan of birth doulas, I hope you find someone who is a perfect fit for you and that you have a great birth! Birth and early postpartum is a time that women remember for the rest of their lives, so it pays to have really wonderful people surrounding you to help you make the best memories!

Much requested: Warm Spinach Salad recipe

This recipe is a client favorite, and so welcome this time of year.

This time of year we doulas are often whipping up warm and nurturing soups, baked dishes, hearty stews or roasts (in the crock pot sometimes!) and filling breakfasts for our tired and hungry clients. Fall is such a fun time to cook and eat, and the food is so nurturing that it fits in super well with doula support.

I have been asked to share one of my most requested recipes for a warm spinach salad. My mom shared it with me, and I am happy to share with others. What I love about this dish is that it is full of iron rich spinach (so good for rebuilding blood after all the loss of childbirth) and it is warm and delicious. A great way to get those amazing greens into your recovering body.
As with all my recipes, most of the items can be adjusted or omitted, and the amounts can be tampered with to your liking. The only thing that is essential is the ratio for the dressing (1/1/1 is the best combination there).
Warm spinach salad (with bacon)
large bag of spinach leaves (I use a 1 lb bag of baby spinach; this can also be  halved or easily doubled for company)
1 lb of bacon (less for the calorie conscious)
1 lg onion (I prefer sweet, but you can use red or white as well), thinly sliced
1 lb mushrooms (your choice, I like the brown button kind), sliced
4 hard boiled eggs, peeled and sliced
seasoning (I like to use Montreal Steak Seasoning)
Cook the bacon until it is done to your liking (crispy works best), save the bacon grease. Cool and crumble bacon and add to the spinach. Add sliced hard boiled eggs to spinach as well. Make sure you have a big enough bowl to be able to toss the salad; you might want a mixing bowl and another serving bowl to keep it pretty after it wilts a bit.
Cook the onion in the grease until golden and soft. Remove with a slotted spoon and set aside. Use remaining grease to cook mushrooms, seasoning as needed. Combine onion and mushrooms.
Dressing:
1/3 c sugar
1/3 c water
Combine and heat until sugar is melted (microwave is easy for this)
then add 1/3 c apple cider vinegar (red wine vinegar works as well, haven't experimented beyond that yet)
To serve I usually heat the dressing and mush/onion mixture and pour over the spinach mixture. Toss a couple minutes to get everything coated and distribute the warmth to all the leaves. Serve quickly, and finish the bowl (not a hard thing to do). This does not keep well, and you will be able to eat more of it than you think.
Ok, this is why it takes me so darn long to write down a recipe! Have to include all those bits and pieces that you probably would have figured out on your own. But there, it is done. And forever when a client says, 'I would love this recipe,' I can now say..."It is on my blog."