Wednesday, December 12, 2012

Got the flu? Don't stop nursing!!

You don't have to tell me it's flu season... my supposedly "great immune system" was no match for this bug I've been battling for the past few days. It seems everyone and their mother has come down with some kind of cold or flu bug, and new mothers - their immune systems weakened by a recent birth and subsequent exhaustion - are at risk.

If you have yet to catch the bug, the CDC recommends the flu shot for pregnant women and mothers of infants under 6 months of age. The vaccine is fully compatible with breastfeeding and pregnancy. Though adverse effects have been wildly hyped, a 19-year review by the CDC in conjunction with the Vaccine Adverse Effect Reporting System found "no unusual patterns of pregnancy complications or fetal outcomes" in pregnant women receiving a seasonal flu vaccine. Of course people have legitimate concerns regarding injections during pregnancy, and I'm certainly not qualified to make benefit/risk assessments, so I'd encourage you to discuss any safety concerns with your care provider.

A question I've been getting a lot lately is, if you get the flu, should you quit breastfeeding to avoid exposure to your child?

The answer to this is a vehement no! And here's why.

For one, there's a chance you've been contagious since before you had any symptoms, and even if you weren't, it's highly unlikely that nursing is the only close contact you're going to have with your baby unless you're somehow able to pass off all caregiving responsibilities to someone else. Influenza is extremely contagious, and simply living in the same house with someone who's infected puts your baby at risk.

Even more importantly, if you have caught the flu, your body is busy producing a wealth of antibodies against that specific strain, antibodies that readily pass through your milk to your baby. I can't tell you how many times I hear a story about every adult and child in a family coming down with the flu, but the one breastfed baby makes it through the season without ever showing a symptom despite her/his immature immune system. If baby does become ill, breastfeeding will provide current antibodies to facilitate a quicker recovery. What's more, a baby nursing actively from her/his mother is getting other benefits conducive to healing: skin-level antibodies, plenty of hydration on demand, warmth, comfort, and pain relief.

A sick baby is very stressful and can be scary, and don't let flu-like symptoms go unexamined; if you believe your child is getting sick, consult your health care provider for complete treatment and diagnosis. But remember, breastfeeding will provide comfort and closeness to help you both make it through the season. Just keep nursing!!

Lauren Guy

Friday, November 2, 2012

The Pacifier Question

I can't tell you how many times I've been working with a new parent when they sheepishly tell me that their baby uses a pacifier. Often it's an admission they don't even want to make, assuming lactation consultants are intensely anti-pacifier, or worse, that using one means they're failing as parents.

So I want to take this opportunity to officially state that I am in no way against the use of pacifiers! What's more, I want to dispell the myth that lactation consultants believe that all of baby's sucking needs should be taken care of at the breast and that mothers who use a fake nipple aren't "doing it right."

I can see no reason why a baby who is breastfeeding well and gaining weight shouldn't be given a pacifier for non-nutritive sucking. Babies, especially very young babies, have an inherent need to suck. It's very comforting to them, and it doesn't always indicate a need to eat. Babies who have gastroesophageal reflux (GER) often benefit from sucking on a pacifier between feedings, and there is sound research that suggests that pacifier use may reduce the risk of SIDS.

Regarding feelings of "ineffective parenting," I would encourage you to relax and ground yourself in reality. While new mothers are often hyper-pressured to exceed attachment parenting guidelines in meeting their baby's needs, allowing your body to be baby's pacifier simply may not be appropriate for your lifestyle. For one, many mothers experience severe nipple pain/trauma from non-nutritive sucking (sucking without making a milk transfer). Others simply cannot be there to meet their babies' sucking needs 24/7. There is no reason to feel guilty about using a pacifier to calm your baby when you can't be there to do so yourself; while parenting certainly requires a high amount of selflessness, you're not going to be able to be an effective caregiver if you've given away all of your personhood in the first year of your baby's life!

On the other side, mothers are often told that acting as baby's pacifier will "spoil" them and impede their independence. This is also a completely unfounded notion; there is absolutely no evidence that responding to a baby's needs on demand will in any way contribute to an unhealthy dependence on their mother. If a mother has no nipple pain, then there is no reason not to forgo the pacifier for more breast time if it fits into mom's lifestyle and desires.

My only recommendation for pacifier use is that parents wait at least three weeks before introducing them or any other artificial teat (unless supplementation with a bottle is indicated, as directed by a lactation consultant). I recommend this for several reasons. For one, I want parents to learn how to read their babies' cues. Are they hungry, or do they just need to suck on something? This learning tends to take several weeks as parents adjust to having a new baby around. Secondly, the first two weeks after birth is critical in establishing mother's milk supply for the long term. If the delicate dance of supply and demand is interrupted by early pacifier use, mom's supply could suffer. Lastly, while true "nipple confusion" is rare, I do like to see babies demonstrate that they have gotten the hang of breastfeeding (generally, they get back to their birth weight in two or three weeks) before putting anything else in their mouths. This is especially true for babies who for whatever reason were slow to start or had any difficulty getting a grasp on feeding from the breast (pun totally intended).

Using a pacifier for your baby's non-nutritive sucking needs is nothing to be ashamed of or worried about. As a parent, you are capable of making the best decisions for you and your baby, and so long as your baby is nursing well and gaining weight, there is no reason to avoid pacifiers if you wish to use one.

Thursday, November 1, 2012

Breastfeeding Credentials, At A Glance

You know those letters after a doula's name that don't necessarily have to do with being a doula? Often those are credentials from different (but related) organizations and may indicate a specialty in a number of birthy areas: childbirth education, massage and bodywork, breastfeeding support, placenta encapsulation, nursing, etc.

There are many credentials that revolve around lactation, which can often be confusing when an already-exhausted family is searching for the right kind of support. Each of the below certifications qualifies one to offer a certain level of breastfeeding support, however, the IBCLC is the only credential that is qualified to provide clinical assessments and address the full scope of lactation challenges.

The following list lays out what each certification means, how one certifies, and the scope of practice associated with each.
IBCLC - International Board Certified Lactation Consultant - This is a clinical credential that requires 1000+ hours of required study, education and training culminating in a once per year international exam given by IBLCE. IBCLCs must recertify every 5 years, and every 10 must retake the exam. These clinicians work in hospitals, birth centers, out of their homes, and in private practices. They perform complete evaluations and assessments of both mother and infant and create individual plans of care, working hands on with all breastfeeding challenges as well as more complex health issues.

RLC - Registered Lactation Consultant - This credential is used in conjunction with IBCLC within the United States.

CLE - Certified Lactation Educator - CLEs have completed a 20-hour course on breastfeeding support and completed approximately 25 additional hours of out-of-class coursework which culminates in a certificate of completion from CAPPA. CLEs are trained to teach breastfeeding classes and answer basic breastfeeding questions, however, they must refer out to IBCLC for more complex cases and are not trained for hands on consults.

CLC - Certified Lactation Counselor - CLCs have completed a 45 hour course of education, culminating in a certificate of completion, sometimes after completing an end-of-course exam, from The Center for Breastfeeding. They are trained to counsel on normal breastfeeding situations and troubleshoot minor challenges, however, they must refer out to an IBCLC for more complex cases and are not trained for hands-on consults.

CLS - Certified Lactation Specialist - Similar to CLC, CLSs certify through Lactation Education Consultants by attending a 45-hour course and completing an end-of-course exam. They are trained to educate, support, and counsel mothers on normal breastfeeding situations, however, are not qualified to perform hands-on consults or administer clinical plans of care.

BEC - Breastfeeding Educator Certification - Those who hold a BEC have completed an intensive course of study with Birth Arts International. Prospective BECs complete a lengthy in-classroom or self-study course on the science of lactation, anatomy and physiology, pedagogy, sociology, medical terminology, and counseling. They must also complete 600 hours of supervised lactation support in varying clinical settings in their communities.  The BEC certification is community-specific and qualifies students to teach, support, and educate the public on breastfeeding and related issues and policies.

BC - Breastfeeding Counselor - A relatively new organization, Breastfeeding USA certifies mothers to lead free, highly accessible support groups for breastfeeding mothers. They answer questions regarding normal breastfeeding situations, offer tips for troubleshooting challenges, and refer out to IBCLC support when indicated.

LLLL - La Leche League Leader - La Leche League International is the oldest breastfeeding support organization in the country, now offering support groups all over the world. LLL leaders receive a multitude of training in normal breastfeeding situations, offering tips for troubleshooting challenges, and know when to refer out to IBCLC support. Offers mom to mom support in a casual and accessible environment. Many IBCLCs started as LLL Leaders.

WIC Certified Breastfeeding Peer Counselor - WIC CBPCs are employed by state WIC offices and provide support to breastfeeding mothers who qualify for WIC at no additional cost. While the requirements vary state by state, WIC Peer Counselors are mothers who have breastfed themselves and have completed comprehensive study in breastfeeding management, counseling, cultural diversity, and education.

Wednesday, October 3, 2012

The Childless Doula

In the very beginning of my doula career (about three years ago now), it wasn't uncommon for someone to raise an eyebrow when they found out that I was a doula yet had no children of my own. And in a way, I understand where they were coming from: it is true that most doulas - at least from what I've experienced personally - came to the work after having children themselves. To some, the experience was beautiful and positive, maybe even involving a doula, and they want to help other families have the kinds of births they had.  To others, it's the opposite: they had negative experiences, felt unsupported or just plain clueless, and want to keep other women from being that way. 

I've engaged in a few conversations (some heated) on the matter of "The Childless Doula" on online forums for birth professionals. While some contributors were complimentary that there were so many young faces in their area's doula communities, others were either skeptical or outright dismissive of the idea.  I've even been passed up by potential clients because of my parental status. 

On a purely superficial level, their criticism makes sense: what can someone who has never experienced childbirth themselves really contribute to someone else's birth? But following that logic takes you to obviously irrational places, such as whether or not you'd have brain surgery by someone who's never had a tumor, or hire a family therapist who has never seen a counselor themselves. I played this defense on loop for a while, until finally I realized that if my parental status mattered that much to someone, then their preferences were legitimate and I was not the right doula for them. Some moms-to-be want motherly doulas for personal reasons that they can't really verbalize, but their preference is valid nonetheless.  Some even going so far as to want a doula that has had a similar birth experience they are anticipating (planned cesarean, VBAC, home birth, pregnancy after loss, etc).  Fortunately, our doula community here in the Triad is incredibly diverse and varied, and there's probably a doula to fit everyone's needs and desires.

But getting back to me, The Childless Doula. I came to this work for reasons becoming more common, more common in fact that I'm starting to get the raised eyebrow less and less.  Miriam Perez says it better:

"We all come to this work for different reasons. Until recently, most of the doulas I encountered were parents themselves–their childbirth experience, whether positive or negative, inspired them to serve others during pregnancy and childbirth.
Now I see a different group coming into this work. Young people without children but with a passion for health activism are finding doula work and see it as a new way to channel their desire to engage in direct service or direct action. Books and documentaries about maternal health in the U.S. have in­spired many people.
The common thread throughout all these experiences ... is unconditional and nonjudgmental support. That is the essence of doula work."

Because of this continuing trend, I get the parenthood question less and less.  People meet me, they sense my passion and energy, and they decide if I'm a good fit for them regardless of whether or not I'm also a mother. For many, the question of parenthood doesn't even enter into the equation.

The raised eyebrow reappears when people find out that I'm on the fence about having kids of my own at all.  It's not completely out of the question, but considering my divorce last year and my continued commitment to my education, I'm reluctant to even consider any intention to have a baby of my own at this time.

That doesn't change my passion for supporting women and their families through what is by far the most intense and awe-inspiring event in the world. Doulas come to the work for a variety of reasons, and as we grow we find new reasons to keep going.  I may have gotten into the work as a move to turn my feminist activism inward, but I continue to do it for reasons that I'm still trying to make sense of. To be sure, part of the work is indeed "the ultimate feminist act," but other parts transcend feminism and pretty much any other "-ism" you can name. And as any of my clients could tell you, it transcends parental status as well.

Saturday, September 8, 2012

Get Yer Freak On. Doula's Orders

The first thing people do when they find out you're a doula (other than asking what the heck that is) is tell you their birth stories.  Which I love, but they very often end with, "So then I had a c-section, and did I really need one?"  Um, I dunno.  I wasn't there, and if I was, I wouldn't exactly have the authority to say.

The second thing people do is ask about some old wives' tales surrounding birth.  The favorite of mine is always, "Is it true that having sex can bring on labor?"  And let me tell you, the answer is yes.
But why?

Oxytocin, the so-called "love hormone," is at least partly responsible for three distinct physiological events in a woman's reproductive life: orgasm, labor, and breastfeeding. As a sex-positive doula and lactation consultant , you might say that oxytocin is my homegirl.

The female orgasm was once thought of as relatively inconsequential to the reproductive process.  In fact, some fertility specialists have even suggested that orgasm "dilutes" a woman's chance of becoming pregnant.  Au contraire, says a bulk of new-ish research that essentially reaffirms what lay-health workers have been saying for years: orgasm increases your chances of conception.  See, when a woman orgasms, her body releases even more vaginal secretion than she does when simply "aroused," helping to lubricate the sperm's path to the egg.  Additionally, the oxytocin released via orgasm contracts the uterus, lowering the cervix (the "neck" of the uterus) and making the uterus more accepting of a fertilized egg (ever wonder what that tight feeling in your lower abdomen was?).

So oxytocin contracts the uterus.  Hence, it may help tip your body into labor.  But the wonder-hormone's job isn't over when the placenta is delivered.  Oxytocin is also responsible for the milk "letting down" during breastfeeding.  See, when a woman first lays eyes on her baby, she's essentially OD'ing on oxytocin, as is baby.  That's the love hormone doing its job.  Baby will hopefully find her/his way to a nipple and begin suckling.  When the nipples are stimulated, oxytocin is released from the posterior pituitary gland, contracting the tiny myoepithelial cells inside the milk ducts, forcing milk out of the breast and into baby's mouth.  That oxytocin release is still doing it's job "down there," helping mama's uterus to clamp down post-delivery, thus reducing risk of excessive postpartum bleeding.

I mention the connection to breastfeeding because oxytocin is also released with nipple stimulation.  Women who enjoy nipple stimulation during sex may enjoy it for a number of reasons, but physiologically it's because that burst of oxytocin contracts the uterus (which essentially puts interior pressure on the clitoris and, well, you get it).  In other words, if you enjoy nipple stimulation, include that in your labor-inducing sex practice.  Otherwise you can just turn on your breast pump when you're finished, and you will probably get many of the same benefits.

If a woman is having sex with a man, he may play a labor-inducing role as well.  Semen contains prostaglandins, autocrine hormones that help to soften ("ripen") the cervix.  A softer cervix makes the fertilization/implantation process more likely, but these hormones work the same when a woman is already pregnant.  The low dose of prostaglandins in semen alone aren't likely to induce labor in a woman who's not yet term (which is why care providers don't warn against sex during pregnancy unless a woman is at risk for preterm labor), but the mild softening in a term mama might just be enough to tip her into labor mode.  As an added bonus, his penis hitting against the cervix may indeed induce some mild (but not earth-shattering) uterine contractions.

Captain Obvious moment: I generally don't recommend the prostaglandin method if a mama is in a relationship where she's at risk for a sexually transmitted infection.  The last thing she needs is to be infected with an STI right before a baby comes through her vagina!  If infection is a concern, sex with a condom still contains the benefits of oxytocin and cervical pressure.  Masturbation is a safe and effective alternative for women who don't have a partner (or just simply don't want to engage in partner sex).  Again, oxytocin is stronger than prostaglandins!

So yes, good sex can in fact induce labor.  In other words, if you're trying to get labor started, just get yer freak on.  Doula's orders.
Lauren Guy

Saturday, September 1, 2012


Greetings, readers!

Welcome to Spiraling Outwards, a venue where I can share birthy news and research while adding some commentary and "doula slant".

I almost didn't start a blog at all. It's tricky business for us doulas. Most of us tow the line between being non-judgmental and highly opinionated on an almost daily basis. We want to be able to present information without a whole lot of bias, giving our clients factual information to help them make decisions that are going to work for them, not us. But given the long, drawn-out rants I've been attaching to reposts on my Facebook page as of late, I decided to just go ahead and attach my business name to a blog.

I have another personal blog, and I also write for RH Reality Check and other related reproductive health news and commentary sites. However, those tend to deal with reproductive health issues that don't always have to do with childbirth and breastfeeding, though I may cross-post some of those here. I am a very political person in my "non-doula" life, and while that's just an inherent part of who I am, I try to keep things more or less apolitical in the birthing room; this goes back to my desire to be the doula for every kind of person, regardless of background, religious belief, political affiliation, etc. So don't expect things to get terribly "polarizing" here.

Comments are more than welcome, as is sharing any content in full or part (with proper credit, of course). All I ask is that people remain respectful. Comments containing hate speech or oppressive language will be promptly deleted (if you don't know the difference between non-oppressive language and just plain "political correctness", a brief primer is available here). I may also remove comments that cite bunk research... sorry, but that's just a big pet peeve. So that's about it. Welcome to Spiraling Outwards!!