Showing posts with label remedies. Show all posts
Showing posts with label remedies. Show all posts

Monday, February 18, 2013

What's In The Bag?

A lot of folks ask me what I carry in my birth bag, so I thought I'd share this image from today as I was packing up for my upcoming birth.
 Now I'm not the kind of doula that spends the entire labor pulling tools and tricks out of my bag, but because labor can be so unpredictable, I find it's important to carry a lot of this stuff with me just in case. What I have includes (in no particular order):
  • Massage tools: Nukkles, an Omni ball, several sizes of balls inside of socks, heated "stones", a foot roller, and a hollow rolling pin.  
  • Bath pillow, fully sterilizable.
  • Stress ball and comb for accupressure/hand rolling
  • Covered kneeler pad (also washable)
  • Flip flops and a change of clothes for me (just in case)
  • Microwavable brley pack - both scented and unscented depending on client's preference
  • Massage oil, lotion, peppermint spritz, and several essential oils for light aromatherapy
  • A compact fan (a client favorite for transition and second stage)
  • Hair clips/pins and ponytail elastics
  • 5 Hour Energy (disgusting but effective)
  • Battery-lit LED candles
  • Extra lip balm for mama or me
  • Sustenance for me (I never want to look at a granola bar after a birth)
  • Extra toiletries for me
  • Birth ball (not pictured) and air pump
  • A "pull toy" for 2nd stage... this was an idea given to me by another doula several years ago
  • Medical gloves in case of roadside delivery (hasn't happened so far)
  • The Labor Progress Handbook (aka, cheat sheet)
  • Client file and numbers for me to call if I need to reschedule appointments
Again, I don't use 90% of this stuff during a single labor, but you never know!

....and it all fits into one bag!!

Saturday, February 16, 2013

To Encapsulate or Not To Encapsulate?

Placenta encapsulation has become increasingly popular in the natural birth community. Claims of lower postpartum depression, the replenishment of vital nutrients, even increased milk production permeate discussions in both mainstream and "crunchy" circles alike.

Placentophagia (the eating of one's placenta) is found in many mammalian species, though interestingly has not been recorded in human history and is only occasionally observed in the reproductive behaviors of our closest cousins. Anthropologists have failed to nail down the specific drive behind placentophagia, however, the hypotheses have become the mantras of today's placental encapsulation enthusiasts.

I'll say this: I'm a huge supporter of the practice. Not only do I believe it can potentially replenish your body's nutrients, I also believe in every person's right to do what they will with their bodies whether or not they're giving birth. If you have spent the better part of 40 weeks growing the organ that sustained your child in utero, it is understandable that you wouldn't want it to just be hauled off to the incinerator. Many families opt to take it home, bury it, save it in a freezer, or have it encapsulated. Encapsulating parents take the capsules like vitamins, and indeed the placenta is home to a number of beneficial nutrients that may aid postpartum recovery.

On just about every placenta encapsulator's website, you can find the following claims:
It is believed that consuming your placenta can:

  • Help to balance your hormones
  • Replenish depleted iron levels
  • Assist the uterus to return to its pre-pregnancy state
  • Reduce post-natal bleeding
  • Increase milk production – this has been proven in a study
  • Make for a happier, more enjoyable post-natal period
  • Increase your energy levels

Sounds pretty good, doesn't it?

As much as I hate to be a buzzkill, I must interject here that there is absolutely no methodologically sound research to back many of these claims (or demonstrate how consuming one's placenta would, say replenish iron levels better than a diet rich in heme iron). I wish there was such research, but unfortunately, the evidence of any of the above benefits remains largely anecdotal.

Deena Blumenfield at Shining Light Prenatal Education breaks down the issues with some of the commonly-held beliefs about placentophagia, noting specifically the questionable claims surrounding oxytocin and postpartum bleeding:
Yes, oxytocin is present in the placenta… but how much of it is destroyed during the cooking or dehydrating process.  No one knows because there are no studies on this.  How much of any of the hormones or nutrients are destroyed during cooking or dehydrating?  Again, no one knows.
Placenta is also used to control postpartum hemorrhage ... by cutting off a small piece of placenta and asking mom to suck on it, or eat it, as her care provider is trying to control the bleeding.  However, this is used in conjunction with other techniques, such as uterine massage, to control bleeding.  So where is the bleeding control coming from?
As a lactation consultant, I wish to specifically address the commonly-held belief that consuming your placenta can combat low milk supply because of its high levels of prolactin. It's shocking to see a number of people citing "a study" on placentophagia and prolactin levels when in reality no such study exists.  Let me rephrase... no such methodologically sound study exists.

The "study" put forth by most supporters of placentophagia is Soykova-Pachnerova et. al, Placenta as Lactagagon. The first thing I noticed about this study is that you can't find it anywhere... I sifted through page after page of placenta enthusiasts citing it, but couldn't locate a primary source at all.

The second thing I noticed about this study, once I found a reliable source with more details about it, is that it was conducted in 1954. It had an extremely small sample size, it was not performed with any kind of single- or double-blind method (in other words, participants knew whether they were being fed placenta or the placebo), and it did not control for outside factors (first gestation vs. subsequent, overlying health issues, etc). It has yet to be replicated. From those issues alone I am prepared to dismiss this research as bunk. Moreover, I am concerned with the number of folks claiming increased lactation from placentophagia has been "proven in a study."

Still, I find that the rationale deserves a closer look. While it is true that placenta contains lactogens (human placental lactogen, or hPL), hPL is slightly different from the prolactin (PRL) responsible for milk production. In fact - to totally nerd out on endocrinology for a moment -  it appears that the similar hPL molecules, along with progesterone, keeps the body's prolactin levels at bay until the placenta is delivered.[1]

Which brings me to my next point: even with lactogens present in placenta, can taking them orally cause one's prolactin levels to increase? For this to happen, lactogens (prolactin, etc) would need to have some sort of oral absorption capabilities.  Do they?

Unfortunately, the evidence seems to suggest they do not. While the body of research on this topic is also lean (and decades old), a well-controlled experiment conducted in 1979 found that the serum prolactin levels of lab rats were not effectively raised by the oral administration of prolactin. This study has also not been replicated, however, the conclusive nature of the results may contradict the need for further study.

Lastly, anecdotal evidence of better breastfeeding success and lower PPD is suspect in that it leaves many socioeconomic factors out of the equation. Consider location alone: the provider listings at PlacentaBenefits.info show that most placenta encapsulation specialists are localized to metropolitan areas, areas where there are also likely to be lactation consultants, peer support groups, friends close by, etc.

Now consider the economic factor. To my knowledge, placenta encapsulation is not covered by any insurance company (and definitely not Medicaid), with out-of-pocket costs ranging from $200 and up. If someone has the ability to pay that fee (especially after having a baby), they probably also have the ability to pay for a lactation consultant, a doula, a therapist, etc. They are more likely to be partnered and have well-paying jobs (which would denote higher education levels). These factors play major roles in breastfeeding success and postpartum depression risk alike; therefore, without research on placentophagia that controls for these factors, there is truly no way of knowing whether the placenta - not socioeconomic status - is what's lending these great results.

Regardless of all the suspicions I have about placentophagia being a "miracle cure," my opinion is that there are probably many benefits (mostly nutritional), and it is likely not harmful. There has been some concern over the 2011 study that found heavy metals present in placenta and cord blood, but those levels are likely a reflection of what the body has been exposed to anyway. I am not clear on whether or not re-consuming those metals will do any more damage, however, I would encourage you to speak with your midwife or doctor if that is a concern.

But unfortunately, the claims involving lower PPD and better milk supply seem to be anecdotal. I'll echo Blumenfield that I would love to see actual research. As someone who works with new parents as both a doula and lactation consultant, it would be great to find out that placentophagia does in fact have these miracle properties. In other words, I would love to be proven wrong.

Lauren Guy
CD(DONA), IBCLC

[1]Jan Riordan, and Karen Wambach, Breastfeeding and Human Lactation Forth Edition, (Sudsbury, Massachusetts: Jones and Bartlett Publishers, 2010), 88-90.



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
CD(DONA), IBCLC




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.




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
CD(DONA), IBCLC