What it means to be an Inclusive Practice

I occasionally get questions about the Inclusive Practice graphic on my website, so I wanted to take a minute to explain it and highlight why I see this designation to be important. We're on the heels of Pride Month, after all.

First off, what do all those color combinations mean?

Put simply, the above color combinations are the flags of the LGBTQIA community.  The most common flag associated with this community is the rainbow flag (left), though because many feel it to only designates gay and lesbian folks, other communities created flags with their own unique color combinations.

This flag represents bisexuality. These are people who feel romantic and/or sexual attraction to two genders. I have worked with many bisexual folks, and while it is not always relevant when they're in a heterosexual relationship, my clients feel they can comfortably disclose this intimate detail about themselves if they are aware that I am an LGBTQIA-friendly provider.

This flag represents the transgender community. A transgender person is a person whose gender differs from the gender they were assigned at birth. For example, a trans man may have been "DFAB", or designated female at birth. Many trans men can become pregnant and some choose to do so. Some nurse their babies and others choose not to or cannot. I am proud to be in a growing community of birth and lactation professionals that have educated ourselves on helping transgender folks meet their infant feeding goals.

This flag represents the genderqueer and non-binary community. Some folks do not identify with a specific gender, or their gender does not fit the typical man/woman binary. Non-binary folks often use gender neutral pronouns such as they/them. Many can become pregnant and give birth, so being knowledgeable about this community is a must for an inclusive birth and breastfeeding professional.

Speaking of non-binary folks, a pansexual is a person who experiences attraction to all genders. They dislike the term "bisexual" because of the implication that there are more than two genders. Again, this is not always a relevant issue for birth workers, but this community is important to include in your awareness base!

An intersex person is a person born with reproductive or sexual characteristics that do not fit the traditional male/female binary. Contrary to popular misconception, most intersex people are able to become pregnant, though modification surgeries to "assign" a sex during infancy often interferes with future fertility. Many if not most intersex people resent this cosmetic modification because they were not given a choice in the matter.

Asexuals are people who do not experience sexual attraction, or experience it very selectively. Many asexual people experience romantic attraction, and therefore do become pregnant and start families with the people they love.

The final flag is the only one that doesn't really "fit" in the LGBTQIA acronym, though it's relevant to doulas. Non-monogamous folks (also called polyamorous) have multiple romantic relationships with the knowledge and consent of everyone involved. A doula very often becomes acquainted with the intimate details of their clients lives, so being aware of diverse relationship dynamics is important. Especially if your client will be accompanied by more than one romantic partner!

In other words, this graphic is meant to signify that I have a great love and respect for diversity! Because no two families look alike, it is important to me to designate myself as an inclusive doula and lactation consultant. Indeed, I enjoy working with pregnant folks and their families regardless of sexuality, gender, or family structure. Additionally, I am committed to being aware and knowledgeable of the unique issues affecting each community.

For those who have asked, yes you are more than welcome to use the above graphic on your business page! I only ask that you educate yourself about each community and know that being an "inclusive provider" means committing to a lifetime of learning and never making assumptions. The experience of one person is not the experience of everyone within that demographic. The best practice is to listen first and echo language. If you're unsure, just ask! A few examples of questions you might ask:

• "What are your pronouns?" (Don't assume based on how someone looks or sounds.)
• "How should I refer to you nursing your baby?" (If you're working with a trans man, he might use "chestfeeding" or simply "nursing" instead of "breastfeeding.")
• "How should I refer to your partner?" (This goes for everyone! Just because someone is married doesn't mean they use terms like husband or wife.)

Sadly, most doula trainings are severely lacking in these topics, so I'm providing some resources to help you educate yourself on the diverse family below:

The Next Family - The leading resource for gay parents, single parents, and city dwellers
World Professional Association for Transgender Health
Milk Junkies - Breastfeeding and parenting from a transgender perspective
Professional Organizations on LGBT Parenting - HRC
More than Two - Resource for non-monogamous families

And a few for your LGBTQIA clients and their families:

Find an LGBTQ Care Provider - Breastfeeding Network 
Overview of Lesbian and Gay Parenting, Adoption, and Foster Care - ACLU 
Trans Parenting Support Group - Web-based community
Family Resources - Family Equality Council
The Basics of Inducing Lactation - Breastfeeding without Birthing
Breastfeeding Inc - Resources from lactation specialist and LGBTQIA ally Dr. Jack Newman
Peaceful Beginnings of the Triad* - Inclusive clinical lactation support for all kinds of families in the Piedmont Triad of NC

*Full disclosure: I am one of the lactation consultants at Peaceful Beginnings.

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

Return to Efference Doula Services and Lactation Support.

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.

Return to Efference Doula Services and Lactation Support.

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.

Return to Efference Doula Services and Lactation Support.