Wednesday, August 24, 2011

Link party, August blogcation

I guess my blogging is on an August hiatus? Between traveling and bracketing the traveling with long shifts at work, I am not doing much blogging (also, my e-mail inbox hates me - at least, I assume the feeling is mutual. So if you've e-mailed me and not heard back, that may be a factor.) Early September may not be much better, but I promise to post again soon!

In the meantime, some links:

* Jessica Valenti on learning to love her baby through a harrowing delivery and long NICU stay

* From Birthing Beautiful Ideas, these are many of the reasons that I too love being a doula!

* Elita at Blacktating ponders the idea of the "relief bottle".

* A doula's birth story that highlights some of the ways a doula can play an important role in a planned cesarean

* The Unnecesarean links to this excellent piece on the co-opting of "pregnancy is not a disease" by anti-contraception organizations, and then breaks it down:

...this whole conversation is ridiculous. We are only having it because somebody, somewhere, is upset that women are having sexy non-babymaking funtimes they don’t approve of, and they’re determined to make us all pay for their inability to deal with not everybody agreeing with them that this is bad.
Go on, read the whole thing!

* And for the lighter side of things... I've just discovered the webcomic Married to the Sea, and in celebration they clearly did a comic just for me:

There are lots more!

Wednesday, August 10, 2011

Link party! CBACs, Fulbrights, and bras

I am on the road! Excited to be traveling to a favorite city to help with and attend the wedding of a great friend. I have several posts in the "What every doula should know about breastfeeding" series in progress, but I don't know how much work I'll get done on them in the next week. So in the meantime, a few links!

A planned, empowered, and enjoyable CBAC story (by a mother who had already had one c-section and a VBAC). "I will never forget these moments. Ever. They were beyond perfect. At last a very beautiful, calm and positive birth experience. I felt fully supported, I felt my son and I were in good hands. My husband and I were respected, and the birth truly was a celebration."

A step-by-step guide for applying for a Fulbright. I am so proud of my sister who has a Fulbright next year to study sustainable agriculture in west Africa! Have you ever thought about wanting to research issues related to reproductive health or other related issues in another country? A Fulbright can fund you for a year, on huge range of research topics!

I've been getting into some different bra blogs lately! They are written by women who have "unusual" sizes (in quotes because it's not unusual for women to BE these sizes, it's just unusual for them to KNOW they are these sizes). This is a great post on how many women are fitted poorly into bras and how the many different shapes and sizes that we come in are not respected:"The War on Plus Four": "...for some women, the fact that they might need a 30 or even 28 band and a significantly larger cup might seem like an alien concept as we generally have it drummed into us that a 32 is the smallest band available, and anything below this should be considered a ‘specialist’ size. Or an ‘awkward’/'odd’ size (I’ve heard it described as such and everything in-between). Even the idea that going down a band size (or even multiple sizes) makes people shudder. "

That's all for now!

Tuesday, August 2, 2011

What every doula should know about breastfeeding: Tip #3: A few must-knows for pumping

Preface: Often as a doula, before I became an LC, I would encounter situations in the hours after the baby was born, or at postpartum visits, where I wasn't quite sure what to suggest; or looking back, I realize I could have done something differently. I've decided to share some tips with other doulas about things that I wish I had known long ago! Today is Tip #3: A few must-knows for pumping.

There are a number of reasons your doula client may want or need to pump, including increasing her milk supply/getting additional stimulation to bring in a good supply, and pumping for a baby who can't latch and/or is in the NICU. Some mothers will end up (short- or long-term) exclusively pumping, aka EPing. If your client is EPing because of latch issues including difficulty getting the baby to latch or pain with nursing, make sure she sees a good LC fast!

Like some other topics in this series, I am bummed to have to give many of these pumping tips to doulas, not because I don't think doulas should know this stuff, but because EVERYONE involved in caring for new moms/babies should know this stuff! Moms often do not get the support they need to make pumping successful. But knowing that doulas are there to fill in the gap, these are important things that you may be the only one to discuss.

These tips are by no means all anyone needs to know about pumping, but they are opportunities for the doula to fill in gaps in knowledge:

With that thought in mind, I am putting two very simple, very important tips first:

#1: Cleaning: On a Medela, the valve and flange come preassembled, like this:

So nobody realizes that the yellow valve and white membrane come off and come apart, like this:

On an Ameda, the valve and flange also come preassembled; their valve looks like this:

Every time the mother uses the pump, those parts should be completely taken apart, washed, and dried separately. If those pieces are not taken apart, milk and moisture can accumulate between them and cause problems like poor pump suction and mold growth (EW, I know.)

People just do not know this; I know people who pump for months or YEARS and do not know this. Tell your doula clients! Tell all your friends! Rent out a billboard! Pump valves come OFF THE PUMP!

#2) Flange fit.


Look at this picture:


Now look at this one:


(Both images taken from this simple, lovely page by Ameda.)

I carry a copy of these two pictures around with me at work (I know, I know... my job is so cool!) Any pumping mother, when asked, can tell you whether her pumping sessions look more like the first photo or the second photo (occasionally they'll say "well, kind of halfway between the two" which still suggests a tight fit.)

The wrong size flange can cause pain and low supply. Once again, mothers pump for YEARS with the wrong flange and say "The pump never worked very well for me" or "Pumping always hurt for me", never knowing there was any size flange but the one that came with the pump!

If you know a mother will be pumping a lot, show her these pictures and tell her in advance to keep an eye on flange fit (consider printing the pictures out and keeping them in your doula bag). Mothers may start out a pumping session with what looks like a good fit, and end it with a tight fit; those women should get a bigger flange. They may also be OK on one size for a while, then start to need a bigger size after a few days or weeks of pumping; those women should also get a bigger flange.

The "standard" size in the box is the 24mm flange. Both Medela and Ameda manufacture various sizes up to a 36mm flange, and Medela also makes a 40mm flange. They can be purchased at stores like Buy Buy Baby, Babies R Us, Target, local lactation consultants, or baby boutiques; or they can be ordered online.

Many mothers find that the Pumpin Pals brand shields are more comfortable for long-term use than the standard flange that comes with their pump kit; Pumpin Pals flanges can be used with a number of different pump brands. They're angled and more curved than standard flanges, so many mothers report they feel gentler on the breast, and they also allow the mother to lean farther back when she's pumping.

#3) Early pumping: As I noted in my hand expression post, pumps are usually NOT very effective at removing milk in the early days. Mothers of a fussy baby may sometimes ask to pump to see "if there's anything there". The pump will not help her with that! Counsel the mother who wants or needs to pump in the first 1-3 days that she may not see much with the pump, and help her learn hand expression to maximize the amount she can get out. Mothers who are totally pump-dependent are understandably discouraged by pumping and pumping and getting a single drop. Give them lots of cheerleading and support, and reassure them that they will see more milk within a few days.

#4) She needs a great pump, aka not all pumps are created equal: If your doula client needs to or decides to EP, DO NOT let her buy a crappy, low-power pump. I usually don't talk in such absolutes, but it has to be said. There are some women who can get and maintain a great supply on those $70 pumps; they are in the tiny minority. Usually women buy one of those pumps because they see the price of a Medela or Ameda as prohibitive, but once they've bought a crap pump they've now sunk $70 into something that causes supply issues, and quite possibly nipple trauma (
I'm looking at you here, Early First Years pump) AND they're looking at spending again on a high-quality pump. These situations just about break my heart. If the mother wants to provide exclusive breast milk, she needs a better pump.

She should also NOT get a single-sided pump, or anything with a little motor like the Medela Freestyle. These pumps are OK for the occasional pumper, not for the EPer. Once again, some women can maintain a supply on these pumps, but if they can't they've just wasted a lot of money and are going to have to spend even more. If she chooses to rent a pump instead of buy, you are on safer ground as she will be renting a hospital-grade pump which are all double electrics and have good suction/motors. (If she is struggling with supply and using a good consumer-grade pump like a Medela Pump in Style, she should also consider upgrading to a hospital-grade rental. Moms with supply issues need the best stimulation possible!) When thinking about pump prices, help her think about the value of the milk she will be pumping out. Good pumps are expensive - but so is formula.

If your doula client has difficulty affording a pump, check to see if she is enrolled in WIC, and if not encourage her to try to enroll. Any mother on Medicaid will be eligible for WIC, but even if she is not on Medicaid her income may still qualify her. (She does NOT need to be a US citizen or resident to enroll in WIC; after all, her baby, the one who will be getting the milk, is a citizen.) Many WIC offices have loaner pumps available for mothers who need to pump for medical reasons. If she tells the WIC office she is enrolling because she needs a pump, they may expedite her enrollment to make sure she gets the pump quickly.

#5: Support! EPing is not easy (even though to some moms it may seem like a quicker fix for latch issues in the beginning.) These moms often struggle with low supply, and with the extra time and work it takes to clean pump parts, bottles, carry the pump everywhere, etc. Suggest EPing moms join an online support group - they can really use the support and camaraderie, and it is easy for them to feel like they are all alone when they don't know other pumping moms nearby.

Mothers who have issues with supply or pain issues while EPing should of course be referred to your favorite local lactation consultant! LCs are not just for direct breastfeeding; they can have excellent resources and advice on pumping comfort, ways to build supply, and may even be able to help get the baby back to the breast if that's possible.


I bet there are some long-term pumpers out there - what do you wish doulas (or birth professionals in general) knew about pumping?

Monday, August 1, 2011

Conferences, everywhere!

With a number of my work colleagues just returned from the International Lactation Consultant Association (ILCA) conference, I've started pondering about how to use the education $$ available from our department to go to a conference myself.

The APHA conference is coming up...ooh, the chance to check out lots of breastfeeding and MCH-related public health workshops/connections! (And let's just say, that conference is not cheap. I would love for my work to cover it!) That is late Oct/early Nov.

Then there's the Academy of Breastfeeding Medicine conference, also in early Nov. They have a track for non-physicians that I would love to attend. So much fascinating stuff on international issues!

If Health Connect One has another conference, I would be so excited to attend...hoping they announce one soon.

Let's not forget the next ILCA conference is a year from now in Orlando!

And although it wouldn't be connected directly enough with my job (so I'd have to pay my own way) - having missed this year's, I am really determined to attend next year's CLPP conference (and I'd like to do a workshop - I am brainstorming ideas at the intersection of birth/breastfeeding/reproductive justice if anyone would like to collaborate!)

Any other conferences out there you'd suggest, or planning on going to?