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Growth charts! They are a huge topic, partly because of many opinions on them. There are good reasons why there are so many opinions on them. One thing to keep in mind, believe it or not, is that they are not all the same. The growth chart I use vs the one some doctors use vs public health vs all the apps is that some use older versions that were made and provided by formula companies, some use the CDC, some use the WHO, and some maybe even have their own.
Once upon a time, I was trained to not really consider what growth charts said because the ones we had were made in the 1970s/1980s with a group of all American Caucasian formula fed babies and they were distributed to health care providers by formula companies. Because of this, it was believed they had no relevance to breastfed babies. This isn't entirely wrong, but this is also no longer the case. The growth charts available today have since been redesigned. The WHO one is now based on breastfed, world wide babies with much more detailed analysis. I will point out there are many growth chart versions available - so please look to see what is being referenced. With proper understanding they can be a very useful tool and tell *part* of the story of growth. The WHO developed standards of growth of the breastfed infant as the norm for growth. The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months. In contrast, the CDC growth charts are references. They identified how typical children in the US DID grow during a specific time period. Typical growth patterns may not be ideal growth patterns. I often say "just because something is common, does not mean it is normal." The WHO growth charts are standards; they identify how children should grow when provided optimal conditions. The WHO standards are based on a high-quality study designed specifically for creating these growth charts. For the CDC growth charts, weight data were not available between birth and 3 months of age and the sample sizes were small for sex and age groups during the first 6 months of age. There are lots of gaps in these charts! Some infant apps actually use their own version! It is still common to hear statements like “don’t worry about it” but sometimes this is secret code for “I don’t know how to help you” or “I don’t know how to read the data” or “I don’t understand what the chart is telling me”. “Hey Kim! Is there a place in Regina that I can donate frozen breast milk. I have so much more than I need and don’t know what to do with it.” This is a common text or email that I receive. The short answer is “Yes”. There is a formal route and an informal route. Northern Star Mothers Milk Bank in Calgary is the closest milk bank that we have to donate to in a formal manner. In Saskatchewan, we do have several depot drop points for approved donors. Approved donors; what are those? Mothers have to be screened and approved before they can donate to the milk bank or take to the milk depots. You can see eligibility criteria here. If you are eligible you can start the intake process. You do need to have 150 oz to donate to a milk bank. At the Northern Star Milk Bank donated milk is pooled, pasteurized and tested. This milk is then provided, at a cost, to sick babies in hospitals and homes around the country The costs are cover the expenses of the milk bank, not for profit.  The informal way is mom-to-mom milk sharing. This can be facilitated within mom support groups or online with social media pages like Human Milk for Human Babies Saskatchewan or Eats on Feets Saskatchewan. This kind of sharing leaves the need of asking questions up to the recipients. Recipients might ask questions about their health history, recent tests, the age of the baby/milk, diet, lifestyle, etc. The people that usually use this informal route of milk donation typically do not quality for pasteurized human donor milk from the milk bank.
The important part of all donating and receiving donated milk, is to do your research, gather an understanding of the processes, benefits and risks, feeding goals and sustainability of using or donating donor milk. I consider donating of human milk to be such as amazing gift. It is such a valuable substance and is in limited amounts, yet widely needed. It is just as limited in the time frame that women are able give so much of themselves to help someone else. Learn about how birth impacts breastfeeding. Breastfeeding complications can be linked to the birth experience, birth choices, interventions and care providers. If you can avoid unnecessary interventions, it is recommended, so you reduce the risk of complications associated with interventions. If you cannot (because birth is unpredictable) then it is good to have an understanding of the interventions and how they impact breastfeeding so you can take necessary precautions or measures to help protect breastfeeding still. If interventions are suggested it is ok to ask more questions, gain more information and make your own decision. It is also important to understand how medications in labour will affect breastfeeding. Again, if you can minimize risk of medication exposure by having a drug free birth it is recommended. This is not alway feasible so understanding the impacts, means you can know what to do to counteract the medication effects.
Skin-to-skin immediately after birth. You want to welcome your baby into your arms and on to your tummy or chest immediately after delivery. This step has so much incredible impact that the first hour after birth is known as the Magical Hour. There is very little of more importance that needs to happen more in this hour, than mom and baby being skin-to-skin. Any infant procedures can be delayed until the first breastfeeding experience has occurred. During this hour baby will start to move towards the breast, without anyone doing anything, and go through a series of steps that come before they instinctively begin breastfeeding. This might take 30-50 minutes. Be patient. Enjoy watching your amazing baby. Take in your baby's smell and look. Talk to your baby. Sing to your baby. Connect with your baby. Once baby locates the breast and latches on, they may feed and rest on and off for an hour or two. This is now three hours post delivery. It will feel like just moments in time for you. Continuing to be uninterrupted during this time is impactful to your hormones, specifically prolactin & oxytocin, which in turn is responsible for your milk production and milk release. Avoiding separation and things like showering & bathing, is recommended. Baby will be receiving colostrum during this stage of feeding. Frequent feeding helps change the colostrum to transitional milk and starts the increase in milk volume. The oxytocin also helps your body with contracting the uterus, preventing against postpartum hemorrhage. Limit visitors after birth and the immediate hours following the birth. I know you want to show off your baby & I know others want to meet your baby. Or maybe you do not want visitors but you are being pressured. This is the perfect excuse to not have everyone visit right away. Your partner is one exception from the handing off of the baby. Having too many people handle the baby interrupts this physiological process that needs to happen in order for long term breastfeeding success. If you would like to have visits, prepare them that baby will likely be skin-to-skin or breastfeeding. They are welcome to come see YOU but may not get to snuggle baby quite yet. REST. So after the first breastfeeding session your baby will likely want to sleep. And you will want to rest, too. Once baby has had some rest, it will be the start of frequent feeding sessions. The first 3 days are hard. You might feel a little like your baby must not be getting anything and that is why they won't stop feeding. This is not the case. Babies are incredibly smart and are setting the stage of their future milk supply but nursing frequently in the first few days. Switching sides often is important; start feeds on opposite breasts at each feed. Babies might have a short nap between sides and then have a longer nap after that second side. Napping when baby naps is critical. Get help with easy nutrition and meals for yourself. Get help early! If you have pain, trauma, a sleepy baby, baby is not latching or baby is not peeing and pooping as expected, you need assistance. These are red flags and not expected and acting fast will make a big impact on your success. Take a breastfeeding class. This will help you learn more in-depth about breastfeeding, prepare for breastfeeding and learn as much as possible and how breastfeeding works, positions and strategies for challenges that come up. I get asked about infants stooling patterns quite a lot, typically from worried mothers who have an infant who has slowed down on stooling, maybe 1-2 days, sometimes 7-10 days. The baby might also be gassy, not sleeping or fussy. Moms often will ask various sources if this is normal or expected. I was certainly taught to believe this with a variety of reasons as to why. As an IBCLC I don’t consider this to be normal, anymore, and I will list some of the reasons as to why later. In my opinion, the information I had been provided over a decade ago is still how health professionals and peer support are being taught in their education and orientation to units and job positions that support infants and mothers is also teaching this way. The number one reason I hear is that breastmilk is just highly digestible & there is nothing left to dispose of. My common sense response to those who say ‘it’s just absorbed’, is why then when babies finally do have a bowel movement is it always reported as “a huge blow out” or why do babies have “poop days”. The days are described as days where, once the stooling starts, it does not stop for several diaper hours. If it was readily absorbed, it wouldn’t be an explosion or take hours to clear out the bowels. In recent years more information has come out to tell us that, in fact, there are known constituents in breastmilk that are not digestible. One specific component is human milk sugars that are attached to the lactose molecule in breastmilk. They can make up to 20% of the content of milk. So, to think that ⅕ of the intake of what an infant consumes is not digestible, makes one wonder where it goes. It appears though, that this doesn’t have a role in nutrition, but instead in gut health. The bacteria of the infant gut is what thrives on these human milk sugars, not so much that an infant's growth thrives here. This could be one of the reasons why we may often see a baby gaining weight well, but not be stooling. But we might see a colicy or gassy baby, because the gut flora isn’t quite ideal. I find often getting more milk into the baby helps these symptoms. More milk = more human milk sugars = more healthy bacteria. Not to mention other little things that end up in stool. The process of digestion alone would have some sort of byproduct left, even just the epithelial cells of the digestive tract sloughing off along the way.  Baby not pooping? 3 days? 10 days? Is this normal? I stated the number one reason that I hear as a reason why babies might not be stooling is that people believe breastmilk is digestible and I have provided some reasons as to why this is not true. But, I am actually more concerned about another aspect of the non-stooling situation, beyond just human milk sugars and bacteria content. I have shown my belief of *if milk is going in, stools need to be coming out”. When I come across a non-stooling infant, I want to have a look at the growth patterns of these infants. I mentioned thriving infants above because it is very important to discuss infant weight gain in all of this. Watching just pee alone is dangerous as babies can get to a pretty scary place before they start to really slow down on the peeing and may be in a state of failure-to-thrive at that point. We can possibly avoid that by watching stooling. I will say it one of the first signs of lower than required intake in many many babies I have worked with. This can all actually have a long term effect on breastfeeding. As babies take in less milk & have slow or no weight gain , milk supply can be lowered, resulting in even less milk being taken in by the baby and the cycle continues. It can also be a sign of more going on and the sooner we intervene and assess the situation, the sooner we can strategize solutions to prevent things from a downward spiral. What should we expect in a babies diaper then? This is what I recommend. As babies get closer to 4 months, they may slow down to 2-3 diapers a day, but in the early days and weeks fore sure with each good feed or couple feeds, there should be a bowel movement.  I also want to mention that these ideas and supporting information is quite new, so just like we have to be patient with babies and how they grow and change and develop, we have to be patient with the research and learning of the changes and developments coming out in breastfeeding. As much as we have been breastfeeding “forever”, it was a time before so much evidence and research existed and was desired.
If you are concerned about your babies stooling patterns, I am always happy to help explore that with you. I welcome you to reach out for a consult, in person or virtually. (originally posted Feb 21...I am sure more will be added as time and linked thoughts come up)  If I asked myself if pumping was being used as a magic fix for common, yet easily managed, breastfeeding concerns I would have to say "yes, it is". The idea to pump instead of, or in conjunction with, breastfeeding is often suggested to mothers by their support people. These support people include other new mothers and experienced mothers at places like Mommy and Baby Yoga, Mommy and Me time, Kinder Music, Baby Signs, the museum, StarBucks, online support groups, mommy chats, any place mom's and babies hang out together; you all know where mommy's go. Other support people are their mothers and mother-in-laws, sisters, sisters-in-laws, aunts, grandma's, that old family friend; again, you know who these people are. Of course, other new mother's support people include Health Care Providers like doctors, nurses, midwives and the complementary support people like doula's and childbirth educators. And, in case you are not aware, these people include many that did not breastfeed themselves or were not successful in their attempts to breastfeed.
Most new moms have the intention of breastfeeding, as so as expected, it comes up in conversation. People feel the need to ask new moms how breastfeeding is going, new moms feel compelled to seek out support in these early weeks or health care providers are following up mom and baby. When moms are asked about breastfeeding they share the concerns they have with breastfeeding in hopes that someone can help them. Here is the list of common complaints and one likely answer they will receive to alleviate that concern. Sore Nipples -> Pump and bottle feed Baby not effectively sucking -> Pump and bottle feed Thrush -> Pump and bottle feed Engorged -> Pump between feeds Plugged Duct -> Pump between feeds or pump and bottle feed Needing to feed in public -> Pump and bottle feed Over Active Let Down -> Pump before feeding Low supply -> Pump between feeds or after feeds Baby not sleeping -> Pump and bottle feed or have someone else feed Colic -> Pump and have someone else feed Foremilk/Hindmilk concerns -> Pump before feeding It appears that pumping can be a common suggestion to alleviate the most probable breastfeeding issues. We need to be aware it is not a magic fix, it is most likely to be a band-aid, and it does not "fix" anything. We also need to be aware that pumping can create more issues. These are just a few ways this pumping band-aid could create more issues for mom and baby. With sore, bleeding, cracked nipples, generally the most common concern, generally easy to fix, pumping only results in double the work. Why would a new mother want to add in all the extra work of pumping and bottle feeding when getting some assistance with position and latch could make the problem go away, in even the very next feed? Or one of the many other solutions with have to help with the pain and healing. Often long term pumping is not going to sustain a babies needs and milk supply like breastfeeding directly from the breast would. Often breastfeeding relationships end far sooner than mother's intended due to supply issues because it leads to supplementation or another feeding method all together. This might not be the case all the time, as some mothers, do exclusively pump, but there is unique difference between a mother who makes the decision to exclusively pump compared to one who is trying to get baby nursing pain free at the breast and needing to pump in addition to. How about that baby that just is not sucking effectively or will not latch? Let's see, how do people learn? We learn by doing. If we take baby away from the breast, how does he learn? Again, we need to support moms and babies in positioning and latch and innate instincts that babies have to feed and let them learn together. If habitual placement is still not getting baby latching and sucking, we need to further evaluate what might be going on with that baby. Ignoring the difficulty baby is having and turning solely to the pump does not make the original issue baby was having go away. Thrush is no reason to stop feeding at the breast. The reality with pumping with thrush is that mothers now have more parts and equipment to treat or throw away. Thrush can sometimes take time to clear up but it spreads so easily, we need to restrict what comes into contact with the thrush to stop the spread of it, not add more to it. There are medication and alternatives that we can use to treat thrush and the discomfort of thrush as we are trying to eliminate the nasty little bug it is. Milk supply works on supply and demand so as well as pumping to relieve engorgement seems like a good idea right now, later on the fullness comes back and generally more full then the previous time, as a mother's body thinks that is milk that baby needed. If moms are engorged because a baby is not eating or draining the breast, then the answer is to get the baby eating and draining the breast, not pumping. The more baby is at the breast the less engorged mother's will be, assuming baby is eating well. Again, back up to latch and sucking. If baby is not waking to feed and mom is starting to fill up, mom can put baby to breast and encourage that baby to eat, to play his role in this breastfeeding relationship. Another concern with engorgement is that as much as it may seem logical that when mothers are engorged, it means they have a good, healthy milk supply, in fact the opposite can occur. The more often a women is engorged, the faster her milk supply will start to decreased. When breasts are full it sends a signal to the part of moms brain responsible for milk supply to slow production down and milk making cells start to shut down, resulting in less milk in the days ahead. Pumping when engorged can also pull more fluid, and not just milk, into the breast, resulting in edema. Often that fullness or edema is confused for milk and "good supply". Plugged ducts are uncomfortable, in fact down right painful, and yes moms want them out, but pumping is not the most effective way to unplug a plugged duct. In fact it can lead mom right back to the engorgement stage and create the spiral onwards from there, when the easiest way to get rid of that plug is by using baby, again, or some other strategies that are much more effective. I am starting to see a larger amount of women pumping so they can feed their baby while out and about. First, people that want to go out in public just need to accept that mothers and babies go out in public, too, and mothers and babies use breasts to feed. Secondly, mothers need to be informed about how this "solution" really is only one that is feasible for a small time. Each feed mom misses at the breast impacts that supply and demand mechanism again. If mom is out and is not feeding baby or replacing a feeding session without pumping again her body and brain communicate this to each other and the process of milk supply slows down. This again goes back to what I mention early about keeping up supply, supplementing and ending the relationship early than expected. Over Active Let Down is a problem that some moms struggle with but again pumping can just aggravate this problem. It is an easy problem to aggravate as it can lead to the engorgement issue and when baby is ready to feed, mom is ready to burst with milk and when the let down occurs it is like opening up a dam. Baby gets flooded with milk, has trouble managing flow, staying latched, becomes upset and this all causes frustration in mom and baby. Positioning, latch and frequent feeds are the easy fix here. On the other side of it, some babies have a hard time handling a normal let down, but it mimics and over-active let down. We need to be sure that we know if we have a baby that is struggling with a normal flow or a true over active let down. Another strategy I will mention here is block feeding. Block feeding used to be a common strategy for overactive let down but in more recent years, we have come to learn this is often detrimental to breastfeeding, as well. It appears to create a downward spiral of low intake, low weight gain and low milk supply. Always have what appears to be an overactive let down assessed by an IBCLC. For the healthy, full-term infant pumping for perceived low supply should be the last resort. Babies truly are the best solution here again; baby to breast = more milk in breast. Secondary low milk supply is a different issue and does not fall into the category of common yet easily managed breastfeeding concerns., which is what I am addressing here. I am also not addressing primary low milk supply which are maternal factors in less than 5% of mothers who do not make enough milk. These conditions should be determined with through evaluation with an IBCLC and primary health care providers. I am talking about common breastfeeding concerns that most mothers face. Pumping to top up or to force more milk into that non-sleeping baby:. Fuller tummy does not equal more sleep in babies. Babies have very small tummies, breastmilk is readily absorbed and digested so babies feed frequently. The issue here is not the amount of milk the baby takes, but rather unrealistic expectations and misunderstandings babies. If babies are really struggling with sleep, it is worthwhile seeking out a feeding assessment to ensure all the things above are not an issue. If baby is not gaining weight well and is also struggling with sleep, this is a different story. Colicky babies are much better soothed at the breast than any other way, pumping to feed another way removes that comfort source from this already high needs baby and can make the baby even more upset. There is no real understanding behind colic and why some babies are colicky and some are not but there is good understanding that skin-to-skin and mothering at the breast calms these babies best. Again, all things above should be ruled out before we just assume we have a colicky baby. I have also come to believe colic is an umbrella to other providers. I think sometimes we can seek some clarity on these babies and get past colic, rather than waiting it out. If you have what appears to be a colicky baby, perhaps booking for a breastfeeding session will give some of that clarity. Foremilk/hindmilk imbalance or what is being perceived as such seems to be rampant these days. It seems like a viral condition that has spread. So many moms seem to feel they have this issue, when in fact it is very rare. However, if a mother thinks this is an issue she has and pumps to get to the hindmilk, we go back to the engorgement cycle where mom has too much milk, can have a forceful let-down and then babies do get more foremilk than hindmilk, they are upset by the flow of milk and we end up in a vicious cycle. Worst case scenario, in fact, this could create that colicky baby we all fear. Foremilk/ hindmilk is best controlled by frequent feeds, proper positioning, good technique, etc. Mom's please seek out appropriate, knowledgeable, support when you encounter these easily managed breastfeeding concerns. So many families plan on breastfeeding before baby is even born. Initiation rates are 90%+ in hospitals but our stats show this drops off very quickly...less than 60% of mothers are meeting their own goals. A lot of people figure breastfeeding won't be too difficult or that they will just try and see how it goes. Many learn quickly that breastfeeding comes with lots of unexpected questions, confusion and lack of knowing what possible solutions are. When mothers find out they could have taken a class, they state how beneficial it would have been to receive some knowledge during pregnancy and know where to get guidance when they need it.  Taking a breastfeeding class with an International Board Certified Lactation Consultant (IBCLC) could help prevent many of the problems that mothers experience early on. A class will highlight common concerns and give you solutions to implement right away. You can also have the opportunity to ask questions that are individual to you. It also helps you establish a relationship with an IBCLC so you can feel more confident calling for help at the first signs of trouble. You will also learn about unique hospital policies and procedures. Taking a breastfeeding class should leave expecting parents feeling calm & confident about newborn baby behaviours and what to expect after baby is born and during their hospital stay. The topics covered in a breastfeeding class should include special circumstances, so if things with the birth do not go as expected, the parents are prepared with solutions, questions to ask their care providers and be informed about their options. They will also be informed about medical issues and an anatomical concerns that might have an impact on breastfeeding.
If there were previous breastfeeding problems in the past, it can be useful to take a class to help identify possible problem areas and make a plan of action for the next baby in case those issues (or others) come up again. I know so many times people say "why didn't anyone tell me". We are hear, ready to dish on it all! Really, are we ever prepared enough? Building your knowledge base and support team before you embark on your breastfeeding experience can make the whole thing a much different experience. I teach the majority of these classes at The Hive Wellness Studio. Topics always covered in the class are: Importance of breastfeeding Tips to successful breastfeeding How breastfeeding works Positions, breast crawl, attachment Hunger cues Intake, output Challenges & solutions and amore... Each registration include a breastfeeding booklet and is for one expecting parent and one support person. Register for a breastfeeding class now! “You need to nurse for 20 minutes on the first side and then move baby to the other side for twenty minutes.” or "You have to empty the first breast before going to the second breast". Did anyone ever tell you these things? What if your baby only nursed for ten minutes? Did you ask what would happen? I suspect you may have been told that is not long enough for your baby to get the hindmilk (higher fat milk). Is 20 minutes that magic “long enough” time frame? What if baby wanted to be there for 25 minutes? What happens then? Do you have no more milk?  Are you breastfeeding and feeling like you have to watch the clock? How about we focus on watching the baby and take cues from them about what they need. Have you ever expressed breastmilk? What does it look like? Have you expressed more than one time? Did your milk look the same each time? I suspect it varied from thin, watery and blue, to yellow and thick. Did you notice a difference with the time of the day you pumped? How about before a feed or after a feed?
What does the research say? In point form the basics are: · As the baby feeds the content of the milk the baby receives is higher in fat · Each feeding can vary in fat content over the course of the day · The fattiest part of one feed might actually contain the same fat content of the start of another feed · Milk is milk; no real need to differentiate foremilk and hindmilk. Some is more concentrated, some less so, but your baby needs it all.(Hindmilk would be better called "concentrated milk" and foremilk "dilute milk") · Babies all stay at the breast for different lengths of time and what satisfies them varies · The breast is not a reservoir. It is never “out” of milk. If babe hangs out nursing more milk will “let down”. If you switched breasts milk may flow faster because more milk is in that breast, but there is no rule to have to take a baby off one side to put him on the other because of foremilk and hindmilk. Yes, if we want "moremilk" Is there a time when we might pay more attention to foremilk and hindmilk? · Is there an issue with baby sleeping at the breast? · Is there an issue with baby being fussy at the breast? · Is there an issue with babes weight? · Is baby swallowing at breast? · Is baby relaxed, with wide open hands and content at the end of feeds or no? If there are any of these types of concerns, seek out an IBCLC to address the concerns. It may be somewhat related to the so called foremilk/hindmilk. It can sometimes be ONE factor to take into account for the whole picture when some of the above issues are seen. But it would not solely be a foremilk/hindmilk issue. When a woman plans to breastfeed her baby and that plan doesn't go accordingly, it can be a time of many emotions. This emotion is often referred to as "guilt". There is a common saying, "we shouldn't make women feel guilty for not being able to breastfeed." Of course, we shouldn't. There are so many factors, however it is not a black and white, can or can't, choose to or not, it works for some, not for others, etc. "Don't make her feel guilty" I don't want a mother to feel guilty, but I do want her to recognize her feelings about her situation. Feelings are not negative. Feelings are just feeling. And we need to feel to work through the struggles. We need to explore the feelings women experience when it comes to feeding their infant. Everything we see now is "Breast is Best". We have become a society that is "great" at encouraging breastfeeding but we are not a society that is even "good" at supporting and sustaining breastfeeding. This means many women are not meeting their breastfeeding goals. With that comes many feelings. Mothers who intended to breastfeed but struggle to meet that goal, feel a sense of loss. We know there is a connection to loss of breastfeeding and postpartum depression. We need to recognize that many mothers experience grief, and not guilt, in the postpartum period. I feel like grief is confused for guilt or a feeling of failure and it is not interchangeable. Mothers need to be given the opportunity to grieve what they had planned, what they believed postpartum would be like, the support they would receive but did not. Hearing “now, now dear, it’s ok, formula feeding is ok” doesn’t really help. It doesn’t help because it is not about breastmilk over formula. It’s about an expectation mothers had. It’s about a decision they thought they had control over, only to find out breastfeeding is difficult, but more so motherhood is difficult! It is all more difficult than society lets people believe. Breastfeeding is not well supported. It is not understood well. So many myths and wise tales still exist and are perpetuated daily, holding women back.  Women are finding themselves alone, feeling isolated & without reliable resources. Women who choose formula from the start don’t feel this way because they got to make that choice consciously. Women who planned to breastfeed but missed out on proper supports don’t feel like they had any other options but to give up their plans to breastfeed. That’s not a choice. That’s survival. We need to guide mothers to the appropriate, breastfeeding educated resources in a timely manner. Mothers deserve to have choices, someone who can offer solutions that are acceptable to them & who can provide support and counsel when breastfeeding isn't the best option for them.
Many mothers will be able to relate to this experience. The experience looks the same; a routine infant check up appointment, baby gets a weight check, the parents are asked some questions about development, etc. Upon looking at the weight, it is determined the infant is not gaining weight as expected. What does this mean? What is the cause? What should be done? It often is quite shocking to parents, especially mothers, to hear this news. They are perplexed because they thought feeding, usually breastfeeding, was going ok. How is it possible that baby isn’t gaining weight? How is it possible she didn’t know that baby wasn’t growing as expected? Can anything be done?  Common reasons provided for this phenomena is that mom has low milk supply, baby isn’t getting enough hind milk or baby is too sleepy and isn’t feeding often enough. I don’t think it is quite that simple.
What I find in these scenarios, because I get calls often after an experience like this, is that what is not communicated to the parents is why we do these checks, why they matter, what they mean and what should be done with the information. The simple answer is that we expect babes to maintain their own curve that they plotted on at birth (or more ideally 24 hours). When babies start to drop off that curve, this gives us a sign to look and assess what might be happening. This is a clue to ask some more questions and see if there are other pieces that can help tell us what might be happening. We want to know more about feeding behaviour, mood, output. Often what I hear is that there is no way baby needs to eat more. They are happy, content, sleep well, don’t really fuss. The opinion is that there is no way it is possible the baby isn't eating enough. People expect a hungry baby to cry, be irritable, to unsettled. I am going to say this is simply not true. I am sometimes more concerned about that “good baby” that sleeps well and always content. A very misunderstood piece of infant wellbeing is that weight gain influences appetite. What I mean by that, is that if a baby is gaining well, they demand to fed and show signs of being hungry regularly with easily identified feeding cues. What we think is a content baby because they have a calm mood, could be a baby who is content but not getting quite enough intake. A baby that is lower weight than expected, will have a lower appetite and will in fact cue less to be feed, will have subtle cues, likely won’t have a late hunger cueing & overall may make little fuss about it. If mother offers they will feed, but commonly have short feeding sessions. When they are being feed, their appetite is low so they do not do an efficient job, leading to milk being left in the breast and the body slowing down production. I give the example that if they are getting 70% of their intake requirement, they will eat at 70% efficiency (this will very baby to baby). This over time can cause a low supply, which influences their feeding because babies like flow...so low flow, means less interest in feeding and the cycle continues. If none of that concern is explained to a family, they leave these routine visits confused and bewildered as to why some one had a concern or what they could/should do about it and have no idea why it happened in the first place. There are lots of factors to consider to understand why this is happening & what the appropriate action for each case should be. If you are experiencing a difficult feeding situation where weight gain is a concern, booking a consult with an IBCLC is advisable. With a good assessment by an IBCLC, the root cause can often be determined and a solid plan can be put into place to get the baby fed, get weight gain concerns addressed, increase milk supply, maintain breastfeeding, etc. Other things to note in cases of lower than expected weight gain could be:
The first 6 weeks of breastfeeding really set the stage for how breastfeeding will be beyond 6 weeks. This is why it is so important for new mothers to seek help as soon as trouble arises, but even more so, knowing what trouble looks like. If someone has never breastfeed before, they may not to be well equipped to know what is normal & what is a sign of struggle. And even when everything goes "right" in that 6 weeks, breastfeeding is still challenging. Not only are mothers learning to breastfeed, along with their baby, they are also recovering from birth, coupled with lack of sleep and changes in hormones.  This is why I am now offering a 6 Weeks to Success Breastfeeding support package. This will take the guess work out of breastfeeding for new mothers. This package means new mothers are getting early, regular check in's with an International Board Certified Lactation Consultant. This package is designed to prevent breastfeeding stress and anxiety and rather build confidence and empowerment. Instead of waiting for problems to arise and then second guessing what to do and who to call for help, possible difficulties will be detected and strategies can be implemented early. If trouble starts to arise, new mothers will know someone is scheduled to come without having to decide they need help & begin to seek it. Sounds good right? So what are the details of the program?
Space is limited for this package offering. The estimated value of this package is over $900. From now until Dec 31, 2018 I am providing this package for an introductory cost of $500. This means 6 visits with an individual value of $75-150, for one price of $500. If you are expecting a baby after Dec 31, you can still take advantage of this price. You can book your spot now.
Has someone suggested to you that your baby isn't gaining weight as expected and the solution is to get baby to ingest more hindmilk? It has become common knowledge that fat content of milk changes throughout breastfeeding. This is true. Milk doesn't change in each feeding session in the same way...it changes over the course of the day and feeding patterns. The anxiety about whether or not baby is feeding "long enough" to get to the hind milk is not necessary.  Something else that is true is that the longer a baby feeds, the more letdowns occur and more fat is released into the milk from the milk making glands, however...there are some things that need to be pointed out and kept in mind.
Foremilk and hindmilk are not two different kinds of milk. Women do not produce a low fat milk and a high fat milk. It is simply that the first milk a baby receives at the start of a feed is *fore*milk and the milk after that is *hind*milk; in a way meaning initial milk and subsequent milk. The change is gradual It is not based on a percertange of fat content, like skim, 1%, 2% or whole milk that we are used to thinking of. There is no magic time in a feed that changes the fat content or we can see a switch of kind of milk. There is no percentage of fat a baby needs to be able to gain wright. On this note, all the foremilk is not always lower fat than all the hindmilk. Foremilk from one feed might have a higher fat content than hindmilk from the next feed, previous feed or other feeds in the day. With this all in mind, when there is a weight gain concern, the focus needs to be on increasing intake of milk and looking at the factors that might be impacting intake & not trying to avoid foremilk. Strategies to avoid formula and increase hindmilk consumption are ideas like pumping foremilk before a nursing session, so baby can only access hindmilk or keeping baby on one breast for 15 or 20 or 40 minutes, depending on who is giving the instructions. In fact, sometimes these strategies means the baby is getting even less milk than before. It is the total daily milk intake that determines successful weight gain. We cannot look at one feed as the way it is for all feeds. We need to look at each day and all the breastfeeding sessions combined and then address ways to increase milk intake overall. I wrote about this again in another post; you can read that here. If you find yourself in the situation of having an infant that is not gaining as expected, not gaining at all, slowly gaining or losing weight, I suggest a full evaluation with an IBCLC. Let's talk about breastfeeding pain. I have a theory. Some others might share this theory. Some might think I am crazy. Pain in the body tells us to pay attention. Pain isn't always bad, but its a way the body signals to the brain to pay attention. It can be *pay attention* because something is wrong, or *pay attention* because this needs your focus. Pain is not always a bad thing, per say. Like birth, for example. Birth can hurt (it doesn't always, believe it or not). Birth is a great thing, not like illness or injury that make you feel pain, but that first contraction will kick you in the @ss as a way to say "Something BIG is about it happen. Pay attention. Cancel all unnecessary things. Put down your phone. Tune into your body. Get your people here."Birth pain doesn't necessarily need attention or anything done to stop it once we are paying attention to the process. Sometimes, it does. I think breastfeeding pain is similar. Either something is needing attention, like baby isn't latching well, position is off, baby isn't getting enough milk, baby is losing weight or maybe it is a message we just need to connect with baby, release some emotions, get hormones flowing, get on the same page, figure some things out, get a groove going. But breastfeeding pain shouldn't be ignored, or accepted as the way it is, in my opinion.  Breastfeeding pain I love talking breastfeeding and I really like talking the history of breastfeeding. When people find out I am an International Board Certified Lactation Consultant, they often respond with, “you’re a what?”. As I continue to explain what I do they say “seriously? People have trouble with breastfeeding? How is it that the human race has made it this far if it weren’t for breastfeeding?” Oh, goodness, what era do you want to talk about? I mean there is so much history about how breastfeeding can fail and what resolutions people had for that, depending on the era and the region. We are part of another era and in the middle of history. I call the time before where we are right now “Before Tongue Tie”. Really, as an IBCLC of just shy of a decade, I had MINIMAL education on tongue ties and their impact on breastfeeding. Like a dismel amount. Then several years ago, I attended a few conferences, online, in person, different geographical locations. Everyone was talking about tongue ties. I said to myself and to others: “Can we not talk about anything else?” “There is no way there are this many tongue ties” “Did we even know anything about breastfeeding until now then, if tongue ties are to blame for everything?”
They had different potential solutions. I come into all of this ready to learn and see if we can address some of the challenges that faced breastfeeding families that didn’t seem to have resolve. Much of what I was learning was that there was hope for these ongoing struggles that my previous education and training didn’t teach about.
I dove in. I recruited other professionals as supports. We networked. We shared experiences. We re-evaluated. We want the best for families. My job as an IBCLC is not the same as those other supports and professionals but I want to share some of my learnings and reflections. I know tongue ties cause a lot of issues. I will not deny that, but I will say that just “getting it snipped” or getting into a dentist for a laser revision isn’t a guarantee things are going to be resolved. A really key piece I have acknowledged is how much better babies that are at an appropriate weight recover and catch on to breastfeeding post-revision compared to babies that are underweight or slow gaining, maybe gaining weight a little faster than what is called a slow gainer and who maybe is not getting much concern from anyone but still not growing on “their curve”. Doing a revision on these babies is something I really hesitate to do now and I won’t make a recommendation for revision until resolution has occurred in the weight department. This to me a really good reason to be working with an IBCLC before hand. Another really important part to working with an IBCLC is to assessing milk supply. Babies respond to flow and without that flow, they just won’t want to try and improve anything. Add in a tongue tie and they just don’t care to breastfeed nicely or at all. If supply is low, again even with a revision, they just are not happy breastfeeders. Both this scenario and the above one make people say “the tongue tie wasn’t the issue” and sometimes add in that “they did the procedure for nothing”. Being able to get moms working on supply, which in turn can help the weight gain issue, if it exists, helps ensure that once they get those two factors sorted out, they are ready for revision and have a good foundation to make the revision successful. The pieces fall into place nicely and almost predictably. It also helps me be able to tell a mom a timeline for “when will this all be better”. I can help them set up a plan so they can see a means to an end, rather than “just keep trying, it will click soon”. There is also maternal pain that is often a concern and should be addressed INDEPENDENTLY of a revision. Sometimes tongue ties cause pain, damage & trauma to mothers breasts and can be resolved with a revision, but ideally more should be done to address this instead of just waiting for things to get better. When we deal with the breast/nipple independently, it makes the revision seem significantly more effective. Babies can have other factors/stresses affecting and influencing breastfeeding that are often identified by IBCLC’s or professionals who assess physical factors, like Chiropractors or Osteopaths. I also find when we resolve these issues first, or at least start working on them, that things get back on track faster post-revision. Sometimes I am not consulted until after a procedure for a tongue tie has been performed. When I get called after, I can most certainly still help and we can get past these remaining pieces, it just is in reverse. What I find though, is it is all a lot more stressful for moms and families because they also have a cranky baby and after care exercises to get in, as well as possible pumping & supplementing, and perhaps appointments with the other professionals we work with. I personally think It is better when I can set up a plan in steps with one focus at a time. Once supply and weight is up, it is one less stress, so the family can handle the stress of the aftercare and extra needs of the baby. I am also aware that some parents would rather not go through a revision at all and this is where my “Before Tongue Tie” experience and knowledge comes in. I say to the parents and myself, “what would we have done BTT?” Are there strategies that would be useful and address the concerns? Sometimes there are solutions that the parents are 100% ok with and will get the baby fed and minimize concerns. Sometimes all of those are tried and the revision conversation might have to happen again. This is where knowing the risks to the situation and knowing what else to watch for is important. Tongue ties are a topic that people get really excited about from many different perspectives and I don't see that changing for awhile, but I wanted to raise the thought that we are in a place of breastfeeding right now that in the years to come will be a historical recollection. It might be known as something more eloquent than BTT but until then we can recall what it was like BTT. Canadian Pediatric Society no longer recommends this practice from the late 1800's (it is now 2017)9/6/2017 What is that eye ointment babies get after birth and why do they get it? It is erythromycin and it is for prevention of severe eye infections in newborn babies. This routine practice has become outdated and no longer recommended. This might be a topic you would like to have a conversation with your care provider about. Neonatal ophthalmia (NO) is a relatively common infant illness & is defined as conjunctivitis occurring within the first four weeks of life. This term originated from cases caused by N gonorrhoea, but the term now currently refers to any conjunctivitis in this age group. In most instances, neonatal ophthalmia is a mild illness and can easily be treated case by case once infectious conjunctivitis is determined & distinguished from eye discharge secondary to blocked tear ducts and from conjunctivitis due to exposure to some kind of irritants or chemicals. The exception to this is ophthalmia due to infection with N gonorrhoea. Those cases are quite dangerous for infants.  Historically, the purpose of prophylaxis treatment with Silver Nitrate at birth was for neonatal ophthalmia eye infections due to N gonorrhoea. But when I say historically, I mean the late 1800's!
A lot has changed in Canada since then and the Canadian Pediatric Society is no longer recommending routine prophylaxis for neonatal ophthalmia. The primary reason is that N. gonorrhoea strains isolated in Canada are showing considerable resistance to the treatments routinely used and there are no recent studies of the efficacy of ophthalmia prophylaxis with these treatments. You can see the position statement, complete recommendations from the CPS and the history of NO, risk factors & legal considerations depending on where in Canada you live on the Canadian Paediatric Society website. What is really happening when the sponsorship of events is by pump companies or formula companies/pharmaceutical companies. I want to be *explicitly clear* that this is NOT about individuals. This is not about the idea or execution of such events. This is not about women supporting or not supporting women. This is not about businesses who chose to plan events. This is not about businesses who participate in events. This is fully about the sponsorship by the companies covered by the WHO Code. (and I promise you they all know about the WHO Code and how that impacts their relationships). So, what is the WHO Code?The WHO Code is the common wording used to refer to the International Code of Marketing of Breastmilk Substitutes. The Code was adopted by World Health Assembly and UNICEF in 1981. Since that time, a number changes have been made with the Code. The purpose of the Code is to protect breastfeeding, to protect all mothers and babies, regardless of their desired feeding methods, and to prevent aggressive marketing practices that often interfere with mothers meeting their own breastfeeding goals. Infant formula, feeding bottles, and artificial nipples are the main products that fall within the scope of the Code. Breast pumps are not under the scope of the Code BUT some pump companies violate the code because they market bottles and artificial nipples. Again, the Code only applies to the marketing of these items–it does not affect whether they are sold or used. Confusing, right? Confused? Of course you are!The Code itself can be confusing, but then try to figure of which companies are WHO code Compliant and which are not is a whole other task. Companies come in and out of compliance all the time. Something that commonly happens is large companies merge, or enter into marketing relationships with each other and they also acquire departments from other companies with buying, selling and trading. Then we have to consider who are the "kid" companies and who are the "parents"? Companies who are owned by Code violators are considered the same as their parent company. You really have to dig deep to find out a lot of this info, but if you start goggling different brands of formula, medications, infant supplies, etc you start to see that there are a lot of kid companies and just a few parents. The parent companies, of course, want to keep their smaller companies WHO Code violating record clean so that health care workers who have to adhere to the WHO Code can still have relationships with these companies, while the parent company gains benefits. They can also give items and samples not covered by the WHO Code and maintain compliance. But in the end, they are still violators. As an IBCLC, I need to educate people about the WHO Code and marketing. What I am encouraging people to do, all across Canada, is to just keep their eyes open a little bit to who is hosting events, who is sponsoring events, what is that relationship like, who is providing the educational piece & decide if the information being given is evidence based and helping mothers meet their breastfeeding goals or if the information might be slanted. You will see a large variety of how these events take place and some will be absolutely ok and some are going to have questionable practices.  This is not about you and it is not about me.Again, none of this is personal. It is not an individual issue. This is a nation wide issue. If one baby store is approached to host an event, any baby store could be being asked. If any doula is asked to be at an event, it could've been any doula they approached. If any nurse is involved, it could be any nurse approached, It happens to doctors, chiropractors, pharmacists, or even IBCLC's. It is anybody who is nice and kind and is buying into the idea of hosting an events for moms to offer support and companionship and education. That in itself is a fabulous idea and needs to happen! I will say people are ALLOWED to do this. As an IBCLC, I choose to adhere to the Code so I will not participate I do let people know that if that is breastfeeding matters to someone else in their profession, they can choose to adopt to follow the WHO Code. I am not here to tell anybody how to run their own business. They CAN participate and have relationships like this if they chose to. But I will always protect breastfeeding in my community. True breastfeeding support does not come from WHO Code Violators.
I want this to be heard by everyone because if the doula/nurse/doctor/pharmacist or IBCLC, asked to participate this time walked away, the companies will just go to find another one. This also applies to educational events for professionals so not only do we look down, we have to look up. I want parents to hear this so if they go to an event they can also see who is providing the funding for the event and the information. Eyes open! Do you remember that time I told you to throw away the Lanolin? (You’re welcome) I am here again suggesting you keep again breastfeeding old faithful on the shelf! At bare minimum before taking fenugreek to help an unsteady to low supply, keep that bottle of fenugreek sealed until some further investigation as to why you might need something to boost supply is started.  Should I use fenugreek to post my breastmilk supply? We are starting to learn that fenugreek may not actually even help a supply but it can actually be quite harmful for many mothers who are struggling with a low supply, depending on why the supply is low. The very reason supply one mothers supply is low can be a contraindication for use of fenugreek on its own. For your own safety, you need to know the reason for the low supply, before taking fenugreek. Of particular awareness would be mothers with thyroid concerns, PCOS, IGT, diabetes, insulin resistant type health concerns. Women who have just had babies may not aware of or have an official diagnosis because until that time they have been mostly healthy. Sometimes it is not until the stress of a pregnancy and birth and early postpartum has an impact on the body that women start to feel unwell. And they might not even feel unwell, but just not be making a full supply. Producing milk is not a necessary part of living, so if the body has stressors then often production is suppressed. Breastfeeding is a time in life where a mother needs to take care of herself in order to be able to take care of the baby.
I think “breastfeeding issues” are sometimes breastfeeding issues but I also think that often time struggling with breastfeeding is just a symptom of something else. Paying attention to your supply as an indiction of something else, might actually help you understand more about your body and its personal needs. This is not to say there are not good herbal options for supply, because there are. It is matter of knowing what is happening with your supply and your body, your own unique challenges and having a health history taken or worked up, so that the right herbal for each individual can be chosen/suggested. It might just be fenugreek for you. But, there is a good chance there is something better. I will also add that many mothers experience upset stomach, gassiness, loose stools, diarrhea, dehydration, low blood sugar & unpleasant body odour when taking fenugreek. Baby may also show similar symptoms. For some people, pregnancy is easy, and they enjoy it, but pregnancy can be tough. Morning sickness, hormonal ups and downs, weight gain, constipation, swollen ankles, heartburn and a plethora of other discomforts, and that's before the pain of childbirth! Why would someone go through all of that for a complete stranger? If you have never considered becoming a Surrogate Mother, and are not in a position to need the help of surrogacy to become a parent, you may be wondering why anyone would want to become a surrogate. We find there are four main reasons the people we work with want to give the amazing gift of parenthood to others!  People become Surrogate Mothers because they want to “Pay It Forward”. “It” can be anything. Most of the Surrogate Mothers I have talked to over my years of involvement in surrogacy choose to become Surrogate Mothers because they want to spread the good and love in the world. These amazing women just want to be a source of light in the lives of others. I cannot think of a more beautiful way to perpetuate positivity. Women choose to become Surrogate Mothers because they believe everyone deserves a chance to be a parent. I have found many people who are called to surrogacy are warriors for social justice. They see how difficult it is for those seeking the assistance of a Surrogate Mother to become parents. Their hearts break for the single Intended Parents, gay couples that are desperate to become fathers, older couples who have yet to experience the joy of parenthood, cancer survivors, and others who have been struggling to adopt or have children on their own. Egg Donors and Surrogate Mothers are the balance that can tip the scales of inequality for Intended Parents. Having experienced and overcome infertility, people become Surrogate Mothers to give the gift they have been given. Some of the Surrogate Mothers I have worked with or spoken to have decided to pursue surrogacy because they required the assistance of an Egg Donor or Sperm Donor to become a parent but were able to carry their baby. Others fought long, and hard battles with Infertility and by chance became pregnant. Their empathy and compassion for others is strong, having experienced infertility themselves. A woman may choose to become a Surrogate because she loves motherhood and being pregnant. Some people abhor being pregnant and view it as a necessary means to an end. Others have never felt more beautiful than when they are with child. Combine that with the joys of being a parent, even when it's the most thankless, draining job in the world, being a parent is incredibly rewarding. For some, choosing to become a surrogate is as simple as wanting to enjoy pregnancy but being finished having children of their own and wanting to help others experience parenthood, too! Surrogacy in Canada is altruistic. This means that everyone who chooses to be a Surrogate Mother in Canada does so out of the goodness of their heart. One cannot be compensated for their surrogacy journey (although all related expenses will be reimbursed). Surrogate Mothers are truly giving a gift that cannot be repaid. I am constantly in awe of the Egg Donors and Surrogate Mothers I meet. Their selflessness becomes a miracle for others. They truly give the gift of life. A surrogacy consultant with Proud Fertility, our guest blogger Nathan Chan has made it his life work to help people fulfill their family dreams. Watch the video below to hear Candice's story with surrogacy. Mary Poppins has quite the bag and all things considered it could make a fairly decent doula bag! There are a few items I would leave out of my doula bag, if I was Mary Poppins. The first one would be her coat rack. I am quite certain I can find a place for my coat at the hospital or a clients home. I can probably do without a plant, but hey, if you want a plant in your hospital room to make it a little more homelike, you can bring one…I won’t complain. Although, keep in mind, you might get some flowers gifted to you after you deliver your baby. Mary Poppins even brought her own lights. Lights are important, but again, I am not worried about the lighting at the hospital or your home. Even if you want dim lights, the doctors and midwives have flashlights - yes, they do! Speaking of lights, some people like to have some flameless candles to create a nice ambience. I do have some in my doula bag, but as an FYI, they are a few dollars at the $1 Store.  I, just like Mary Poppins, have in my doula bag. A nice pair of dedicated runners for the hospital are in my bag. Mary Poppins has a mirror in her bag and I sure could use a mirror in my bag. It would be perfect for that moment the baby is crowning and a mother wants to look. Hold on, wait, that hasn’t happened. I have yet to have a mother giving birth who wants to see…. Now, of course, I know some moms would want to but in my experience it is not super common. Again, if that is something you think you might want to try in your birth, lets chat about it and make a plan about who should bring the mirror, just like the plant. That tape measure Mary Poppins has in her bag is amazing and I would love one! I mean imagine being able to measure up people I am going to work intimately with and be told all about their personality. Wow, what a benefit that would be to me and to my clients. Wait, hold on. I do often have a tape measure in my doula bag…with my knitting. Yes, I pack knitting into my doula bag. What? Why on earth would I have knitting? We can talk about that later in another blog post. Back to this tape measure idea. I don't have a tape measure that will tell me easily what your personality is, but I do however have a tool that will help me discover more about your personality and help me connect with you to make our work together easier and a little more flawless. The “Your Birth Experience” (YBE) program allows me to connect with you, identify your needs and then equip you with the resources necessary to achieve your goals. This leave mothers and their families empowered to envision their ideal birth, prepare for that birth and ultimately achieve the birth experience they desire. That’s pretty close to the magical tape measure, right? It is close enough for me. So far you now know my doula bag has a few tea lights, running shoes, knitting and a tape measure. That tape measure isn't the good personality one - that comes from our prenatal meetings. That is all I have in my doula bag? Don't I have a rebozo, massage balls, TENS machines, birth balls? Nope. I do have some gum, some cash for parking, some hair ties and some snacks. Why some simple? Largely, infection control. For real, I don't want to disinfect birth balls and I surely don't want to clients sharing “dirty” ones. I don't want to have to wash beautiful fabrics in harsh chemicals made for industrial disinfection standards. I sure can do some neat stuff with a hospital sheet that I can get at the hospital and then leave at the hospital to have cleaned properly, just like the birth balls. Massage balls and TENS machines…what can be bad there? Nothing is really bad, but I prefer to not place an object between my clients and I. I find a better connection with direct contact and that increases endorphins which are great for labour. Again, if clients know they want to try a TENS machine or like the porcupine balls, I can help them use ones that they likely already own. What I do have that cannot be packed into a bag is my years of experience and my confidence. Relief comes to my clients simply by my being present, much of the time. Clients know they can count on me to be present for them. I am a familiar face they know already and our relationship is solely focused on me helping them have a positive experience. They are presented with a bendy straw in a cup of water to juice, before they even knew they were thirsty. I am leading them to the washroom to pee and get that bladder out of the way of babies path because they didn’t realize they needed to pee. I am lightly touching and stroking their feet to remind them to relax their WHOLE body. I am that voice in their ear telling them that they can and are “doing it” when they feel like you are not being strong. The thing is, people don't give birth every day, (truth be told, I don't attend birth everyday), but I do support women giving birth more often than the average person will give birth. I have been alongside many others before. Each experience is different and no path looks the same, but they are similar enough that I can follow the flow and go alongside and help women through it. They can say things like “Is this normal?” or “what else can I do?” or “what did that nurse/doctor/midwife mean?”. I will reassure them things are normal and they are doing great, I will make suggestions about what else they might want to do, or reassure them what they are doing is perfect & I will help them understand what the care providers are doing or saying. I can help the partner and encourage them just as much (maybe more, maybe less) as I do a labouring woman. My doula bag started out full of items, and honestly, I could have taken a small suitcase on wheels to births when I first started because I felt like I needed to bring it all. I how know that to "bring it all", we need to do more work in the time before labour, and when I “bring it all” now, I am bringing our conversations, unique goals, unique desires, unique choices and my confidence, my experience and can be “tricky” just like Mary Poppins. I am confident I can pull stuff out of thin air that will help me meet your needs without carrying a lot of baggage. If you would like to explore the idea of having a doula support you during your birth, I would love to hear from you. Newborn babies are dirty business and believe it or not that white substance on newborn babies is good for them and shouldn’t be washed away! Here are 15 things you might not already know about vernix: 
I think we can agree vernix is pretty amazing. What is a Lactation Consultant, LC, IBCLC? The term lactation consultant or LC has become the known, accepted title for a professionals with expert knowledge in breastfeeding. They may work with moms and babies to address breastfeeding issues and concerns. They may also teach classes, assist with establishing breastfeeding one on one, and promote and protect breastfeeding through policy, procedure within health care and government. Origin of the term “Lactation Consultant The accepted term for “IBCLC” or International Board Certified Lactation Consultant in many geographical areas is "LC" or Lactation Consultant because, as you can see, that term is a mouthful. “LC” is not trademarked and does not hold the professional standard like “IBCLC” does, so one will occasionally find a practicing LC who is not an IBCLC. Consumers (mothers and families) and other professionals (doulas and doctors) need to be aware of this. As well, not all those who work as “lactation consultants” in health centres or breastfeeding support centres are IBCLCs. Some employers encourage employees to pursue the credential but don’t mandate it for employment. Many times, nurses with some basic breastfeeding education fill these jobs. Why is this IBC part so important? The International Board of Lactation Consultant Examiners (IBCLE) awards the title of International Board Certified Lactation Consultant to only the candidates who meet the comprehensive pathway requirements and pass an international exam. This allows IBLCE to establish the highest standards in lactation and breastfeeding care worldwide and to certify only the individuals who meet these standards.  Breastfeeding education, support, clinical management Breastfeeding alphabet soup I’d like to explain some of the breastfeeding alphabet soup by using the birthing support alphabet soup, as people seem to relate to that. All the roles are important, but they provide their own distinct scope, responsibilities, and abilities. They can all work together to provide comprehensive support. Primary roles of the individual bodies As you can see, I’ve broken this down into three primary roles. 1. Education 2. Support 3. Clinical management Education Educators teach you about the normal and expected processes of childbirth and breastfeeding. They typically call themselves childbirth educators and lactation educators. They teach the normal process of birth and what you can expect when having a baby, as well as encourage and promote breastfeeding. This information helps you make decisions, helps you know if you are on track, gives you references for getting the birth and breastfeeding relationships you want, and helps answer your questions. Educators typically teach community classes in group settings. Support Support people are typically those who have additional training in supporting mother, baby, and family during crucial times: birth and breastfeeding. They’re typically doulas and La Leche League (LLL) leaders. Doulas are usually paid professionals, and LLL is a mother-to-mother peer support group. These roles offer the encouragement and motivation you need to get through the processes of birth and breastfeeding. They are well versed in normal and expected outcomes. They know to watch for red flags to ensure they can guide you further if you have come outside the normal, expected process. Their job is to provide physical and emotional support, encouraging you to ask questions of your caregivers to make sure you’re well informed about what occurs. They have resources and guidelines to reassure you that you’re indeed in the realm of normal, and if things deviate from normal, they can point you in the direction of more resources. Clinical management Lastly, we have the clinical management professionals. These are the folks responsible for the clinical and medical bits of the scenario. They look at the facts and figures, big picture, and red flags to rule in or out the things that are not in the normal and expected category and then make management plans from there. They have the clinical experience of things that fall outside normal and how to manage them. Working together All of these people have a place in the realm of support and caregiving; what’s important is they know their role and responsibility and respect the others’. Where it becomes problematic is when the client receives something different from what she expected to receive. Sometimes, this occurs because the roles of each provider isn’t clear to her, and she might conclude that one person isn’t performing a role properly. Let’s look at how this might apply to IBCLCs specifically. In our example, a mother assumes that a breastfeeding educator* is an IBCLC. She notices that despite consulting with the helper, her breastfeeding issue remains unresolved. She decides to seek more help through a La Leche League leader, who determines that the issue is outside her scope and recommends an IBCLC. The mother insists that she already saw an IBCLC, but received no help. *this person could also be staff at a breastfeeding clinic or nurse who comes to her home This example is typical, and it hurts all support people. The educator gets a bad rep because she didn’t help. The LLL leader is helpless because the needs were outside her scope. The IBCLC profession gets a bad rep because the client misunderstood the different roles and expectations. Clients need to know clearly what their expectations are and who can best meet those expectations based on role, scope, and experience. I want to be asked and welcome being asked these questions! I want you to go and look at the IBLCE website to see what IBCLC's are all about and verify I am indeed and IBCLC and see what scope and standards are laid in place for my profession. I welcome the same questions about being a doula! I would love to see a blog about midwives and how they are different from doulas and childbirth educators (wink, wink, nudge, nudge midwives). All breastfeeding and lactation professionals have a responsibility to work together to ensure mothers have accurate information, so they can receive the support and encouragement they need as efficiently and as quickly as possible. The names Sarah Ockwell-Smith, Darcia Narvaez, Wendy Middlemiss, Helen Stevens, James Mckenna, Kathleen Kendall-Tackett & Tracy Tassels might not be familiar to you, but I will tell you they are some of my favourite people and they just came out with a brilliant new resource. I am keen to share it all with you. It is a based on one of those HOT parenting topics; SLEEP!  Do you want answers to questions like how many times a night it is normal for my baby to wake up or why does my baby only sleep when I am holding her? Do you want to know how you can create a calming sleep environment for you baby? Do you wonder if your baby should sleep in the same room as you? Or how about in the same bed as you? Do you desire to learn about ways to calm your baby, keep yourself calm and help your baby learn to calm herself?
This is the perfect handout for you! Hope you find this resource helpful and reassuring. Simple Ways to Calm a Crying Baby ... and Have a More Peaceful Night’s Sleep This week husband of Florence Leung released an emotional statement about postpartum anxiety & depression after losing his wife two months ago. He also commented about the pressure to breastfeed in the same comments. I commend him for speaking up, being brave, being seen, wanting to improve other peoples situations & for encouraging all new moms experiencing low mood or anxiety or depression to seek help. He added that these mothers are not alone and that they are not bad mothers. I agree and know he is correct. I don't believe there are bad mothers. I know mothers feel alone and isolated. Too many mothers feel this way. They are alone but not alone at the same time. When we pull in the breastfeeding component it gets super confusing and conflicting and very, very emotional. There are so many versions of how breastfeeding plays into postpartum anxiety and depression. Part of it is emotional and the feeling part of our brains and body and some of it is biological and chemically controlled in our brains and bodies (hormones are so complex). Some of this is controllable, in the sense that we can just change our outlook and start to feel better, and much of it less controllable and sort it feels like it is happening TO the mother. It really feels like a loss of control.  It is true that all over the place, in so many places new and expecting parents are visiting, there are posters and flyers and brochures and people encouraging breastfeeding and exclusive breast-feeding. This recommendation is world wide and comes from the World Health Organization. While I agree with all the benefits of breastfeeding, as most people would, it is NOT enough to just give benefits. In fact, it is dangerous to encourage and promote breastfeeding & yet not be able to follow through with the support needed. Breastfeeding is significantly more complex than the two-dimensional vision posters make it out to be. Most women are certainly not relating to the mothers on the photos of the breastfeeding books. You know, the mothers who have perfect skin, no bags under their eyes, pristine hair and makeup looking like they have zero cares in the world…beyond oxytocin highs.There needs to be support for the mothers that can breastfeed "easily" so they succeed. We also must meet the needs of and support the mothers in which breastfeeding is not going to work "easily" or perhaps not at all….and all the unique, complex cases in between this. Blanket statements are harmful, on all sides. Supports for new families are getting less and less available and the resources we do have are not always adequately trained and skilled to handle the cases they have presented to them. For every mother who feels judged because she could breastfeed, but doesn't want to, there is another mother who is feeling judged because she wanted to breastfeed, but did not meet her goal. There are mothers who celebrate being told their babies need to be supplemented and welcome supplementation. There are mothers who are devastated when they are given the same news. We need to learn how to support all kinds of mothers and all kinds of scenarios. We have to be prepared for that to take more than 5 minutes in the doctors office. Let's look at one way this all gets blurry. There are the mothers with babies who are not sleeping well but the mother has been reassured that this is just how breastfeed babies are. I don't believe that to always be the case…sometimes babies are not sleeping because they are hungry…breastfeeding is not working in that case, not for anyone. Mothers and babies need to sleep. Feeding endlessly for days and weeks is not healthy for anyone. The issue then becomes "exhaustion due to breast-feeding" weeks later, when breast-feeding issues could have been addressed, resulting in more sleep. Beyond that, families need support people to come in and do practical stuff, like care for a baby so mothers can nap, feed themselves, go for a walk. That doesn't mean breast-feeding needs to be discontinued, it just has to be understood and managed. Other examples would be a woman in so much pain from breastfeeding. Who wants to torture themselves 10 times a day. That is a breakdown waiting to happen. Again, lets get to the source as soon as we can. Get to the resolution so the mother can be pain free. There are so many options for that. We know about postpartum blues and depression and how common it is. We also know that for many women it is so bad they are taking their own lives. It is horribly, horribly sad and devastating. I don't believe it is about mothers breastfeeding or not. I believe it is about support, or lack there of, about misunderstanding babies and mothers, about isolation and healthcare systems that seem to be set up for failure and not success, it is about misunderstanding what the Baby Friendly Initiative is and what it was intended to do and how it is supposed to work. We can do better. We need to do better. Lives matter and are being lost. 1. You do not know what a doula is. It is said that less than 6% of mothers use a doula for their births. That could be because many people have no idea what a doula is. It can also be that there are misconceptions of what a doula is and what a doula does. Doulas are certainly not new and there are many stories of how doulas originated. A modern day doula is known as a non-medical support person for pregnancy, birth and postpartum (the time after the baby is born). A doula can be a source of encouragement, empowerment or simply a coach to the birthing person and their partner. Modern day doulas work professionally, confidently and comfortably alongside medical care providers such as doctors, midwives and nurses. A doula is a constant in the process. They meet with people during pregnancy and remain into the postpartum period. In a system where care providers rotate and work in shifts, there is often change in who is looking after a birthing woman, as labour can take more than one shift, maybe two (sorry, maybe more). Feeling safe and secure can be difficult around strangers and often the time is not there to develop relationships with the care providers. A doula can help keep feelings of safety and security by being a previously known relationship and remaining as a constant. With that in place, a doula can help bridge relationships with the changing staff to make the transition easier on the labouring woman. 2. You are worried a doula will not allow you to make your own decisions about your birth. Now that we know a bit more about what a doula does, one might wonder if they will tell people what to do for their births…the good news is doulas should be unbiased in their support of individuals. A doula might have particular views on how she would have a baby, but that should not be projected onto a family. I am supportive of all kinds of births. I want people to aware of what their choices are. Did you know people have choices in pregnancy, labour and birth?  I want it known that the birthing women are the ones that make decisions for their birth. Birth does not need to be an event that happens to women; it is an event that women should be an active participant in. Once people know the options, I respect their ability to make a choice that works for them. If people do not know how to find out their options, I help people communicate with their care providers in a positive manner so they can be presented with all the options and ask questions they need to ask to be full informed. 3. You are having a caesarean section.
A caesarean section is no less of a birth than any other birth. A doula can help prepare expecting families for the upcoming birth. They can help you formulate questions you might have for your care provider. They can help you prepare for what the procedures & processes of the day may be. They can even help you plan a birth plan for the day. Even with a scheduled caesarean birth there are still options and a birth plan is an ideal way to communicate those choices. While waiting for the birth a doula can help ease parents mind and help them prepare emotionally for the birth as they would during a labour setting. There are uncomfortable moments preparing for a caesarean, like an IV or epidural, and doulas help support parents through those moments. Inside the operating room, a doula can provide details that parents would like to know about. The doctors and nurses are busy with taking care of mother and baby. The partner is awaiting the baby and may feel uneasy in the hospital setting. Doulas are there to support partners as well. If the baby has to go to another area of the hospital, the partner can follow along with baby, and the doula will remain with the mother. This is reassuring to both new parents. Mothers do not need to be alone at all during a caesarean. Doulas also help in the postpartum period such as breastfeeding and making sure the mothers is comfortable and doing as well as she can be after the birth. 4. You have a midwife As I said above, modern day doulas work professionally, confidently and comfortably alongside medical care providers. Midwives and doulas are a complement to each other. Midwives are experts in pregnancy and birth and the most compassionate people who provide amazing support to families. However, they have the primary responsibility to be clinicians which is quite different from a doula. They have a lot of things to set up, monitor, chart, etc and often have to take off the unbiased support hat they wear and move into more of a decision making role or give an opinion as to what they feel is best and safest for mother and baby. They might even have to be taking care of more than one family at a time. If things are calmer and quiet, sometimes midwives leave to go and rest/sleep while a woman is labouring, so she can be rested and in her best mind and ability for the birth. Having a doula there means mothers is continuing to receive emotional and physically comfort. 5. You don’t need one You are giving birth to the baby, and that is one fact we cannot change, but the experience of birth often includes another person - the partner. Sometimes the partner is who needs that constant support and encouragement. I have been invited back to be a repeat doula for families I have served previously, not because the mother feels she needs a doula, but because the partner did not want to go through the process without a doula. Sometimes as a doula, providing support and encouragement to the partner, means the partner is who shines in the mothers eyes as her primary support person. That is wonderful! I love when that happens as birth should belong to that couple. And, maybe, truly, neither person needs a doula. I do not believe doulas are needed at births…you know, those babies are coming out at some point regardless of who is at the birth. Doulas are not a must have, doulas are an added extra. Doulas are a must have for some people, but not all people, and I support that decision. If you would like more info on the doula services I provide, I have more information readily available for you.  The landscape of breastfeeding discussions has changed. I have been in breastfeeding conversations now, actively, for 12 years. The conversations I am having now do not resemble the conversations I have had in the past. I cringe now when I think about many of those conversations, knowing what I know now. What is that saying? When we know better, we do better…YES, yes we do. One of the primary changes to the conversation is that we no longer can look solely at what is happening with the mother of the breastfeeding dyads, but we are looking at the baby also. I don’t mean positioning. I don’t mean skin-to-skin. I don’t mean early and often feeding. I mean, just as in how we look at a mothers ability to produce milk, we need to look at the babies ability to extract that milk. We know production of milk is primarily about supply and demand. Demand needs to be present first; this is the baby. Expulsion of the placenta stimulates the start of milk production & then the baby needs to drive it from there. If we are seeing something not working as expected, we need to assess both mother and baby. Often what appears as not working is “mom hasn't started to produce, her milk is not in yet, she just can’t produce milk or she cannot produce enough”. However, we then also say, and I am sure you have heard this, that very few women truly do not produce milk or produce lower amounts of milk. We use completely contradicting statements, loosely, but they are taken as hard, fast truths. Or we will say, “No, no, you are making enough for your baby. Of course, you are making perfect milk for your baby. Your body knows what your baby needs. Some babies are just slender. That is how breastfeed babies are. They feed all the time. They are slender. Babies on formula weigh more. Don't worry about it. Just keep feeding," Or have you heard about the mothers being told their breastmilk is made of water. They just don’t make “cream” like their friends. How confusing! When the new growth charts came out, we expected to prove some of these theories .The new charts were based on breastfed babies, internationally, in favourable living environments. There is lots of history to read on the development of the WHO growth charts. In short, people expected to see breastfed babies being slender and slower gaining and waited to be able to say, “we, told you so”. Well, the laugh was on us. The new charts show that under favourable environments and feeding conditions, breastfed babies do weigh more than their formula fed counterparts and on the new charts breastfeeding concerns show up even sooner than previously. For example, it is common at a 4 month check up to see a baby on the old chart to not be gaining on the curve anymore. Now, with the new growth charts, that same baby would show up with less than ideal growth earlier, perhaps at 3 or 4 weeks. Growth failure was being seen as a normal negative deviation and being missed! It appeared almost as if advocates of breastfeeding were trying to downplay growth failure, because they so truly believed breastfeeding is the way to feed an infant and didn’t want to admit when it wasn’t working. I was fascinated by the charts and wanted to know why the data spread that way. (That could be my former career as a Medical Laboratory Technologist shining through). About the same time I started looking at breast-feeding failure with my new set of lenses; the lenses that looked at mom and baby, not just a mother seemingly making too little milk, with pain or maybe without pain, with a screaming baby or maybe a sleepy baby, maybe a baby gaining weight but seemingly hungry all the time, maybe a baby with slow weight but seemingly content. I wanted to know more about all the babies & was learning more about babies. (What you seek you shall receive) I was introduced to the idea that babies cannot always function at the breast well, and therefore, the demand is not put on the mothers supply. Without demand, there is no supply! But can’t a mother just offer the breast more, get into bed for 24 hours for a breast-feeding vacation, do skin-to-skin, put baby in a wrap and walk and feed as baby needs and get that supply up? That is exactly what I was taught. Mom just needed to try harder and get supply up, drink more water, rest, take some fenugreek, drink lactation tea and eat lactation cookies. But, you know what? That wasn’t always working. Not with the cases I was seeing.  If the baby cannot function fully at the breast no amount of time at the breast is going to drive supply. At the same time, we also learnt the breast doesn’t function like we thought it did. The new science tells us we make more milk by emptying the breast more, NOT by letting it get full and empty every 4 hours. Hold on, what? But babies don’t like when the breast isn't full, they scream and protest or fall asleep. They are happy when it is full, let-downs come easy and milk leaks into their mouths. We now understand this all as a compensation for babies inability to function and realize that this routine of feeding can, in fact, cause (secondary) low milk supply down the weeks of feeding. If we address the babies issues, we can have proper feeding, proper demand and proper long term supply. We are starting to make progress with this and changing the idea of low supply.
What i am not seeing is a change is how we see the idea of oversupply or overactive let down. If the idea of low supply is often being perceived incorrectly should we not consider the idea of overactive let down or oversupply isn't a true phenomena either? Could oversupply also point back to the baby? Is this another function consideration? I certainly think so. I would like to ask that we consider the let down and supply as normal flow, but, too fast for that particular infant. The infant, for varying reasons (and an assessment would be needed to determine the reason) is having a hard time controlling the flow of the milk. They choke, cough, sputter, leak milk, etc. They might have fast feeds, gain well and seem to adapt to this "overactive let down". As time goes on, supply decreases (we respond saying milk supply is now regulated as nothing was wrong anyway) and soon, the same mom with overactive let down, is saying she has low supply. WHY? Because the baby could not feed correctly from the beginning. They had difficulty at the breast, relied on that fast letdown and now without correct feeding behaviours, just like the low supply moms I talk about above, the demand is not there and so the supply goes down. Something else we now know, that we used to say the opposite of, is that a hungry baby will cry and a content baby cannot be hungry, Regardless of weight gain plateauing on the curve, being slow gaining, so long as baby seemed content, no one worried. What we know how is that as milk supply goes down, appetite of the baby goes down. That appetite is the demand we need! So without the demand, we again will have no supply. This is quite a different tale than has been told in history! Let's keep chatting! If you think you need some hep navigating your breast-feeding I am happy to book a time to see you and your little one. Yes, I am a doula and many doulas offer placenta encapsulating as an additional service. I am not one of those doulas. I am a doula that is happy to refer that job out. Why? There are so many more evidence based things I can do to help new mothers that relate to most of the reasons why they are considering placenta encapsulating. There is simply not enough evidence for me to feel that this is how I would like to spend my time instead of doing the other things I can be doing for clients.  One of the primary reasons women consider encapsulating their placentas is anecdotal information that it can aid in appropriate milk supply. As an IBCLC, of course, I think milk supply is very significant. One of the driving factors of good production is good breastfeeding, early and often. This helps lay the foundation for the days and weeks to come. Breastfeeding, in fact, is one of the reasons I became a doula. We know that better birth experiences also aid in better breastfeeding. I wanted to support as many families as i could through the whole experience, rather than coming in after the birth and trying to catch up. Being there right away at birth and returning within 18-24 hours to see how things are progressing really helps get things off to a good start. Early identification of any potential roadblocks and removing them as soon as possible can make a big improvement to how breast-feeding starts off. There are so many reasons for milk supply being low. If as an IBCLC, we identify a supply issue and a suspect cause, knowing the mechanisms of some of the remedies available helps us know what to recommend to help resolve the issue. Ee do not yet know the mechanism of how placentas work to assist in lactation, if they even do. If we identify a supply risk, there are many more evidence based recommendations that can be made that we know with much more certainty should help the situation.
I will also state that I and other IBCLC colleagues have witnessed mothers with supply issues that resolve after they stop taking placenta capsules. Again, this speaks to us not knowing the mechanisms behind how a placenta might aid or impact lactation. In the end, my skill set as an IBCLC is of much more value than the time I would spend processing a placenta, in my opinion. I do also have some personal hesitations that I wish for people to consider. I am not saying that they need to decide not to encapsulate after the considerations but just that they consider the points. When we discuss postpartum mood imbalances & disorders we need to look at a larger picture than just a placenta. We see many mothers of multiples who state they did not consume their placenta after baby #1 but did after baby #2 and felt better emotionally than the first time. However, did they review the other differences? Baby #1 we often know little to nothing about what the experience of mothering will really be like, we go at it alone, we are not very confident in what we already know and we hesitate to seek out much information. Often baby #1 was a longer labour and longer pushing stage. Going from no baby to a baby, no sleep, constant physical and emotional demands from the infant, plus ones own recovery can be overwhelming. Baby #2, labour might be drastically different, maybe this time more supported, a shorter labour, easier pushing, the lack of sleep one gets with a newborn in the house is not as much as a surprise and there is much more understanding of normal newborn behaviours. Maybe the second time she had a doula, the same lady who encapsulated the placenta for her, and also provided postpartum supports, like helping with baby care so she could nap or helped with dishes and laundry so mom can rest, put up her feet and just focus on breastfeeding. Having some healthy meals with nutritional elements similar to a placenta might be a more regular occurrence the second time. Speaking of nutrients; sometimes it is said that mammals consume their own placentas, so why wouldn’t humans? Some theories are that mammals do it for safety; that in the wild the smell of afterbirth would draw predators near and the mother & the newly born were vulnerable and at risk, so for safety, the mother would quickly consume the placenta. There are also some theories that a mother would be hungry and in the wild food is scarce. Their own placenta vs nothing was the best they could get so it could be considered a last resort for a nutritional deficient animal. We no longer live in the wild and food scarcity is not as prevalent. In this day and age, most humans don’t look at their placenta and see their next meal or have a desire to consume it. Even in the wild, they consume it mostly in one sitting and not small amounts over days and weeks like the placenta encapsulation community recommends now. Even with diminished nutrition in food sources, we can purchase vitamins and foods enhanced with vitamins, which could provide the same effects. There is a study I am aware of that is not yet completed and it does show that the mothers consuming their placentas do have higher hemoglobins at 6 weeks postpartum. However, it has also been commented that there is a chance that the families that have the available monetary funds to pay for placenta encapsulation services, also have the monetary resources to purchases better quality and quantity of foods. The cost of the placenta encapsulations has not been covered for the study. It is a control that needs to be considered. As a former Medical Laboratory Technologist who worked in manufacturing of blood and blood products, I also worry about an appropriate environment to encapsulate and I do have concerns about infection control. I know that might be over-reactive but as someone who had to do quality control, sterility checks and saw the process of recalls, I think safety and specifications are important. I mean, after all, the placenta might be contaminated with poop. Even a small amount of bacteria can cause a big tummy ache. I say that more tongue in cheek than anything, but it is a thought. There is equipment needed to encapsulate and I am just not 100% that the risk of cross contamination is not there. Now, I am not an encapsulator and maybe there are steps in place to account for that risk. I am unsure about that. I am just saying, for me, it is something to think about. In the lab, in food processing, in other areas where contamination is a risk, sterility checks and quality control is what keeps stuff “clean and safe” and where recalls start, if they are needed. Just because you made the organ does not mean it cannot hurt you if bacteria is at play. After all that, we do know that placebo effect can be strong and powerful. I am happy to accept placebo effect if you are and I am happy to refer you to a local placenta encapsulator if your desire is to encapsulate your placenta. |
Kim Smith
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Kim Smith, Lactation Consultant (IBCLC) Breastfeeding Education & Support
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Quick facts:
International Board Certified Lactation Consultant (2010), Re-certified (2015, 2020) TummyTime Method Instructor Retired Doula, CAPPA trained, Pre-Certified ProDoula (2009) Your Birth Experience (YBE) Certified (2015) Wife & mother of 4 Retired Medical Laboratory Technologist |