3 Doulas

Ina May's Books: Betcha Can't Read Just One!

By Mandy Schutt  

I picked up my first Ina May book back when I was just learning about birth and wanted to become a doula. The title of the book was, Ina May’s Guide to Childbirth. It was a treasure trove. May wrote about the raw, magnificent beauty of birth, in particular natural birth. She wrote about the physiology, chemistry, and anatomy of birth. She had this Biology flunk-out drawn into her pages as I’ve never been before. She was brilliant and passionate and I wanted to know more!

What makesIna May’s books so great is not just the scientific and historical aspects of her writing but the fact that she includes real birth stories in her books. They aren’t gussied up by ghost writers or edited to literary perfection, they are written by every day women, some who write well and some who just write with sincerity…it doesn’t really matter because as a reader you can see their stories unfold. Seeing these births in the mind’s eye is an incredibly powerful experience for western women who have, for the most part, seen birth as a certain way (screaming, painful, traumatic, a means to an end, doctor dominated, fearful, etc.) and have come to believe that this sort of birth experience is an inevitable part of becoming a mother. We NEED positive birth stories in this society.

Since that first life-altering Ina read, I’ve had the opportunity to read her other books, and even voyage to Tennessee to see the infamous “The Farm” with my own two eyes. One of my dearest, oldest friends is now receiving prenatal care at The Farm and will birth there this coming July. The Farm is a community that dates back to the early 70s when a group of hippies (Ina May included) bought a parcel of land and decided to live there together. Ina May was an English Major, with no medical training. She tells of her midwife metamorphosis in more detail in her first book, Spiritual Midwifery (first published in 1977 and peppered with terms like, “far out”, “psychedelic” and many a reference to "aura color"). She caught her first baby with the help of a pocket guide and quickly realized two things: being in the presence of a birthing woman was indeed a spiritual experience and she really should try to learn more about birth than what was in the contents of her pocket guide. And so she did…years later Ina May became a CPM (Certified Professional Midwife), wrote five books, teaches OBs and midwives across the globe, has developed the “Gaskin Maneuver” to aid babes with shoulder dystocia, appears in many well-known documentaries, is known as, “The Mother of Authentic Midwifery”, and still runs a birthing center on The Farm with a--- wait for it--- cesarean section rate of under 2%.

Wha? Huh? Come again?

Yes, that’s right under 2%.  (The national average for low-risk mothers is around 20%.)

Ina May’s newest book, Birth Matters, which she was working on when I visited The Farm, two summers ago, has now been released. As I read through the first few chapters, once again I am drawn to her words with deep passion and awe. Gaskin has written this book specifically for modern mothers of today- we who have grown accustomed to technology and fearful of natural birth.

If I had a nickel for every women that I have spoken to who said,

“…and then I read this book by Ina May.”

Or

“…but that all changed when I read this one book by Ina May.”

In truth, sometimes I have more than a nickel, because her books have challenged so many expecting mothers to become educated, supported, encouraged, liberated; which often leads them to me in search of a childbirth educator or doula.  I just sent my sister, “Ina May’s Guide to Childbirth”, she’s 19 weeks pregnant. When someone asks me for recommendations of a good pregnancy read, I always send them to Ina May, after all she’s sent plenty of women to me!

If you’re pregnant or want to be pregnant some day or if you are just curious about the hows and whys and ifs of birth in general, check out Ina May’s Guide to Childbirth or Birth Matters. Regardless of how little or how much you know about birth, Ina May’s books are an mind-opening delight.

Ina’s first name is pronounced “eye-nuh”. She's now in her 70s and fantastic as ever! For more Ina info, see: Ina May's Biography, The Farm Midwives, Ina May's Safe Motherhood Quilt Project.

 

Why Taking Your Hypnobabies Childbirth Education Class Early Is A Smart Move

By: Mandy Schutt

 

Many times expecting moms begin researching their childbirth education options toward the beginning of their pregnancy expecting to enroll in a class that is close to their estimated due date (I like to call it a “guess date” since it’s a pretty general date. First time moms go an average of 8 days past their given due date!)

So, as a Hypnobabies instructor, I often receive calls and email from moms who are looking to enroll in a class that is in the almost distant future. This is a great plan for a lot of childbirth education courses but Hypnobabies is a little different.

 

Why? Well, there are several reasons why it might be best to take a Hypnobabies Childbirth Hypnosis class earlier in one’s pregnancy but I’m going to address two of them here.

1. The Hypnobabies Childbirth Hypnosis class consists of six wonderfully dense classes that are simply jam-packed with childbirth education. To name a few: pregnancy nutrition, cord-clamping issues, care provider choice, medications used in childbirth, partner support, doulas, newborn appearances, breastfeeding, skin to skin contact, and many, many more. For a more extensive list of topics covered, click here.

 

With all of this new information available for new moms and dads to further research and study, some parents actually discover that their birthing plan begins to change a little (or a lot!) and taking the class early allows them to arrange these changes in a timely, non-stressful manner.  For example, parents will learn in class about what a doula does and may be interested in hiring one for their birth. Taking the class early on would allow time to interview several doulas and choose the one that best fits their needs and personality. After learning about cord clamping parents may want to discuss this thoroughly with their care provider to see where she stands on the issues and then include their wishes on the birth plan. After learning about the importance of choosing a care provider that you feel comfortable with and who supports all your birthing wishes parents may choose a completely different care provider. Taking the class early and making changes early can eliminate a lot of hassle with medical institutions and insurance companies.

 

2. An important element of Hypnobabies that is not offered in many other childbirth education courses is that of hypnosis. When one begins to understand how hypnosis works and how well it works when practiced consistently, it’s easy to see why taking the class earlier in pregnancy can be extremely beneficial. Imagine knowing that you are going to run a marathon in six months. You wouldn’t wait until the very last minute to start training, you would start as early as possible to prepare for the big event knowing that the stronger your body is when you run the marathon, the easier it will be for you. This is similar to how hypnosis for birth works. The stronger the mind is, the easier it will be to use on your birthing day. Having time and dedication to practice hypnotic concepts after the six week Hypnobabies course has finishes is very beneficial indeed!

 

What's Your Hospital's Cesarean Rate?

By Mandy Schutt

 

A recent study that took a look at the astronomical cesarean section rates in California came to a very un-shocking conclusion:

Women who give birth at non-profit hospitals have a significantly lower c-section rate.

I’m talking, in some cases, significantly lower.

For example, at Kaiser Permanente Redwood City Medical Center (a non-profit hospital) new moms had a 9% chance of having a cesarean. While a mom at Los Angeles Community Hospital had a 47% (yes, you read that right, forty-seven percent) chance of having a cesarean.

The study showed that some hospitals located very close to the other, so serving the same population, had drastically different cesarean rates depending on well, the amount of money they would make from performing a surgical birth.

As quoted by California Watch, Desirre Andrews, president of the International Cesarean Awareness Network, a nonprofit that would like to see C-sections only in cases of medical need said, "This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate," said

Wondering what the Cesarean rates are at your local hospital? Find out here.  

Okay, so let’s say that you just found out that your hospital and/or doctor have a higher c-section rate than you're comfortable with. (Remember to always make this one of your first questions when vetting obstetricians!)

What next?

You are not stuck! You have options- yes, even up until the actual birth of your child! Regardless of insurance issues, you have choices. Of course, it’s easier and more enjoyable if you change care providers early on but I’ve heard of mothers literally firing their OBs as they are giving birth! Your first step might be to:

-speak with your doula about your concerns and see what sort of local connections and resources she can offer to assist you

-contact your local ICAN chairperson, they will be happy to walk you through your options

-call your insurance and see if you can simply change care-providers (you would then seek out your ideal care provider and begin seeing them) a lot of times it’s just that easy!

Through the entire process of finding your ideal hospital and care provider, keep the following in mind:

The World Health Organization recommends that the cesarean rate in any country should not exceed 15%. If your hospital or care giver has a rate higher than this, it very well may be a red flag.

 Download your Southern CA Cesarean Primer here.

 

Homebirth As A Wedding...the price of having (or not having) the homebirth you want

By Mandy Schutt

This past week, I celebrated my ten year wedding anniversary and still think marrying my husband was one of the best choices I ever made! I’m crazy for the guy and somehow, he’s still crazy for me. Even after all this time, I remember the insane amounts of thought and research that went into our wedding…

 
The author, Mandy, and husband Griffin in 2000

My wedding dress was custom made by my aunt who is a seamstress. I designed it as a classic, elegant statement. It fit me perfectly, and very well should for all the dress fittings I stood through as my aunt laboriously trimmed, measured, hemmed, pinned, and stitched. The dress meant many trips around town for just the exact right lace and the perfect texture of silk. Hundreds of hours were spent bent over that long white gown as my aunt hand-embellished the bodice, sewed in the ribbing to the exact centimeter, and then if it wasn’t just perfect- she’d rip it out and do it all again.

And this, folks, was just the dress.

I could write pages about the number of churches and halls we walked through, the thousands of flower arrangements I scoured, the antique stores I visited to find the perfect vintage jewelry for my bridesmaids, the fittings at the tux shop, the trips to the bridal stores and beauty parlors, the consults with professionals, and of course, the daily trips to the gym to get INTO the dress! When “the” day came, my wedding was indeed lovely despite the fact that it was actually much less expensive than the average American wedding. It was held in a chapel, not a cathedral, and as beautiful as it was, many would still consider it a relatively humble affair.

I look back now and wish I had eloped...or at least toned it down a bit.

Why?

Oh, it’s not that I disliked the wedding; it’s just that it was so much tadoo for an outcome that would have been the same with or without all the pomp and circumstance.

With or without a wedding, I was getting my man.

All this reflection on my wedding made me realize more than ever, how flip-flopped our priorities are as American young ladies. We grow up and dream of the dress, the flowers; the ceremony of our wedding. But the ever-important ceremony of becoming mothers rarely crosses our minds until we see that pink line on a pregnancy test. Only then will most of us begin to envision what our birth will look like…and when we do,

“Eeeeek!”

most of us are terrified.

Some women don’t react like this though. They manage to get their hands on some more substantial reads like, “Ina May’s Guide to Childbirth”, “Your Best Birth”, or “The Thinking Woman’s Guide to a Better Birth”. They gather information from research that has no hidden agenda. They may even hire a doula. These women want something more than freedom of decision-making in their pregnancy- they want the sort of birth they know deep inside, that they are capable of and that actually entails making a whole lot of decision making!

It is more often than one would expect, when a mother like this mentions to me, “You know, what I really want is a home birth. But…my insurance won’t cover it.”

My heart sinks.

It’s not that you have to have a home birth to have a beautiful birth, but if a woman truly WANTS a homebirth and understands what that entails, without a doubt she will have expectations about her birth that are not met in a hospital setting.

I’d like to pause for a moment to point out that many western women would happily spend money on a wedding and never question its monetary value, but when the idea of spending money for a birth is raised, there is much more pause.

We are raised knowing that our wedding day is:

...one of the best days of our lives,

    ...the beginning of a new life with another human being

        ...symbolic of a deep and meaningful love and commitment

            ...to be celebrated and commemorated in a meaningful manner.

Now, correct me if I’m wrong, but isn’t that exactly what our birth days are supposed to be as well?

I understand why it happens. Birth isn’t really something we grow up anticipating spending money on. It’s not like a wedding, or a car, or a home (actually it’s far more important!). Most of us envision giving birth in a hospital- after all that’s where most of us were born and it is certainly where all the Hollywood babies we’ve been watching on T.V.get born! It’s not a culturally accepted idea to have to pay for our births. We don’t plan on it.

Now, I don’t want to get into the politics and business aspects of why home birth is not covered on most insurance policies. That’s a whole other deal. What I do want to do is to simply present the question that I ended up asking myself when I was considering my impending birth day:

“Why did I feel so comfortable spending money on a wedding ceremony that was pleasant, yet unnecessary but I am questioning the out of pocket expenses for a home birth?”

Having a baby and the manner in which I did it, far outshone the importance of a white gown and flowers to me. There were certain aspects of my birth that I wanted done my way. I knew that I’d have to either fight for or surrender these preferences in a hospital setting. I just wasn’t okay with that. Unlike marriage, where I would have gotten my man through a courtroom ceremony or a traditional wedding, the process of my baby’s arrival was actually very significant to me.

Not having a home birth was never an option for me. I wouldn’t let it be.  Paying for it was hard; we worked out a payment plan with the midwife, my husband and I worked a ton of hours, and we lived in a 300 square foot apartment until the month before I gave birth. We made a way for it to happen. Now, it would be incredibly naïve of me to think that it was this simple for everyone. I certainly understand that even as tight as finances were for us, we weren’t poor and we were both employed. This is why I love the idea of a new non-profit that offers home birth scholarships to those who truly cannot afford them.

There are many things moms can do to make their home birth a reality despite tight finances. If you are questioning home birth and if it is worth the out of pocket expenses, I cannot encourage you enough to at least look into your options. You don’t have to commit ahead of time, but my guess is that once you start speaking with midwives, looking at their care plans, realizing that your prenatal appointments are generally 45-60 minutes long (Yes! There IS that much to talk about during pregnancy!!), that you will have continuous care, and that your newborn will be tended to in the comfort and convenience of your home in those first few weeks of life, you will begin to truly understand the value of your dollars.

After having a home birth, I will never be able to “go back” to my childhood idea of birthing in a hospital. I was tended to by the most generous, kind, and thoughtful birthing team. In all seriousness, the care I received was so wonderfully humbling- and the postpartum attention that was given to every detail of my healing and wholeness as well as that of my child, far exceeeds anything a hospital would ever be able to logistically provide. I also totally understand that home birth is not the right choice for everyone and many women prefer to birth in a hospital. That’s great, and I will continue to support these women, but for me, home birth was the right choice.

I imagine that if I am blessed enough to give birth a second time, there will be even more financial sacrifices made to make a home birth happen. I don’t care; I’ll do it. I’ll beg, borrow, trade, research, negotiate, and barter if I have to! In fact, I’ve created a long list of all the items I would sell in order to get money to pay for it- my wedding dress is one of them.

 
 Mandy & Griffin welcoming thier daughter to the world, moments after her birth in 2009

Affording a Homebirth

By Mandy Schutt

Some women dream of a homebirth but when they realize that insurance won't cover all/some of the costs involved, stop considering it as a serious option. I urge every women to seek out the birth of her dreams, if that involves birthing at home, don't let insurance companies stand in your way!

 
This amazing art by: Richard Wilkinson

There are many things moms can do to make their home birth a reality despite tight finances. Here are some ideas to consider:

-contact several midwives and ask about payment plans

- inquire about fees they may offer on a sliding scale or part-trade options

-many midwives accept payment via credit card (though I am not an advocate of depbt, I do know some clever folks who have opened particular cards that offer 0% interest and just used the card for their births and then closed the account)

-some midwives accept government subsidized medical programs, like Medi-Cal in California

-check and double check that your insurance truly won’t cover homebirth, there are several insurance providers who cover a certain percentage of the costs

-keep in mind that home birth can be itemized on your taxes

-if you want a doula and a home birth but can’t afford both, contact a local doula or doula training agency/organization, most of the time there is a certifying doula who will do a low or no cost birth to gain more home birth experience (doulas love attending home births!)

-if you have hired a doula, she may be able to connect you to some midwives in your area that take lower cost births- search around your city's birth community and snoop around midwifery schools- don't be afraid to ask for help!

-check out the non-profit, Normalizing Homebirth; they are in the process of offering scholarships to women who cannot pay for a homebirth but would like one.

Hypnosis, Pleasure, and Pain- My Personal Story

By Mandy Schutt 

 “So, when you used hypnosis to birth your daughter, you didn’t have any pain?”

That’s one of the first questions I am asked when I share that I used hypnosis to prepare my mind and body for birthing.

However, the program that I used: Hypnobabies Childbirth Hypnosis, is careful to stress that their program is not all about achieving a pain-free birth. Sure, there are many women who are fully capable of birthing painlessly (I’ve seen it!). Most western women, however, move into their birth so amped up to go through labor’s agony that they defeat their chances of a painless birth before contractions have even started. Tension caused by fearful expectations cause the body to birth more slowly and painfully. Knowing this, we can easily understand that the more relaxed we are throughout pregnancy and birth, the less pain we feel during our birthing time.

Personally, I did not have a pain-free experience for most of my birth. I can however, tell you what hypnosis DID do for me: Mandy's birth, "It's a girl!" Not to be published elsewhere without permission from author.
 

-Allowed me to address my birthing fears head-on and deal with them before I was giving birth so that my birthing time was a joyful versus a fearful event

  

-Reminded me every day that I was capable of birthing and mothering my precious baby

  

-Provided wonderful bonding time between my baby, my husband, and myself for months before my child’s arrival

  

-Prompted me to take time out for myself amidst life’s business. During the last few months of my pregnancy I was working, traveling, bought a house (a fixer at that!), and doing all the other baby-prep stuff. I was so relieved to have an “excuse” to escape it all for a few minutes a day!

  

-Provided an in-depth and complete childbirth education course. Yes, I was a professional birth doula already but the Hypnobabies Childbirth Hypnosis program taught me even more!

 

-Really got me excited for my birthing time! I didn’t view labor as a means to an end, I looked at it as a metamorphosis; a wonderful event that would change my life forever and bring me closer in touch to the woman that I am.

 

-Allowed me to feel comfortable and beautiful through my whole pregnancy and birthing.

 

-Pain-free pushing. I pushed for about an hour and a half and while I did exert great effort, there truly was no pain during pushes nor did I ever experience the ring of fire. My daughter’s head came out along with one of her little fists (“nuchal hand” is the technical term for this, though I prefer to call it the “Superwoman Pose”) and even with this uneven, extra stretching I felt no pain.

 

 

Who knows how much longer or more intense my birth would have been had I not used hypnosis. I remember my mind pulling to its forefront specific lines and affirmations from the hypnosis scripts that I had practiced, “I accept whatever my birthing time brings me.” was the one that presented itself to me again and again. Acceptance. That could have quite possibly been the biggest benefit to using hypnosis throughout my birthing.

 

Cool article! I’d like to read more about the Hypnobabies Childbirth Hypnosis classes Mandy teaches.

Still waiting...

By Jenny Gillespie

Ok so mom is now 4 days past her due date...The birth story unfolds:

Saturday:

In the morning, mom began experiencing contractions that were irregular every 30 minutes down to about 10 minutes.  I was on the phone with her most of the day.  She napped, ate, drank water (see importance of hydration) went to the bathroom.. 

10:00 pm: After spending most of the day texting and talking on the phone, it was time for me to go and give mom support.  I arrived at her house about 45 minutes later and we stayed inside for about an hour. Contractions every 10 or so minutes, mom was tired, uncomfortable and experiencing back pain and pelvic pressure.  

11:10 pm: We decided to take advantage of the cool night and went for a short 20 minute walk.  Contractions spaced  out a little.  Baby moving a lot! We went to the store and bought some more water.  Went back home and assessed the situation.  We both agreed that I should go home and get some rest.

1:00 am: Contractions mild and spacing out.  We decided I should go home and rest and mom should sleep also.

2:00 am: Last text. Mom relaxing going to sleep.

Sunday: 

7:00 am: Fairly uneventful night, we both got some sleep.  Contractions returned and again were every 10-8 minutes apart.  Mom was doing well, and was fine without me there.

10:40 am:  Encouraged mom to take another nap.

12:12 pm:  Mom who was napping woke up to 2 contractions 9 minutes apart with a little bloody show.  I told her that reddish/brownish bloody show is normal. Mom wanted to know why her contractions weren't getting stronger or closer.  I told her this was still early and ok.

1:30 pm:  Mom nervous about bloody show and insisted on going to hospital to get checked.  Getting checked can take a while, it's not as if you can go into the hospital and run up to Labor and Delivery and say :"Hi I would like to get checked" It can be a long process, as mom and baby need to be assessed.  Mom is monitored, baby is monitored, information is logged into mom's chart.

3:50 pm: Almost 2 1/2 hours after arriving at the hospital, mom gets checked and is 2 cm dilated and 60% effaced yay!, the bloody show is normal.

7:30 pm: 6 hours after going to get checked, mom is encouraged to go home.

10:19 pm:  Mom goes to bed for the night.  Contractions are still all over the place and mild-ish

Monday:

6:50 am:  Mom still hanging in there.  Contractions  a little stronger and longer....

Let's see what today brings!

    

The last great secret-Finding out if it's Pink or Blue

 
 

By Aimee Oswald, CD (DONA), HCHI

www.sweetpeabirth.com

I was 16 when my mom's youngest sister got pregnant.  She had always been my favorite aunt, she was young. Listened to Rock music, took me to the zoo and bought me my very first burrito from Tito's-the best local taco joint in our neighborhood.  She was the first pregnant lady I ever saw close up.  I really got to look at her tummy, feel the baby kick and listen in awe to her stories of the hospitals new "ABC Room" where she was going to have a natural childbirth.  She had taken Lamaze and my uncle was going to coach her.  She had a plan and knew what she was going to do.  The only two things she didn't know were what day this birth would occur and what sex the baby would be.  At her baby shower the women had her lay down on the floor and take off her wedding ring. The ring was put on a chain and this was hung over her belly- if the ring swung side to side the baby would be a girl and if it moved in a circle then the baby would be a boy.  I can't remember what the "test" showed but boy do I remember all the laughter in the room.  Some of the older women wanted to see how she was carrying, out in front=boy while all over meant a girl.

When I got pregnant years later and was asked if I wanted to find out the sex of the baby by the doctor I thought, "wow is he really going to do the ring thing?" of course not. He would have the ultrasound technician look for me.  I immediately said I didn't want to know.  This I found out annoyed many, many people.  But my thought was and still is- "How many TRUE surprises do we get in life?"

The way the world is now we can find out news the second it happens. We rarely get anything "good" in the mail and you can instantly reach anyone anyplace by text.  So whats left?  Babies' birth dates and their gender.

With many women scheduling the birth of their babies (that's a whole other argument that I'll save for another day) truly their baby's sex is the last great mystery.  I know I'm old fashioned and some would say I have no curiosity.  But I am curious I just loved loving my baby without putting a name or gender on them. This was just our baby.  Our nameless, faceless bundle of joy.  I loved picking out names for boys and girls and trying to design a gender neutral bedroom.  I know I may be the cheese standing alone in this world of instant information so here is some information if the suspense is just too much for you to bear.

The most common method to find out the sex of your baby is ultrasound or sonogram. This method is most accurate between 18-22 weeks. Earlier than that it is hard to tell and sometimes later there is simply too much crowding in there to get a good peek. There are still many factors in this method that prove it to be not 100% accurate; they include the mothers weight, The gestational age of the baby, The training of the technician and the equipment being used and of course the baby's position.

Other methods of sex prediction are more accurate but carry more risk to the pregnancy. The most commonly used methods are amniocentesis and chorionic villus sampling (CVS). These tests can be used earlier in pregnancy. They are also much more accurate than ultrasound, with results very close to 100%. 

Miscarriage is the primary risk related to amniocentesis. The risk of miscarriage ranges from 1 in 400 to 1 in 200. In facilities where amniocentesis is performed regularly, the rates are closer to 1 in 400. Miscarriages can occur because of infection in the uterus, the water breaks or labor is induced prematurely. Although extremely rare, it is possible for the needle to come in contact with the baby. Great precautions are taken by using a sonogram to guide the needle away from the baby. The mother may experience some pain or discomfort as the needle pierces the skin and following the procedure she may undergo cramping, leakage of fluid and minor irritation at the injection site.

Of course you can forgo all these modern methods, take off your wedding ring and tie it to some string or just go to any grocery store and people will freely offer their opinion on how you are carrying and what that means. It may be hard to wait all those months to find out if you'll be buying pink or blue curtains but the moment that baby is in your arms you will find you knew all along exactly which sex your baby was, you knew it in your heart.  ( Oh! And just a side note I did keep myself busy waiting on my bundle by sewing baskets of curtains....all yellow. My daughter just loved them!)

Nursing after breast Reduction

By Aimee Oswald, CD (DONA), HCHI

www.sweetpeabirth.com

 
Breasts are now one of my new obsessions! I've had them since I was about 12 years old and to be honest for a large portion of my life they were in my way, more of a hindrance than an asset. They were great for attracting men and once in a while I was able to get something at a discount, but beyond that they were not of much use to me...then I got pregnant.  For the first time in my life my tummy stuck out farther than the girls! I need to back track a little now. When I was 18 years old the doctor discovered a substantial lump in my left breast. It was determined to be benign but only after two surgeries which required that my left nipple be practically removed and then re-attached.  After the birth of my first daughter no milk flowed from this breast, not even a tiny drop.  The right one was not much better at producing and after many hours, countless sleepless nights, and pumping only bloody "milk" into bottles I labeled my breasts failures and picked up a bottle. 

About 8 years after the birth of my second daughter my girls had gotten totally out of control; I was now wearing a 36 I Bra, I as in after H!! The weight, headaches and constant strain of trying to find tops was enough and I decided to have a breast reduction.  I had no idea how very common this surgery was.  I knew lots of ladies that went up in size but since my surgery I've met many more who have chosen to down-size. Several of these woman are now venturing into mommyhood and have questions about how to be a successful nurser.  Here is what I've found out: 

Breast reduction surgery almost always compromises lactation potential to some extent, the good news is a woman can still breastfeed her baby. The question becomes not whether she can or can't breastfeed, but rather how much milk she will make.

Almost all post-breast reduction moms will produce some amount of milk, though some types of surgeries are less damaging to the mammary system than others. Some mothers will still have a full supply of milk after surgery, especially if their surgeon took care to preserve their mammary tissue, vital nerves, and ducts. Some women will find that even though they do produce milk they may need to add some supplemental milk supply.  There are options for this as well, one option is to use an at-breast supplementer such as the Medela SNS or the Lact-aid Nursing Trainer. These apparatus are basically a pouch or container filled with supplement that hangs around the mother's neck with a thin tube that is positioned alongside the nipple. When the baby takes the nipple and areola into his mouth, the tube goes in too, and the supplement flows along with any mother's milk that is being extracted from the breast at the same time. You can use expressed milk in the system. There are also several places to purchase donated breast milk that you can use in the supplementer. 

Whether you have or have not had a reduction surgery I strongly recommend that you attend a breastfeeding class prior to your birth. Not only will you learn about nursing but you will learn about the anatomy of the breast and this is very beneficial when trying to work your way to nursing your baby.  I also urge you to meet with the hospital or birth center provided lactation consultant, even if you are off to a wonderful start this highly trained professional can save you hours of crying (both you and the baby!) and sore nipples by just making simple adjustments to holds. If you get home and then discover you have run into a snag your doula, doctor,nurse, or childbirth educator can refer you to a home lactation consultant who will visit you or you can go to your local nursing support center and the amazing volunteers from La Leche League are always eager to assist.

Okay say you've done all of the above, took a class, pumped worked with a professional but for one reason or another you choose not to nurse. Are you a terrible parent? Will you have no bond with your baby?  Absolutely not!  You can still have wonderful bonding time with your baby during feedings and here are some hints to help with that:

First explore the possibility of either using your own pumped breast milk or donated milk in the bottle. Breast milk really is the perfect food for baby and should be used whenever possible.

Second when you bottle feed your baby go ahead and take off your shirt, hold baby skin to skin  and right next to your breast. This is the perfect distance for baby to see you and the closeness you both feel will be pleasing to both of you.

Lastly do not blame or become angry with yourself. Your baby loves you and just wants to spend loving quite time with you.

Best Laid Plans of Mom's and Dad's-What to include in your birth plan

By Aimee Oswald, CD (DONA), HCHI                                

www.sweetpeabirth.com

I am sure you've heard the saying; "If you want to make God laugh tell him your plans", Sometimes I think this also goes for Caregivers, Family members and well meaning friends when you bring up the topic of a birth plan.  Those previously mentioned will often look at the expectant women and try to nod in a supportive all the while trying to hide a look that says; "Poor thing. She thinks she can plan this".  Can she plan this?

Having a baby is a life changing, momentous event.  I often tell my clients that unlike planning your wedding, dream vacation or extravagant party with this event you have no idea what time it will start, what day it will be and sometimes you don't even know the sex of the guest of honor! Despite what you may assume it is actually very productive to prepare a birth plan for your labor and delivery. The tricky part is knowing what to include and what to leave out. Here is what I advise the couples I work with to cover in their birth wish list;

You should begin your birth plan with a short introduction of you and your partner, just a few sentences stating who you are and how excited you are about meeting your little bundle. Next include any very specific issues or concerns you may have, this would be a fine place to inform the staff of a back or any other prior injury. The final sentence of your introduction should include the members of your support or birth team, just their names and what their function is on your team. For example; Mary is Sue's mom she will be in the labor room until delivery, Nancy is our doula and will remain with us throughout labor, delivery and for about an hour into our postpartum time.

The second thing to do is to break your birth down into stages and state your desires for each stage.

First Stage of Labor: declare your wishes for the environment; things such as lighting, your mobility, if you would like to eat or drink, how much fetal monitoring you are comfortable with, what you would like to wear during this time, would you like to be offered pain medications or alternative options, if you need any augmentation with your labor would like it to be medical or would you rather try things like nipple stimulation first, do you want to have a routine IV, in the event of a C-section who would you like to accompany you, who will then cut the cord.  Cover all possible scenarios of this first stage of labor.

Second Stage-Pushing: What position would you like to push in, would you like the nurse to direct this pushing by counting to 10 or would you rather try spontaneous bearing down, who would you like to help you hold your legs or would you prefer stirrups, What type of care would you like to your perineum, would you prefer to tear or have an episiotomy?

Third Stage- Delivery of the Placenta: Would you like to exam your placenta, would you like to keep it or take it home (please note that if you are interested in taking it home you must make arrangements to have it removed from the hospital premises very shortly after your birth), Do you wish to deliver the placenta spontaneously, would you like your baby placed directly on your chest for skin to skin contact.

Finally you will want to include a section on newborn care, this can also be a separate "newborn plan" In this section you will address things like who will cut the cord, are you banking cord blood, do you want delayed cord clamping, are you inclined to delay the routine newborn procedures such as the vitamin k shot, antibiotics drops to the baby's eyes, any other injections and weight, head measurements and length of the baby. This section is also the place to state weather or not you'd like the baby to have a bottle, pacifier, be separated from you or have a bath.

Once you have made all these choices and done your research on any you are not familiar with you are going to type them all up on a single sheet of brightly colored paper.  Give a copy to your doctor or midwife, a copy to your doula and keep about half a dozen in your hospital bag.  This will become your birth plan. Embrace your plan, visualize it, speak it out loud, draw a picture of it and then be prepared to change it at a moments notice.  Birth is a completely unpredictable event and for you to enjoy your Birth Day you will need to wrap your arms and heart around flexibility. Being flexible is the most important component of every birth plan.

Make your plan, let them laugh because you know the truth...Plans, like rules are made to be broken.