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BirthWays Newsletter

Preparing Nutritionally for the Fourth Trimester: It’s all about you, Mom

October 14, 2011

By Sarah Brick

The first 3 months after the baby is born is referred to as the fourth trimester, a time where we are adjusting emotionally and physically. The emphasis is often on the baby, but we need to take care of ourselves to enable us to have the energy necessary to take care of our little one. While everyone tells us how important it is to eat healthfully during pregnancy, this important postpartum period is often overlooked.

Nutrition is crucial during this time and can help us balance emotions, hormones, and replenish iron and minerals lost during the birth. Good nutrition will ensure a good milk supply and help us maintain the energy we need.

When your baby arrives it can be difficult to think about preparing healthy meals and snacks for yourself, so it is wise to prepare in advance. Good ways to ensure you are well nourished include: having a well-stocked pantry, keeping a few easy recipes on hand, and cooking a few meals ahead and storing them in the freezer. Completing a full pantry clear out and restock is a great way to ensure you have a full supply of healthy, nutrient dense foods to get you through the long days. It is important to remove any processed and refined foods from your diet, as these foods will hinder your recovery. As always, ensuring a balanced diet using whole foods is the way to go.

Here are a few healing essentials to help with an optimal recovery:

Seaweed – In Korea, women who have given birth are fed a seaweed soup called miyeok guk one or more times each day for a minimum of two weeks following delivery. Sea vegetables have the broadest range of minerals of any food. They are an excellent source of iron, which is important, as there is usually significant blood loss during birth. Add seaweed to soups and broths or toast nori in a pan for 5 minutes for a healthy snack. Crumble seaweed in with some raw nuts to munch on while nursing.

Herbal Teas – Loose-leaf herbs are a wonderful addition to your pantry, so stock-up on nettle, raspberry leaf, peppermint and chamomile. You will benefit from the vitamins and minerals present in the herbs. Nettle, raspberry leaf, fennel, and fenugreek are said to help milk supply; while peppermint and chamomile will calm the system. It’s easy to make up your own blends according to your preference. I like to blend peppermint, raspberry leaf, and nettle in a jar and let it steep in the sun.

Soups & Broths – Soups are amazingly versatile and healing. Preparing a nourishing bone broth* in advance, then simmering vegetables for a soup, will help sustain your energy to ensure you are getting a wide range of nutrients. You can make a big batch and put in the freezer for later use: Ziplocs work well. Soup is an excellent first meal after birth. Parsley is a particularly good addition to soups as it helps reduce inflammation and adds a good amount of iron and vitamin C to your diet and both are needed for your recovery. Preparing a mineral rich vegetable broth with a variety of vegetables and sipping throughout the day will help facilitate healing.

Nuts & Seeds – Having a supply of raw nuts and seeds will ensure you always have a ready to go snack. You can mix and match them as you want. Make sure you have a variety using walnuts, almonds, hazelnuts, pecans, as well as sunflower, pumpkin, and sesame seeds. Roasting nuts and seeds destroys much of their nutritional content, so they are best consumed raw.

Nutritional Yeast – Available at most health stores, nutritional yeast has a cheesy/nutty flavor and is packed with B vitamins. It is so easy to sprinkle on popcorn for a snack, or even to blend into milk as a drink. Vitamin B6 is critical in maintaining hormone balance and proper immune function. Due to the rapid readjustment of hormones in the mother’s body after birth, it is essential to eat vitamin B rich foods. Other sources include organ meats, raw milk, and organic free-range eggs.

Eggs – Touted by some as the perfect food. They are a great source of protein and B vitamins. In traditional Chinese medicine, eggs are recommended to strengthen one’s blood and energy by enhancing digestive and kidney function. Hard-boiled eggs are an excellent snack; you can pre-boil a few at a time and keep them in the fridge.

Healthy Fats – Whole fats are essential for maintaining hormone balance; they nourish us and satiate us. They should not be restricted in a mothers diet! Some experts believe that postpartum depression can be attributed to the depletion of omega-3 fatty acids in the diet. Use real butter, drink whole milk, and eat plenty of wild fish and even sardines. Try to use coconut oil for cooking. Olive oil, sesame oil, and walnut oil are best used cold over salads and vegetables. You will need fat in your diet to help with healing and recovery; it is critical you have enough.

Probiotics – Lactobacillus acidophilus and bifidobacteria not only help regulate bowel movements; they increase the absorption of minerals that require acid for absorption such as calcium, copper, iron, magnesium and manganese. You can take good quality probiotics in capsule form as well as eating plenty of cultured foods such as: raw sauerkraut, yogurt, and kefir.

Multivitamins – It is wise to continue with a good multivitamin during the fourth trimester. It should not be used instead of but rather as an insurance policy to compliment your whole foods diet.

Caring for a newborn baby and becoming a mother for the first, second, or even third time is truly a special experience. Providing ourselves with healthy ingredients to nourish our strong bodies will enable us to relish in the delights of motherhood.

*For more information on making nourishing bone broth, see my article on www.livingnutrition.net.

References

Murray, Michael. The Encyclopedia of Healing Foods. New York: Atria Books, 2005.

Lipski, Elizabeth. Digestive Wellness. New York: McGraw-Hill, 2004.

Enig, Mary G. Know Your Fats. Silver Spring, MD: Bethesda Press, 2000.

Fallon, Sally. Nourishing Traditions. Washington D.C.: New trends Publishing, 2001.

Weed, Susun S. Wise Woman Herbal for the Childbearing Year. Woodstock, NY: Ash Tree Publishing, 1986.

Sarah Brick studied holistic nutrition at Bauman College and founded LivingNutrition.net at the beginning of 2011. She specializes in nutritional support for pregnant women, postpartum recovery, and families. Services Sarah provides for families around the Bay Area include: cultivating healthy mealtimes through cooking classes in your own home, introducing solid food to babies, market shopping trips, and pantry restocks. She is a member of the NANP – National Association Of Nutrition Professionals.

Sarah Brick

You can contact her by phone (415-309-4179) or email (sarahbricksf@gmail.com), or visit her website at www.livingnutrition.net.

Informed Choice:
What does it mean for pregnancy and childbirth?

March 15, 2011

By Anna Hurty, CD, CCBE, PES

I once had a couple in my childbirth class at Stanford. When discussing pros and cons of various types of technology, “Mark” said that he was planning to do whatever his doctor said, and, if anything didn’t work out the way they wanted it to, he would file a lawsuit. The class seemed shocked and his wife was embarrassed. I suspected that he didn’t want to know, was scared to know, or didn’t understand the value of knowing, the options that were available. He was choosing to leave all the responsibility to the care provider, while accepting none in return. I’m actually thankful that he made that comment, as it opened up a helpful conversation and spacious discussion about personal responsibility and opportunity, reflective study and informed choice. As the years have passed, I realize that there are many more “Marks” than I would have expected. So, the question is: Who “wants to know?” If you are one who does, I hope that today will be the beginning of your journey towards readiness. I hope that you find time to reflect, study and prepare to make your birth the very best it can be.

During the months of pregnancy and as we prepare for our labor and delivery, we are bombarded with information, advice and opinions. It seems that everyone, from the media, our caregivers, to our friends and families, has something to say about what is best for us and for our babies. In addition to what can seem like a deluge of opinions and birth stories that may influence us one way or another, we face decisions about testing, type of provider, place of delivery, pain management, interventions to speed or “enhance” the birth process, and how to care for our newborn. As a doula and childbirth educator, I often emphasize the importance of “informed choice” when women and their families consider their options and make decisions and plans during pregnancy and for childbirth. But what does this term mean, and why does it matter? And how can we find the information we need to make the decisions that feel right for our own unique experience – for ourselves and our babies?

An informed choice is a carefully considered decision, based on accurate information, an understanding of the various options available, the risks and benefits of each option and their possible results. Making an informed choice implies thorough education and clarification of issues to allow us to confidently decide what to do – or not do – in our own best interest and in the interest of our unborn children. In California, patients are protected under CACI No. 532, an informed consent law that states that patients have the right to a full explanation of any procedure, medication, drug, test or other treatment that is being considered as part of their care. Our care providers therefore have a responsibility to provide clear information, but the responsibility does not rest with them alone. As we prepare for the birth of our babies, we too have a responsibility to learn about our options and consider our choices.

Becoming informed enough to make a choice or confidently “consent” or “refuse” takes time. It requires time to research on our own, time with our medical caregivers who can shed light on benefits and risks, time to tease out and understand research and statistics, as well as time to consider the physical, spiritual and philosophical values and goals that we hold dear. While it initially may seem daunting and stressful to fully explore and understand our options, the decisions we make are extremely important, as they may be birth- or life-altering in unforeseen ways. For example, there may be certain physical or psychological consequences to having or not having had a specific test, procedure or intervention. Being educated about our options allows us to take responsibility for our health and for the health of our babies.

So how can we prepare ourselves to confidently make such decisions? Our decision-making must be preceded by investigation and understanding of alternatives. This process is most useful when undertaken before we are in the throes of labor. That is, before we are in the somewhat delicate and necessarily vulnerable state when our bodies and minds are functioning in a primal physical and emotional state, rather than an analytical and intellectual one.

I believe that one of the most proactive ways to feel confident about our decision-making is by nurturing a solid, trusting relationship with our medical caregiver (midwife or obstetrician). Our caregivers should be open to our questions and concerns and be willing to explain their reasons for, and thoughts about, any tests, procedures or interventions they recommend – or do not recommend. They should offer this information in language that is clearly understood so that we may make our decisions voluntarily and without a sense of pressure. If we feel that our caregiver appreciates and respects our need to know, our values, goals and determination to be a full participant in decision-making during our pregnancy and birth, then we are off to a healthy start. If, on the other hand, our questions are met with condescension, or we feel “brushed off” and are left out of decision-making, our ability to trust may be threatened. With mutual trust and respect, there is a much greater chance that conflict of any sort can be avoided and confidence enhanced.

When considering a specific option, we can use the acronym BRAND to help us get the information we need to make the decision that feels best.

B – What are the Benefits of this test, procedure, intervention?
R – What are the Risks of this test, procedure, intervention?
A – What are the Alternatives to this test, procedure, intervention?
N – What if I do Nothing?
D – Based on the information gathered, we make a Decision.

We can gather this information by asking questions of our caregivers; talking to a doula, a childbirth educator, other mothers; reading up-to-date books and seeking other sources of reliable information. While the Internet is an incredible resource with a wealth of information, we must be aware that not all information is cross-checked for accuracy or based on actual research. There is a risk of being misinformed or getting caught up on a site that is more a forum for emotion than evidence. One exceptional online resource is the Cochrane Collaboration (cochrane.org), a research organization which reviews studies and provides summaries of current evidence-based health care practices. Seeking recommendations from the key resources mentioned above can lead to sources of high-quality information.

An in-depth understanding of pregnancy and childbirth options, which allows for knowledgeable informed consent (or refusal), should benefit all involved:

- Benefits to the provider include more positive patient evaluations, possibly a greater number of referrals, possibly improved communication with patients, and the satisfaction that comes with a happy client.
- Benefits to the mother include greater trust in birth and in herself, enhanced communication with her provider and support team (which decreases fear), as well as a greater sense of empowerment and self-esteem.
- Benefits to the baby include the mother’s enhanced sense of connection and confidence, which, I believe, will enhance her awareness and capabilities as a new mother.

It is often said that if we don’t know our options, we don’t have any. When we commit to being active and informed participants in making decisions during our pregnancy and in preparation for the birth of our babies, we increase the chance for a positive and satisfying birth experience. We expand the range of options available to us and ensure that we are engaged in and involved with the process that will bring our babies into the world. This deep dedication to the birth process provides a powerful beginning to what may be the most magical time in our lives.

Anna Hurty is a Certified Doula (CD), Certified Childbirth Educator (CCBE) and Placenta Encapsulation Specialist (PES) living in Oakland. www.birthgarden.com

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Queer Solo Parenting

The Prospective Queer Solo Parent

By Rebecca Plum, LM, CPM

I have always intended to be a parent. Knowing this, and knowing that I may or may not fall in love with a wonderful woman who could skillfully navigate this journey with me, I began to plan from a very young age; every decision I made about schools, careers, cities, all centered around the question of how each choice would lead me towards my goal of motherhood. Though I have yet to conceive, adopt, or in any way be an actual parent (I’m told that a cat doesn’t count), parenthood, in many ways, has been my life’s work.

When a person is in the ‘thinking’ or ‘trying’ stage of creating their family, they think about it all the time. Their child, though not yet in their arms, exists already in their daily life – in their choices, in their language, and always in their thoughts. So, in a very real way, that parent and that child are a family unit that is just, thus far, not-yet-united.

This is a powerful notion, because it invites the prospective parent to craft an intentional environment, community, and parenting self, all before the child ever sets foot into their world. This is also a revolutionary notion, as it suggests that family can exist in the theoretical, intentional plane before it ever enters the literal, physical one. This experience is the unique province, privilege and gift of those who choose parenthood consciously, with intention and love.

A person who parents on their own takes full responsibility for every choice that will ever be made on their child’s behalf. They claim every step, from choosing the method of finding or creating that child (adoption vs. fostering vs. conception, anonymous vs. known donor, and countless other choices), through every parenting choice, from vaccinations to preschools to when they can pierce their ears (or whatever else is popular to pierce at the time).

There are thousands of questions one may ask when embarking on and preparing for this journey: How will I support my family if I am on my own? What kind of childcare will I need? Who do I know that has been through this, and what can they tell me/teach me/show me about this path? How can I plan for this life to be not just manageable, but sustainable, fulfilling and joyful?

One of the most primary answers is that of community, and of family. All the questions we face when preparing for and moving toward parenthood are made more navigable and less foreign when we draw on the wisdom of another who has walked that path before us. The challenges that can arise along the way invite us to lean on our chosen friends and families for support, transforming what might have been an isolating experience into one that deepens our relationships with those who will be taking this journey alongside us.

The term ‘family’ was originally re-claimed by queer culture some decades ago, when coming out frequently meant alienation from one’s family of origin. This concept of family, as used by the queer community, came to refer very specifically to the larger community of queer folk, as a way of identifying places and people that could offer safety and solidarity. Many of us also came to apply the term to our intimate communities of close friends who, especially when our family of origin had been less than supportive, became our true and chosen families.

As members of the queer community who choose parenthood, we take the reclamation of the term ‘family’ one step further. In defiance of all the social norms that dictate who is best qualified to parent, to commit, to love, we declare that family is what we make it. It is the community we joined when we came out, and the communities we choose as our most intimate and loving support systems, and now it is also the family made up of parent and child/ren, created consciously, with intention and love.

Queer families are not the only non-traditional family structures that have been gaining visibility in our culture. The solo parent (aka ‘Choice Mom’) community is a growing and vibrant one, and it is bringing visibility and support to those that have been, until recently, an isolated and misunderstood group of parents. Often dismissed as irresponsible, or disrespected by those who assume that their pregnancies wereunintentional or ill-considered, solo parents are breaking increasingly visible new ground and setting a new standard for the culture of parenting in our society. As Jennifers Aniston and Lopez portray empowered solo moms on film (though in admittedly unrealistic scenarios), and our country is led by the son of a powerful and celebrated solo mother, our cultural consciousness is experiencing a dramatic shift. Add to this the movements around gay marriage and gay parenting (both of which are also becoming increasingly visible in the media), and we have an even more dramatic transition.

As each new image is added to the collective vision of what parenting can look like, our definition of family continues to evolve. There are support groups for every conceivable permutation of ‘parent’ that we creative Bay Area folk can come up with, new language to describe our chosen arrangements, and parenting blogs and listserves spring up every day, offering reflection and support to others in the community.

So, while we each choose our own unique course into parenthood, this does not mean that we must actually be alone on this path. Our chosen people, the communities of friends and family that uplift and love us every day, will be our children’s families too. One of the wisest and most empowering things we can do, therefore, is to create strong, compassionate, like-minded communities that we will be well supported by and connected to by the time we are in the throes of new parenthood. Attend a support group. Check out an online forum. Post on Craigslist or the Berkeley Parents Network and meet other prospective solo parents for lunch. Make friends with others that can relate to and share our experiences, so that when we are deeply in it, we will be able to skip the explanations and get right to the real stories of our lives. As one queer solo prospective parent advises, “Get your support team in place… you will need to have friends capable of holding you without attachments, friends who can be a sounding board, or mirror to your inner process, someone to remind you to ground, be present and not get lost in the cyclical nature of trying to conceive.”

The phrase ‘It takes a village’ has been overused, but the wisdom in it remains profoundly true. Our lucky children’s fabulous aunts and uncles (and whatever other groovy names we find for them) will be sources of unlimited support, love, consolation and celebration, and they will be the greatest gift (second only to our children!) that we could give ourselves on this path.

Realities & Resources for the Queer Solo Parent

By Meghan Lewis, PhD, CMT

Becoming a single parent by choice assumes great love and great fortitude. For many queer solo parents the understanding exists that, yes, love makes a family, and fortitude is required, but an additional quality is oftentimes necessary: The ability to jump through hoops with great hope (and great humor) that one’s intention and purpose to become a parent will be validated with the proverbial and literal stamp of (social/political/institutional) approval.

Unfortunately, this is not always true. For example, queer solo parents may have to wrestle with insurance companies to have costs covered for reproductive technology, such as intentional fertilization/artificial insemination; they may have to cross their fingers that the licensed clinical social worker at the adoption agency acts in accordance with the non-discrimination by-laws; and they likely will contend with other social ramifications and political injustices that stigmatize and scrutinize not only those who are categorized as single mothers, but doubly-so as those who breed queer spawn.

In an interview with a queer solo parent of a preschooler, one Oakland lesbian mom shared her experience of joining a mom’s group wherein the conversations often turned to the topic of the other women’s husbands’ roles and responsibilities in their respective families and the particular challenges therein. It was not long before she saw her social life growing more and more heterosexually-oriented. Being consistently surrounded by straight mothers with marital privilege, she felt somewhat othered and out of place. In response, this mom sought balance by joining queer family-oriented social groups. A bi-identified mother of an elementary-age student described her experience similarly, wherein the majority of her social contacts, such as at her son’s school, athletic events, and play dates, were with people of two-parent, heterosexual, legally married households. She felt compelled to find folk that reflected her family constellation so her son would see that, though they were unique, they were certainly not alone. The proactive actions of these moms worked to prevent isolation that could otherwise occur as a result of insufficient reflection in the face of the predominant parenting paradigm.

In an area rich in resources for families, from farmers’ markets to fine art museums, holistic pediatricians to homeschool playgroups, soccer coaches to spiritual communities, more and more families are finding what they need to feel nourished. The Bay Area also is home to a wide range of queer-focused groups, organizations, and professional service providers offering unconditional support and community connections. Our Family Coalition (OFC), founded in 1997, regularly offers queer single parent gatherings, monthly transgender parent support groups, as well as an annual LGBTQ Family Day event at the Berkeley YMCA. OFC also strives to create safe and welcoming environments in schools, and works to promote social justice for all families. Also available to East Bay families is the Berkeley Lesbian Moms Meetup Group, which organizes monthly events such as holiday cookie decorating parties, 4th of July BBQ’s, bowling parties, trips to the beach, visits to the zoo and many other child-friendly activities throughout the year. At these gatherings it is easy to find other queer solo parents with children of all ages, and to join in the various fun-filled, community building activities.

An additional challenge for queer solo parents may be in seeing one’s family as a complete family, especially for those who spent many years envisioning a co-parent in the picture. Embracing one’s position in the spectrum of family diversity may feel increasingly daunting within the maelstrom of such frequently posed questions as, “Where’s the daddy/mommy?” and “Don’t you think your child should have a male/female role model?” These queries seem to insinuate that the wisdom underlying the very personal choice of becoming a solo parent (possibly the most personal choice) is in question. They also may imply that the queer solo parent is inherently not good enough. Having a plan to probe and challenge well-intended inquiries and concerns may be of benefit, as the opportunity invariably will arise to enlighten the perplexed and the doubtful.

And for the femme-identified parent, who appears to be gender-conforming, there may be a sense of invisibility in her seeming passability. For example, there may be situations in which she must decide whether or not to come out when the other new mom at the park asks her what her husband does.

Transpeople also may face gender biases regarding their fit-ness for family. One Berkeley transparent of two described his experience of creating family through a fost-adopt program. While there is always a real possibility of re-unification with the biological family and, thus, loss of adoption for any foster family in the program, this transparent had to cope with the added worry that the adoption process could be reversed if the adoptee’s biological family discovered, and disapproved of, his gender non-conforming status.

As parents we are called constantly to dig deep. As queer solo parents we have to dig deeper still. We have to stand our ground, to affirm and reaffirm our parenting positions. We are a rich and resourceful community of the strong, the independent, the bold and the brave. We push the boundaries of established realities, we question authority, we follow our own leads, trusting our instincts and our hearts, believing in our right to parent. And when in doubt, we can call on those who have been there. We can choose to remember that though we are solo, we are not alone. We love, we cherish, we sacrifice, we share. We are devoted. We are parents full of pride.

Queer Solo Parent-Friendly Providers in the East Bay

Adoption:

A Better Way, www.abetterwayinc.net
Alameda County Social Services, www.alamedasocialservices.org
Family Builders, www.familybuilders.org

Fertility Support:

At Home Fertility Services, www.athomefertility.com
Maia Midwifery & Preconception Services, www.maiamidwifery.com
Swift Stork Courier Service, www.swiftstork.com

Sperm Banks:

Pacific Reproductive Services, www.pacrepro.com
Rainbow Flag Sperm Bank, www.gayspermbank.com
The Sperm Bank of California, www.thespermbankofca.org

Birth, Postpartum & Lactation Support:

Ellah Ray (Birth & Postpartum Doula, Childbirth Educator), 510-610-1844
Monica Zimmerman (Lactation Support), www.birthtransitions.net
Postpartum Warm Line (Parental Support available 9am-9pm), 888-773-7090
Tomi J. Knutson (Postpartum Night Doula, Newborn Massage Instructor), www.tomiknutson.com
Ursula Ferreira (Birth Doula), 510-470-8129

Midwifery Care:

Hearthstone Midwifery, www.hearthstonemidwifery.com
The Sacred Birth Place, www.sacredbirthplace.com
Tres Lunas Midwifery, 510-704-8366
Womb Service Midwifery, www.wombservicemidwifery.com

Medical Practitioners:

Dr. Ayanna Bennett (Alameda Pediatrics), 510 523-3417
Dr. Elizabeth Salzburg (Kiwi Pediatrics), www.kiwipediatrics.com
Dr. Roxanne Fiscella (Family Practice, Alta Bates), 510-843-0692

Acupuncture, Bodywork, Chiropractic, Craniosacral & Massage Therapists:

Bridget Scadeng,www.bridgetscadeng.com
Jill Stevens, L.Ac., www.yourwholefamilywellness.com
Kristin Peters, D.C., www.optimumwellness.net
Tomi J. Knutson: www.tomiknutson.com

Mental Health Support:

Gaylesta, www.gaylesta.org
Laura Goldberger, MFT, www.lauragoldberger.com
Lisa Kully, MFT, embodiedpsychotherapy.net
Meghan Lewis, PhD, www.meghanlewisphd.com
Womens’ Therapy Center, www.womenstherapy.org
Pacific Center, www.pacificcenter.org

Childcare Referrals, Parenting Classes & Groups:

Bananas, www.bananasinc.org
BirthWays, www.birthways.org
Colage, www.colage.org

Support Groups:

Hearthstone Midwifery, www.hearthstonemidwifery.com
Laura Goldberger, MFT, www.lauragoldberger.com
Meghan Lewis, PhD, www.meghanlewisphd.com
Our Family Coalition, www.ourfamily.org
Pacific Center, www.pacificcenter.org

Real Estate Agents, Attorneys & Financial Resources:

Amber Crowley: www.marvingardens.com
Carole Cullum, JD: www.cullumlaw.com
Family Equality Council: www.familyequality.org
Queer Cents: www.queercents.com
Jan Zobel (Tax Preparation): www.janztax.com

Blogs & Lists:

Berkeley Parents Network: bpn_admin@lists.berkeley.edu
Choice Moms Blog: www.choicemoms.org
Doula Right Thing: www.doularightthing.blogspot.com
Oakland Hills Gay and Lesbian Parents Meetup Group, www.meetup.com/Oakland-Hills-Gay-and-Lesbian-Parents
Queer Baby Making, www.queerbabymaking.com
Queer Parents Forum: www.circleofmoms.com/queer-parents
Single Mothers By Choice Blog: singlemothersbychoice.blogspot.com
The Berkeley Lesbian Moms Meetup Group: www.meetup.com/gay-berkeley-moms/suggestion

Directories:

Gay Lesbian Directory: www.gaylesbiandirectory.com
Gay Yellow Pages: www.gayellowpages.com
The Sperm Bank of California’s Resource List: www.thespermbankofca.org/pdf/resourcelist.pdf

Books:

‘Choosing Single Motherhood: The Thinking Woman’s Guide,’ by Mikki Morrisette
‘Considering Parenthood’, by Cheri Pies
‘Lesbians Raising Sons,’ by Jess Wells
‘Single Mothers by Choice: A Guidebook for Single Women Who Are Considering or Have Chosen Motherhood,’ by Jane Mattes
‘Taking Charge of Your Fertility,’ by Toni Weschler
‘The New Essential Guide to Lesbian Conception, Pregnancy & Birth,’ by Stephanie Brill and Preston Sacks
‘The Queer Parent’s Primer: A Lesbian and Gay Families’ Guide to Navigating Through a Straight World,’ by Stephanie Brill
‘The Ultimate Guide to Pregnancy for Lesbians: How to Stay Sane and Care for Yourself from Pre-conception Through Birth,’ by Rachel Pepper

Rebecca Plum, LM, CPM is a Licensed and Certified Professional Midwife, offering homebirth midwifery care, well woman care, and support groups for prospective, pregnant and parenting solo parents, and for queer (prospective, pregnant and parenting) families. She also provides in-home inseminations through At Home Fertility. www.HearthstoneMidwifery.com

Meghan Lewis, PhD, CMT is the founder of Integrative Psychological Services in Oakland, CA, next to Alta Bates Summit Medical Center. With over 15 years of experience in maternal mental health, Meghan brings unconditional support to her clients exploring a range of parenting-related issues from preconception to postpartum and beyond. Meghan is a queer solo parent by choice of a five-year old and serves on the BirthWays Board of Directors as Resource Coordinator. www.meghanlewisphd.com

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Preventing Breastfeeding Problems
by Preparing Prenatally

July 1, 2010

By Sabrina Easterling, MPH, IBCLC, ICCE

When it comes to feeding your baby, many expectant and new parents have heard about the importance of breastfeeding and breast milk. For instance, you may have heard that breast milk is the perfect food to support a baby’s developing brain, that it completes the development of baby’s immature immune and digestive systems, decreases the risk of reproductive cancers for moms, and provides cost savings for parents and the health care system. Studies even indicate that parents of breastfed babies get more sleep, on average, than their formula–fed counterparts. This may explain a bit about why the percentage of U.S. moms who initiate breastfeeding – approximately 77% – is the highest it has been in the past several generations.
sleeping_baby
Similar to other vitally important health activities, like exercising regularly or consistently eating a balanced diet, knowing that something is good for us is only one small part of the picture. It may provide the rationale – the “reason why to do this” – but it doesn’t always provide the motivation and support to make it feasible for the long haul. This may be some of the reason why less than 15% of babies are exclusively breastfed for the first six months of life – the length of time that the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) strongly recommend.

For expectant and new parents who are hoping to start the breastfeeding relationship off on the right foot, the great news is that each year there is more research that can serve as a guiding light. After your baby is born, a combination of education, counseling, and hands-on assistance with breastfeeding techniques and problem-solving provides essential support. However, studies consistently show that prenatal preparation is a critical, if not crucial, component of breastfeeding promotion, and mothers who are prepared prenatally are likely to nurse their children longer than women who are not.

Here are some key considerations of what to consider or do before you have a baby in your arms:

Take a great breastfeeding class and do some reading on your own time

Studies indicate that breastfeeding knowledge is strongly correlated with breastfeeding confidence, and that learning prenatally about various breastfeeding issues increases the length of both exclusive and total breastfeeding.

Strike the right balance between empowering yourself with information and hitting info overload. It’s a good idea to bring your partner and/or a close family member along with you to a class, since two brains are better than one when it comes time to remember some of the things that you learned.

Get your obstetrician or midwife in on the action

While it is natural during pregnancy to put a lot of focus on preparing for the big birth day, a common sentiment heard from moms postpartum is that they wish they had spent more time learning about the thing they would have to do every day with their baby – feeding it!

Your health care provider is likely focused on pregnancy and birth-related issues, too, and you may need to be proactive and ask for breastfeeding-related care. Ask your health care provider to do a breast and nipple exam. It takes just a few moments, but can provide really helpful information. For instance, if you have flat or inverted nipples it is helpful to learn a bit more about their potential impact on breastfeeding (and strategies that can help) before your baby’s birth day.

Another thing to discuss with your health care provider before birth is whether there is anything in your health history that may impact initial or long-term milk supply. While more than 95% of women can produce the milk their baby needs, women with a history of diabetes, anemia, hormone-related difficulties getting pregnant, thyroid issues, or breast surgery sometimes need professional lactation support to help stimulate and maintain milk supply.

Finally, you may want to learn a bit more about the potential effect of birth practices on the early breastfeeding days. While it may be true that a suggested birth intervention is the most appropriate thing in the moment, making informed decisions also includes considering their potential impact of birth practices on the initiation of breastfeeding (this way you can ask for the breastfeeding support you need immediately). For instance, some birth practices may have an impact on a baby’s ability to latch and feed effectively. These include epidural anesthesia or analgesia, assisted delivery, and Cesarean birth.

Know that until recently medical schools and residencies did not provide instruction on breastfeeding-related issues – even for obstetric and pediatric specialties – and many health care providers are still unconvinced or unaware of the research. You can talk to a breastfeeding educator or lactation consultant about the impact of potential birth interventions on breastfeeding if you prefer.

Choose your pediatrician wisely

While there are likely several important factors at play when you choose your pediatrician, be sure to keep breastfeeding issues in mind. In the first year of life, some of the top reasons why babies need to be seen by their pediatrician or other care provider – diarrhea, ear aches, and colds – are significantly less common among breastfed babies than among formula-fed babies. Some new mothers who want to breastfeed encounter challenges along the way. Since many parents rely on their pediatrician to offer guidance, studies show that the information and recommendations parents receive from their pediatrician strongly influence their feeding choices. It would serve you well to ask potential pediatricians what kind of training they have regarding breastfeeding issues and how they stay up to date on them.

Learn more about pediatric support for breastfeeding. Beyond words, what do they do to support breastfeeding? Things to consider are:

- Do they work in collaboration with an IBCLC (Internationally Board Certified Lactation Consultant)?
- For which medical indications do they recommend the use of formula?
- Do they routinely assess the lingual frenulum of a newborn? (This is the connective tissue under the tongue that, when short, can affect the mobility of the tongue and a baby’s ability to latch on well to the breast).
- If your baby has jaundice or is born late pre-term or pre-term, what are the things that they do to help you learn more and get the professional lactation support you may need?

Plan for getting support while you are learning the ropes

After the baby is born, most hospitals offer professional breastfeeding support from a Lactation Consultant (IBCLC) during your hospital stay. Before birth, ask your health care team – or directly contact the hospital if need be – to find out how early and often you can anticipate breastfeeding support. Helpful questions to ask are:

- Will someone be available to help my baby to nurse in the first hour or two after birth?
- Will I be able to see a Lactation Consultant before the day I am discharged?
- Will I be able to see a Lactation Consultant more than once if I need the help?
- What level of breastfeeding support can I expect from my postpartum nurses and what kind of training do they have in providing support?

Similar to many medical schools, until recently most nursing schools did not provide lactation-specific training to students and many nurses have not received recent training on the topic. Therefore, misinformation abounds. For this reason, many people plan ahead to have a lactation consultant visit them either in the hospital or soon after.

Don’t go it alone: plan to get support when you need it

Though it is natural, breastfeeding isn’t always as simple as it seems. If things feel a bit wobbly once the training wheels are off and you are home without a lactation consultant or nurse a call button away, getting help early and often can help you get to the root of what is causing the challenge and get you on your way to resolving it. As the old adage goes, “An ounce of prevention is worth a pound of cure.” It’s nice to have a lactation consultant in your back pocket in case you need to tap into her knowledge base, and support may also provide important comfort.

A lactation consultant can guide you and your family on what to expect, assist with trouble-shooting and problem solving, and provide practical advice and solutions. (Local breastfeeding resources are listed at the bottom of this article.)

Build confidence

Learning about breastfeeding prenatally has been associated with increased confidence about breastfeeding – a valuable ingredient for reaching breastfeeding goals. Believing you can make it through the early weeks while keeping your breastfeeding relationship intact may help you on the days that you are feeling just darn tired, irritable, and as though you are running on fumes. Each person has a different tolerance level and capacity for exhaustion and coping when it’s just not smooth sailing. Having that seed of confidence deep down can be your guiding light when you need it.

Leave pressure and judgment at the door

For those who have breastfeeding challenges, the combination of postpartum exhaustion, significant hormonal shifts, and uncertainty is a recipe for self-doubt. Many moms start to reconsider whether breastfeeding is really possible for them. Be kind yourself. Allowing yourself some emotional flexibility can take some of the pressure off.

Surround yourself with supportive people who do not have any “agenda” other than helping you and supporting the decisions you are making.

If you find yourself wondering if you can “make” it, try not to think of the long haul. Studies show that women who are nursing at six weeks have a strong likelihood of nursing at six months. Many women make a commitment to get to six weeks – day-by-day, week-by-week – and take it as it goes from there. Often by that point breastfeeding takes less time and energy than in the first six weeks and is a pleasurable experience for both mom and baby.

Recognize that breastfeeding has a learning continuum

While you will learn to breastfeed “on the job,” learning about breastfeeding before the baby comes can help expectant parents have realistic expectations, gain some perspective, and anticipate some of the ups and downs of the early breastfeeding relationship. Learning to breastfeed is like learning to ride a bike: it takes patience, practice, and for some a bit of perseverance, but once you have it down you don’t have to think much about it – you just do it.

Your Local Resources

- For an abundance of great, researched-based info: BabyCenter.com or Kellymom.com
- Low-cost breastfeeding clinic (Tuesdays): BirthWays.org
- Referrals to local lactation consultants (in-office or in-home): BirthWays.org
- Local Breastfeeding Support Groups:

• TheNurtureCenter.com
• AltaBates.org
• DayOneCenter.com

Sabrina Easterling is a Lactation Consultant for Contra Costa Regional Medical Center and Then Comes Baby, and a Perinatal Educator with UCSF and BabyCenter.com. You can contact her by email.

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Working with Disappointment:
When Things Don’t Go As Planned

By Gina Hassan, Ph.D.

Unlike other creatures, human beings are prone to a particular “habit of mind.” We expect! We look forward to, we consider, we think. We have ideas of how things are supposed to be, and, therefore, how we want them to be. But life does not always unfold as planned and disappointments can be hard to weather, particularly in a culture that teaches us that if we work hard we can make things happen according to our wishes. While practice, discipline, and intention certainly influence what happens, the idea that we should be able to control how things unfold is a mistaken belief that can lead to great suffering.

Pregnancy, childbirth, and parenting are not subject to our control. When we get pregnant, how our baby arrives in the world, whether breastfeeding goes smoothly or not, and exactly who our child is – these are things that we can influence, but not dictate. Yet we often come to these experiences with elaborate fantasies about how things are supposed to be – and, when our expectations diverge from our lived experience pain, suffering, and, in particular, disappointment can result.

So how can we work with the emotion of disappointment? How can we make room for the experience we are having rather than cling tightly to the experience we hoped for? Whether this means letting go of our fantasy of natural childbirth, or of an easy entry into breastfeeding, or of being able to breastfeed at all, acceptance can be hard to come by. For some, acceptance is equated with a kind of helplessness, passivity, or even depression.

There is, however, a way for us to honor our disappointment without being caught in its grip. After all, when we try to pretend that something isn’t so, or try to force ourselves to “think positively” in the face of disappointment, the emotion doesn’t usually diminish. We may be able to hide from it briefly, but the power of the emotion will persist and will ultimately take up more room than if we grant it the space it needs. In fact, the harder we try and push something away, the more persistent it becomes.

To clarify, acknowledging disappointment is not the same as wallowing in it. In fact, we can notice the contour of the feeling without getting caught up in the content or the story. We can observe our disappointment, for example, as it arises and as it passes. We can also notice when there is a story attached to the emotion. The story usually has something to do with culpability: It is my fault that I can’t feed my baby as nature intended, or it is my OB’s fault that I ended up with a C-section. We can get caught up in the “if only she had …,” or “if only I had…” Getting caught up in the story in this way usually intensifies emotion, trapping us in its grip. Accepting that things are not always in our control and that things happen for unknown reasons, that they are simply part of life’s journey, is a stance that can ultimately help us to move through difficult emotions.

As parents, we frequently find ourselves in the position of having to make difficult decisions. Since we cannot see or control the future, we make the best decisions we can, given the support, resources, and information we have at the time we are making them. The reality is that no matter how much we have prepared, how many books we have read, how many prenatal yoga classes we have taken (or skipped), or how well we have eaten, things don’t necessarily turn out as planned. When we have worked hard to have a natural childbirth, for example, and end up with medical intervention we may feel that we are at fault, we could have done something differently, should have known better, should have prepared more, etc. The truth is that we are not in control of the outcome and we are not at fault.

To sum up: If you find yourself caught in the grip of a difficult emotion try observing it through the lens of the following paradigm. An easy mnemonic for remembering this paradigm is – R.A.I.N.

Recognize: I am feeling disappointed.

Acknowledge or Accept: I am aware that I am having this feeling and will try as best I can to accept it without judgment.

Inquire or Investigate: I will notice what this feeling of disappointment looks like, feels like, sound like, etc.

Non-clinging: I will make space for this feeling to arise and to pass, I will neither cling to it nor push it away.

Gina Hassan, Ph.D. is a perinatal psychologist who offers individual and couples therapy, as well as Mindful Mothering Groups. She has been on the Birthways board for 3+ years. For more information visit www.ginahassan.com.