The Birth Doula-Helping to Ensure Breastfeeding Success in the Hospital

Joining a family for the birth experience is both a great honor and a great responsibility.  Doulas enter the most amazing place as they simultaneously witness and support in a miracle.  It is sometimes difficult to focus on the tasks and not get caught up in being merely a spectator in the blooming of a birth, but the focus comes with the realization that the goal is to support the family. A doula plays a crucial part in how the birth will be remembered and how breastfeeding will be initiated.  

Birth and breastfeeding are as closely related as a key to a lock.  Often, moms are discouraged by difficulty in breastfeeding which is often brought on by birth practices or protocols during the immediate postpartum period.  Many routine procedures jeopardize breastfeeding success. Having an understanding of how medications effect a baby can be a huge advantage to assessing the breastfeeding relationship.  Doulas need to keep a mental note of medications being administered and the type of birth a mom experiences in order to provide the best postpartum breastfeeding education and support.  A skilled doula can avoid long-term problems by anticipating possible consequences and formulating immediate solutions to common problems.

A doula can also be proactive by assisting in formulating the Birth Plan.  This is an excellent time for the birth assistant to explain all the procedures and the pros and cons of each intervention.  Once a mother's wishes have been spelled out, the doula is able to advocate for the family throughout the birth day. 

The keys to supporting a mom in the hospital begin before her first contraction.  Statistics show that most families reach their infant feeding decision prenatally.  It is important to offer education during prenatal visits with clients.  These scheduled visits are great opportunities to discuss what the client knows about breastfeeding.  One open-ended question I often begin with is, “What have you heard about breastfeeding?”  This question will often reveal fears, concerns, misconceptions and the mother's confidence level. 

Once the desire to breastfeed has been established, the doula’s role has a new facet.  The mom will rely on the doula to support her in this momentous decision. Breastfeeding is a brief event (in comparison to the entire life of an individual), that has life-long effects.  The research and resources about formula risk is abundant and breastmilk will insure protection from many childhood and adult health conditions.  I take breastfeeding support as seriously as all aspects of my work, and commit to helping a mom reach her breastfeeding goals—whatever they may be.

Observation is the first key to breastfeeding success.  Observations can even be made prenatally.  Statistically, obese, diabetic, and older moms (over 40) may have delayed Lactogenesis II (onset of copious milk supply).  Additionally, clients who birth cesarean may not experience fullness in the breasts until day four.  Being armed with this information is a huge advantage to the mom who is convinced she “has no milk” based on breast fullness postpartum.  Moms need to be reminded that the infant had a direct line to the all-you-can-eat buffet while in utero and does not enter the world starving. 

A doula’s immediate postpartum role is to encourage skin-to-skin and protect the “quiet hour” for bonding.  Doulas may encourage the mom to slightly recline, place Baby between the breasts (somewhat vertically) and assist as the baby scoots down to self-latch.  Doulas and hospital staff may offer additional assistance to the medicated mother if necessary. Most babies when placed skin-to-skin will initiate breastfeeding within the first two hours postpartum.  I encourage a "babymoon" much like a honeymoon where the family commits time and attention to love, learn and hold the new baby.

Medication taken during labor can also affect the breastfeeding outcome.  Natural pain management is the least likely to result in breastfeeding issues.  If medication is necessary, generally, the epidural is more desirable than anesthesia for c-section births.  The epidural allows for earlier contact with mom and longer nursing sessions.  The infant born via cesarean will often be sleepy and lethargic, especially if anesthetics were administered for a prolonged period.  Doulas can help with positioning, supporting the baby at breast, and helping to arouse the sleepy baby.

The baby who was exposed to narcotics during birth may be agitated and restless.  These medications are often administered with a promise to “take the edge off” during labor. Sometimes medical staff try to minimize the effects of labor medications, but it is important to understand that all medications can affect breastfeeding. Fortunately, with the support of a well-prepared doula, the transition from belly to breast can be smooth and natural. 

I Am "Mom Enough" and So Are You

The recent article by Time Magazine did precisely what it intended to do--get a reaction.  I must say, I am surprised at the amount of discussion and attention the cover photo has received and even more surprised by the individuals making these comments.
  
I fully expected the twist from the media mongol when it comes to "Attachment Parenting."  If something is not portrayed as controversial or scandalous, no one takes note and as a result, magazine purchases and subscriptions plummet. In fact, I have to congratulate Time on their illustration choice.  If anyone were to ask me how to display a mom feeding a toddler in a way that would provoke shock and controversy, I don't know if I could have come up with an idea as effective as Time.  The tall child, clothed in camouflage and combat boots (adding to the effect of aging the toddler), on a stool with a super model mom who has the demeanor that she could take on the world...  The illustration was about as extreme as it could be at portraying Attachment Parenting.  


Time had no objections to the stir it created.  The cover, labeled by many as "provocative," drew in large crowds.  The subscription sales doubled, Twitter trending boasted over 50,000 mentions and the Time Facebook Page received 43,000 likes.  I have several concerns about the article and subsequent backlash that the model/mother and Attachment Parenting received.  First, the view of this parenting choice was skewed.  It depicted parenting as “extreme.” For individuals who have not had an opportunity to be exposed to or practice the principles of attachment, they may have been led to believe this dyad is posing as the Poster Child for the organization.

I practiced Attachment Parenting with all of my children.  The principles of AP basically include 1) Be Prepared for Birth and Parenting 2) Feed with Love and Respect 3) Respond with Sensitivity 4) Use Nurturing Touch 5) Ensure Physically and Emotionally Safe Sleep 6) Provide Loving Care 7) Use Positive Discipline 8) Strive for Balance.

I cannot imagine anyone being offended by this list of parenting techniques. The skills are also very subjective…what is meant by “Respond with Sensitivity?” The answer may be different for different moms. Of course, the last step “Strive for Balance” can help to adjust all other aspects of these suggestions.  I absolutely loved Dr. Bill Sears’ (who coined the phrase “Attachment Parenting”) response on the Today Show.  He assured the reporter and audience that, “The list of principles were tools not rules.”

If experts in our field could have looked past the photograph and into the teaching opportunity, we could have educated the world and created better parenting resources for new moms, but the photograph debate waged on.  We attacked the mom, reporter, article, and each other. It was like  the media in general from Time to talk shows, (along with some frenzied individuals) picked up stones and began to throw them at the Attachment Parenting and breastfeeding crowd, and in return we gathered those rocks, glanced at the mob, but chose to throw the rocks at each other!

Lactation Consultants and Attachment Parenting advocates had a problem with the rendition of breastfeeding that was portrayed.  I have been asked by so many to share my opinion and it leaves some perplexed.  I don’t mind that the child was older, that he was on a chair, that the mom was not in a nurturing position, that the cover read “are you mom enough.”  I guess I don’t get offended very easily.  I have seen moms feed in this position, or very similar ones—it does happen.  I have also seen moms lying on a couch as her toddler stands and nurses.  I don’t have a list of “appropriate and acceptable” positions that I will endorse.  If it works for you and your child, congratulations, enjoy the bonding experience.  I also had no problem with the article title (besides the obvious goal to pit moms against each other).  My inclination was to answer the magazine matter-of-factually, “Yes, I am mom enough” and so is every single mom I have met.  Moms may parent differently, feed differently, have different priorities or even show love in unique ways, but she is definitely “mom enough.” What do children need?  Acceptance, love, compassion, safety, nurturing—all qualities that moms can and affectionately do give. Do we have to be super moms in order to be successful? Can I offer a resounding “no!” From the teenager with twins, to the corporate CEO, to the stay-at-home mom, I have never found a woman who does not strive to give her child what he needs. I embrace this ambition that moms have of  learning and growing and I support the moms that I have the honor to serve. 

So my conclusion on the matter:  An article and cover like the one that surfaced may not occur for a very long time and we should all take advantage of the conversations that are presented as a result.  This opportunity is still upon us.  We can use this time to educate, encourage, and explain so many aspects of infant feeding and parenting.  Let’s get beyond the photo and into the dialogue because it is still true, “You can’t tell a book by its cover.”

I also understand people may feel provoked to argue and revisit their platform about all the damage that was done via this cover, but I think our energy can be used more effectively.