Articles
- Before you breastfeed...
- By Karen Wang
- Doulas and Doctors
- By Karen Wang
- Building a Family Plan
- By Karen Wang
- What I wished I had known about parenting...
- By Karen Wang
- Birth as more than pain management
- By Karen Wang
- Help is on the way
- By Marylin Linton, Toronto Sun — June 25, 2006
- You & Your Newborn
- By Teresa Pitman
Doulas in the News
Feature Article
Before you breastfeed...
By Karen Wang
Long before I even knew how to breastfeed, I had already made up my mind that I would do it. I did not realize until much later that breastfeeding is a learned skill, and with any new skill, it takes patience and practice! I had the unrealistic expectation that my daughter would latch on perfectly and that I would have enough milk to feed a small family. Of course, there are some people blessed with an easy transition into breastfeeding, but for most of us who have never watched a woman breastfeed nor have been in a breastfeeding community, here are a few things you may want to consider:
1. Breastfeeding takes time.
For the first few weeks and months, there will be lots of time spent on feeding the baby. Each breastfeeding session may only last twenty to thirty minutes, but the frequency in which you will have to breastfeed (8-12 times per day) can exhaust even the most energetic mom. It is therefore highly recommended, that as a new mother, you find the time to do only three things: feed the baby, sleep, and eat. Cherish the fourth trimester, and nourish your body. As much as possible, line up other family members and friends to help you with the household chores including cooking, cleaning, and giving the pets a decent walk every now and then. Consider hiring a postpartum doula if necessary. They are trained in helping new parents adapt to their new roles, and can provide education on matters relating to infant care and breastfeeding.
On the same note, breastfeeding takes time to learn. The key is not to give up too soon! The wisest advice that I got from another mom was that I keep at breastfeeding for forty days before throwing in the towel. When breastfeeding got difficult, and I became tired and grumpy, I reminded myself there were only x number of days before I hit the big 4-0, and so I persevered. By the time the fortieth day dawned, breastfeeding had become a natural part of my life, and did not seem so difficult after all. Of course, this does not mean you should persist with breastfeeding if you develop any complications--see your lactation consultant!
2. Breastfeeding problems need to be solved earlier rather than later.
The first five days are crucial for establishing a good milk supply, and many mothers do not realize how serious problems can be until it is too late. By then, there may be issues of low milk supply, sore nipples, inflammation--which usually makes mothers want to give up. Most issues can be resolved easily and quickly, but putting it off, particularly beyond the first two weeks can be detrimental. If you are planning to breastfeed, make sure you have at least two contacts on hand when difficulties arise. One should be a professional (i.e. a lactation consultant or nurse) who can give clinical advice; the other can be a breastfeeding mom who can support you emotionally through the hurdles that come.
3. Familiarize yourself with breastfeeding BEFORE you give birth.
Start getting some books on breastfeeding in the months before you give birth so that you are not walking into this cold. Dr. Jack Newmans The Ultimate Breastfeeding Book of Answers and Breastfeeding Made Simple by Nancy Mohrbacher are both excellent resources that are easy to read and not too lengthy. There are also yearly breastfeeding conferences offered in the city of Toronto which you may be able to attend. Another excellent option is to make a visit to a local breastfeeding clinic, and see what resources are available there. La Leche League is also a well-established breastfeeding support group which you may consider joining even before you have your baby. Learn the lingo of breastfeeding while you are there!
4. Breastfeeding is a relationship, not just a feeding method.
About three months into being a new parent, I was breastfeeding my daughter one morning when she stopped and flashed her big brown eyes up at me. She smiled and began patting my breast, jiggling it from side to side with her small puggy hands. I giggled and tried to get her back on track, but she lay there staring contentedly at me, bemused by my expression. I did not know whether to laugh or get mad. It was then that I realized breastfeeding is not just a feeding method, but a time for building a relationship with my daughter. I had been so task-oriented during breastfeeding that I had missed out on the joy of embracing our time together as mother and daughter. If I could turn back time, I would have been more present with my daughter during her feeds. As you contemplate whether or not to breastfeed, consider the four points mentioned above, and feel free to apply what makes sense in your context. Your breastfeeding journey will be unique, and perhaps you will have different words of wisdom to share when you are done.
Doulas and Doctors
By Karen Wang
A friend of mine recently commented on her misgivings about using a doula during birth. Her concern was centered around the possibility of disagreement between the doula and the doctor. What if the doula disagreed with the doctor? What if there was some kind of confrontation over highly contested issues like episotomies or the use of various interventions? What if the worst happened, and the labour room turned into a battle ground?
I believe my friend has a valid point. There have been rumours of doulas pushing forward their own agenda to such an extent that they were asked to leave the labour room. However, in recent years, organizations like DONA International, which certify doulas, have provided distinct guidelines that doulas are NOT to provide clinical advice, question the caregivers judgment, or contradict the caregivers orders. It is best then to discuss with your potential doula whether or not they abide by similar codes of practice, and how they would handle doctors that oppose their birth philosophy.
Having said that, there are also circumstances where the labouring mother has made it adamantly clear that she wishes her birth plan to be followed exactly--and as a doula, it would be my responsibility to help her fulfill her desire. In those cases where the mother has birth goals that are different from those of her primary caregiver, the doula would help to mediate bewteen the woman and her nurse or caregiver.
The doula is to be the mothers advocate, not her voice.
This is a fine distinction, but one that is important.
Building a Family Plan
By Karen Wang
First things first
In the world of business, entrepreneurs are encouraged to think carefully through the logistics of their new venture before making any major decisions. A business plan helps to allocate resources properly, handle unforeseen complications, and make good business decisions.
Similarly, managing a family can be analogous at times to running a business. There are bills to be paid, people to please, resources to be used, and positive or negative returns on investments! With only a limited number of hours each day to handle all the different aspects of family life, it is easy to shift into an unconscious mode of living—a mindless repetition of habits that may not bring you the kind of family life desired.
Plato once wrote that “the unexamined life is not worth living”. Though that may seem harsh, there’s definitely an inkling of truth for all of us parents who often just go through the motions without clearly thinking about where our actions are leading the rest of our family members.
Benefits of a Family Plan
Thinking through your goals as a family is an important step in maintaining a sense of peace and order. It can help by:
- giving you and your family a sense of direction and purpose
- allowing all family members an opportunity to communicate needs and wants
- being a mile marker so that you can assess what needs to be improved
Starting a Family Plan
Below are some guidelines on how to start drafting up a family plan.
1. Establish a family vision statement
What do you want for yourself, your partner and your children? Set aside some time to think through this carefully. Try to imagine what would be important to you in 50 years time. Think about the big picture.
Keep it simple.
Don’t worry about writing a novel—keep it under a paragraph. Even one or two sentences.
Read it.
When you are done, have it framed up, and placed in a location where you can easily read it. On the days when there are boundless choices to be made, use your family vision statement to guide you.
2. Setting goals.
Having a family vision statement is knowing your destination, but how do you get there? That’s where setting goals come in. Set aside one hour for this activity. For each of the following items, list 1 goal that you and your family would like to accomplish. Be very specific. Some ideas are listed as well to help you start thinking:
- Health and Body
- taking one night each week to exercise as a family (a stroll around the park for instance)
- getting the kids to bed earlier
- learning how to cook some healthier dinner options
- Financial wellness
- cutting down on credit card debt
- having a family budget and sticking to it
- reading a book on financial planning
- Household maintenance
- making a commitment to de-clutter and organize the home better
- assigning roles and responsibilities for household chores
- deciding on one renovation project
- Social and Spiritual Connection
- making new friends or re-kindling old acquaintances
- becoming an active participant in your place of worship
- setting aside time to volunteer with an organization
3. Reassess your goals and celebrate
Every few months, reconvene as a family, and discuss what goals have been accomplished so far, and decide if there needs to be any changes made. Make it a time to celebrate your family life together, and to make new resolutions.
What I wished I had known about parenting…
By Karen Wang
I had my daughter exactly one year after my husband and I married. Having gone through four years of undergraduate study, five years in a teaching profession, and then now undergoing my masters in education, I thought I had parenting figured out. How difficult could it possibly be?
In hindsight, I realize not only was I inadequately prepared (regardless of my education background, consistent baby sitting, and childbirth preparation course), but I was altogether mistaken about some very important things. Here is what I discovered:
1. Babies are not pets.
Okay, this sounds so ridiculous, but the sentence encapsulates my thinking exactly. In my simplistic mind, I had the belief that babies would eat, sleep, and take a whiz every now and then. Other than that, they would be as quiet and undemanding as my two transgenic green mice Pinky and Brain, and would occasional nestle in the crook of my neck purring like my feline friend Murphy Brown.
This idyllic dream was shattered the moment my daughter left the hospital. The first night, she screamed and screamed and screamed—not just a loud wailing, but a hair-raising, wake-you-from-the-dead screech that woke up the whole house, and sent my heart racing. I remember staring at her and wondering if I had taken the correct baby home.
Unfortunately, or fortunately, babies are not pets. They do not eat when YOU want, nor do they entertain themselves in a corner. You are ‘on call’ every minute of every day of every week for at least the first few months. And there is no baby spa that you can drop your delightful wee one off for a few days to catch up on some much needed sleep.
2. Babies do not come with a manual.
I wish that someone had said to me before I left the maternity ward: “Okay, when you go home, you will now become the mother, teacher, doctor, chef, counselor, therapist, fitness instructor—you will have to deal with issues round the clock, and have hardly anyone to help you. Are you sure you want to leave?” If I had heard that, I would probably have asked to stay on a few more days while getting the hang of things, instead of wanting to rush out the doors as quickly as possible. Again, it was a gradual process of enlightenment, as I discovered that while there were professionals who I could turn to in my major crises, the day to day dealings of an infant were left up to me and my spouse. And most of the time, we simply stared at each other. Clueless.
3. Babies are not adults.
There were times when my two week old didn’t eat. I was worried, so I tried reasoning, using persuasive arguments, smiling, frowning, raising my voice, singing, but nothing—babies are simply not adults. No amount of cajoling or pleading will make them do what you want. Its not that they are trying to control you. It’s simply that they do not operate on the same routine that we are used to, and this means coming to terms with some sense of powerlessness and frustration.
4. There is help available. You just have to be proactive.
The other day, my father called me at home. He was wondering why I wanted to become a doulee. I chuckled and told him the correct pronunciation: doula. Not that it made any difference. I told him that because of my difficult experience as a ‘young parent’, I really wanted to help other parents who may also be struggling through this transitional period. In some ways, I want to give back what I had never gotten. I wanted to provide the emotional, physical and instructional support to others that I didn’t receive during my postpartum period. Looking back now, it wasn’t that there wasn’t support, I just didn’t know how to ask for it, or where to go. There was too much general information it seemed. Hard to navigate when you’re so engrossed in your own issues.
What I see is that a doula brings all of that information and makes it personal for the parents. There is and always will be a plethora of books and websites on, but nothing beats having a real-life person guiding you each step of the way, through the sleepless nights, and constant feedings to show that there is a light at the end of the tunnel. There is help; you just have to ask for it.
Birth as more than pain management
By Karen Wang
Mothers often ask how to deal with pain during labour. What breathing techniques should they learn? What about massage and hydrotherapy? When should they request an epidural? In all these kinds of questions, the paradigm is that labour is only about pain management. This view of birth is one which continues to be propagated by the media so that it almost becomes inconceivable that birth could somehow be different.
Through my birthing experience and also with my training as a doula, I began to see that there is a different way to approach labour and pain. I do not consider these alternative or strange views because they are what many women have experienced around the world.
1. Pain is NOT the ONLY sensation during labour.
During early labour, contractions may come and go infrequently. There may be a feeling of tightness, but it may not be particularly painful. There are feelings of excitement as the baby is coming. Women often report an urge to make sure everything is ready around the house (also known as the nesting instinct). This early portion of labour can last for several hours to even a few days.
Usually, it is during active labour that contractions become longer, stronger, and harder. This is where most women consider getting an epidural, narcotics, or using various forms of relaxation techniques. However, even though this is typically a trying place for women physically, it is amazing how the female body is able to quickly recuperate between contractions. Endorphins, produced by the brain in response to the pain is a powerful and natural pain-reliever. Furthermore, these endorphins help to create a hazy rememberance after the birth process, so that what might have been considered very painful is no longer a present and active worry.
There have also been reports by Ina May Gaskin, a well-known midwife, that some women experience orgasms during birth. This may come as a shock and surprise, but why should it? An excerpt from her book "Ina Mays Guide to Childbirth" explains why this phenomenon seems to be so rare:
"I want to note how infrequently this possibility is mentioned to women who are preparing to give birth...One is that most childbirth professionals simply do not know that it can and does happen. Another is that when it does happen, no one mentions it, since orgasm is generally considered to be too private a matter...Finally, orgasm during labour and birth does not seem to happen very often in women whose labours are medicated with narcotics, epidurals, or barbiturates. Since so many women in our society do have medication of one kind or another during labour, this may be a significant reason why this phenomenon is so unrecognized by birth professionals and most of the general public"(160-161).
2. The emotional and mental wellbeing of the mother affects the perception of pain.
During pregnancy, there is an emphasis on the physical wellbeing of the mother, particularly in terms of nutritional needs and exercise. However, an often overlooked dimension is the emotional or mental preparedness that the mother has towards childbirthing. Good questions to consider with the mother prior to the birth are:
- How much emotional support does the mother have during birth?
- Are there traumatic events in her life which have not been dealt with emotionally?
- Has there been any sort of physical, sexual, or emotional abuse which needs healing?
- Will there be constant disruptions during labour which may hinder the progress of birth?
Birth is a process that involves all a womans faculties--mental, emotional, spiritual, and physical. These domains are all inter-related, and can either enable a woman to feel empowered or overwhelmed during labour.
3. There may be pain AFTER birth, particularly with interventions during labour.
A lot of women think that if they can numb the pain during labour, then the worst is over. This was not the case for me. Even though I had an epidural, I suffered from backache and headaches many weeks after the birth of my daughter. Furthermore, because I was induced and had an IV inserted into my wrist, I also later developed pain in my hands, and this caused a great deal of frustration when holding the baby and breastfeeding.
The pain of spontaneous and natural labour eventually dissipates after the baby is born; it does not linger around for weeks and months which does occur often with the use of interventions. These are all important facts to keep in mind when considering options for pain medication.
- What are the potential side effects of using a particular pain medication?
- And am I willing to tolerate those effects in order to dull the momentary pain during birth?
Regardless of what decisions you make surrounding pain management, it is wise to speak to your primary caregiver, and gather all the facts beforehand. Talk to other moms as well - those who have had natural births without medication, and those that did opt for medication.
So when you finally do give birth, trust yourself to make a decision that is right for you and your baby.
Help is on the way
DONA International supplies doulas who offer emotional support and expertise
By Marylin Linton, Toronto Sun — June 25, 2006
Mothering the mother may sound like a strange career but it’s what Ottawa’s Susan Martensen does for a living. As president of DONA International, a doula (labour assistant) organization with a presence in 22 countries, Martensen has nurtured mothers through more than 400 births.
Ottawa’s Debra Binda is one of them. As she prepares to give birth to her fourth child (any day now), she will do so with the help of Martensen.
“I wouldn’t do it any other way,” says the mother of three who had Martensen’s help throughout her pregnancies. “It has been very comforting having a woman with me who has given birth herself and who has attended hundreds of others, someone who can be there just for me.”
The word doula comes from the Greek and means “a woman who serves other women.”
“The doula (pronounced doo-la) works for the woman,” explains Martensen who adds that, in many societies, it is typical for mothers in labour to rely on experienced women in the community for support.
“The kind of support provided is emotional and informational; a doula also offers physical comfort.”
By bringing a kind and nurturing touch to the birthing experience, a birth doula is at a mother’s side (along with her partner and the midwife or doctor) for continuous support during labour and birth. Helping parents to experience a smoother childbirth is generally the goal, though the doula-mother relationship usually starts earlier in the second trimester with a series of pre-natal meetings.
‘WELL-KEPT SECRET’
After the birth, doulas can return for a few more visits to help with breastfeeding or to answer postpartum questions.
“Typically, a doula would be someone who would not be family,” says Martensen, whose interest in the profession began in 1990 with her second pregnancy when she enlisted the services of one.
“ ‘Wow,’ I thought. ‘This is a well-kept secret!’ My husband loved the fact that there was someone there with us who knew more than he did so that he could fully engage in the birth without worrying if there was something wrong. I decided it would be wonderful if there could be access to this kind of service.” Debra Binda’s first doula experience, three births back, was also positive. “I had heard so many horror stories of birth and I decided I never wanted to remember my childbirth that way. During your first delivery, there can be a great amount of fear and the pain can seem to overtake you. Susan had many different suggestions as to how to alleviate the pain and the fear. It was very comforting to have someone just for me.”
Though Binda has had natural childbirth, Martensen stresses that DONA doulas do not work exclusively with women who choose that route. “The woman defines her labour. It is not the doula’s agenda, it is the mother’s,” she says of the type of labour (natural or with epidural pain control, even cesarean) chosen.
“We are not there in any activist role. Our role is to nurture and protect the memory of that woman’s birth.”
The role of a doula also differs from that of a midwife, Martensen explains.
“The midwife is a clinical care provider who is responsible for the medical health of the mother. The doula has no clinical responsibility and works with a woman and her care provider.”
In addition to reassurance and emotional support, a doula provides an extra pair of hands whether it’s offering a mother a warm cloth or getting her a drink of water.
An acronym for Doulas of North America, DONA now includes services world-wide through its 6,300 members; it also offers doula certification classes. Doulas usually work in private practice, charging an average of $600. Some liken them to personal trainers for moms-to-be. Nonetheless, a study of 13,000 women concluded that those with continuous one-on-one support in labour needed less pain relief, had fewer cesareans and more positive birth experiences. Worth looking into?
For more, visit dona.org.
You & Your Newborn
Postpartum Doulas
Support for new moms when they need it the most
By Teresa Pitman
Imagine your first baby turns out to be twins. Now imagine one of them is colicky, and you’re breastfeeding around the clock. That was Linda Marzec’s reality. “Because Sarah was so irritable, I couldn’t feed her and Andrew at the same time,” explains Marzec. “So I was breastfeeding about 20 times a day. I was going on maybe one or two hours sleep a day — and that wasn’t in one chunk of time. I guess I was exhausted.”
What Marzec needed was a fairy godmother. But since one wasn’t available, the public health nurse who visited recommended that Marzec hire a postpartum doula and put her in touch with Liza Hagusa of Mother Me, in Vancouver.
“What impressed me about Liza was her ability to quickly assess the babies’ personalities and how they’d respond,” Marzec says. “With Sarah, it’s very important the way you hold her, the way you rock her, and Liza just seemed to have the knack. I could go off and sleep, and she would wake me when they needed to be fed. For me, that was the best gift anyone could give.”
You’ve probably heard about doulas — trained women who provide support during labour and birth. But you may not know that postpartum doulas are available in many communities as well, to help women after their baby has arrived. They may come for a few hours each day to do some laundry, prepare dinner, give you a backrub or help with breastfeeding and baby care. You may even be able to arrange for an overnight shift, to help you get a little more sleep. “Many women have no family support close by, and they may not have much experience with babies,” Hagusa says. “The doula’s role is mothering the mother, providing that non-judgmental support.”
And mothering is definitely what most new mothers need. Nicole Oliver decided on a postpartum doula to help her get through the early weeks of parenthood. “I don’t have any family here, and my husband and I are pretty much on our own,” she comments. “My little boy, William, was born on August 3 [2004], and our doula came the next day when we got home.”
That first day could have been a disaster, Oliver says. “I have two cats, and one got diarrhea and it was all over the house, and I was trying to figure out how to breastfeed, and my husband, Chris, was frantically working away in his home office on a project that was due in two days. And here’s our doula, cleaning up the cat poo everywhere, cleaning up the cats, making me lunch, drawing me a bath, helping me with breastfeeding…it was just incredible.”
When William was four weeks old, Oliver’s husband had to leave town for four days, so she arranged for her doula to stay overnight. “When Will woke up, she got him and came in and woke me, literally put him on my breast and, when he was done nursing, she removed him, gave me some orange juice to drink, and told me to go back to sleep. She took Will, burped him, changed him and got him relaxed so he could sleep too,” says Oliver. “I actually got to sleep almost all night.”
But this kind of care comes at a price: Liza Hagusa, for example, charges $20 an hour. This could be a great gift from grandparents or other relatives who want to help out the new parents.
In some communities, there are other options. Halifax has a unique volunteer doula program, funded by a partnership of several organizations, and has trained about 150 women to support new parents. As you might expect, the number of requests for doulas exceeds the program’s capacity. In other communities, public health nurses may be able to help a mother find a doula who is willing to donate her services or provide them at a reduced cost.
Nicole Oliver feels the doula support she received was worth every penny. In fact, when she was eight weeks pregnant with her second baby, she called to book another postpartum doula. Now that’s a pretty convincing testimonial.