 |
 |
make mothering.com your home page |
| shopping guide | ||
editorial columns
family tools
community features
 |
ask the experts  karen
salt |
Karen Salt
Doula, Holistic Pregnancy, Teen Counseling
- First pregnancy stress
- Breastfeeding after failure
- Post-Partum period concerns
- "Catching" the baby at a hospital birth
- The "period of seclusion"
- Wanting a natural birth
- Promoting breastfeeding as a doula
- How to find a doula
- Wicked PMS after giving birth Help!
- Father's drug use effect on fetus
- What should I look for in a doula program?
- Encouraging menstruation without weaning
- Risks of pre-term labor when breastfeeding
- Birth classes
- Middle school bullying
- Placenta previa
- 13 year old with depression
Article continues below
Dear Resting Momma:
You've raised a number of interesting points in your question, which I'm going to answer in a fairly roundabout way—not because I would like to avoid any of your concerns, but because, as with most things dealing with the body, there is no immediate yes or no answer. So much depends on you and your situation in this that I have to start with that first.
So... the immediate issue is your stress-load. Now, in your question, you don't list the stressors that you face everyday. From your brief entry, I can't tell if you are in school, working, living with your parents or another family member, living on your own, or in contact and/ or in a relationship with your baby's father. All of these scenarios carry with them distinctly different circumstances, but all of them are possible sources of stress. Everyone deals with stress differently. I believe that how a person deals with stress in life is a good indication of how one will deal with pregnancy—at least mentally. In your case, you have a few additional issues to consider. Given your age, in some states, you are a minor; in others, you are as much an adult as I am. Either way, you have the added job of mothering a new life added to your long list of other responsibilities that may include student, worker, sibling, partner, friend, and possibly, child (and this is not an ageist comment. I am still my mother's child after all these years.) Most women have to figure out how to navigate this minefield; in your case, you have to add the details of your age and your pregnancy into the mix. I won't even presume to know what your situation entails. I will say that odds are high that it's probably a bit of work navigating your way through it all. While there can be a lot of issues, and lots of people with opinions about them all, try not to lose sight of your little bundle of wonderment. He or she should be the center of your world, not the issues, or the need to be right, or anything else. Losing sight of that will only impact your baby negatively in the long run.
In light of this, the real task is figuring out what you can change, what you can't, and trusting enough in yourself to give your baby the care and attention that he or she needs. Yet, you also need to receive care and attention. I strongly believe that we make our jobs harder for ourselves when we try to give and give without receiving anything that can help to "fill the well," so to speak. What happens is that we end up having nothing left to give ourselves, and nothing but duty to give others. Essentially, we end up running on empty. And being empty is not any way to live or love.
Just judging from your communication with your doctor, and the care that he or she has taken with you, I think that you probably have a good support team. Now, I need you to think about these people a little more. Do they love you, support you, listen to you, ask you questions, solicit your opinion, and congratulate you on the small and large victories in life? If they don't do all of these things, that's okay. You may not even need them to do them for you. However, if you do need anything, and your support network isn't giving it to you, tell someone. Be vocal even as you are being respectful. You deserve to be surrounded by positive, caring people, just like any other woman in the world. You deserve it and your baby deserves it too.
Before I go on, let me return to stress for a moment. Because you have not divulged what stressors—beyond health concerns—you are dealing with—I can only wonder if you have more going on in your life. Ask yourself about your relationship with your parents and your partner. Are both in a good place? Do you try and communicate openly with both? Do these groups get along? Why not? Be honest here. So many things can impact love and parenting that I could devote an entire book to the subject. I will say that what's central to moving through life is recognizing the choices that we have made and continue to make every day. Look at yourself in the mirror after you read this and ask yourself if you are making decisions that place your baby first. If you can say yes, then you're on a clear path that may continue to offer challenges, but one where you hopefully won't have to second guess your own motivations, or the motivations of others. If you're not sure, think about it for a bit. Don't let having your baby turn into a battle over issues that are not about loving and caring for your baby.
Finally, you brought your question to me after experiencing some health issues. Because you haven't named them, I can't speak about anything other than spotting, which really is a common occurrence for a host of reasons. You also have another significant concern: your growing body. Right now, your body is trying to finish growing you as well as your baby. That's a lot of physical strain. Try to help your body by doing some really simple things:
- Eat enough calories every day and stay clear of foods that aren't high in nutrients and packed full of natural ingredients.
- Avoid foods that come with an ingredients list a mile long.
- Stop eating fast food.
- Eat more fruits and vegetables every day.
Here are a few quick tips. Deep breathe. I know that this sounds way too simple, but breathing deeply not only gives your body (and your baby) much needed oxygen; it also releases lots of tension. Smile and laugh more. Studies show that laughter might just be a fantastic natural medicine. Love. I can't emphasize enough how key love is to healing one's body. Both receiving it and giving it in return. Learn to let go. We often hold on to things and issues until they become like a poison, lingering in our minds. Try to lessen this mental and sometimes physical load by letting go of many of these issues, including anger.
I hope your health concerns lessen as you finish growing your baby. Keep talking to your doctor and recognizing that pregnancy and birth are normal life events that often bring with them challenges and the impressive curveballs of Mother Nature. You aren't any less normal than anyone else experiencing a pregnancy; you just bring your own specific set of circumstances and energy to the baby-making party. Good luck.
I hear your pain so clearly in your letter. Your feelings of failure stem from a deep place of anguish. I can offer you some guidance today, but I implore you to talk this information over with your partner, a good friend, or just someone you trust. You owe it to yourself to unravel the conflicting emotions that compel you to consider yourself a failure and drive you to view breastfeeding not as a vital food-source for your baby, but as something you have to succeed at. Again, it sounds like you are placing a lot of pressure on yourself to "perfecta^?? parenting in the future. This is something I would suggest you have to let go. Parenting is often an act of letting go of control and embracing the complex art of imagination and creativity (as well as having nerves of steel).
So, I have a lot of information for you that I hope will help you center yourself and trust your voice and mothering instincts. But I need you to consider all of your concerns as a total package. It will take some time to unravel all of this. Let's begin with the most important thing: your mood.
Dealing with the leftover issues from your postpartum mood disorder
Many women in America deal with the "baby blues" yet, there is still less awareness of the reality of postpartum depression. I'm not certain if you talked to someone after your first baby's birth. Your letter hints at lots of struggle and an immense amount of isolation. For the future, one way to combat this is to recognize that mood disorders cannot be handled by simply pulling yourself together. Isolation and a feared loss of control can severely exacerbate these issues. How to help yourself? You need a Family Support Team. At the head are you and your partner. The two of you are the leaders of the village raising your family. You don't need to be perfect or have all the answers. You do need to be open and willing to get help from whomever as you attempt to navigate your lives into the future. This means that you should talk to your family if you can. Bring them in as needed to help with everyday concerns and to offer cheerleading support.
Also, find professionals who can help. A postpartum doula could be just what you need after your next baby's birth. These wonderful women offer sensitive, loving care, and mother-focused support—something I think would be an added resource for you. There are also postpartum therapists who focus specifically on birth and parenting issues. Check with the Association for Pre and Perinatal Psychology and Health for professionals near you.
You can also find other mothers in your situation by joining a La Leche League group in your area. League leaders can be lifelines for families committed to breastfeeding, and LLL groups can be vital resources when information is the key to extended breastfeeding.
Lastly, don't forget your local lactation consultant. These board certified professionals can answer nearly every breastfeeding question or concern. Keep the number of your local IBCLC on speed dial.
But there are also a few things that you can do for yourself.
Seeing yourself in a positive light
The struggles that you encountered after your first baby's birth do not define you as a person. You encountered challenges, learned from the experience, and now feel compelled to ask more questions. And this is a wonderful thing. There are lots of places that can provide you with details about how to pump your milk and your diet. Right now, I am concerned about the negative thoughts that continue to surround you.
So, repeat after me. I am not a failure. I am a Queen. I am a mother. I am a Goddess. I am a loving spirit.
Believe in yourself. Everyday. Recognize that perfection is a dream-killer that can suck the creativity and joy out of parenting by setting up unrealistic expectations and goals.
A few comments about breastfeeding
Practically speaking, I would talk to your midwife or doctor about your breastfeeding goals—as well as a local breastfeeding counselor. You will hopefully find many resources in your community—from WIC breastfeeding peer counselors to lactation consultants at your local health clinic. There are even wonderful places on-line to surround yourself with information and support. Check some of them out for reading ideas, finding breastfeeding supplies, and listening ears.
Two things that you mentioned in your letter greatly impact breastfeeding: lack of support and feelings of isolation. Addressing these two issues—especially in light of your previous concerns—should help you on your journey to nursing your baby with confidence.
I completely understand your concern. Adjusting to life with a new baby can be stressful and amazing at the same time. How you and your partner cope with a new being in the family depends on a lot of things—like both of your mental images of new parenting and how that squares with reality, and how much sleep everyone gets each night (or day). You pointedly want to know if you can manage with your husband as caregiver---Absolutely! Fathers are loving forces in many babies' and mothers' lives. Most importantly, the needs of most new parents (and new babies) are often surmountable compared to the growing list of worries many new parents start creating before their babies are even born.
You, though, sound like you are looking for less stress in your life by asking sound questions ahead of time. So—here are a few answers:
- Keep it real
Babies don't come with instructions and neither does parenting. Your midwife has probably encouraged you to rest after birth so that you can heal and enjoy your baby in relative peace. But guess who should be right there beside you? Your partner. Cuddle your bundle of joy together when the baby sleeps. Nap together. Let your family love each other. Cleaning comes second to that.
Encourage friends and family who would love to come for a visit to send you things that you might need ahead of time. Friends are often more than willing to drop off nutritious meals, shop, or even run errands for a new family. Many families also pool their money together and instead of getting another duplicate baby gift, purchase the services of a postpartum doula.
Most importantly, you two need to not let sleep deprivation and adjustment dominate your thoughts. You will be parents soon, but hopefully, you will remain lovers. Keep your intimacy high and your stress level down by massaging, hand-holding, and talking to each other. High profile cases of postpartum mood disorders in women have recently dominated the news. Increasingly, research shows that men may also be affected mentally and emotionally after the birth of a child. Reaching out to him may help him cope as well. - Ask questions
I'm often amazed that people don't ask questions for fear of sounding odd or silly. There are never, ever any silly questions when it comes to the life of your baby. You've reached out to me. Now, set up your own team. You sound close to the mothers in your life. Who else do you trust? A local La Leche League leader? Other mothers in your neighborhood? Your midwife?
You asked me whether the first week is the most difficult. The only answer to that question is maybe, probably not, and even yes. Much of the stress during the early months after birth depends on your health, your uncertainties, and your network of help. Your partner has already sounded the alarm for help. While I believe that he will probably be fine, you might want to consider another team member. Do you have a trusted friend or neighbor who could come over for a couple of hours and just help as needed?
You also might want to ask around about the postpartum period for women in your family. Some women feel emotionally and physically drained after birth. Others feel like they can tackle the world and still have mother power to spare. How you will feel after birth depends on many, many factors. What you don't want to do is try to overdue anything in some search for perfection. Finding your happy medium will come about the more open you are to the wonders of parenthood. And don't underestimate your man. Many, many partners cook, clean, and diaper their babies without being told or hassled to do it. Our society has stereotypically cast partners as incapable parents. These is a stereotype that often becomes a self-fulfilling prophesy for the next generation. While I know not every partner will do these acts, many do.
Final points
As the mother of teenagers, I can assure you that parenting is an act of continuous adjustment—for everyone, including you. Will the first week be difficult for you? Maybe not. You might realistically see this time—and the coming months and years beyond—not as some sort of test of perfect motherhood, but as moments of connection. As I often remind myself, babies grow and change constantly, and parents do too. This growth and change means that nothing can ever be simple. As a result, wonder and joy can often emerge from the chaos of life.
Your question provided me with a beautiful image of the two of you grasping with joined hands to draw your baby onto your stomach. Although I recognize your need to question whether this is something that you can do in the hospital, I am a little saddened that our healthcare system is designed in such a way that you would have to question whether your partner can touch the baby he helped create.
Sorry, I digress.
The answer to your question is yes. It is perfectly reasonable to ask your OB if your baby’s father catch the baby. This concept may be a little difficult for some OBs to get since they typically “deliver” a baby versus “catching” a baby that has been birthed through the power of its mother’s body.
Talk to your OB about the fact that you want a more mother-friendly, baby-friendly, family-friendly approach. Let her or him know that you would like to move your baby between the warmth of your womb and the sometimes sterile world we live in with your partner right there beside you.
Do minors who have children, have rights? A 15 year old girl and a 17 year old boy have a baby. The girl’s mother whom she lives with, will not allow her to take the baby to the boy’s home, or anywhere for that matter. Does her mother have the right to not let the rest of the baby’s family have contact with the baby? The mother is making all the choices for this girl and her baby. I mean I fully understand she is only 15 but she is also the baby’s mother, and I would think that if the baby’s father is willing to help take care of this baby, he should be allowed to. I just don’t know what rights they have as parents and minors. Any ideas or advice?
Your question is very, very complex. I could just give you a simple answer, but I feel like more is at stake her for your friend and her baby. Let’s see if I can break things down a bit so that you can offer as much advice and support as you can to her.
Let’s start at the beginning
I’m not one of those educators who believe that a magic, non-intimate shield exists for teenagers. Instead, I recognize that there are drives that rumble through the hearts of many teens. But from there, nothing else is a given. Sexual intercourse does not have to happen just because others assume all teens are sexually active. Oral sex does not have to happen just because people like to imagine that this activity is somehow less intimate than sexual intercourse. Intimacy should happen when all parties in a relationship are ready for the responsibility of this kind of connection. It’s hard to determine whether your friend was ready for this kind of relationship, or whether her family or her baby’s father’s family was prepared or accepted this kind of relationship. Sometimes, problems that appear after a baby is born to teens are actually problems that have to do with the acceptance of the relationship. This could be important given the fact that in some states a 17 year old having sex with a 15 year old is considered statutory rape.
Now, of course, this is coming a bit after the fact for your friend who is now connected to two other people for the rest of her life. I don’t mean any of this negatively. It is important whenever a baby is involved to look at everything in the relationship with honesty. Why? Theoretically, this child is now connected to its mom and dad forever. This means that the mom and dad are connected forever in many subtle and not-so-subtle ways due to their child.
Of course, many women enter into parenthood without a male partner—either by choice, or by default. However, in many of these cases, these women are not minors themselves.
In the scenario facing your friend, she is the legal responsibility of another person while she is legally responsible for someone else. Kind of complex, no? According to some states, a teen mm is the legal guardian of her child unless the court’s give legal custody to someone else. What about the father? Right now, the paternity of your friend’s baby has not been established legally. There is a way to establish paternity outside of marriage—but this can lead to two very important things: custody or visitation and child support. Establishing paternity leads to set child support payments. For some youth, paying child support can be difficult, but raising a child isn’t supposed to be easy. In most cases, the court can take steps to assist a young or low income dad to obtain training in order to provide support in the future in the event that he cannot provide support for financial or school reasons.
But there is another important element to paternity. Once paternity is established, a child can collect Social Security benefits from the father in the unfortunate case of his death. Plus, the father can establish either joint custody or parenting time (often called visitation rights) with the child that cannot be refused by anyone other than the courts.
So…the answer to your question is yes. Your friend and her baby’s father do have rights as the legal guardians of their child. However, in the father’s case, that means establishing paternity and finding ways to arrange his life to truly take on the awesome responsibility of parenting. In the mother’s case, the parent who appears to have custody in this situation, it means doing some clear soul searching.
I haven’t even asked what kind of life or family atmosphere the father faces. Is it safe? Is he committed to fathering? Does he want to be with the mother in an intimate relationship? How does his family feel about everything? Have they embraced the child? Do the families work together for the child in any way? Are the mother and father still in school? Who pays for the baby’s bills?
I ask these questions to try to help everyone contextualize the situation. Babies that are born from casual relationships can face problems, but this reality can occur even amongst relationships formed from love if there is mistrust, confusion, or other problems between the two families. If your friends have become parents in a dynamic fueled with drama, then, unfortunately, the drama that led then to the relationship will just keep following them through this new complexity of parenthood. In essence, the drama won’t go away until everyone decides to deal with their issues. From the picture you paint, the grandmother is either controlling her daughter’s life, or protecting her from a life or a situation that may cause more harm than good. It would be tempting for me to take sides here, but I can’t. My sympathy is with everyone, but my gravest concern if for the little, innocent baby who deserves to live a life surrounded by nothing but love.
So, what can you do? Talk to your friend. Be frank. Ask her about any risks. Ask her whether she thinks her baby is surrounded by more drama than love. Then, ask her where she thinks the drama may be coming from.
Becoming a new mom can be challenging for a woman of any age. Becoming a new mom at fifteen means that life just became even more complicated. Add in a grandmother with concerns (or issues) and a distant partner and you can see how one could be living without positive energy. Perhaps, your friend needs some outside help to achieve this. See if she is interested in talking to a family member or a trusted adult in her life who may be able to intervene. It may be something as simple as the grandmother being overwhelmed herself with the new baby for financial or emotional reasons.
Here’s hoping your friend can resolve her issues without alienating herself from her family. I wish everyone lots of healing energy.
I've heard about the idea of a seclusion period
after childbirth, but what on earth does that mean?
Cultures around the world often encourage new mothers to spend secluded
time with their newborns where they are cared for by women in their family
and community, and given special food and drink that strengthens and restores
their body after birth.
This seclusion achieves two important things: 1) It helps a mother and her baby connect in a deeply spiritual and physical manner; and 2) It enables a mother to receive care, attention, and guidance from other women who have blazed the motherhood trail before her.
You have to find out whether this type of approach will work for your family. Many mothers have to work soon after birth and do not have the ability to spend forty days being cared for by members of their family. Other mothers are alone soon after the first few visitors leave or their partners return to work. This kind of isolation is what has enabled Postpartum Doulas to grow into a notable force in the maternal and child health world. For many mothers, a Postpartum Doula gives to them what community women and family members give to other mothers throughout the world.
However, a Doula or other supportive person can only benefit a mother if she is the focus of their care and attention, and she is nurtured in the process. This may be why so few mothers feel cared for in busy postpartum floors of hospitals. There is often so much going on that is not focused on them that many star t to feel like the system has given birth, not them. Don't believe for a second that this has to happen to you. You can have a satisfying postpartum time with your family, no matter where you have your baby. The first step is in knowing what you want, and why.
Studies have shown that when mothers have their babies with them in the hospital instead of in a nursery, they feel better about their mothering abilities and more comfortable with their babies. There is even some evidence that this "rooming in" idea may benefit a mother's mental state, allowing her body to flood with hormones that may counteract postpartum depression. Why all the benefits to simply being with your baby? This is where research is finally catching up to what mothers already know: Magical stuff happens when mothers (and fathers and partners) interact with their babies.
Research shows that mothers can identify their babies by smell, touch, cry, and sight. Babies can also pick out their mothers by smell, touch, sound, taste, and sight. Babies may also be able to smell their fathers and other extended family members, picking up on metabolism and sweat.
You and your little wonder engage in sensory rich cues from breastfeeding to simple touch that benefit both of you. To allow these moments to occur with few interruptions (including product interruptions like strong lotions, soaps, and other chemicals) limit your interaction with others for as long as you are comfortable. Kind friends and family members who want to see the new baby can wait. Let them know that you are busy loving and learning about your baby. It may seem rude, but when your little toothless wonder snuggles in your arms, and sighs sounds that you recognize as contentment, you will know that what you have done is simply focused on the one thing that matters most: your little miracle.
I am expecting a baby in June and would like
to deliver this child naturally. I have a 4-year old daughter who is perfect
but my delivery was anything but natural. I had an epidural and then my
baby was taken out of me with forceps and suction. I felt very depressed
after this experience. I have heard hypnosis is something to really
look into. I have a woman who volunteered to be my doula and I am currently
practicing pain management methods and feel pretty good, some days, about
this birth. If you have any advice to offer I would gladly love to hear
from you.
Anyone who believes that birth is just a basic, physical event needs only
to read your passionate letter to get a sense of the depth of emotions
that birth can engender. I am struck by the fact that the daughter you
feel is perfect was also "taken out" of you-as if you were an observer
in the magic of your baby's arrival.
I know that the events left a lasting residue in your mind. However, you need to heal that experience in order to embrace the next. My suggestion? Write, paint, howl, or sing to cleanse your soul. I call what happened to you a spiritual wound. I'm not referring to religion, but the inner sense of who you are...that inner part of you that breathes, feels, loves, and anchors to the world. Close that wound. Don't forget what happened-just close the door. This will allow you to look at this next birth, not as something that you need to fix with techniques and tools, but something that you can enjoy, remember, and embrace.
Sounds good, right? Unfortunately, our maternal health care system in this country works overtime to make it hard for mothers to birth normally-that is, a birth without excessive medical management as routine practice. To that end, it sounds like you've surrounded yourself with people who see birth as something normal. Great. Hypnosis may enable you to face your fears and the unknown of birth, but don't forget the role that your baby's birthplace and your practitioner has in this equation. I call this a birth philosophy. Everyone and every birthplace-minus a home environment-has one. What philosophy of birth does your practitioner have? What about your birthplace? What would those coming to aid you at birth say about the power of women, the strength of mothers, and the beauty of babies and families? Why are these questions important? Because they may let you know whether your goals for your baby's birth are in conflict with those around you before you are in labor. This kind of probing can often show a mother places she may have to negotiate for or advocate against certain things in order to experience her baby's birth as an active participant.
There's so much more that I want to say to you yet, I am not sure if it fits your particular situation. If you had an epidural during your last labor, you gave birth in the hospital. Are you going back to the same one for this baby's birth? How do you feel about this? Have you chosen a birth center or a home birth? Did you come to the hospital last time too soon? Did your labor stop and start [perhaps normally] while you were there so that you ended up being giving synthetic hormones that forced your body into labor too soon? Was your baby in distress? Why forceps and vacuum extraction? Did one fail to bring your baby out of the birth canal?
So many questions. But birth is that powerful. It brings us face to face with our greatest fears and our most amazing powers. It humbles us, as much as it awakens us to the potential that lives within us all.
I hope that you find your way through this birth-at least so that you can embrace your baby and know that you gave birth to him or her. That is something that no one can take away from you.
As a doula I instinctually promote breastfeeding,
but I have alienated new moms who don't see the choice as so obvious.
So my question is, What is the best way to promote breastfeeding while
still encouraging all parents to do what is right for them and their families?
You've touched upon one of the hardest parts of being a doula-being both
an advocate for maternal choice and an advocate for what we each perceive
to be positive health care options. It can be difficult to work as a doula
in any situation where these two goals don't end up as the same thing.
Yet, that is the life that we have chosen as doulas. We have set ourselves
up as conduits of truth and advocates for families; however, we cannot
choose the path that a family takes. We can only present honest information
that enables a mother (and her designated family) to choose what works
for them.
But that still doesn't completely answer your question, does it? How's this: Speak the truth. Seriously. Speak honestly, without value judgments, about breastfeeding. Don't make moms out to be good or bad for making informed choices about their babies' health. Help them to see why they are choosing a certain approach and what it may mean. Long-term. Short-term. With their partners. However, evaluate your approach to truth telling. There is a way to speak the truth that sounds as if you are right and everyone is wrong, and a way to present the truth as the facts, plain and simple. You also might want to consider altering your focus. When you change your efforts to providing accurate information, and shift your focus from what a mother chooses, you pull your "pushing" out of the equation, and really let a mom (and her family) find the path that is for them.
If you do want to continue advocating for breastfeeding, set up events sponsored by your practice that explain breastfeeding basics at your local library. Hook up with your area La Leche League or a Lactation Consultant to offer a Breastfeeding Information night at an area clinic, midwife, or doctor's office, or even your local YWCA. These types of advocacy ideas promote breastfeeding exclusively, and enable you to focus this effort wider than just within a doula-client relationship.
My husband and I are expecting our first
child in January 2004. I recently heard about the existence of doulas
and would like to explore working with one. What is the best way to find
a doula? What types of questions should I ask to ensure we are a good
match?
First off, congratulations on your baby-in-the-making. It may seem like
a long way off, but your baby's birthday is right around the corner. Of
course, since it feels so close, you are doing some reading and information
gathering about all manner of things. Good for you. Mothers should have
the freedom to ask questions and search for answers that will help them
understand as much as they can about this whole life-altering experience.
To that end, you have presented me with two simple questions that I can't wait to answer. However, before I do, let me give my one-minute doula talk.
Some incredible doula studies have been conducted over the years. In many of these studies, mothers report increased satisfaction after the birth of their baby when a doula is present. Of course, some of the most interesting data points to a significant decrease in cesarean sections, epidurals, and oxytocin (synthetic) use if doulas are present.
I'm going to guess, judging by how careful you are being about your options, that you aren't choosing a doula to decrease your chances of a cesarean. While having a doula can lower your chances of having one, a doula is not a magician. Some people erroneously believe that a doula acts like a talisman, warding off procedures or natural birth events with her presence. She does no such thing; she simply nurtures and assuages the spirit of a mother to enable her (perhaps with a physical hand) to give birth to her own baby, her way.
That is what I imagine prompted your seeking a doula in the first place. And now, you would like to find one.
Doulas may or may not advertise in a local telephone book or in a doctor or midwife's office. Since the baby making information vine is active in most communities, it shouldn't be too hard for you to find a doula in your area. I would talk to other pregnant and new moms you know about doulas. Someone in this group may actually be able to recommend a doula that joined them at their baby's birth.
Next, ask your midwife or doctor for any contact names. Even if they haven't worked with a doula in your area, they may still know the ones who are actively taking clients.
La Leche League Leaders and Childbirth Educators can also provide you with the names of doulas. I find that no matter what city I am in, the birth professional community knows everyone who works in the field.
There are a number of professional doula and childbirth assistant organizations that keep lists of active members in various states (and in Canada). There are also a few doula locator web sites that provide similar information (although their lists aren't necessarily people who are members of professional organizations). I won't give you the name of any one non-organizational list so I won't seem as if I am promoting one over the other. A simple web search under "doulas" will give them to you. Here are three national organizations that provide information about their active members: www.alace.org (the Association of Labor Assistants and Childbirth Educators); www.dona.org (Doulas of North America); and www.cappa.net (Childbirth and Postpartum Professional Association).
But once you have a list of doulas to contact, how do you find "the one"? Take it in stages. Most doulas welcome an initial phone conversation and then a face-to-face meeting. This is the moment to ask more detailed questions, and to listen to your instincts.
For questions, you should ask about the doula's education and training background, her comfort level with various situations, her knowledge of your birth environment, the times she has worked with your practitioner, and her fees, schedule of visits, and back-up doula situation (in case she cannot make it to your birth). Once you get a sense of these things, pay attention to how she makes you feel. Your internal radar often lets you know that certain people make you feel warm and comfy and others make you want to run very far away in the opposite direction. Now, a doula isn't trying to be your best friend; she just wants to offer you some of her time, skills, and nurturance. However, both of you want to jell. Birth is an extremely intimate event. You deserve to surround yourself with people you trust. If you do not feel that with a doula you meet, thank her for her time and most on to the next name on your list. (By the way, the above information applies to Postpartum Doulas and doctors and midwives.)
There are doulas across the country and in various countries around
the world. I feel confident that you can find one for your baby's birth.
And you never know - you could be like so many women who are transformed
by their baby's birth and the presence of a doula, and decide to become
a doula too!
For more doula information:
Klaus, M., Klaus, P., & Kennel, J. (2002). The Doula Book. Cambridge,
MA: Perseus Publishing.
Salt, K. (2002). A Holistic Guide to Embracing Pregnancy, Childbirth,
and Motherhood: Wisdom and Advice From a Doula. Cambridge, MA: Perseus
Publishing.
Before I had my son 15 months ago, my periods were
somewhat painful and my PMS just made me cry, a case of the sad and lonely
blues. After giving birth my periods (which came back at 8 months post
partum) are completely pain free, but my PMS is WICKED. I am hysterical,
upset, hating everyone and I feel like I want to quit everything. The
feelings are terrible. I also have major nightmares and migraines. I am
still breastfeeding my son in addition to his eating regular organic meals.
I have heard B12 might help.
I have read your powerful letter many times. It sounds as if you are experiencing
a cascade of mood swings and emotions. Hopefully, I can offer you some
assistance. Although I am not the right professional to give a definitive
explanation for your mood problems, I can give you some suggestions, some
information, and some reassurance. Please, though, take everything that
you have expressed to me seriously. While I can give you some things to
ponder, and even do, you must consider this advice as only a tentative
step in the right direction. You will have to do more to help yourself
(or perhaps to get help for yourself). I shall get to that in a bit. First,
I shall give you some information that will tie your menstrual cycle to
your brain. Then, I will give you some things you can do to help yourself.
Finally, I will give you some things to ponder and some critical advice.
Above all else, know that what you are feeling is real, and what you feel
matters to everyone in your family.
Your menstrual cycle and your mind
You are born with about 300,000 eggs (each one resides inside a follicle).
Follicles are circular sacs in the ovaries that contain one egg. Parts
of your brain, and other integral parts of your body, talk to each other
to initiate follicle stimulation in the ovaries. A number of follicles
are stimulated each month, but only one releases an egg. (This is obviously
not the case when a mother conceives dizygotic twins and other higher
order multiples. In those cases, she releases more than one egg.) Hormones
released by the brain, the pituitary gland, and the follicles themselves,
play a role in the growth, maturing, and expulsion of an egg at ovulation.
Many women know when they ovulate. They experience physical symptoms, perhaps tender breasts or abdominal pain known as mittelschmerz. Other women know when their blood flow is about to start. They feel bloated, irritable, restless, clumsy, and moody. Amazingly, many women who experience mild premenstrual mood disorders simply wake up from the emotional pushing and pulling of PMS the moment that their bleeding starts.
I have heard many women blame estrogen, the so-called "female" hormone, as the cause of their PMS symptoms. This would be an erroneous charge. It is not simply having estrogen that makes some women experience mood changes during their cycles. For some, it is the sharp rise and fall of estrogen, the disruption in the mood-regulating neurotransmitters like serotonin around mid-cycle, and the precipitous drop in estrogen, progesterone, and endorphins, just before blood flow starts that actually cause the mood swings that people call PMS. People who are mood sensitive anyway, and those who may be more genetically predisposed to mood problems, may find that menstruation affects them immensely. And sometimes, life-changing situations and other hormonal changes, like birth, can be enough to put everything in place for an actual mood disorder such as mild, moderate, or even major depression.
There are various types of mood disorders and various types of depression. For our purposes, I'm going to limit our discussion to just basic minor and major depression. I do have a few brief comments to say about postpartum depression. Although many practitioners consider postpartum depression as something that occurs within four weeks of birth, there are a number of practitioners who believe that postpartum depression can start much later after a woman has given birth, perhaps even up to a year postpartum. As you can imagine, this might coincide with the reemergence of a womanis menstrual cycle. This does not mean that every woman who gives birth will develop postpartum depression. Currently, about one in ten women will develop postpartum mood and anxiety disorders. When you consider that four million women give birth every year, you start to realize that many women may be affected. A number of studies suggest that this statistic might even be an underestimate. I cannot diagnose this as your condition, but I can entreat you to go and see a counselor or therapist who specializes in postpartum issues.
According to The Diagnostic and Statistical Manual of Mental Disorders (4th Edition), minor and major depression includes many of the items you listed: difficulty sleeping, difficulty thinking, and agitation. But true depression includes more than just that. Often these feelings are prolonged. It is not clear to me whether you are experiencing these feelings often, or just mid-cycle. For your own sake, I would recommend that you start keeping a diary of your moods. For a month, record how you feel everyday. Try to include any thoughts you had about others, and even any specific comments you can remember saying. I would also recommend that you include your sleep patterns, dreams, and your food intake.
While many symptoms we have can point to a certain condition, there is no guarantee that what we think is going on actually is. For example, what can sometimes appear to be postpartum depression may in fact be a thyroid condition. Some interesting studies have noted that hypo- and hyperthyroidism can actually be the causal agent for mood disorders. Once the thyroid is tested, and then managed, the mood problems disappear. (This is due to the fact that the thyroid released (or didn't) certain hormones that can affect the brain and the body, and consequently, oneis mood.)
If what you are experiencing only occurs in the middle of your menstrual cycle, then perhaps there is some hormonal trigger for your mood problems. You mentioned taking B12. While I cannot find any statistical evidence that B12 intake can alleviate postpartum or premenstrual mood problems or depression, I have found some studies that discuss folate intake as a benefit. A number of the current studies looking at depressive disorders are drawing only a casual relationship to Vitamin B12 Deficiency. More studies will have to be done to see if Vitamin B12 Deficiency causes some depressive disorders. If you are concerned about your nutritional intake of Vitamin B12 or folate, you should talk to a nutritionist. They can provide you with information about items that can stabilize your mood fluctuations, and give you the positive boost you need. We know that having a good, balanced diet, participating in moderate exercise (for endorphin release), utilizing good sleeping habits, and lowering stress and anxiety can affect mood and PMS.
While you are exploring the other options I have mentioned nutrition, talking with a therapist or counselor, and being tested for another concern like hypo- or hyperthyroidismoyou should also do these simple things for yourself:
*Breathe - Several studies show that breath work can strongly impact stress and anxiety. Notice what happens when you feel stressed. Your breathing and heart rate often accelerate. You can counter this by calming yourself down through gentle breathing, and noticing the air entering and exiting your body.
*Laugh - Laughing has also been proven to lower stress. There may also be chemicals released in the brain that may lighten mood during laughter. The adage elaughter is the best medicinei may not be too far off.
*Dance - Many mothers have a difficult time scheduling exercise in their busy lives. Many think they should go to a gym or set up a complex exercise machine at their home. This is only one model of exercising. You can still exercise, but do it with your baby right beside you. How? Dancing. Moving slowly or quickly to music can cause the same endorphin rush in your body that someone experiences while running. Endorphins can have a positive affect on your mood.
*Rediscover pleasure - Many mothers run at ever quickening speeds through life, busily doing many things at once. Often, they miss out on simple pleasures and discoveries for themselves. Remind yourself that you enjoy things. Take time out to do things that make you happy. Set up time to read a book. Take your baby with you to one of your favorite natural places. Walk. Breathe. Enjoy.
I have covered many topics in this answer, but I must reiterate something. Brain chemistry and the workings of the body are complicated things. You, though, know that something is not right in your world. The next step is to figure out what is the cause. So far, I have only discussed biochemical causes; however, there may be external, stressful things in your life that may increase the chances of your mood problems. Take the time to figure out how you are living, since all of these things can contribute to your emotional state.
Please take care of yourself, and remember that what you are feeling is something that you cannot wish away, or just get over. The things you mention are serious enough to consider talking to a specialist (and your partner, if you have one) as soon as you read my answer.
For more information: Sichel, D & Driscoll, J. W. (2000). Women's moods: What every woman must know about hormones, the brain, and emotional health. New York, NY: Quill (an imprint of HarperCollins Publishers)
I am 14 and pregnant. The father of my baby does
a lot of different drugs. I am concerned that my baby will have something
wrong with her because I choose to have sex with a person who does drugs.
Since he does drugs, is there a high chance of her having something wrong?
I've asked many people and each of them has told me the same thing - there
hasn't been a lot of studies done so we're not quite sure.
You have asked a simple question that I have to answer in steps. Why?
You've presented a complicated situation that I must take into consideration
in my answer. Please read each part of my answer and take in the suggestions
and the well-meant positive energy that I am sending your way.
Part One
You are a young mother who has the most incredible job in the world: caring
and raising a new life. Your baby looks to you, while she is in your stomach,
to nurture her, keep her safe, and help her grow into a healthy, strong
baby. She also needs you to feel safe, be nurtured, and remain strong
for her. In order to do these things, you need to look at your life and
ask yourself if you can give your baby safety, security, love, and nurturance
in an environment that is surrounded by drugs. I know that you know the
risk factors of drug use and violence, as well as the risk factors of
drug use and ill health. But there is more to it than that. Your baby's
development, safety (as an infant surrounded by drug affected adults),
and even growth into a strong, capable person can be affected by parental
drug use. I am not saying all of this to lay any type of guilt on you.
I think, judging by your letter to me, that you are a strong woman who
is already thinking about the safety of your baby. Go further. Think about
your baby at age fourteen and ask yourself would you want her to be in
the environment that you now face. I bet you want more from life. What
dreams do you have for yourself? Your baby? How can you make them happen?
What can the father of your baby do to help you and your baby? Ask yourself
these tough questions and reach out to others in your family or community
who can help. I don't know if you live with the father of your baby or
with your family. Regardless of where you live, you have to protect your
baby and yourself.
Part Two
Your question about your baby's health is actually two different questions.
One question has to do with your baby's growth from the moment of conception,
with your egg and your partner's sperm. The other question has to do with
the safety of your baby while you have had sex with a person who is taking
many different drugs. Let's examine each question separately.
Whoever told you that there have been few studies done examining drug-taking fathers and the health of their babies was right. A large number of the published parental drug use studies actually focus on the mother's drug use, and reports from the mother about the father's drug use. In these studies, very little testing of the father's drug intake, and the effect this intake has had on his sperm, has been done. Instead, researchers have had to depend on anecdotal stories from the mother about the father's drug taking, type of drugs used, and frequency. This is hopefully about to change. Scientists are realizing that fathers are the forgotten quotient in drug testing and questioning in order to create true family dynamic studies. It may be easier to talk to and work with women who give birth in facilities or go to see practitioners (as it sounds like you have done.) Yet, it is hard to work with partners who may not show up at appointments or even come to their baby's birth. Having said that, I must state that fathers are not in any way exempt from being responsible for the health and safety of their babies. As is the case with all babies, regardless if a mother and father are actively together, we still need an egg and a sperm to make a baby. And, everyone should be as healthy as possible. Intentionally taking a lot of different drugs will not make someone healthy. So, even though we do not have a lot of studies that conclusively tell us whether a father's sperm can be damaged, and how that will affect his unborn baby, we do know that people can be damaged from drug use. We also know that drug use often goes hand in hand with other factors: abuse, violence, low self-esteem, mental disruptions, unemployment...and the list goes on. These things are not an indication of chronic drug use, but are conditions that can set the stage or be affected by chronic drug use. You must consider how this instability will affect your baby and yourself.
The second part of your question deals with having sex with someone who is a chronic drug user. This brings up some of the concerns of chronic drug use: unprotected sexual encounters, possible encounters with multiple partners, exchanging sex for drugs, experimenting with more and more dangerous drugs to chase the high, and becoming exposed to HIV or sexually transmitted diseases. Viruses or bacteria cause sexually transmitted diseases. You can become infected with an STD by having sexual intercourse, or other types of sexual contact, with a person who is infected with a specific virus or bacterium. Sexually transmitted diseases are infections like hepatitis B, HIV, herpes, chlamydia, gonorrhea, and syphilis. Each one of these diseases can harm your baby, causing a range of problems from life-long acute illness, blindness, pneumonia, premature birth, anemia, and even stillbirth. If this list sounds scary, it should. Numerous people have STDs and never even know it. How prevalent are they? The United States government estimates that there are 3 million cases of Chlamydia alone each year.
I wish you nothing but joy and good thoughts as you embark on a new life-long journey of parenting. But, I need you to do something. I need you to look within yourself and see the beauty and the strength that resides within you. Then, I want you to imagine that same strength living within your baby. The two of you need each other. And, the two of you deserve a whole, healthy person in your lives as your baby's father and your partner. If you need help to achieve this kind of change in your family, reach out to people in your community or your close kin. Utilize the resources available and harness the positive energy that others can send your way. You, your beautiful baby, and even your partner (as he struggles with chronic drug use) deserve nothing less.
Before I end my remarks, I must remind you that sometimes we have to let others heal themselves. This may be the case with your baby's father. He may not want to change or get better. If that is the case, you need to seriously consider whether you can have him in your life as a drug-affected adult. Life is hard enough without inviting hardship, trauma, and instability into your home.
And finally, please have a safe birth. I hope it will be one surrounded by healthy, loving people in your life.
I have been recently researching becoming
a doula and wondered if you had any advice about choosing a certification
program. I am living in an area where the use of a doula is not very common
and I wonder if the more "official" looking programs (like CAPPA) are
the way to go since they might be more readily accepted in the hospital/agency
communities. Or perhaps the origin of certification doesn't matter since
the requirements seem to be quite similar. I realize that most important
is that the organization's philosophy must be a good fit with me, but
beyond that are there specific things to look for in a program? Any thoughts?
Dear Doula-in-the-making,
First, congratulations on finding the doula path! Many women find doula work heart-felt and life-changing. I'm sure you will too -once you get some practical knowledge under your belt. Your knowledge path might start in a number of different ways. How you start out doesn't matter. You are now on a journey of obtaining relevant and helpful information and being and working as a doula. Doing this will place you in good company. Many practicing doulas go to medical or women's health related conferences and seek out additional training to strengthen their skills. What you want are skills that keep up with the changing environment that many women give birth in. Because of the sensitive nature of doula work, I believe that all doulas need some type of formal training. But which "type" is the best? You'll get my take on that in a moment. First, I have to say a few things about the various ways to get on the doula path for others who may be interested in doula work.
Reading and Studying Various Books and Articles
Some women start on their path to doula-hood by learning all that they
can on their own. They read classic, and current, books on pregnancy,
birth, and motherhood, study research articles, and join discussion groups
at their library, midwife's office, or on-line to further think about
women, babies, birth, breastfeeding, and families. For many women, they
feel this burning need to learn about these issues, with or without a
formal program. They search out and utilize resources in their communities,
and from other parts of the world, that can provide them with useful information.
Some local options include attending a childbirth class, a breastfeeding
course, or taking a tour of a hospital or birth center. Some women also
join womenA-s circles where they can share birth stories and other empowering
energy-filled stories with other women.
This self-knowledge gathering is only a start. The next step is one that many women undertake first: becoming a doula while or after becoming another birth professional. This one is pretty self-explanatory so I won't devote a lot of space to it other than to say that many nurses, childbirth educators, and lactation consultants see doula work as a natural extension of their efforts on behalf of women and their families. Even midwives -especially those who are students -offer doula services to mothers. Just so you know, many doula programs have a 'face-track' program for those who are already birth professionals. But how do you pick which one?
Choosing a Program
You should know that there are doula programs everywhere. Many, though,
are very similar in nature. Why? This actually gets into how the doula
program is set up. Some programs rely upon various individual doulas or
a team of doulas to conduct trainings in various locations. This allows
many different trainings to take place without the main organization having
to coordinate too many of them from the main office. These localized trainings
are run by credentialed doulas recognized by the main organization as
a trainer. (This may sound familiar. Doulas of North America and CAPPA
have something similar to this.) You can note these types of trainers
because they will usually have "blank organization-approved trainer" behind
their names. Other organizations, like the Association of Labor Assistants
and Childbirth Educators, coordinate trainings from their main office
utilizing a core set of trainers. Both of these types of set-ups have
benefits. For you, though, it may not matter where the training is located.
You may be willing to travel anywhere to receive quality training. Wait,
though. There is an important distinction I need to make between a training
and a training program.
A number of community doulas (and midwifery schools and even hospitals) offer doula training workshops. Some even offer advanced workshops for those who have been practicing for a number of years and want some additional "hands-on" information. These workshops can range in price from a minimal fee to a more "conference" ranged price of $300. Depending on your needs and what is offered, you will probably find that the training lasts anywhere from one day to two or three. If you find a long training like this, inquire about what you get for the stated price. Is this training recognized by a national doula group? Do you get a training packet or binder with resources and information? Is the workshop evaluated? What training and professional background does the instructor have? Can you see any testimonials from people who have attended in the past before you sign up? And two more important questions: Can attendees bring babies to the workshop?; and How are cancellations or refunds handled? These may seem like strange questions, but they say a lot about the kind of training that you have signed up for. While I understand that many intensive trainings are not the best place for crawling babies, I would like to know if a training program I was interested in actually discouraged breastfeeding mothers from attending. This is a un-doula approach and probably won't be something that you will encounter, but you should be careful. You should also know about the refund policy (or rescheduling situation) just in case you, or the trainer, are unable to make it to the training.
Of course, this is not the same as a training program. Training programs are on-going educational opportunities where you receive guidance, perhaps work through modules, and attend one or maybe two workshops. Many programs have their participants work through a detailed reading list of important pregnancy, birth, doula, and motherhood related books (including breastfeeding), and perhaps work on assignments that are evaluated. Many doulas-in-the-making who choose doula programs also go on to secure certification through the program. Again, if this is your route, pay close attention to the national affiliation, or the workings of the training program. You mentioned working with a more "official" looking program. I'm not sure what you are alluding to with the quotes, but I can alleviate any fears you may have about doulas trained in the largest national organizations, and responses to them by hospitals. Doulas, because they typically (although not all) work for a mother and her family, do not need a "medical" or "official" background in order to be accepted by a mom. What a doula needs more than anything is a good grounding in birth physiology, body dynamics, birth blessings and natural occurrences that are outside anyone's control, and the ways that she can contribute in various birth environments. Learning communication skills and a good helping of self-employment business savvy would also aid a doula immensely.
You mention that the philosophy of the program should match what you feel about doulas, women, and their families. This is true, not only in terms of the skills taught, but also from a financial level. You are paying for something when you embark on a training program. What you want, more than anything, is to feel as if you are getting your moneyA-s worth. By recognizing that most national programs are staffed by women's health advocates just like you (and not corporate, bureaucratic sharks), you'll come to value the efforts that many organizations go to ensure that every woman has the privilege of having a doula should she desire one.
While I agree with you that many of the doula programs present similar information, there are differences between them. Some are more adept at working psychological and cultural teachings into their training information. Some training programs are also more focused on training doulas to work in various birth environments. If you plan on working in a birth center, at homebirths with a midwife, or in a hospital exclusively, this may be an important concern for you. Plus, you may want to become a postpartum doula as well as a labor doula. Check to see whether the training program offers this option as well, if it is important to you.
And this takes us back to the place I started - any doula program or training is just the beginning. Trust me when I say that you will learn tons from the mothers and the beautiful babies that will cross your path. They will leave their footprints of beauty in your life for years to come.
I am a 35-yr old mother of a one year old.
My husband and I would like to start trying for our second child, but
I have yet to start menstruating again. I am still nursing 4-5 times per
day. Is there any way short of weaning that I can bring on my cycle? Months
ago (before the issue was as pressing) my midwife thought maybe there's
a dosage of progesterone that could do it, but I don't think she ever
fully researched it. I really want to nurse for as long as my baby needs,
but I also don't want to wait too long, because we think we'll have a
third, too!
I'm so glad you contacted me with your question. It contains issues that
I need to lay out in sections. While I can't give you a definitive date
when your menstrual cycle will start again, I can provide basic information
that should help you understand what could be going on and why. I may
repeat information that you already know (since you sound like a knowledgeable
mom), but bear with me. I'm sure your question can help others who have
similar concerns.
The Rush
Over the past two or three years, major newspapers and news channels have
devoted considerable time to discussing what I call, "baby rush." According
to a number of pundits, mothers who are over thirty are in dire need to
give birth quickly because their chances of getting pregnant have dwindled
to one or two chances. This may be a slight exaggeration, but the sentiment
is the same. Suddenly, many women think they will never get pregnant if
it doesn't happen tomorrow. While there are definitely women who are struggling,
managing, accepting, and living with infertility, a large percentage of
women are being driven to think they are infertile because they do not
get pregnant quickly. Of course, you may not be in a hurry. But please
note that the average age of menopause is 51 in the United States. The
last menstrual cycle can occur around 48-55 years of age. Hormonal fluctuation
can start much earlier, but is often an individual thing (what you may
have heard called perimenopause). So what does this mean? My 35-year-old
friend, you have twelve chances a year to get pregnant. While you may
want to speed up the time between children, it is still a good idea to
wait some time so that your body can shore up reserves for the next bambino.
In your case, your cycle will probably start as soon as your infant starts
to eat food in addition to breastmilk. Many cultures around the world
have extended periods between babies where they breastfeed exclusively.
This approach is not a guaranteed way to extend amenorrhea (or the cessation
of the menstrual cycle), but it typically will prolong the period before
the next pregnancy and this is a good thing for the health of the mother
and her current and next baby. Now, those who have chosen not to breastfeed
their children should not take that sentence to mean they are not doing
something for their children. They have just chosen a particular strategy
(or felt that it was chosen for them). I could talk at length about breastfeeding,
but the point of this is to remember that you have 12 chances a year and
many more years of possibly conceiving. Don't fret. Besides, the more
you fret, the more you can affect your body's hormones.
Body basics
Each month, ten to 20 follicles (the ball-like things in your ovaries
that contain a developing egg) become stimulated by your hormones. You've
got a group of them that work in a kind of sensuous tango to bring about
the expulsion of an egg each month. Interestingly, many things affect
your hormones. For some women, a bit of missed sleep, high levels of stress,
a poor diet, and other concerns can all affect their menstrual cycles-in
terms of length and intensity of menstrual symptoms. However, there is
another important point I have to make here. You will ovulate before you
experience your first cycle of bleeding. In essence, you could release
your first egg and not know if you are pregnant again. How? Imagine ovulating,
conceiving, and then not bleeding a few weeks later. Many women never
even know they are pregnant until they notice breast tenderness a few
months later. Right now, you can check your body's ovulation signals by
noting any cervical mucous change (noticeable in your underwear or by
inserting a clean finger into the vagina), or noting any breast changes.
I cannot repeat enough that ovulation will occur before you experience
your first period. Many women wait for signs of bleeding as an indication
of the resumption of their cycle and never remember that they should be
looking for signs of ovulation first.
Now, you mention utilizing progesterone. I'm not sure what form you were thinking about, but please note that any synthetic hormone will affect the production of your own hormones. Think about that carefully before trying anything-including herbal remedies to trigger your menstrual flow. There are a number of herbal options, including some that are toxic in high dosages, which have been used by women for centuries to start their menstrual cycles. Again, don't experiment with something you aren't sure about. Talk to an herbalist before trying anything on your own. You might also want to note whether you are having trouble with anemia or other concerns. Diet, breastfeeding, and anemia can extend the resumption of the menstrual cycle. In the case of breastfeeding, for most women, this is due to the fact that the body is working on keeping a little one alive. It does not want to compete by growing another life. Of course, there are a number of women who breastfeed and conceive at the same time-as well as tandem nurse. Yet, the issues of diet and anemia are things that can affect even non-nursing women. Check with your midwife if these are concerns for you.
Hopefully, you will soon notice the telltale signs of your body's return to ovulation, and can then decide when you want to get pregnant again.
I had pre-term labor during my first pregnancy
at 25 weeks. Luckily, medications and bedrest enabled me to carry my baby
for a full 41 weeks. The cause of my pre-term labor was unknown. I am
nursing my 10 month old and my husband and I would like to get pregnant
again. What are the risks (with my history of pre-term labor) of nursing
while pregnant? I don't want to stop breastfeeding but I don't want to
go into pre-term labor again and risk a baby's health.
Your question is intriguing since it circles various topics. Even without
your concern about preterm labor, you are essentially asking a question
about nursing while pregnant. Add in your concern and history of preterm
labor, and you have a rich, complex query. I'm going to break up my response
in order to answer you completely.
Preterm Labor
You should know that more than half of all preterm births occur from spontaneous
preterm labor. In these instances, labor occurs spontaneously and is not
a direct result of some noticeable occurrence. More is being studied about
this since little is definitely known about preterm labor or birth. Every
year, new information is added to the puzzle (i.e., additional causes
of preterm labor like infection, periodontal disease, etc.)
One important thing to note is that preterm labor that will lead to preterm birth rarely can be stopped. Fortunately, it can be slowed to allow the treatment of possible infections treated, as well as allow time for the administration of things that can aid a baby's health (like administering surfactant). Some causes of preterm labor, as you probably know, include poor nutrition, preeclampsia, diabetes, smoking, infection, premature rupture of membranes, and a pregnancy of twins or higher order multiples (about 50% of the time). (FYI-My twins were born at 41 weeks of gestation.) Interestingly, a 2002 Obstetrics and Gynecology article discusses the fact that bed rest, sedation, and drugs that stop contractions show very little evidence of effectively preventing preterm birth.
Because so little is understood about preterm labor, it is hard to write a detailed response to your situation. It is clear that since you did not have (I presume) premature rupture of the membranes, and bed rest and tocolytic agents were used, your preterm labor was not destined to be a preterm birth. All of the information I could find suggests that you would be monitored for any preterm labor symptoms in a subsequent pregnancy, but not considered at risk for a preterm birth since your first lovely baby was carried to term. There is a risk for a subsequent preterm birth if one has had a preterm birth. Making the same case for preterm labor is harder since it is hard to pinpoint in more than 50% of the cases what caused the labor to occur in the first place.
Breastfeeding
Many older infants and toddlers note a change in their pregnant mother's
breastmilk as she nears the end of the new pregnancy. I have often speculated
that this occurs naturally in order to move the first little snacker over
for the second. Not all babies want to stop snacking, and instead, mom's
who follow their infant or toddler's lead, will need to tandem nurse both
babies until weaning occurs. Mothering.com has a thread on extended nursing
where people have discussed tandem nursing. You should check it out.
Regarding nursing while pregnant: Typically, mothers report sensitive nipples early in pregnancy that may not respond happily to nursing an eager infant or toddler used to extended cuddle sessions. (To offset, simply do sensitive nipple treatments as you would after birth.) Mothers also report a decrease in their milk supply that (of course) may lead to additional feeding sessions. This may depend on how often your baby is feeding on simply breastmilk or additional foods.
An interesting study in the Journal of Human Lactation found that mom's who breastfeed while pregnant find that child led weaning is often initiated in the 2nd trimester as milk levels decrease. The main issues you will want to consider if you want to breastfeed while pregnant are keeping your nutrition levels up, getting adequate rest, and educating those around you about the normalness of your choice. Educating yourself and others will go a long way to smoothing out any rough spots you may encounter.
(I do have a quick aside about getting pregnant: If you have started menstruating again, you may want to wait a few months in order to ensure that your cycle is back to normal. If you have not started yet, be prepared to wait a little longer. Consider carefully the risks associated with taking any organic or natural product that aims to hurry menstruation along.)
In your last sentence, you display some concern about how breastfeeding while pregnant will affect the health of your next baby. While I cannot guarantee you that nothing will occur from any choice that you make, I can give you some reassurance and direction. Given your situation, I would anticipate that your midwife or doctor would recommend gentle weaning of your breastfeeding baby sometime in your first trimester so that the oxytocin release of breastfeeding would not trigger uterine contractions in the 2nd trimester. (This would be a precautionary action since no one knows what sent you into premature labor the first time.) Since I am uncertain about your medical history, and I am only suggesting one possible course of action, I strongly urge you to talk to your midwife or doctor to get her (or his) opinion.
I am 29 weeks pregnant with my second child and would like to have a natural birth experience. My midwife keeps telling me that my husband and I need to take a childbirth class. I can understand this somewhat because during labor last time I was induced and needed medication. But the classes are all very expensive and I feel that I won't fit in with the group because I have been through labor before although not natural. My husband also opposes another childbirth class and says that we don't need it. What should I do?
The first thing you should do, my friend, is listen to your own instincts. Your instincts steered you towards a midwife for this birth because you wanted something more normal this time around versus a medically managed birth. This sounds like a choice you stand behind. Regarding childbirth classes (and let's set aside cost for a minute), you present your midwife's and your husband's view on the issue. Yet, you don't seem to be agreeing with either of them. Why? What's stopping you from presenting your view? I have a few ideas that will hopefully help you to hear what you are probably already feeling.
Childbirth classes-in general
Childbirth classes no longer resemble instructional or educational meetings
where someone stands in front of a group of harried mothers and their
partners with charts that show headless female bodies giving birth the
hospital way. While there are a few classes that still string together
phrases like 'you should,' 'don't complain,' and 'this is the way our
hospital does things,' many, many childbirth classes start by centering
their focus on mothers and their concerns. Psychological changes, social
messages, and philosophical questions inherent in birth are raised side
by side with the normal, chaotic magic of labor and birth.
Because women have babies at various ages, childbirth classes, especially ones run by midwives or childbirth educators who embrace the beauty of birth, tend to have women of all ages, persuasions, temperaments, family situations, and often, incomes. As a childbirth educator who has consistently championed the lives and needs of women of all incomes, I can state that many childbirth educators are sensitive to their fees. In an effort to provide services to as many women as possible, some offer reduce fees or even free classes to eligible women and their partners in need of positive energy and information.
Often, childbirth classes that are run privately tend to be smaller, more informal gatherings that embrace and uplift everyone involved. Many women learn information at a class, but they also share with others their ideas, fears, celebrations, and desires. In essence, a community of powerful women is born. Should you go to a class? Maybe. But, just because I mention going to a class does not mean that you should go. What you should do is touch your belly daily, laugh just because, breathe life slowly, and embrace your blessings.
Childbirth classes-in particular
This may sound like a sound bite, but it is true: Childbirth classes do
not give birth to babies-beautiful women do. What classes can do is transmit
information and provide answers or pose questions that mothers are already
thinking about. Take your situation. What do you think about birth--in
general? Do you imagine your baby emerging from you as others have emerged
from their mothers through the centuries? How comfortable is your husband
with the idea of your powerful body birthing this beautiful, new baby?
These and many, many other questions are probably swirling around in your
head. A childbirth class, or perhaps a discussion group of other mothers
and their partners, could give you a place to share these questions and
talk to others.
This sounds great, but is it what you need?
You mention the word 'need' twice in your note; yet, you never use the
word to state what you need. You only mention what your partner and your
midwife think you need. What about you? What do you need while you prepare
for labor, birth, motherhood with 2 children, and postpartum (that may
include breastfeeding the new little wonder)? Don't worry about other
people's response to this question for now. Just listen to your own truth.
If you feel that you do have questions or even ideas, look into which
childbirth class fits your needs and philosophy about birth (Hint: Not
all classes are the same.), or consider checking books and videos out
from your local library. This second alternative won't give you the group
dynamic of a class, but it will provide you with information.
Now, it may seem as if I am asking you to do a lot of listening to yourself about something as simple as a childbirth class. I am. However, I have a reason for this. We, as in mothers, need to spend more time hearing and listening to our own instincts and our own voices regarding caring for our families. Instead of this scenario, we have a created a system of knowledge sharing that reduces many mothers to feeling inadequate and uncertain about everything-large and small. I want to challenge this trend.starting with you.
You are wonderful. You are strong. You are powerful. Claim these truths. Live them. Spread them to the next beautiful mother that you see.
I am a middle-schooler currently being bullied at school. Can you tell me what are some of the causes of bullying and what are some steps I can take to prevent it happening to me?
Although I am not the only person who needs to know the information you’ve told me, I am thankful that you have at least told someone—even if it is through the magic of cyberspace. As a person who was bullied both in school and in my community as a child, I can relate to your emotions and feelings at this time. As a former middle school teacher, maybe I can even give you some advice that can help you seek out support within your school. By having the courage to reach out to me, you have helped shed light on an issue that affects thousands of children and adults every day. (Yes, there are adults who are bullied. In many ways, we have created the concept of harassment to address this very issue in the adult world.)
Many people are unsure what to do when they are bullied. A few wrongly believe that they deserve to be bullied--or worse yet, that their bullies will stop once they make themselves as silent as a mouse or as invisible as a strand of hair. No one in this beautiful world should muffle their beauty, stifle their passions toward life, or alter their personalities in order to “persuade” a bully to let them live freely. This kind of living is not real. This kind of living is not alive. You deserve more. You are more. Hopefully, I can share some ideas with you that will slowly (and permanently) help you walk your own beautiful path. First, I will cover some ideas that swirl around education circles about bullying. Then, I have some uplifting ideas for you that have less to do with your bully and more to do with you. These are things that I want you to do for yourself. Why? You are more than just a person being bullied. You are a person, a being, and, to me, a friend. No matter what, I want you to love yourself for all that you give to yourself and the world. We’ll talk about your bully; but here, with me, this conversation is your show, not your bully’s. He or she does not own your thoughts or your joy. Don’t forget that. Ever.
Understanding why bullying happens (the short version)
Some people imagine a bully as a ten foot tall male who demands the lunch
money from a slightly younger schoolmate, or a kid who knocks someone’s
books out of their hands in a crowded hallway. While some of these
things may be forms of bullying, they do not have to occur for bullying
to take place. In fact, no physical contact at all can still count
as a bullying episode. People who call others by rude, insulting, or
even nonsensical names, threaten, spread rumors thorough school, or
exclude others could also be acting as bullies. In essence, bullies
exhibit a behavior pattern (often repetitive) where they intentionally
oppress someone else either in a physical or mental way.
This tells us what it is, but not why it happens. Believe it or not,
scholars are still not certain. Some people bully others as a way to
strike out against those less powerful than them because they are being
bullied by someone else—perhaps a relative or an older person in
their community. Violence sometimes leaves an emotional and physical
scar that a bully can only mask with more violence.
While there are some people who bully others because of peer pressure,
there are a host of others who learn their behavior from either society
or those around them. They ingest the best ways to resolve problems,
make friends, and force others to do want they want by mental or physical
force. What does this mean? That bullies have no specific gender, race,
class, or even popularity profile. All people could potentially be bullies.
So why isn’t everyone?
There is something inside many of us that rises to the occasion when we see trash on the sidewalk, a child wandering the park alone, or when we hear a racist or sexist joke. We don’t stand to the side, shrug it off, or pretend when something bad happens. We know that something is not right. We speak up. Too many people, especially at work and at school, ignore their internal radar of goodness and let things happen. Before long, a climate that accepts bullying is born. There is some strong evidence that suggests that the best way to eliminate bullying within schools is to create an environment where it isn’t tolerated—from the students down to the teachers. And the results are intriguing. People have started to claim their schools back. So, in no particular order, I want to list some of the things that can be done community-wide, school-wide, and finally on an individual level to eradicate bullying. I know this is a little more than you asked for, but this question affects so many people that I felt compelled to take this opportunity to help as many people as I can.
Community-wide:
1. Talk about it: You would be surprised what can happen once people
start talking about bullying in a global way. Too many people isolate
bullying to behavior on the school grounds. Communities need to create
community groups that deal with this head on.
2. Gather information: Communities should work with research centers in various industries to evaluate the types of bullying that might be going on. Some places have self-reporting mechanisms and even offices for harassment that do some of this. Unfortunately, some people have relegated harassment to the invisibility shelf.
3. Foster a supportive environment: Counter bullying behavior by fostering a spirit of community sharing and involvement so that members are not excluded or ridiculed.
School-wide:
1. Report bullying: Some schools have made reporting bullying easier
than ever by having counselors, creating questionnaires, and adopting
peer-groups that focus on bullying behavior. If you haven’t already,
you should seek out a friend, a trusted teacher, or a counselor and
share your concerns with them. Talk to others so that you aren’t
trying to carry this by yourself.
2. Educate the staff and students about bullying: There are curriculum packets and skits that are available that can educate parents, students, and teachers about the various forms of bullying and the ways that bullying can affect people.
3. It’s about everyone: One of the most effective things that a school can do is create an atmosphere where bullying and other forms of negative behavior and intimidation are dealt with by everyone. If one child is being bullied, in effect, the entire school is being bullied. This reminds me of a moment in a Star Trek film where Cpt. Kirk heads off with his crew to save Spock. While Spock was only one person, not saving him wasn’t an option since his needs were the needs of everyone.
4. Help everyone learn to deal with anger: Students, teachers, and parents can all learn new ways of dealing with anger so that the entire school community models positive energy giving, cooperation, and goodwill problem solving.
On an individual level (this information is for others too):
1. Stay safe in school: There are some spaces in school that are more
user-friendly than others. While I am not encouraging you to hide,
I am encouraging you to think about your safety.
2. Talk to others: You may think that you are alone in this, but you aren’t. Reach out to people and talk about what you are going through.
3. Forget about the bully: This is incredibly hard, but it is important. Live your life without the bully controlling what you do.
And, finally, for
you:
1. Live: I mean it. Live life with heart and faith and pride. Don’t
let anyone deny you the right to embrace the world as you know it.
2. Play: Often worrying about bullying and its aftereffects can make life one un-fun party. Claim your fun back.
3. Make healing friends: Nothing is more effective than surrounding yourself with good people. Having healing, helpful, supportive friends can give you the buffer you need and create the community you deserve—especially if your school or community is slow in reacting to this issue.
4. Create: Pour your emotions and energy into creative outlets. Try not to bottle your emotions inside. Let them out in artistic or other ways that can give you a way to re-focus your emotions.
5. Don’t blame yourself: You aren’t doing anything to deserve a bully.
6. Take self-help classes: You can take martial arts or other physical protection classes, but recognize that you cannot solve bullying with violence. If you do decide to take one of these classes, focus on the positive, life-channeling aspects of these defensive body skills.
To recap: There is no magic solution to bullying, and no sure-fire way to prevent people from oppressing others. However, there are some strategies that all of us can employ in order to create a positive, safer world.
Good luck, my friend. Remember, you are stronger than you think, braver than you believe, and more powerful than you can imagine.
At 20 weeks an ultrasound detected I have placenta previa and will have to have a c-section around 37 weeks. How can I make this experience less traumatic and more natural for myself and my baby? What effect could this have on our bonding process and getting breastfeeding off to a good start?
You have asked a very perceptive question. While many educators, activists, and mothers have become more and more vocal about the increasing number of what appear to be unnecessary cesarean sections, and the country becomes enamored with the latest craze of what I call fast food cesareans, one question often gets unanswered: How can those women who require the medical assist of a cesarean section still have a holistic experience? This question often gets buried under other questions that probe the rationale for so many births occurring through surgery. For those women who find themselves in need of this surgery, finding information about claiming the birth in the face of technology can sometimes be difficult. Your insightful question brings this issue front and center, and offers me a moment to speak frankly about a mother’s power, technology, and the way birth is viewed in an evolving society that often relegates women to the periphery of a majestic moment where they should be the center of attention.
I aim to give you lots of information tempered with grace. Why? I know the difficulty many women face when confronted with the option of a cesarean, and the rage others feel when they believe they aren’t given a voice in the decision. To you, and the other birthgivers out there, claim your mother power, revel in the sustaining energy of your body in growing your baby, and marvel at life. Many women facing a cesarean section focus on how they are to give birth rather than this: the technological assistance of a cesarean cannot and will not mother a baby, love a baby, or grow a baby. You (and all the other mothers and others who adopt, act as surrogates, and foster care children) do these things and more every day with much strength and wisdom. Never forget these truths.
What follows, then, are some practical, spiritual, and natural ideas that can help you stay centered and focused during a cesarean surgery.
Demystify the unknown
Women often go into a cesarean ill-prepared for the grit and reality
of surgery. In some ways, this is understandable. Many people, even
those fascinated with reality medical shows, have a hard time imagining
any of those procedures being done to them. Don’t shy away from
knowing exactly how this surgery is conducted. Talk to your practitioner
about all of the surgery specifics—from pre-op to the moment
you move to the postpartum floor. Learn what you can anticipate occurring
during the surgery, the things you can’t control, and what your
practitioner will do (as well as where—in general—he or
she will be throughout this time).
Try to understand your own body too. How do you respond to medication? If you have an epidural, how long will it be before you might need pain medication? Do you have any medical concerns that would make recovery more time consuming for you? What are your pain medication options—and how would any of them affect your baby?
Ask these and any other questions that come to you so that you—and the loved ones with you—can know your practitioner’s and the hospital’s procedures.
Stake your claim on this birth
At the hospital, and earlier with your practitioner, talk about how “present” and
focused you want this cesarean to be. Make it clear that you would like
to focus on your family, not on the surgery. In many ways, considering
a cesarean in this light places you and your baby (as well as any partner
you designate) at the center of this surgery. In truth, this focus should
be the only focus since a cesarean should be happening because of the
medical staff’s focus on the mother and her baby. The moment that
technology becomes the most important ingredient at a birth, mothers
and babies are forgotten. We don’t want this to happen to you.
Since you want a comfortable and supportive atmosphere, be vocal, but encompassing to medical staff. Let them know how much you appreciate their efforts in keeping your birth sacred. (Sometimes this gentle reminder is all an overworked, understaffed team needs to hear to rejuvenate their passion in birth.)
(FYI—Some women decide to enlist the services of a doula who works with women having cesareans for support at the hospital and in the weeks postpartum.)
Breastfeeding after a cesarean
Recent research into the effects of a cesarean on breastfeeding have
found two intriguing things: 1) mothers who have had a cesarean may
experience a small delay in their milk coming in (perhaps due to anxiety);
and 2) mothers who are rushed home following a cesarean may breastfeed
for less time. These two issues really showcase the reason why I have
been suggesting that you lessen your anxiety, find your mother power,
and place yourself and your baby at the center of this surgery. This
approach could lessen your anxiety level, and, in turn, help you to
breastfeed. Healing your body and taking the time postpartum to adjust
should also help you meet your breastfeeding goals.
Since you are a committed breastfeeding mother, I would suggest that you talk to a lactation consultant at the hospital about any specific ideas: perhaps things like positioning your baby for breastfeeding after surgery, the effects of an epidural and other meds on your baby, and the ways that you can practically breastfeed once home with relative ease.
Once home
Although your question does not address postpartum, I do have four last
pieces of advice for you once you are at home:
1) Take things slow and easy
You have just had major surgery. Let your body catch up. This includes
only letting people around you who can help you heal. Those who might
potentially impede your recovery should be asked (gently or firmly)
to come for a later visit once you are stronger.
2) Move
You will need to do this within hours after birth. It will help you immensely
although you won’t believe it at the time.
3) Focus on healing and cuddling
I can’t force you to do this—but your body will. It will
demand that you sleep, slow down, and rest—and will protest (loudly)
when you do not listen. Give yourself the care and attention you deserve
so that you can proceed with loving, nurturing, and cuddling your baby.
Good luck!
My 13-year-old son has all the symptoms of a depressed child but does not want to see a counselor for help. Should I force him to go, or respect his decision even though I know he is suffering?
Your question has a lot of layers to it. One part addresses how you would like to raise your child; the other points to how best to manage your child's mental health. Both of these are important things to consider since how you raise your son will affect his future development, and your son's mental health will forever affect his (and your family's) life.
Many parents, especially the ones I have met over the years, believe in a parenting philosophy that is often child-led or discovery-led in its intention and formation. Often, these parents engage in a particular relationship with their children, in which, each child independently moves through the world with parental guidance and support—not with parental dictatorship and enforcement. I "feela^?? elements of this in your question. In some ways, your inquiry shows how difficult it can be to balance discovery-led and independent parenting with the challenges before every parent of guarding and protecting their children within a world that often teeters on its own angry axis. This is a difficult concept to work through, but I have a suggestion in this situation. Your child's mental health is sacred. His mental health will affect more than just his life at this particular moment. How he handles stress, experiences new encounters, engages with people, works through difficulties later in life, and copes with an ever-changing world will depend (in large part) on the stabilizing forces of his mental world. Therefore, his mental health is something that you should safeguard—as much as you probably do his physical health. And you are not alone in this quest. The US Department of Health and Human Services estimates that there are between 4.5 million and 6.3 million children with serious emotional disturbances. With current studies showing that 1 in 5 adolescents have a mental disorder, the magnitude of the difficulties facing parents (and their children) cannot be overstated. Yet, for many, the question is how to help.
You stated in your question that your son does not want to see a counselor for help. Amazingly, he is not alone. Many adults are reluctant to talk to anyone for perceived mental imbalances due to stigmas within their communities or personal beliefs about those who are mentally ill. It is not clear to me why your son does not want to see a counselor; however, I can assure you that other types of support are available (depending on your location). Some children, once seen by a counselor (including a school counselor), may create a plan of treatment or service that includes group therapy, family therapy, or individual therapy. Some may even find diet, exercise, yoga, and other alternative therapies equally beneficial. What can be done to improve mental balance depends largely on the apparent cause(s) of the depression. Mental imbalances can have a biological or environmental origin. Biological origins include things like chemical imbalances; while environmental origins include things like exposure to toxic chemicals, stress, and violence in one's life. Before any effective treatment plan can be arranged, the source or potential sources of your son's depression needs to be found. Of course, I should say that drug and alcohol dependency are also on this list. I do not mean to frighten you—just to prepare you for this journey.
Your son's mental health is more than just a "thinga^?? affected by other things. This is who he is and how he views the world and his place in it. So, in answer to your question: Should I force him to go? No. But I would insist, gently and with love, that you look for answers to his problems. No teenager should ever have to suffer through life because we respect them too much to help them get better. He wants to live life (hopefully). Love him enough to help him do just that.
Featured Product
Advertisement
