Bed Sharing with Amanda Jansen

Wednesday, March 23, 2022

Bed Sharing with Amanda Jansen

Today we're talking about bed sharing with Amanda Jansen, who is a registered nurse and IBCLC. She has eight years of L & D and postpartum experience as a nurse.  (This blog is pulled from a The Birth Lounge podcast interview with Amanda Jansen.)

So let's start off with the basics. 

What is Bed Sharing? 

If you get online, you'll realize there's not a set definition. Just to make it clear bed sharing, obviously infants in the bed with you. Co-sleeping, you know, there's something right beside the bed, like kind of like an arms reach but not necessarily, you know, right next to mom.  And then there's room sharing, which could just be a crib in the same room with you.  So those are the three levels parents should be informed of, and then of course the independent sleep in a separate room, that a lot of families choose to do.

So a little bit more of my history. I did bed share with my first as a postpartum nurse, you know, I'm teaching parents, you know, the ABC's asleep. I was working in a hospital setting at that time and this was kind of around the time that the you could get a special initiative if you follow these five things, you couldn't have pictures of babies cuddling with a blanket in the hospital, because it was against this specific initiative. 

So we were kind of given this gag order where we couldn't share anything outside of the ABCs of sleep- alone on their back in the crib. I mean, there's other little things that have kind of been tacked on to that, to additionally decrease the risk. But when you're only given that, and you're in either that dire situation where you're like, so sleep deprived and you literally cannot help yourself to fall asleep with your baby. I think we've all done it, like, that's what happened to me.  I had my rocker and my nursery that I would get up and go to every three to four hours.  There are times where you start nodding off and you like look down and you're so thankful that you didn't drop the baby or the baby didn't fall into the crack of that oversized, plush sofa.  The American furniture industry was not made for baby.

How to Bed Share

Parents just need to know where to get good information. And that's the road I like to go on. So if you're going to do it there definitely are things that need to be put in place to make it safe. The number one resource that I like to send parents to is James McKenna's work.

So he actually has, you know, the mother-baby like sleep laboratory that where he's put babies up against mom, it's a monitored situation. They're monitoring heart rate, oxygen levels, respiratory rate, brainwaves, etc. He actually has some guidelines on there that you can print out and read through. But the main thing is sober parent. No drug use, no heavy sedating of like medications.  Baby needs to be termed. So preterm babies are definitely more at risk, because of the brain development. And there's so much that we still don't know about SIDS.

So we've got no alcohol use, no drug use, no sedation  medications. Then it needs to be like a primary caregiver. So mom, dad, both aware that baby's in bed.  Both parents have to be on board and agree.  Both parents should have a sense of awareness and not be incredibly deep sleepers.  Also, ideally,  until the infant is one, they should not be sleeping in a bed with an older sibling (who may be lacking awareness of their body while sleeping). 

There's a few other things.  Long hair needs to be tied back cause it could be a strangling issue.  Where your baby sleeps actually in the bed around the other adults in the bed matters as well.  Moms have an instinctual position, it's been coined or termed the C hold (knees are at an angle and you kind have your arm around baby).  They're snuggled in that perfect little spot that our bodies were made to either breastfeed or sleep in, So it really just depends on bed size, size of the parents- what you feel comfortable with. 

Also, a lot of parents  don't want to put your mattress on the floor, so that's another thing. Getting the mattress off a platform in case the baby would roll off as they get a little bit bigger.   You also then want to avoid any type of gap or crack  against a dresser or a nightstand or something that could entrap baby and fixate them. 

If we do it appropriately - no heavy bedding- then you can still sleep with a pillow, you can still have a light blanket on the lower part of your body. I personally like to sleep with just a nursing bra, because loose clothing is just another thing to factor in. So just removing all those things that you can control and knowing what to look out for.

It is also really important to say babies should still be on their back when they're in bed. 

You know, as an IBCLC, I saw moms, you know, they went back to work, either babies, you know, maybe. Started eating less during the day because the bottle refusal, and then their babies were cluster feeding, you know, at night. And they were either going to wane altogether or, you know, they were dragging their tired bodies, you know, to a nursery, you know, three, four or five times a night.

And it just was not, it's not sustainable. And so that's where I think that. Yeah, implementing the safer steps if you choose to continue to breastfeed should be a valid option. I wasn't able to really give that to parents in the hospital setting. So that is what I do now in my private practice.

I bring the information. Parents make that decision for them and their family. 

How about swaddling? 

It's not recommended that they be swaddled. Being against another human is so much more subtle in bed sharing space. So it's not recommended that they are swaddled, they could be in a sleep sack if you want their feet contained, but their arms actually should not be restricted.  They get the same sensory input. It just is in a different way. 

Can you bed share no matter how you feed?

We should be exclusively breastfeeding. I think a lot of people are trying to work on breast milk and bottle being the same.  However, if you're waking up and doing a bottle versus a bottle of breast milk versus feeding directly at the breasts, but it gets a little tricky because while it may not impact baby as much, just that mom baby connection, the slight hormone adjustments, and just the awareness of breastfeeding mother has it is slightly different.

It is specifically with James McKenna and his recommendations.  It should be breastfeeding mothers. And he's actually coined the term breast sleeping, so it should just be exclusively milk from the breast. 

Sleep Deprivation 

Sleep deprivation can cause so many issues. If you want to start going down the maternal mental health route it's huge.  There are some instances where we need to be more careful if you were to that point where you just cannot even carry a conversation, you are so tired.  That's probably not the time to start bed sharing. That's what I would call in your outer resources. Bring baby to you to be fed, overnight care, etc. 

Sleep deprivation will absolutely impact your healing too. So I think if you're in a bind and you know, maybe a doula isn't within your means to have, have your partner get up and go get your baby and bring them to you. 

It's also an option for you to set up camping your baby's nursery. Reduce the amount of time that you spend out of bed in a awake yeah, sleep deprivation is huge.

So just to set the scene for everyone, some of the benefits of not having to get out of the bed is, you know, let's say you're laying in bed with your baby bed sharing and they start to wake because they're hungry. You don't get out of bed. You don't have to turn on the light. You don't have to get really situated.  You just get situated enough to get a boob in their mouth and they're already on their back. You keep it dark. So you don't you know, you don't kind of get your baby more. Awake than they really need to be. You don't have to get more awake than you really need to be. 

It's just easier. 

Seek out the information and seek out the resources. If something just intuitively does not feel good for you. You can find what works for you. Feel free to take and choose and leave from all the options that you know, to make up your own equation.


Follow along with Amanda:

@midwestmamacollective

Website is Midwestmamacollective.com

Email is hello@midwestmamacollective.com

MTHFR Gene Mutation and Pregnancy

Wednesday, February 23, 2022

MTHFR Gene Mutation and Pregnancy


Every human has the gene known as 5-Methyltetrahydrofolate, but a significant percentage of humans have a mutation of that gene, simply known as MTHFR Mutation. MTHFR mutation boils down to the body’s inability to break down folate. Folate is imperative to the process of making DNA and modifying certain proteins as they relate to DNA. When looking closely into MTHFR, we find that people with this mutation have high levels of homocysteine. Homocysteine is the amino acid produced when proteins are broken down within the body. This high level of homocysteine can lead to arterial damage and blood clots. Hand in hand with this elevated homocysteine level, we find both a folate and vitamin B-12 deficiency. MTHFR mutation is hypothesized to affect 25% of hispanic people and 15% of white, and is likely to affect 40% of the overall population according to the genetic care and rare diseases information center. This mutation is not a random occurrence, in fact it appears to be passed through genetics only, meaning it is very hereditary.

So how does this gene mutation affect pregnancy? Well, the entire answer to this question is still cloaked in uncertainty, but here is what we know. The first clue that may prompt a Dr. to test for the mutation is recurrent miscarriages. However, it is important to note that at this time there is no solid evidence that MTHFR is at fault for these miscarriages. It is anecdotal evidence we have collected in caring for these individuals, but has not been officially studied and scientifically proven. It is hypothesized that these miscarriages could be the result of irregular clotting factors that come with the mutation, as these clots can form within the placenta and interfere with proper development. Alongside the potential risk of miscarriage we find heightened risk for Pre-eclampsia, neural tube defects, spina bifida, anencephaly, and of course blood clots.

Treating pregnant patients with MTHFR mutation has no hard and fast rules. Many Drs may recommend nothing more than a daily aspirin and folate supplement, while others may recommend a similar regime in combination with heparin or lovenox injections through to the second trimester. In patients with a history of blood clots, these shots may be recommended throughout the entire pregnancy and up to 6-8 weeks postpartum. Extra testing and scans may also be recommended as MTHFR gene mutation brings about an increased risk of preeclampsia, neural tube defects, blood clots, preterm birth, and spina bifida. For patients that use lovenox injections, it is recommended that they be replaced with heparin injections at roughly 36 weeks gestation. This is due to the blood thinning factor that can lead to an increased risk of postpartum hemorrhage. In fact, the risk for hemorrhage goes up to 12% in the event that you have been injected within the 24 hours prior to the onset of labor.

The MTHFR gene mutation is still largely a medical mystery. The lack of concrete evidence means that your treatment plan should stay an ongoing and in-depth conversation with your birth team throughout your pregnancy. Remember that you are in the driver’s seat of your pregnancy, labor, birth, and postpartum. A treatment regimen that feels safest to you is imperative to a happy, healthy pregnancy.


Resources:

No Scientific evidence to link miscarriage to MTHFR is broken down here https://www.medicinenet.com/can_you_get_pregnant_with_mthfr_gene_mutation/article.htm

The study discussing the risk of postpartum hemorrhage when actively using lovenox injections 24 hours or less before labor- https://pubmed.ncbi.nlm.nih.gov/22475315/

This blog was written by a former Tranquility by HeHe team member.

Cesarean Section Recovey

Wednesday, February 9, 2022

Cesarean Recovery


No matter how we bring our children into this world, our bodies will have some healing to do. Bringing a baby earthside is physically taxing, and involves so many different systems of the human body. In the case of cesarean delivery, there are a few more steps added to the recovery process. We tend to neglect these steps when leaving the hospital, but it’s important to know what tools are available in your recovery toolbox. Here are the five most impactful tools that ensure a faster and more complete recovery.

Walking- After surgery your epidural or spinal will be removed and over the next few hours the numbness will begin fading away. While you may leave the OR expecting to take it as easy as possible, you will quickly find that the first task on your “to-do list” is getting up and taking a walk through the hospital corridor. While this can be painful and feel like it adds insult to injury, ambulation is imperative to proper recovery. Why? Because it is the action of walking that jumpstarts our body’s routine functionalities. Walking as soon as possible after surgery, and continuing to take several short walks around your home each day encourages proper blood circulation, decreases the risk of blood clots, disperses any built up gas and the pain that it may be causing, has been shown to lower the need for narcotic pain relief, shorten hospital stay length, and ensures that the muscle movements of your digestive tract begin working as soon as possible which will lead to less constipation and discomfort throughout the coming weeks.

Proper Nutrition- Several studies have tested the efficacy of enhanced recovery after surgery pathways (ERAS). These pathways include measures such as decreasing the amount of time patients go without food and drink, encouraging early mobility as we covered above, providing regional anesthesia, etc… One pathway found to be very helpful is not only a proper nutritious diet both before and after surgery, but also ensuring limited interruptions to that diet during the pre and postoperative periods. Keeping fasting to a minimum has shown to have many benefits. These benefits include reducing pain levels, stabilizing blood sugar, and reducing tissue hypoxia. Because of these benefits the American College of Gynecology (ACOG) has encouraged providers to use this pathway. It is now recommended that liquids in moderation should be encouraged up until 2 hours prior to surgery, and instead of no food by mouth policies starting 12 hours prior to surgery it has been decreased to 6 hours. Food and drink is encouraged between two and four hours postoperative.

Abdominal Binders- Abdominal binders are one of the most underutilized recovery tools in the post cesarean (post birth) toolbox. While not widely studied, there are small randomized case studies on their benefits. In a study of 89 patients, all with similar hemoglobin and hematocrit levels, it was found that the group of participants that were given abdominal binders not only had better hemoglobin and hematocrit levels at 36 hours post surgery, but they reported lower pain levels as well. Binders are also instrumental in supporting the return of postpartum abdominal muscles to their original placements. While all mothers will experience some degree of Diastasis Recti, binders can prevent this muscle separation from advancing, and help close the gap overall.

Pain Management- Unfortunately cesarean recovery can come with a great deal of pain. Bending, standing, walking, and even turning over in bed can become difficult tasks even with pain medications, let alone without. Because of this, pain management is one of the most important parts of a proper recovery plan. Not only does adequate pain management keep the patient in a certain level of comfort, It will reduce the overall length of opioid usage, shorten the length of hospital stays, aid in returning to normal functionality, lead to a higher level of maternal satisfaction, which in turn effects breastfeeding, bonding, and postpartum mood. While opioid usage is still the most effective and most common form of pain management, there are local anesthesia options being used in select hospitals that can deliver lidocaine or marcaine directly into the incision. One form of this is known as the ON-Q pump. This small pump delivers numbing medication to the incision site through a small catheter placed within it. These pumps will be sent home with you, and will last an average of three to five days post-op. Afterwards it can be gently pulled out of the incision. While this sounds scary, I assure you from my personal experience that it does not hurt, and in fact is hardly even felt. This mode of pain management is not available at all hospitals and it may be worth inquiring about prior to settling on a birth location. These pain management options may not entirely cut out the use of opioid pain relief, but it is likely to decrease the amount needed and the length of use.

Birth Processing- In many cases, a mother may have arrived on the OR table after a scary or confusing turn of events. The fear of getting to the OR and the fear of Being in the OR can bring about a trauma response, and this may affect her overall feelings about her birth even after that fear has passed. The mental health aspect of birth is overlooked across the board, not just with cesareans, but we commonly see trauma based mental health issues arise after traumatic births. Having access to proper therapies and a support system in place is vital to the postpartum experience. Without these we may see this trauma develop into a myriad of postpartum mood disorders which can leave long lasting impacts in the life of mom, baby, and family. Without mental health, there can be no physical health.

Resources:
This blog was written by a former Tranquility by HeHe Birth Doula.

The Truth about Glucola Alternatives

Wednesday, February 2, 2022

The Truth about Glucola Alternatives


What is gestational diabetes and how do we diagnose it?

Gestational diabetes testing is a routine screening that almost all pregnant parents will encounter around 26 weeks gestation. To get the big picture of why we screen for this we should discuss how the pregnant body metabolizes sugar in comparison to a body that isn’t pregnant. So let's dive in. When we eat carbohydrates (think bread, rice, pasta) our bodies break them down into glucose. This glucose is what gives us energy as we go through our day, and it is aided by insulin, a hormone produced by the pancreas. Insulin is also capable of turning excess glucose into stored fat. So how does this differ from how glucose is metabolized in a pregnant body?

Think of hormones as the catalyst for nearly all bodily functions. Hormone levels in pregnancy are wildly elevated, and these higher hormone levels can actually impede the body’s ability to use insulin as efficiently. We refer to this as insulin resistance. In some cases our bodies may need up to three times the amount of insulin to metabolize the same level of glucose. These changes are normal and expected in healthy pregnancies. However, when we see the body producing that extra insulin and still not being able to metabolize the body’s glucose level, we deem that too insulin resistant and often diagnose the mother with gestational diabetes.

So how do we carry out this screening?

The glucola drink, often marketed as fruit punch or orange juice flavored, has spanned the nation far and wide and become readily available in all maternity care offices. This drink, containing 50mg of dextrose, a sugar derived from corn syrup, along with citric acid, food dyes, brominated soybean oil, and modified food starch has been considered as harmless for many decades, but have recently come under scrutiny because of both its heavy amount of dyes and the brominated soybean oil. Food dyes have long since been discovered to be less than great for the human body, but the brominated soybean oil being both banned in Europe and marketed as a flame retardant, has parents searching for alternatives. Thankfully to a handful of recent studies, they haven’t had to look far.

What are the alternatives?

In 2014 a small study looked into switching glucola for strawberry flavored hard candy and found that not only did the candy alternative test, sensitivity wise, the same as glucola, it also lead to a lower false positive rate. This study deemed that any sugary food or drink that contained 50g of sugar could be a safe and reliable alternative to the typical glucola drink that so many providers still push. As these findings are being further studied and confirmed we have seen the options expand to things like pancakes with syrup, a handful of jelly beans, and orange juice. The lower rate of false positives has also been noted to be supported by the differing rates of gestational diabetes diagnosis among the US and other developed countries. In many European countries, these alternatives have been part of standard care for several years. A group of nearly forty studies found that Europe’s rate of GD diagnosis is roughly 5.4% of pregnant parents. Whereas the US, still widely using glucola, has a diagnosis rate of 10%. While these studies support this hypothesis, it should be noted that they did not include the varying rates of obesity amongst these countries in their publications which may skew the numbers slightly.

One option for some parents is a relatively new product known as Fresh Test. This drink is marketed as gluten free, vegan, is free of artificial dyes and flavors, and carries the same 50 gram sugar load that glucola carries. One major plus of this product is the short and concise ingredient list. Included in this list are citric acid, lemon oil, lemon juice, and organic peppermint leaf powder, but it is worth noting that it still contains dextrose just as glucola does. While marketed as gluten free and vegan, it is produced in a facility that handles wheat, soy, tree nuts, peanuts, eggs, milk, and shellfish. For many parents, this product may be a perfect alternative to traditional glucola. However there is a dye and flavor free version of glucola should you prefer that.

Opening the conversation

While this article has no intention of standing in as medical advice, it is meant to inform you of your options and encourage an open conversation between you and your provider about whichever screening method feels most aligned to you and your baby. That said, we understand that having these conversations can feel scary and intimidating. So let's take a moment to lay out a few ways you can advocate for your preferences. These conversations can happen whenever and wherever you are comfortable. If you go into pregnancy knowing you won’t be utilizing glucola, you are welcome to have this conversation as early as your first prenatal appointment. Or maybe you plan on waiting until closer to when you’ll do the actual blood test. The call is always yours! Here are a few examples of how opening this conversation can look:

You: So I understand that this office mainly uses glucola for gestational diabetes screening. However after looking at the research I’ve decided that I’d much rather use one of the alternative methods, such as a juice cocktail, a sugary breakfast, or the FreshTest beverage. Is there an alternative that you prefer over the others?

You: I know that my glucose test is coming up very soon and I wanted to take a moment to ask you a few questions. Your knowledge is valuable to me and I’d like to consider it in whatever decision I make pertaining to this test. I have been reading a lot about glucola alternatives, and after looking at the ingredient list of glucola I am really leaning towards choosing an alternative. I know you may prefer your patients to use glucola, but since that doesn’t feel aligned with my needs I’m hoping you can advise me on which alternative you think would be most reliable.

From here, there are two outcomes. Your provider will either pushback, or they will engage in a conversation and offer their opinion. Let’s take a moment to discuss why we might see pushback. First and foremost, Drs can be creatures of habit just like the rest of us. Perhaps they’ve been practicing for forty years and glucola is the only thing they’ve ever used. Letting go of something that feels so reliable might feel counterproductive to them. Or maybe they haven’t read the research. We tend to forget that continuing education requirements for physicians are abysmal and can be used for holistic specialties such as acupuncture. It’s entirely possible that a dr just hasn’t read the research. One of the biggest reasons we see pushback is because many Drs have doubts about the reliability of putting such a test in the hands of the patient. Human error seems to be a large concern among physicians. Handing a patient a 10 ounce bottle of perfectly portioned and formulated glucola seems so much more reliable than a patient with a plate of pancakes and a bottle of syrup. Let’s take another minute to explore what the conversation might look like after a bit of pushback.

Doctor: I know there has been some nuance around glucola, but we use it because it is reliable and it yields the most accurate results. I know there’s a lot of stuff on the internet that can make it seem bad for you, but it’s no worse than a soft drink.

You: I understand. I know it’s been around a long time and I thank you for explaining why you recommend that I use it, but it just isn’t aligned with me so for right now I am giving my informed refusal for glucola, but I would really like to know which alternative you recommend. If at any point I test high for blood sugar, we can revisit this conversation then. I really appreciate you taking the time to give me your feedback.

At the end of the day, it’s important to know that your care is always squarely in your hands. While some providers may push for glucola, it’s ultimately your hands that will put the bottle to your mouth. What’s in that bottle or on those pancakes is entirely up to you. What is most important is that whatever choice you make is informed, and aligns with your needs. While providers may have a preference, if that preference doesn’t match yours? Well, informed refusal is your right.

Breech Birth

Wednesday, January 26, 2022

Breech Birth

Breech birth is a variation of normal. Hopefully you’ve heard this before, but oftentimes parents carrying breech babes are met with dead ends and discouragement that leaves them with the idea that their baby or body hasn’t done its job properly. Before we go any further, allow me to repeat myself. Breech is a variation of normal, occurring in 3-4% of term pregnancies. Breech fetal presentation means our body, which has answers no text book can teach us, has chosen this position for reasons we may not understand. Remember, things are not inherently bad or dangerous just because we don’t understand them. It just means we have knowledge to gain.

What’s important to know is that vaginal breech birth is absolutely possible, and not only that! Vaginal breech birth, when properly supported, can be totally safe. While many providers may push a planned cesarean, you have the right to decline.


The Safety Factor

If breech presentation is normal, why are discoveries of Breech babies met with a frenzy of ECV conversations, cesarean planning, chiropractics, and desperate attempts to flip Baby head down? Allow me to be realistic with you. When a breech baby is born vaginally, there are some risks. In most cases these risks do not outweigh the risk of a major abdominal surgery, but they are there. Having a head down baby does alleviate some of that worry and in all cases, lower risk means safer. If we can encourage baby to flip, let’s do it! So what are the risks? The hot topic risks we hear of are cerebral palsy and neonatal mortality. A study published in 2017 looked into these risks and found that vaginal breech birth showed no variation in cerebral palsy rates in comparison to head down vaginal birth. However, it did find an increase in rates of neonatal mortality. While a sure increase was noted, the increase is marginal in comparison to neonatal mortality rates in breech cesarean birth. The risk of fetal demise in a head down vaginal delivery is 0.3 per 1,000 births. The risk of fetal demise for breech cesarean is 0.8 per 1,000 births. The neonatal mortality rate for vaginal breech birth? 0.9 per 1,000 births. 

Another risk of breech birth is umbilical cord prolapse. This occurs when the baby’s body compresses the cord against other structures within the womb and in some situations the cord may even slip into the birth canal. Umbilical cord prolapse is considered an emergency. When the cord is compressed, it reduces, or entirely cuts off the flow of blood and oxygen being delivered to your baby. If not addressed quickly, this event can lead to fetal demise. It is important to note that umbilical cord prolapse is a risk even in head down deliveries, and can be the result of too much amniotic fluid, water breaking before labor begins, you have a low lying placenta, or you have a small baby. 

The bottom line? Breech birth comes with risk, but with proper support these risks can often be managed and avoided.

The Education Factor

Another reason we meet breech discoveries with attempts to flip baby is because a majority of providers refuse to vaginally deliver a breech baby and instead immediately push parents to consent to a cesarean. If asked why they recommend this, they will cite the risks we discussed above. Here’s what many won’t tell you- 1. It comes down to liability over patient satisfaction and 2. They don’t know how to deliver a breech baby. Why? Because they were handed a license to practice medicine without ever having to learn how to handle and deliver this totally normal and often safe fetal presentation. This fact is disparaging when you put it into perspective. We entrust obstetricians with our entire pregnancy, our well-being, and our baby’s well-being. They are supposed to be the experts, yet here they stand before us scheduling us to have a major abdominal surgery because they don’t possess this very basic knowledge. What a broken system it must be to have experts who lack expertise. In fact, it’s midwives who are most often taught how to deliver breech babies, while a majority of obstetricians continuously fall short on the knowledge.

The Options

Let’s say you get the news that your baby is breech. What are your options? Thankfully you have a few. First and foremost we always try to start with the smaller things and work our way up to the larger ones. Safe sitting is always a great starting place. Things like ensuring that your belly button is always parallel to the floor, sitting on a birth ball instead of an office chair, etc… We have a great safe sitting guide you can find here. Along with safe sitting we use spinning babies to help make enough space to encourage Baby to flip. From there we might do moxibustion, acupressure, chiropractic work, etc… If all else fails we may explore the option of an external cephalic version (ECV). An ECV is a procedure where your provider will manually turn your baby from the outside by pressing against your belly. 

In the event that you have decided to vaginally deliver regardless of how your fetus is presenting, you can skip right to finding a breech educated provider, as well as a breech educated doula, and work on a plan of action with them. It may be that some parts of your dream birth plan can’t work out, but with the right provider and doula you can and will maintain a sense of control over your birth. All in all, breech presentation is a hiccup, but it most definitely doesn’t have to derail your entire birth, and it certainly doesn’t mean your baby or body are broken.

This blog was written by a former Tranquility by HeHe birth doula.

Guide to Galactagogues

Wednesday, January 19, 2022

Guide to Galactagogues

Chances are that if you’ve ever had a baby, you’ve faced some of these agonizing anxieties: am I making enough milk?, is my baby getting enough milk?, is my baby gaining weight properly?, etc… While these questions may or may not be unfounded, we’ve all spent time wondering where we even start to look for answers.  Thankfully the options are plentiful, from basic body mechanics, to herbal support, all the way to off label prescriptions. So let’s die in and review the risks, benefits, and the mechanisms that make them effective.

Body Mechanics

Before jumping headfirst into costly supplement regimens, consider making an appointment with a recommended lactation consultant, or purchasing a scale for doing weighed feedings at home. This involves weighing your naked infant just before a feed and just after a feed. The increase in your baby’s weight will reflect how much your baby has eaten. Being able to visually see that your baby has taken in three to five ounces in a single feed may help calm your anxieties. Other emotional physical adjustments include skin to skin, breast compression during feeds, wearing loose fitting bras, shirts, and tank tops, and more frequently offering the breast. These simple adjustments can make breastfeeding not only more effective, but more comfortable. Comfort is a major part of breastfeeding. To produce adequate milk we need hormones like oxytocin and prolactin to be excreted which trigger milk production and flow. In situations where we feel physical, mental, or emotional discomfort, our bodies are more likely to excrete stress hormones. Stress hormones will always impede milk production and flow. Restricting breast tissue with too tight bras or clothing also signals to the body that it doesn’t need to produce as much because the ducts are confined and unable to transfer milk as easily.

Lactation Diet

Let’s say adjusting body mechanics shows some improvement, but the boost didn’t quite get you over the hill. Now would be a good time to look into dietary additions. Oats, brewer’s yeast, raw nuts, and leafy vegetables are all wonderful options for supporting and increasing milk flow. Adding brewer’s yeast and oats into a cookie, brownie, or breakfast bar recipe has shown great success and comes highly recommended. Just be sure that you’re maintaining a healthy sugar intake. It is entirely possible to incorporate these items into low sugar options as well. Brewer’s Yeast is hypothesized to be effective because of the many nutrients it can replenish in a nursing parent’s body. These nutrients include Vitamin B, easily digestible proteins, amino acids, and chromium. All of which support milk production. Fair warning though, many have reported uncomfortable gas, bloating, and headaches with the routine use of brewer’s yeast. Similarly, oats support lactation with their high source of iron. This super food can be especially helpful if you experienced excessive blood loss during or just after delivery. Oats are also thought to lower stress levels based on its hot and soothing nature. Unless you’re gluten intolerant, there are no reported risks of using oats to boost supply.

Herbal Boost

Herbal supplements are where we tread lightly until footing is sure. Not only can supplement regimens be costly (though arguably worth it if they work),they each affect individuals so differently. Where one person reports incredible results with fenugreek, another reports decreased supply and horrible digestive issues. Of all the herbal supplements, we’ll go over the most popular ones.

Fenugreek: Fenugreek is a plant that has white blossoms, stands about two feet tall, and its blooms contain small golden seeds. The seeds are what we’re after. While studies as recent as 2018 ensure its efficacy, this herbal supplement comes with a long list of side effects that are responsible for its recent decline in use. These side effects include diarrhea, gas, an off putting maple syrup smell, fussiness in baby, and even low blood sugar. While not everyone will experience this, it is widely reported. It’s also important to note that researchers still aren’t entirely positive why fenugreek works. The hypothesis? The plant contains phytoestrogens which closely mimic human estrogen and this supports the production of prolactin. It’s unknown mechanisms and long list of side effects make this supplement one you should tread lightly with, but not one you have to cross entirely off the list. If the side effects of fenugreek prove to be intolerable Milk Thistle is a very similar supplement with less side effects that may be worth looking into.

Fennel: Fennel is similar to fenugreek in the way that it contains natural estrogen like properties that raise prolactin levels. While it’s unlikely that fennel alone will raise milk levels quantifiably, when used in combination with other galactagogues it does seem to show improvements. However, fennel is a rather finicky herb and carries some rare, but worth mentioning risks. In some cases parents with a history of seizure activity may want to avoid the use of fennel as it has shown to increase the risk of seizure. Many babies that drink milk boosted with fennel may be more likely to fall asleep at the breast as it tends to make babies a bit more drowsy. Finally, fennel also carries a risk of lowering blood sugar which should be weighed carefully by parents with a history of hypoglycemia or other metabolic conditions. All in all this herbal supplement is likely a safe option for increasing milk supply, though taking too much fennel has shown to decrease milk supply.


Goats Rue: Goat’s rue is a personal favorite of mine. As a mother with insufficient glandular tissue, I saw so much improvement with this supplement because it doesn’t just work as a prolactin boost, it facilitates the growth of new breast tissue! Goats rue is a plant related to the pea family and has shown many lactation benefits. Particularly useful for parents that have insufficient glandular tissue, previous breast surgeries, are trying their hand at relactation, or are simply just seeking a general boost in milk supply. Unlike the supplements above, goats rue has actually shown to stabilize blood sugar as well. However, goats rue should NEVER be ingested as a fresh plant as it is very toxic and considered poisonous in its live form. Skip this one when you plant your garden and leave the formulation of this supplement to reputable sources.

Off-label Prescription Use:

The use of prescription medication for low milk supply most certainly isn’t new, but you may want to regard it as a last ditch effort. While these medications have shown promise, not all of these medications and their long term effects have been thoroughly researched. This is not to say that prescription medication should be avoided altogether, but more so to stress that the decision to use them should be a highly informed one. The medications most commonly used for milk production are considered dopamine antagonists (like Domperidone and metoclopramide), anti-psychotics (like reserpine, sulpiride, and thioridazine), and medications that work with blood sugar and the pituitary gland (like metformin). Of these medications we will cover the two most researched and most common, domperidone and metformin.

Domperidone: This medication was developed for the treatment of nausea and stimulation of movement within the gastrointestinal tract. Throughout its on-label use it was also found to raise dopamine levels in the brain and in turn it raises prolactin levels. Soon this medication was being prescribed for the off-label purpose of increasing milk supply. This medication has been, and is currently, a widely researched medication for this use. However, side effects of this medication include breast tenderness, galactorrhea, itching, breast enlargement, dry mouth, and menstrual irregularities. Increased milk production will usually be noted within 48 hours of use and is generally considered safe.

Metformin: This prescription shows milk production improvement in a particular group of people and will not be for everyone. For parents with a history of polycystic ovarian syndrome, gestational diabetes, diabetes, and general insulin resistance metformin may be particularly helpful as it helps stabilize the pituitary gland and the hormones it secretes and creates more consistent levels of blood sugar. Hormone regulation is a paramount part of breastfeeding. Without this the production of milk will be inconsistent, and oftentimes insufficient. If you have concerns with your postpartum hormone levels and how they’re impacting your breast milk production, it is always worth running a blood test to check these levels and addressing them from an individual aspect.

But, what if that doesn't work?

If you’ve found yourself reading this article you’re likely sitting in so much uncertainty. You could try every single thing on this list and still struggle with low supply. First, it’s okay to keep trying. If exclusive breastfeeding is your goal, keep going.  It’s also okay to protect your mental well-being and decide that breastfeeding isn’t something that aligns with you anymore.  Second, I want to tell you breastfeeding is not an all or nothing sport. You don’t have to regard formula as the enemy. Low supply doesn’t mean you won’t ever be able to breastfeed. It means you may need a little help. That can mean that help will only be needed for a couple weeks, or maybe you and formula will team together to keep baby thriving and also maintain the bond of breastfeeding. 

With low supply can come feelings of failure or resentment towards your own body. Put that burden down and listen for a moment, the fact that you’re here reading these words is proof of what an incredible parent you are. You’re not giving up at the first sign of struggle, you are here making a ten mile list of vitamins and recipes, you are here learning about the plants and herbs that might help your body produce more and more, you are here reading through side effects and likely thinking “I can deal with that if it helps my supply enough”.  How lucky your baby is to have such a dedicated and determined parent. Try to be gentle with yourself.  Thank your body for all it’s doing for both you and your child. 

This blog post was written by a former Tranquility by HeHe doula.

Tearing in Birth - What is the Norm?

Wednesday, January 12, 2022

Tearing in Birth: What is the Norm?

If there was ever one hill almost every doula would die on, it would almost certainly be that episiotomy and tearing are not by default, a normal part of birth. While episiotomy is blog for a different day, now is the perfect time to dive headfirst into perineal tears, labial lacerations, and everything in between. Let’s discuss why they occur, how to prevent them, how to know how severe they are, and how to heal them.

When we think about tearing during childbirth, we often jump to thoughts of torn perineums, but the truth is that tears can affect almost every part of the vagina and vulva. Each tear comes with its own set of challenges, and some are more avoidable than others. However, no matter the location(s) of your tearing, healing will require care, delicacy, and kindness towards yourself.

  • - Perineal Tearing: Tearing of the perineum is the most common and widely discussed area where tears take place. This is the tissue located between the vaginal opening and the anus. These tears are typically graded in degrees, which we’ll dive into in a moment, but generally the less tissue/structures involved the lower the degree. The perineum is the area of the vagina and vulva that stretches the most as your baby descends down and out of the birth canal. In cases of natural, physiological tearing your perineum will be the area most affected.
  • - Labial Tearing: Labial lacerations are far less common than tears in the perineum, but are seen most often in situations where an episiotomy is performed, a birth is instrument assisted, or a baby is born quickly. While these tears are easily repaired with a few stitches, it’s not uncommon for doctors to leave them to heal naturally, or even miss them entirely. In many cases these tears may leave behind a slight deformity. These deformities can be fixed with reconstructive surgery in most cases.
  • - Periurethral Tearing: Periurethral tears are tears to the tissue around your urethra, the tube that drains your bladder. These tears are often superficial and only require stitching if they bleed freely. Because these tears don’t involve muscle they typically heal faster than perineal tears and typically heal without complication. These tears are most often observed when a baby is born face up, also known as sunny side up.
  • - Clitoral Lacerations: While the thought of having your clitoris tear is admittedly worrisome, rest assured that these tears are rare, occurring in an estimated two percent of births. Similarly to periurethral tears, clitoral tears are observed more often when a baby is sunny side up. They can also be the result of instrumental or precipitous birth. In most situations clitoral tears will heal within one to two weeks.

Perineal Tears and their Degree

To rate the severity of perineal tears we use a 1st, 2nd, 3rd, and 4th degree rating system. These degrees relate to the depth and involved structures affected by the tear. For example, a first degree tear is considered a “graze” or “skid mark”. They affect only the top layer of skin and often won’t require any stitching. A second degree tear will affect the skin, and some of the muscle in the perineum. Second degree tears will require a few stitches to heal properly. A third degree tear refers to a laceration that affects the skin, muscle of the perineum, and extends into the anal sphincter muscle. Third degree tears will require stitching and may be done in an operating theater. Finally, fourth degree tears refer to tears that extend all the way into the lining of the rectum. Stitches will be required, as will some level of reconstructive work. Complications of third and fourth degree tears can include scar tissue buildup, fecal incontinence, and pain with intercourse.

How To Prevent Tearing

Before we talk about preventing tears, we should talk about why they sometimes occur naturally. The obvious answer? While your birth canal can stretch up to three times it’s typical size, it takes a little work to get it there. Is tearing sometimes part of physiological birth? Absolutely. Does it happen 100% of the time? Absolutely not. Here’s how we can work with our body to give it the best opportunity to birth your baby without tearing.

  • Perineal massage: This massage technique involves the use of your or your partner’s fingers to gently stretch and mobilize the tissue just inside the lower wall of the vagina and the tissue between the vaginal opening and the anus. These gentle stretches prepare the perineum to expand and mold around the shape of your baby. Always start with clean hands, use a warm lubricant like grape seed or olive oil to lend more moisture and hydration to the tissues so they can stretch more freely, and build up the intensity of the stretch slowly.
  • - Avoid pushing on your back: In order for the vagina to expand to three times its size, we have to give it the room to do so. Pushing on your back can close the pelvis by up to 30%, which will in turn impede the birth canal’s ability to fully expand as your baby passes through. Pushing in a side lying, hands and knees, or even squat position removes any outside pressure that could close off the pelvis and will in turn greatly reduce your chances of tearing.
  • - Say no to purple pushing: You’ve probably heard the phrase “ring of fire” in relation to the moment your baby begins to crown. It can often be instinct to forcefully and quickly push your baby through in attempts of shortening the time spent with that sensation. This is an almost sure path towards a third or fourth degree year. In parents who have gotten an epidural, providers may use purple pushing, or coached pushing.To learn how to push with your body instead of against it, check out The Secret Sauce to Pushing. This is another sure path to severe tearing. To combat this instinct or coaching technique, we say “blow out the candle”. As your baby crowns, the sensations will build until they seem bigger than you. This is when we tell you to blow out short small breaths, as if you were blowing out a singular candle. This pause in pushing will allow more time for the blood flow to rush to the surface of your tissues which allows them to stretch more. The more blood flow, the more expandable.

How To Heal A Tear

While most tears will heal within four to six weeks, they still require care in order for them to heal well and bring about the least complications. Avoiding any further trauma to the area is most important. Instead of wiping with toilet paper as you usually would, try using a peri bottle to cleanse the area and gently pat dry. Sitz baths come highly recommended as they can increase blood flow to the area which in turn soothes the affected area and promotes a quicker healing process. As your tears heal they may become itchy and tender. Using something like dermoplast spray can relieve the itching and tenderness you encounter as you heal. Monitor the area for any signs of infection, such as a green or yellow discharge and/or a strong foul smell. If you begin to think you may have an infection, touch base with your provider right away.

Tears Happen

In closing, it’s important to understand that tearing naturally is sometimes part of physiological birth, but is by no means a given. Taking control of how you birth, where you birth, and who catches your baby are all factors that play into your likelihood of experiencing a tear during birth. It is perfectly possible and normal for first time mothers to make it through childbirth without anything more than a graze. Your body knows how to make space, it just asks for your steadfast cooperation and commitment.

This blog post was written by a former Tranquility by HeHe doula.

Consumer Complaints: Essential To New Wave Maternity Care

Wednesday, January 5, 2022

Consumer Complaints: Essential To New Wave Maternity Care


What Is A Consumer Complaint?

Certainly we’ve all received a long awaited package, torn it open out of excitement, and come face to face with disappointment. This product we purchased is not the product we were sold. When faced with this situation, a vast majority of us will go back onto the website we purchased the item from to leave a review explaining why the product does not live up to its advertised quality. We do this not only to let the company know we’re not happy with our service, but also to warn other consumers that this product isn’t worth their time, energy, and money. This is a normal part of life, right? An online consumer’s right of passage, if you will. What if I told you that you can do the same exact thing with Drs, Hospital Staff, and Nurses? What if I told you that doing so doesn’t just warn others that they shouldn’t waste their time and money? instead, it actually sends a clear warning that their body, baby, and well being are greatly at risk in the hands of the professionals in question. Perhaps your honesty could not only bring you closure, but also save lives.

So How Do I File A Consumer Complaint?

  1. 1. Write down your story as soon as possible— a stream of consciousness— if you can record it on video or voice recording is even better as it capture the true thoughts without the hindrance of having to write it down
    • ● Think about the scope of the complaint—was this an ongoing issue or a one time offense?
    • ● Was it an overall safety concern or one incident/person?
    • ● Is this a system issue or specific to your situation?
    • ● Provide them with feedback as to how they can improve to avoid this in the future. 
  1. 2. Research your hospitals process for reporting complaints. There is usually a “patient advocacy’ or ‘patient relations’ department that handles all complaints. Making sure your complaint gets into the right hands is crucial. If it lands in the wrong inbox, there will be no forward progress because they won’t be able to do anything about it. DO NOT FILE YET! 
  2. 3. Obtain your medical records and operative reports
  3. 4. Report to your states medical board, HERE.
  4. 5. File a report with the Joint Commission (manage patient safety concerns) HERE.
    • ● If you need to edit your complaint, do so HERE.
    • ● Their priority is patient safety so coercive care, abusive providers, and failure to gain consent is very important to them and will be investigated.
  1. 6. Visit My Patient Rights and file a complaint
  2. 7. If you are a POC and/or your provider is a person of color, visit BirthXapp.com and file a complaint.
  3. 8. If this was a OBGYN or midwife (reproductive health providers), report to The Birth Monopoly Map.
  4. 9. File with your state—where you file will vary state by state, but you can check with your states Department of Public Health.
  5. 10. Now file with your hospital directly.

Why Should I File A Complaint?

Whether you were deeply traumatized, dehumanized, spoken to unkindly, or touched without consent, these reports hold providers accountable for their transgressions. It is lack of accountability that has bought our way into a medical industrial complex run on trauma and dehumanization. So these reports, whether dismissed or investigated, hold intrinsic value that our attempts at reform desperately need. That’s the selfless side of it. Then there’s the other hand where filing these reports can give us clarity, closure, and help us make sense of our experience. Writing down your story is an intense process, but putting that pen down after it’s done is cathartic. It’s not just this experience that's memory is isolated to your mind, but a clear and concise retelling of what shouldn’t have happened to you, and what needs to change as a result. That feels GOOD. Your report could save lives. Your report could open the provider’s eyes enough to make them change something about their routine care. Your report could even affect change and reform within your hospital. No effort to affect change is too small.

The Nursing Code Of Ethics

While misconduct is overlooked on a near daily basis, nurses are ethically obligated to report colleagues and providers who are practicing bad medicine. You may have heard the term “Mandatory reporter” and thought of domestic abuse, child abuse, and sexual abuse, but in fact, nurses are also legally and ethically bound to report malpractice, obstetric abuse, etc.. If you know the names of the nurses that witnessed the actions you are reporting to the board, it may be wise to include their names in your complaint. Doing so raises the likelihood that they will be questioned if an investigation is opened on your behalf. While nurses may overlook these abuses on their labor and delivery ward, they are more likely to be transparent and forthcoming when sitting before their state medical board, especially under oath.

The Big Picture

Reporting a provider’s bad medicine, especially when it’s been practiced on your body, can be scary and emotional. As a person who has filed these reports twice, I understand how monstrous and consuming the mental aspect of this can be. I understand that sitting down at your kitchen table and typing out your trauma line by line can feel like you’ll come entirely undone. You won’t. At least, it won’t be entirely, and it won’t be forever. If you feel that the emotions that will arise could overpower you, there is no shame in asking a friend or partner to help lead you through the process or simply sit next to you as you do it. While many people approach reporting with the mentality that their words could protect others, I think there is just as much good to be said about reporting with the intention of raising your voice loudly enough to say “What this Dr/nurse did to my body and my baby was not, nor ever will be, acceptable. I am here to make that claim over and over until somebody truly hears me”. Just as filing these complaints can be scary, they can be empowering too! It takes bravery to hold a human with a medical license accountable for their actions. After the fear and emotions of writing out that report, comes the closure and courage you’ve gained by doing so. I wholeheartedly believe in that bravery of yours, and I wholeheartedly hope you don’t have to use it again for quite some time.


This blog post was written by a former Tranquility by HeHe doula.

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