What confident births look like

The weekend, during the Ready for Birth: Express class, I took a couple of minutes to show a birth video that I don’t always show; it was a larger class, and it was wonderful to have so many different families. Some were giving birth in birth centers, others in hospitals, some with OBs, others with midwives. There are a billion birth videos out there, but I love this first one because it’s a wonderfully accurate depiction of birth: the mom has intense contraction waves, but is able to still laugh a little during the breaks in between. It shows her moving around and changing positions. And more importantly, it shows how gorgeous birth can be when the person giving birth is surrounded by caring providers in a calm, patient environment. On Saturday, after this video, there weren’t many dry eyes.

The birth of Cody Taylor | Waterbirth at Mountain Midwifery Birth Center in Denver, CO from crownedbirthphotography on Vimeo.

Why do I want to show you these? Because birth is usually talked about in a way that’s scary. Because birth isn’t shown realistically on TV or in the movies. Because most people never hear about the amazing empowering, positive births– only the traumatic ones.

Here’s a birth in a hospital. It is another water birth, and I’m not terribly thrilled with how long it took to get baby to the surface, but it’s cool.

Milo’s Water Birth from David Mullis on Vimeo.

Here’s a hospital breech birth–keep in mind, these care providers are taught how to deliver vaginal breech births. It is something that is possible, but ONLY when the care providers know how to handle it. There are still quite a few places where vaginal breech birth is a skill still emphasized during education and training. Unfortunately, it’s not taught in the US on anything approaching a regular basis.

Nascimento Mariana, parto natural hospitalar pélvico – 04/jul/2013 – Natural breech hospital birth from Além D’Olhar fotografia on Vimeo.

A preterm birth of a wee double rainbow baby; again, the care provider is calm, patient, and caring. Births of rainbow babies are emotionally challenging. When a family gets pregnant after a previous stillbirth or miscarriage, there’s the very reasonable fear that another loss can happen. BUT, and this is important– in these cases, it’s even more critical to have a calm, caring, supportive birth environment rather than a fearful, negative birth environment.

Double Rainbow Baby, the Birth Story of Emilia from Jennifer Mason on Vimeo.

A hospital birth in—well, not the US. I love everything about this video. Again– you see calm, patience, and encouragement.

Thomas | Parto natural hospitalar from Ana Kacurin on Vimeo.

So here’s the deal: Everyone deserves this kind of environment during birth. Full stop. It’s not about medicated, unmedicated, natural, vaginal–it’s about understanding that birth is a normal biological process. It’s about a mother who is confident in her body’s abilities. It’s about having care providers and support people present who hold the space. Birth can be positive. It’s a lot of work, it’s never easy, but it doesn’t have to suck. A triumphant experience is possible.

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

The Problem* with Breastfeeding

Problem with breastfeeding

When I meet people for the first time and tell them that I’m a doula, Lamaze educator, lactation counselor, and car seat technician, it’s interesting how they react. Some people respond by telling me all sorts of things. I end up being told birth stories, completely unprompted, or they tell me about a friend who is also a doula, or they tell me what their breastfeeding journey was like. Sometimes, there’s an air of defensiveness to their confessions. And I get it– I really do. Breastfeeding isn’t the most cut and dry thing to wrap our arms around.

1) We have no good way to tell how much milk a mom is making- If a mom pumps milk, we assume that the pump, which is this expensive machine that’s supposed to be really good at getting milk out of human mammals, is going to do so efficiently and is a good way to determine if a mom has supply issues or not. Yeah, that’s not the case. Not everyone responds well to pumping, especially in the first week or so, and if you use pumping to see if a mom is making enough milk, there’s a good chance that her pumping output is going to be disappointingly low. Ignorant providers use this as proof that a mom’s body is broken and can’t produce enough milk. Oh, and by the way….those pumps are having major quality issues and breaking all the time.

2) Since there’s no gauge on the side of the breast, we have to guess how much milk a baby is taking in- There’s an elaborate method of weighing a baby before and after a feeding to estimate how many ounces of milk a baby took in, but that’s still not bullet proof. It’s not an uncommon impulse to have so little confidence in the breastfeeding process that providers will make mothers bottle feed babies just to verify input. Even when bottle feeding pumped human milk, the message is strong–you can’t be trusted, your body can’t be trusted, and only the bottle can be trusted.

3) The nutritional content isn’t static, so it’s really hard to know what the caloric content is- The more we understand breastfeeding and the production of breast milk, it’s become startlingly clear that the milk a mom makes for her baby changes hour by hour, day by day, month by month. It changes depending on which child you’re feeding. If you have a preemie, we’ve just realized your milk is really a lot more calorically dense than we ever thought. We do know that on average, breast milk is a lot more calorically dense than formula, so it does take a higher volume of formula to approach the nutritional needs of a baby. At least, though, health care providers know exactly what is in it, unlike breastmilk, which changes if baby is getting sick, or needs more calories, or based on the time of the day.

4) It’s really hard to trust that you’re breastfeeding the baby as much as you say you are- When we talk about breastfeeding, we tell moms to watch for cues. We call them hunger cues, but babies also cue out of thirst. News flash– babies are human and get thirsty, even when they aren’t hungry. Expecting a baby to get hungry and thirsty on a set, quantifiable schedule is about as crazy as expecting you to only be thirsty every 3 hours. So with breastfeeding, every time you sit down to nurse baby can be different in length and frequency, which is maddeningly hard to plan out and account for.

5) Only a few people are qualified to help you- Breastfeeding has a learning curve. It’s not easy for most moms and babies at first, but if they can make it past the 2-3 week mark, it usually gets much easier. However, getting past that hump can be really, really %@$*!#* hard. If you had a baby 100 or 200 years ago, by the time you had your own kids you would have watched lots and lots of babies be breastfed, and most women knew enough about breastfeeding that they could help each other. Now, we not only have so few people (including medical professionals) that are appropriately and accurately trained to help with breastfeeding, but we wall them off and only make them available during banking hours. It can take a lot of dedication, perseverance, and tenacity to get through the early breastfeeding struggles, but there’s a huge role that luck plays. If you find the right lactation specialist, you’re good. If you have a bunch of lactation specialists who don’t really care…you’re probably screwed.

6) Your mom didn’t breastfeed, and her mom didn’t either- Breastfeeding rates have risen since the 1950s, when only about 5% of moms ever breastfed their babies, but the 6 week breastfeeding rates in the US are still pretty low. Initiation rates are high, but almost 70% of moms give up breastfeeding before they initially planned to. There are a lot of moms out there who had bad breastfeeding experiences. This makes breastfeeding seem impossible; more tragically, it can unintentionally undermine a mom’s desires for feeding if she’s hearing from others that it’s just not important. And this one is the trickiest thing about breastfeeding. We know there’s a sociological component to breastfeeding. The barriers aren’t just biological. The biological barriers can be real, but we still struggle to have good, healthy conversations about breastfeeding within the larger construct of motherhood.

As is the case with most medicine, we’re realizing more an more that there’s a whole hell of a lot of nuance with breastfeeding that we have to get used to. Pumping and bottle feeding human milk can seem like a good solution, but most people who suggest it completely ignore how draining the process of pumping for every feeding or after every feeding becomes. They suggest pumping and make it seem that it’s as easy as brushing your teeth. Constant pumping sucks. I don’t have anything super simple to offer as a solution to any of these things, other than education. Humans are mammals. We are mammals with young that need fed. Rather than think that the process is broken, I’d posit that breastfeeding usually works– but we are the ones who are making it not work with our bad information, lack of trust, and unrealistic expectations.

*I decided to couch it in these terms. It’s kind of tongue in cheek.

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

NICU Options in the Twin Cities

UPDATE 2/14/13: After posting this, I got an update saying Children’s Minneapolis was a Level IV, and St. Paul was a Level III. From this AAP chart, you can see the level designation that were in place until last August.  After that, the AAP issued these revised guidelines, which helps explain the “Level IV” and “Level III” designations some of the hospitals are now going by.  However, some places are still sticking with the old levels, so there will be a mix of both below.  I have corrected some errors below.

I’m not even sure what got me thinking about this, but this morning, I woke up curious what the different Twin Cities hospitals had for options for Special Care Nurseries and NICUs.  I knew there were different levels and was aware of some of the differences from hospital to hospital, but t struck me that I didn’t know the information for every hospital.  It took me some digging online, a few phone calls, and even a couple of well- answered tweets, but I was able to put this little chart together. (More information on the various level designations can be found here.)

Hospital NICU Level How many weeks gestation?
Children’s St. Paul (United) IIIb  III 24 weeks
Children’s Minneapolis (Abbott) IIIc  IV 22 weeks
Hennepin County Medical Center IIIb 23-24 weeks
Maple Grove II Info not found
Methodist II 32 weeks
Mercy II  Info Not Found
North Memorial Medical Center III 23 weeks
Regions II 30 weeks
Fairview Ridges IIIa 30 weeks
Fairview Riverside (Amplatz Children’s) IV Info not found
Saint Frances II Late preterm
Saint Joseph’s II 34 weeks
Saint John’s IIIa 28 weeks
Fairview Southdale IIIa 30 weeks
Unity II 34 weeks
Woodwinds II 34 weeks

*The Level IV designation is used to indicate a very specialized level of care is available  but is not recognized formally by the American Academy of Pediatrics as a designation.  (See above)

Now, as I used to tell families on hospital tours, I hope you never have to see the insides of any of these nurseries, but the information is still good to know, especially if you have a higher risk pregnancy.  For low risk pregnancies, this is probably not an important factor– making sure you give birth in the place you are most comfortable with a care team that you trust is of utmost importance   In the cases where there is a greater chance of complication, it might be a good idea to plan to give birth at a hospital where they will have the capacity to care for your child, rather than give birth at one hospital and have your baby transferred elsewhere.  Please note– this is by no means the only thing you need to consider when choosing a place of birth.  However, for pregnancies with a higher level of risk, this is something to think about!

Did you consider NICUs when choosing a place of birth?  Is this information helpful?  Sound off below!

 

Warmly,

 

Veronica

printedLogo

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.