Beau Choix

“What can I gift my doula?”

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I saw this question from a soon to be mom on Facebook this week. This was my answer:

“#1-Send back evaluation forms if you are given one, write a testimonial for her, offer to be on her referral list for future families, refer her to pregnant people you love, send pics, invite to first birthday. Yes, those are all listed under #1.

Anything else is gravy.”

Of course, it’s absolutely lovely to receive a small, deeply meaningful gift from a family.

Gifts from generous families I've had the honor to support as a doula.

But what better gift than to help a doula grow her business? Every suggestion costs the birthing family only a bit of their time, yet is invaluable to the doula. Ok, except an additional place at the first birthday party. We thrive on our families networking for us with referrals and testimonials, helping us with our certification evaluations, and spreading doula love in general. The best gift of all is when a family reaches out to say, “We’re pregnant again! Are you available?”

So if you have decided to invest in the support of a doula for your birth, and I hope you do, be sure to help her grow. This gift is priceless.

Breastmilk: The Movie

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Last night was the much anticipated Washington DC premiere of Breastmilk: The Movie from first time director/producer Dana Ben-Ari and executive producers Ricki Lake & Abby Epstein hosted by Claudia Booker – Birthing Hands of DC.

Claudia introduced the film as a cautionary tale inviting us to think as we watch, not just about breastmilk, but about the support around breastfeeding mothers. She said that we need to bring in our partners, our men as vanguards to breastfeeding because it takes a family to raise a baby no matter what that family looks like. Yes, we need to surround ourselves with the women in our life, but our partners need to be educated about breastfeeding and support of breastfeeding. Who is  usually with us at 3 a.m. when we are trying to latch our babies? Not very many of us are lucky enough to have our mothers, sisters, aunts near us and if we do how many of the women in our lives who birthed before us actually breastfed a baby? There are generations of women who don’t what normal breastfeeding looks like. As so many of us know, there are well meaning people in our lives who unintentionally throw roadblocks into our breastfeeding relationships.

The emphasis on breastmilk as opposed to breastfeeding is clear in the opening scenes of the movie. The first image is that of a breast being expressed by a pump. This is a clear reflection of the breastfeeding culture in the U.S. today. Women talk about breastfeeding and breastmilk feeding as though they are one in the same. So much emphasis is put on pumping, not expression, but pumping. “Have you bough your pump yet? What kind did you get? When are you going to start pumping? How much should I be pumping? How often do I pump?” As much as women know about pumps we don’t know enough about normal breastfeeding. Isn’t this what should come first? Do you know that manual expression (not with a manual pump but with your hands) is often more efficient than a pump? This is true especially in the early days and weeks of breastfeeding! But how many classes teach manual expression? I know I’ve been guilty of teaching about hand expression, but not necessarily teaching the technique. What about breastfeeding? What does normal breastfeeding look like? Why does the baby have a witching hour in the evening? Do you know that watching the baby not the clock will tell you how often your breastfed baby needs to feed? It’s ok for baby to want to put their hands in their mouth when it’s time to feed. It’s ok if your new baby wants to feed every 90 minutes. Breastfeeding is not supposed to hurt. Pain is not normal and is an indication that something with the baby’s latch needs to change. Breastfeeding a baby after eruption of teeth is normal. Breastfeeding a baby past a year is normal. Tandem feeding is normal. Breastfeeding in public is normal Who is talking these aspects of breastfeeding? In my opinion, not enough people.

The movie show many of the interruptions women and babies have while they are trying to learn to breastfeed, especially in the hospital.  Mairi Breen Rothmann who spoke after the movie quoted a study I’ve heard before where women who birth in hospital are interrupted an average of every 17 minutes! If a newborn feeding session (positioning, latching, re-latching, re-positioning, feeding) takes about 40 minutes, she’s interrupted 3 times in that one session.  This only stresses that the Golden Hour after birth needs to be protected and revered so that the initial feed happens without interruption and subsequent feeds are easier for everyone.  Babies should not be taken from their mommas to be bathed early in this relationship, certainly not taken away for hours on end creating anxiety and doubt for the mother. They need that smell of amniotic fluid on their bodies to help them organize and find the breast, to properly colonize with momma. There is one hospital in this area I know categorizes babies as hazardous materials if they have not been bathed and the staff are required to wear gloves to handle the baby.  A grand policy in my eyes, only the parents should have hands on the baby.

The shape and shade of the families is phenomenal.  It’s not a movie about the typical middle-class white, husband and wife breastfeeding couple. There are families of color, adoptive families, same sex families, single parents, working parents, stay at home dads, you name it. Subjects discussed through the movie include extended breastfeeding, milksharing, formula feeding, tongue tie, induced lactation, going back to school or back to work, pumping, relationships, sex and intimacy, public breastfeeding and many worries about milk supply. So much is packed into  a short 90 minutes. And I haven’t even touched on the experts who share all kinds of information surrounding breastfeeding.

Many of the interviews take place in the bedroom of the families, on their beds. It’s very warm and intimate. The opening scene of the trailer is just that, an interview from the bed. This particular couple crack me up! Even with this humor there are elements of guilt, shame, embarrassment, failure as well as immense pride and joy. The emotions run the gamut.

The biggest surprise for me was the outcomes as they follow the families for a year. I think you will be surprised too.

I hope this film will serve as another jump-start to the conversation about breastfeeding in the United States. We need a change in the culture of breastfeeding for the health of our children, our society, our health care system, our future.

Some of my favorite clips are in the trailer. Watch it here.

The Circus aka A Royal Birth

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So the Duchess of Cambridge’s estimated due date has passed.

Whoopie.

I don’t mean that in the sense that I am not watching for the Royal Birth Proclamation, because the truth is I am. However, the intense scrutiny she is under while she is (hopefully) peacefully gestating cannot be conducive at all to a relaxing start to labor.

They’ve estimated that this birth will generate 400 Million Pounds into the UK economy! From ONE baby! That’s pressure enough. The paparazzi have been camped out for weeks. People have been speculating over the baby’s sex, it’s name, when it will be born, & how the Duchess will birth her child. Most new families only have their own friends & family breathing down their necks waiting for the call that labor may be starting. Any inkling, any sign.

I have a friend who was a new doula a few years ago. She was so nervous about one of her first clients she wanted to check in with her every day & didn’t know what to do if she didn’t hear from the momma on a regular basis as the due date approached. You can chalk that up to a new doula & many of us go through this early in our careers to some degree. It’s not how we should wait for our clients to birth. We wait, patiently, not hovering. Imagine the entire country virtually the Entire WORLD with their eyes on you. A virtual bounty on the head of your child for the first glimpse of his or her face. Surreal to me, but reality for the Royal Family.

I know they are forced to live their life in the spotlight. It’s not a choice. But do I ever wish everyone would just leave them alone to birth their baby.

I hope that she is somewhere serene & quiet. Walking grounds in peace, caressing and talking to her wee bub in her belly, dreaming the dreams that all parents do while they wait for their child to arrive.

I would love to see her birth their child quietly at home & announce it a few days, even weeks later. Oh what a bubble burst. I doubt that would ever happen, but a doula can dream.

Good Luck Royal Family. Wishing you a most peaceful birth.

What is Perfect?

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A beautiful photo of a breastfeeding mother with the caption The Perfect Latch [sic] caught my eye this week. Ok I won’t lie; most photos of this nature catch my eye but this one made me stop & think. The latch did look nice from a lay person’s perspective, but I could see things mom could tweak to make it better. If the mother was comfortable with the latch & the baby was having good intake, then there’s no reason to change it.

As a bystander, how do we gauge if something is perfect & should we even express that sentiment? What do we really know about that breastfeeding dyad? Has that mother struggled with breastfeeding issues in the past? Perhaps her latch was causing a little pain when the photo was taken but she didn’t want to say so because she was told how perfect it was so why should she say anything?  This happens so often in the hospital after birth. A well meaning nurse comes in & sees those beautiful outturned “fish” lips on a baby who is having a feed & tells the mother how perfect a latch it is, but the mother says it hurts. The nurse tells her to give time, however there is an underlying issue you can’t see without further investigation, more questions, more time talking with the mother.  So this mother goes home having nipple pain, perhaps baby isn’t gaining quite enough. By the time she goes to the next pediatric appointment she has painful cracked nipples, a baby who looks like it isn’t gaining weight well, is told to supplement with a breastmilk substitute & use nipple shields until her nipples heal. Is this a fix? No, not at all. All because someone said that latch was “perfect”. And the cycle begins.

The same thing can be applied to birth. A doula says how perfect a birth this mother had, but the mother is questioning things that happened during or after her birth & is battling with postpartum anxiety during her babymoon. (Yes, there’s postpartum anxiety.) Only the mother can label her birth.  No one else should color her birth story for her.  Instead she should be asked about her experience & we should just listen. No interjection about how awful or wonderful someone else’s birth was, including our own. Just listen.

Parenting falls in the pitfall too. “I don’t know how you do what you do, you’re SuperMom!” is said to a mother who is running her children to all their schooling & activities, perhaps works or volunteers as well  (or both!) & is also trying to keep house & the family fed & happy. But at night she collapses because she is utterly exhausted & isn’t sure how much longer she can keep going this way because she doesn’t have enough support knowing she’s doing too much. She already knows she doesn’t know how to say No. She doesn’t feel like she can change the status quo without causing more issues that will have to deal with in the aftermath.  Then there is the mother feels like she needs to do as many things as SuperMom does, but she really can’t do more either. It’s classic keeping up with the Jones’.

We all get caught in the cycle when what we need to do is help one another break free.  Leave the labels to the packaged goods & let’s go find our tribes.  You are welcome in mine.

Yours in Birth
Angela

Creating a Birth Plan

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Coming to your care provider or place of birth with a birth plan in hand isn’t as uncommon as it once was 10-15 years ago. You even find auto-generating birth plans and outlines all over the internet. In reality, most birth plans (or wishes or desires, however you word it) are pretty similar.  Most women want to be left to labor & birth  with the least amount of intervention, with the people they feel most close to and will give the most support, and to keep their babies close after the birth. Pretty simple, right?

That being said there are still care providers who scoff & huff at the idea of planning or asking for anything at birth. I was on a hospital tour with a client recently where the nurse actually laughed & said, “Good Luck with that!” It took us all by surprise, like, did we hear her correctly?

There are a few ways to help your birth plan be read by the hospital staff on duty when you come in for your birth.

  • Double check your content. Leave out things like “I’d like to labor at home as long as possible.” You’re already left your home so you’ve likely already done this.  Or “I’d like to discuss induction methods if I am to have a scheduled  induction of labor.” This is a conversation you are more likely to have during an appointment with your provider and should be on a separate list to discuss with your provider.  Also, when you are not birthing at home you will need to take into account what is available to you at the birthing facility you’ve chosen.  You can’t ask to labor in a tub if the facility doesn’t have tubs for laboring.  Doing this kind of editing will help the next point.
  • Keep your plan as short as possible. Write out what you feel are the the most important points. This way you can try to keep your plan to a single page. The less there is to read the more likely the staff will be willing to read it.
  • Ensure you aren’t repeating yourself through the document.
  • Try to keep your plan organized. If the person reading it doesn’t jump from how you’d like to labor to delaying initial immunizations, to how you’d like to push, they will be more likely to read and follow through with your wishes.
  • Consider writing separate plans for a cesarean birth, care for baby while in the hospital for the postpartum period or in the event the baby’s health is compromised.

So why bother writing a plan if no one will read it? Well, someone will read it, but the most important reason to write it out is that it creates a dialog between you, your partner, your doula, & your care providers. You can hash out what policies you can’t get around at your birthing facility and which  might have a little wiggle room.  There may be something you hadn’t thought about before that may change your thoughts on a procedure or practice. You and your partner may find that you don’t see eye to eye on a particular event, procedure or policy. This gives you time to talk about and research these things well before they might become a reality.  No, you can’t predict the outcome of birth, but you can talk about the many facets & be prepared for most eventualities so that in the moment you feel confident to discuss and move on to the next step.

What you know

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As in many professions, when someone finds out what you do for a living,  a story comes out &/or you are effectively pumped for information. For birth professionals, it is inevitably a story dump – a disappointing or traumatic birth, bad hospital stay, inability to breastfeed, you name it, it all comes out.

What I’ve discovered is that most moms just need validation. Simply, “You did the best you could with the information you had.” This is not a  condescending pat on the head. It’s a rare for a mom to hear this simple phrase from anyone. What is more likely to happy is the person listening breaks into their own tirade. More about that in a minute.  We all find out more information we could have used  for a birth, breastfeeding or parenting experience after the fact & then are guilty of beating ourselves up later for it (hand held high here). We have to break this cycle.

But how do we do this?

Let the experience be what it is & let it go. Debrief with a trusted person who isn’t just going to be your bobble-head.  It may take some time, allow yourself that time. Be gentle with yourself. Learn from it, but don’t dwell on it. This is not the one experience that will define you as a parent if you don’t let it. Rather, use it to shape what is to come. Share your story, but not as the scary Oh-Em-Gee story you tell to every pregnant or new mom, at every baby shower, at every gathering of moms. This practice infuriates me. People gather to celebrate a birth but then use it to play “My story is worse than yours”  or  “This will be the worst experience of your life”. Why? There is enough misinformation & fear-mongering.  Rather, tell your story to gently educate others. Explain what you have learned. Pass your experience in a way that can help someone else avoid the same situation.  Finally,if you know your experience has left you with post traumatic stress, find a professional who specializes in this work to counsel you through your experience. This is a real condition and it requires real help.

If you intend to have more children, research, research, research before your next birth. Do not just rely on anecdotal information, hospital based childbirth classes, mainstream websites & books. Seek out all the information you can find. Go beyond your comfort bubble. Pay for a private educator who isn’t going to give you the hospital party line. Look for evidence based information – there is a difference.  A couple of  good places to start: Science and Sensibility and Childbirth Connection.

Research your care provider & birth location. You cannot expect a hands off, physiologically normal birth from a provider who is known for highly interventive practices. It’s just not going to happen. You cannot change them. Same goes for birth facilities. If you want to use water during labor or a water birth, you can’t choose a hospital with tiny, regular sized American style tubs it’s simply not possible. If they will not allow you to have your choice of support  people, or allow your preferred comfort measures that is a Big Red Flag to look elsewhere. A couple of great sites to do research: The Birth Survey and Cesarean Rates. Also, look to your state’s Department of Heath vital statistics to see an overall snapshot of the births reported around you. Virginia’s can be found here.

Set your support team in place during your pregnancy. Hire a doula. Yes I’m obviously biased, but the evidence is out there for you to see in black & white. Don’t forget your lactation team for breastfeeding support, postpartum doula after your birth, know your area resources for postpartum depression, massage therapy, cranial-sacral or chiropractic care, area mother’s groups, etc. Even if you don’t need them or use them, do your research so if you do need any of them you know exactly who to contact. Too often a mom realizes she needs help & is so overwhelmed she doesn’t know where to start. I’ve lost count of the number of times I’ve gotten a tearful phone call from a mother or a frantic call from a father looking for breastfeeding help NOW.

Which brings me to my next point: don’t wait until the last minute to call for help. If it looks like you need some help, pick up the phone before desperation sets in. You’re not bothering anyone. That line about it takes a village, it really is true.

“What if I can’t afford it?” Do you really need or want 12 packages of bodysuits & socks, 2 dozen plastic electric toys the baby isn’t going to play with anyway, a bunch of matchy matchy outfits that the baby might wear once? Be upfront about what you do need and want. Ask for donations to your doula or breastfeeding fund at your shower, a gift certificate for a postpartum massage, ask for your friends to bring their local resources to your shower. People really do want to give you what you need, but will default to the big box baby store if you don’t tell them. Also, many doulas and other birth professionals are wiling to barter or to work on a sliding scale. Many don’t advertise this, but if you ask they will tell you.

The more prepared you are for birth & postpartum, the more positive your experience is likely to be. Yes it’s work, but so is parenting. Give yourself the tools to get there. You are worth it.

Leave the Process Alone

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Once again I find myself in the bathroom at 11:40 pm waiting for my toddler to do her thing. Bear with me here, this isn’t a post about toddler poo per se.

She is potty learning, but her body’s clock tends to interfere with when I’m falling asleep (if I am so lucky). I can’t begin to tell you how normal this is from infancy and beyond.  Anyway, she knows she needs to go & isn’t as distracted at midnight as she is during the day. She needs help getting her diaper off & getting on the big potty. But after that she only needs some time & a little atta girl. No one needs to help her or tell her what to do or how to push. She knows how to follow her body’s cues.

As I was waiting for my wee nymph it dawned on me, this is not that different than birth. I’m not comparing poo to birth, but the two events themselves. Many labors start in the dark night hours as everyone is trying to rest. As things ramp up, Mommas might need some help changing positions, rooms, clothes or to be supported during the surge of a contraction. But other than that laboring women don’t really need that much assistance. If left undisturbed, no one needs to tell a momma how to make her surges stronger, to make her cervix dilate, or how breathe or push her baby out if she is left to listen & respond to her body’s cues. Gentle atta girls for support, time et voila, baby.

It’s all about not messing with the process.

Glossy Prints

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I went on a tour of the Women’s Center at a local hospital recently & was given a folder of information related to their pre & postnatal services.

There a sheet listing the agenda of the tour, and a brochure of their childbirth education offerings. The tour is a rattling off of hospital procedure. If you need any in-depth answers, don’t ask the tour guide. If you’re not planning a “normal hospital birth” but a physiologically normal birth you will make the guide quite nervous. It’s clear that not many people just give birth.

Much of the rest of the folder is focused on breastfeeding.  I thought, “This is better.”

That is until I sat down & looked at it all.

It was wonderful to see all the support they have set up for area women, but it is far from making breastfeeding normal. There is a lot of information about support, support groups, classes, pumping & where & how to buy or rent pumps. So many gorgeous glossy pictures of beautiful babies. Only one of a mother very very discretely breastfeeding her baby.

All the support is great, but without the depiction of breastfeeding being normal the message is lost.

My region is filled with support & some really great resources. I’ve lived in many places where this isn’t so. Regardless of where you live, it’s very important to search out all your options before you are in the throws of labor & realizing that your birth plan can’t be & won’t be followed because the facility you’ve chosen has a completely different definition of normal that is not the same as your own. Make sure that your care providers, birthing facility and after support are fully vested in you. Some issues can be solved through self advocacy, but you shouldn’t have to fight uphill when you should be completely zoned out in Laborland or  blissfully snuggling your new baby. You shouldn’t be worrying about what you have to give up to get the care & support you need & deserve.

You Are Worth It.

 

The first birth

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So 16 years ago, I was in the midst of a change. I was getting divorced, had left active duty military, moved home with my family & was back in university. So different from my dear friend who was married & pregnant with her 2nd child. I just happened to be working as security at the maternity entrance of the hospital the morning her labor started. Despite having worked all night, a shot went through me & I was energized to await this precious baby. I was afraid to run home & get changed or anything. I was convinced that this baby was imminent.

Knowing what I know now, it was a rather quick labor, typical for a 2nd time mom. But for me then, it was a long one. We waited until late in the afternoon, and then, finally it was time.

I was awed by her power, the sheer feminine force she tapped into to birth this boy. I had no idea of the hormonal energy that we shared. I had never experienced anything like this in my life.

I had no idea back then what a doula was. I had no clue that only a few years later I would be happily married and bringing my own children to the world. I had no idea that I would understand what it means to have such intimate support around you as your family grows.

I am fortunate to have had this singular experience before my life played out the way it has. I feel as fortunate as I did 16 years ago to be asked to attend each and every birth. I feel just as awed every time I support a woman in her birth journey. The hormonal high never ceases to touch me to my core.

I’m not ashamed to say it. I love what I do.

 

So Very Tiny

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This is a reflective paper I’m writing for my certifications with Childbirth International. It is the postpartum experience I had after the birth of our 3rd child who was born SGA (small for gestational age). While she was not a preemie, we experienced many of the same experiences as preemie families. November 17th is World Prematurity Awareness Day.

Our third child in born 2009. I was an American living in Germany. Our baby was due 18 October, but was born on 6 October after a prostaglandin gel induction beginning on 5 October. I consented to an early induction because she was diagnosed as being Small for Gestational Age and there was concern that my placenta wasn’t working effectively.  The labor and delivery were rather easy and unremarkable with the exception that our daughter was born weighing only 2160 grams.

In the many weeks leading up to the birth there was not discussion about what would happen after the birth. My biggest goal at the time was to do everything I could to make sure she was growing & getting the nutrients she needed to thrive before her birth. When she was born I thought I would just breastfeed her until she was nice & plump like my first 2 babies. The ultrasound scans did not indicate any physical issues other than her size, and all my prenatal testing came back negative. There were no expectations for an impaired baby.

There is no nursery in the hospital where I gave birth.  My OB came in to check on me after the birth and said he didn’t think the baby would need to go to the Kinderklinik (NICU).  I was sure I would be taking our tiny baby home the next day. A short time later the pediatrician came in & said our baby would be transferred right away to the “well-baby” NICU and I could follow later after being discharged.  They could not guarantee that there would be a bed available for me to stay with her.  I called our military patient liaison to come for help and guidance. She was of no assistance.  I asked that no one feed my baby any glucose water or formula, that she would be breastfed by me when I arrived.

By the time I had arrived a few hours later she had already been fed glucose water.  Communication with the nurses on duty at the time was minimal because few of them spoke English. I had to wait for someone who could translate better. I was allowed to sleep in her room.  The baby was subjected to constant monitoring of her temperature, oxygen and heart rate as well as a battery of tests while we stayed. In addition she was having latching problems. The doctors’ solution to this was for me to pump and feed & supplement with formula. I had to document every gram going in and coming out. I asked for someone to help me fix her latch, but was denied as there was no one trained at this hospital. There wasn’t an internet connections to search out a private IBCLC nor would the staff search for one so I sent my husband a list of books to bring me from home. I was determined to fix it myself. It wasn’t worth transferring to another hospital because it was over an hour away and our baby wasn’t sick. She just needed to gain weight. And I needed to be close to my family so that when they were able to come see us it wasn’t additional stress on everyone to come to the hospital.

Once she began gaining weight they had no reason to keep her any longer. We had been in the NICU almost a week. None of their tests showed a single anomaly. Upon their determination of her ability to self regulate her body temperature she was given a final battery of normal newborn testing, pronounced ‘perfect but tiny’ by the resident assigned to her, and we were released to go home.

—

 After the birth I was elated because the release of all the worry in the culmination of this pregnancy with an induction that worked the way it was intended to, a relatively easy birth, and a baby who was wee but healthy.

This quickly turned to frustration and anger. I was told her transfer was policy because her weight too low, was unavoidable and couldn’t wait. She wasn’t sick, acute or in grave danger, yet they wouldn’t wait until I was discharged, they wouldn’t let me go with her during transfer nor would they let me drive her to the NICU myself. I pulled one of the nurses aside and tried to tell her this was happening too fast and I needed someone to talk to. She was empathetic, but couldn’t help me or fully understand what I was saying despite my tries at some decent German. Few people on duty that morning spoke English. My efforts were futile. When I called the patient liaison for help, I was told I should listen to the doctor & I was frustrated she wasn’t listening to what I was asking. She should have been the person to help me iron the transfer questions out. I felt like no one was listening to me.

Upon arrival at the NICU I was so upset to find our baby crying, in a room alone. I went from upset to infuriated when she vomited glucose water. She wasn’t supposed to be supplemented. Again I felt like no one was listening to me.

Through our entire stay I felt like I was fighting to be listened to. About day 2 or 3 the doctor came in with his entourage and told me to take my baby home to die because I didn’t just want to pump & supplement with formula. I wanted to breastfeed her but no one wanted to help me breastfeed her.  At that point I was like a Momma Bull in a China Shop. I was being treated with such disrespect & wasn’t being listened to. I can only think of one other time in my life that I was so angry, disappointed, disrespected & completely let down by everyone around me. It was bad enough that I was the lone American on the floor completely segregated from everyone else, but they treated me like I was a nuisance. That I wasn’t worth their time because I asked questions and challenged their standard treatment.

At the same time I was worried about my family at home. They couldn’t come up because my oldest was sick so I didn’t have the full support of my family at the hospital. We couldn’t all just be together and work it out. And I couldn’t take care of my older daughter. I felt like I wasn’t there for her. My husband wasn’t able to be at the hospital & help be my back up for the majority of the time we were there. I really felt alone. He had just returned days earlier from out of the country for the previous 3 months and hadn’t had time to even reintegrate back to regular family life let alone deal with this situation our daughter’s birth brought. I wanted him to be there for me, but I also didn’t want to overwhelm him. I know he was feeling lost not being able to help but I felt even more abandoned not having him there to help me.

I was afraid to leave her alone at the hospital at all because even when I went down the hall to pump after breastfeeding her, at night especially, if she woke up & cried, by the time I got back to the room there would be a pacifier in her mouth with an empty syringe of gas drops or something beside her. Everywhere I turned there was something else that was interfering with her breastfeeding.

It was at that point that made the switch in my head that I couldn’t feel sorry for myself. I had to work to get her weight up so we could go home. So I felt comfortable taking this tiny baby home. I took my anger and made it productive.

—

I was so focused on the pregnancy itself I didn’t think to ask about what happens after. I knew there wasn’t a NICU at the hospital I chose, but I didn’t ask my doctor what might happen to the baby after the birth. After the induction I thought we were in the clear. She was tiny, but perfectly healthy. I could have asked to transferred to the American hospital at Landstuhl an hour away at the end of my pregnancy. They have an in-house special care unit and an IBCLC on staff. It would have been further from my family, but I see now I may have had a better chance at the care I wished we’d both had.

When the baby was transferred I could have been less passive in allowing it to happen & found a way to go together to the Kinderklinik. I didn’t ask enough questions of the patient liaison so she would also ask questions. Her every answer was, “It’s their policy”.  I didn’t keep asking why. When I felt she didn’t have an answer to my issues my focus turned to getting discharged so I could go be with our baby. I just wanted her to go so I could make the rest of the calls to leave.

When the doctor ripped me down & told me to take my baby home to die I should have stood up for myself in the moment. I was tired, hormonal, worried, but I could have stood my ground instead of breaking down. No doctor should speak to a parent that way. My baby was not in grave danger. Yes she was still losing weight, but simply saying do it my way or go isn’t proper care. I didn’t ask for his supervisor, I didn’t ask for another doctor to take my case, I didn’t complain later through our military channels. I should have and I kick myself for taking that kind of abuse. Although he never came back to my room again, not even to do the final assessment. One of his interns did the final exam. Again, I could have asked for a transfer to Landstuhl, but I felt that she wasn’t sick so why make that long trip to have to start at square one again. I only wanted to get our baby home.

When I was denied an IBCLC at the Kinderklink  it didn’t occur to me to ask for a telephone consult with the Landstuhl IBCLC for more suggestions to get the baby to my breast or for suggestions to create an SNS system with what was on hand at the hospital where we stayed. I would not have had an in person consult, but because I did have a professional report with her I may have gotten extra telephone time if she was available. This may have sped up the baby’s weight gain & latch issues & we might have gone home sooner.

I was focused on getting the baby back on the monitors after every feed because the nurses said to. Instead I could have worked out a schedule with them for intermittent sessions & just taken the baby with me to pump so she wouldn’t cry and they wouldn’t feel like the needed to do something to her to make her stop. I could have had much more skin to skin time if I hadn’t allowed her to be put on the monitors constantly. This might have helped her breastfeeding issues too.

Instead of involving my husband more, I tried to take everything on myself since he had to be home so he wouldn’t have double the stress. I buried some of my feelings which came out later after I came home. It wasn’t the fix I hoped that would be, it added to stress later.

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At the time I thought I was being proactive in my actions, but I see now that I could have done more. I was asking questions but they were not enough or the right kind of questioning. I let the policy guideline be the end of the road. I allowed the cultural and language barrier create a bigger wall to scale than it needed to be. My anger allowed the staff to take power away from my choices and kept me from seeing that I had more choices. I know some of the emotions came from the intense hormonal shift, lack of sleep and being in an uncomfortable environment, but I could have kept pushing. I need to let go of the anger because I made a choice &I didn’t change it then & I can’t change it now. I can only make decisions in the now and move on.

I needed to involve my husband more in the process instead of shielding him from it. Some of this wasn’t possible because he couldn’t be there, but I could have had him working behind the scenes making phone calls to our American clinic in town trying to find some better answers. I didn’t have to try do it all myself. He would have coped better knowing he was doing something to help me beyond caring for our older children.

However, this event has changed how I deal with stressful situations. I have learned how to be more proactive in how I question practices in general. Its lead me to keep asking questions, not just be satisfied with a single answer whether or not I’m comfortable with that answer.

I know I need to continually work to keep working at doing all this.

There are times the system isn’t going to change for me and if I decide not to step outside of it I will have to deal with what it brings. When I stay within this system I know that I can find allies, but that their hands may be tied. It’s better to recognize it now than to try to fight it in the middle of a situation.

Knowing all this makes me continually look at how this will affect my clients as a doula, breastfeeding counselor and childbirth educator. I am always looking for additional resources that other families might not know about or prepare them to deal with a situation without having to live though it like I and others have. I try to prepare them for the unexpected without overwhelming them. When I see a resource is needed I try to bring it in, or, if I’m able, provide it myself. I know I can’t do everything for everyone, but if I can enhance the birth and parenting period in some subtle way that makes the smallest difference, then I have found my niche. I hope to be able to effectively communicate how to navigate the system that most parents are left to muddle through alone. Leaving my baggage at the door is the first step. Being as unbiased as I can is the next. Realizing there is always room for growth and learning is the key.