
By Kenneth Chang from NYT Health https://ift.tt/2ShDrc0
via IFTTT
During the start of the Covid-19 pandemic, I have heard from other doulas the issues of hospitals separating mother-babies which is driving the fear of these mothers in giving birth in hospitals, aside from the concerns of the virus patients in hospitals.
I want to let mothers know that separating you from your baby, especially during these times is the worst thing you can do. This is aside from being riddled with stress (being away from a newborn to fend himself/herself to a new surrounding outside your womb) will surely not help also.
Essential Interpartum Newborn Care (EINC) / Unang Yakap should still be done especially since it’s Administrative Order 2009-0025 by the Department of Health with the support of the World Health Organization (WHO).
Mantra: DO NO HARM.
The below is a Public Service Announcement from ALIMA Mother Support Center
The “mother-and-baby” dyad is one unit. Take them away from each other there are risks and consequences.
For the mother, if a baby is separated, she may be at risk for bleeding because the baby is not there to stimulate oxytocin release that aids in the uterine involution.
For the baby, if she is away from her mother, she is taken away from her main source of protection and nutrition. High levels of cortisol or stress hormones rush the moment they are not with their mother. A baby in a state of panic is not shown by crying but by shutting down to hibernation/survival mode.
Dr. Mianne Silvestre is the reason why we have UNANG YAKAP. Her work is the very foundation of the Essential Intrapartum and Newborn Care that is saving thousands of lives in the world.
She reminds health care providers that separating babies would mean a 4x increased risk of infection of dying.
Isolating babies will not ensure us they will not get COVID19. There is a big chance that babies can be exposed to the virus.
Last April 13 in Lipa, Batangas, a 10day old baby girl was positive with COVID19 and her mother tested negative.
Manage the risks but a mother and child should not be separated.
If the baby has COVID19 her saliva will signal her mother’s body to create antibodies for it. Breastmilk is both food and medicine!
This is a viral photo of cute babies in face shields in a hospital in Thailand. Face shields and isolation cannot protect these little ones.
FACE SHIELDS FOR BABIES
Babies should not wear face shields. This can pose as a hazard for breathing. Babies cannot maintain oxygen saturation and may rebreathe the CO2 under their shields. Or the headband may slip off and cause strangulation.
Routine separation delays breastfeeding initiation. They can get exposed to pathogens at any time during their stay in isolation or in the NICU and have no breastmilk to actively protect themselves.
Here is the evidence of the 4 fold increase of infection-related death.
This is not just 10 babies. These studies are from observing thousands of babies. This is not just 1 study but 2 different ones.
Please listen to evidence based studies!
Hey Mamas here are some quick tips I learned from my lactation consultants. If you’re able to access one – even virtually, it can bring you and your partner some peace of mind.
I requested to speak to one during my stay in the hospital, and also hired one while I was pregnant to come to my home. She met us the day we came back from the hospital, she was invaluable. We had her come couple times a week for a few weeks after giving birth. As much as our family members might have some experience with children, these specialists have worked with hundreds of babies and Mamas, and are a wealth of knowledge. But even if you are unable to access to one, here are some top tips I took to heart:
You’ve got this Mama!
-Jess
Being a doula, I try my best to equip my clients on their upcoming birth and postpartum journeys. It is important to keep educating mothers (and partners) to ensure that they can arrive at an informed decision based on evidence-based information.
Books by reputable authors and teachers are the best start aside from attending our workshops will help empower these women.
For new/first-time parents who would like to understand and empower themselves for the upcoming birth can start with the below books:-
Those who are looking into VBAC (Vaginal Birth After Caesarean) would want to prepare with the below books:-
For Spinning Babies books, I would recommend the following:-
Bereavement and Postpartum Depression Books
Karen Kleiman’s This Isn’t What I Expected [2nd edition]: Overcoming Postpartum Depression
This book was written by two postpartum experts. It is a definitive guide in offering support and solid advice on dealing with every aspect of Postpartum Depression (PPD).
If you or someone you love is among the one in seven women stricken by PPD, you know how hard it is to get real help. This proven self-help program, which can be used alone or with a support group or therapist, will help you monitor each phase of illness, recognize when you need professional help, cope with daily life, and recover with new strength and confidence.
Fertility Issues:
Toni Weschler’s Taking Charge of Your Fertility, 20th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Heal
Since the publication of Taking Charge of your Fertility two decades ago, Toni Weschler has taught a whole new generation of women how to become pregnant, avoid pregnancy naturally and gain better control of their gynecological and sexual health by taking just a couple minutes a day using the proven Fertility Awareness Method.
This 20th Anniversary Edition has been thoroughly revised and fully updated with:
(a) the latest medical advances in assisted reproductive technologies (ART)
(b) more in-depth coverage of women’s gynecological and sexual health
(c) new illustrations, photographs, and an expanded color insert
(d) new sample charts
(e) an expanded appendix
(f) Six new chapters including Three Prevalent Conditions—Endometriosis, Ovarian Cysts, and PCOS, Natural Ways to Balance Your Hormones, Preserving Your Future Fertility, Miscarriages, Idiopathic Infertility, Causes of Unusual Bleeding
It is clear and comprehensive, yet warm and approachable, and is one of the most universally lauded health books on the market today. It is an essential reference for every woman of reproductive age.
No matter where you may be on your breastfeeding journey, there’s one topic that comes up over and over again, and is a source of stress and preoccupation for so many mamas. You guessed it – this topic is MILK SUPPLY.
…Will my milk come in?
…How can I tell if my baby is getting enough?
…Can I skip feedings without affecting my supply?
…How can I increase my supply?
…What if I have an oversupply?
These questions come up time and time again, and unfortunately, while there are many resources out there, there is also a lot of outdated and inaccurate information. This is the first of a series of posts talking about the basics of milk supply, where we’ll delve into some of the most common questions.
What does a “normal” milk supply look like?
First of all, there is no real “normal” in anything related to lactation, as every woman’s body is slightly different. There is a typical progression, though, in how milk production happens for most women – we’ll talk elsewhere about some of the most common situations that might make this not the case.
Prenatal
Throughout pregnancy, most women will notice some breast changes. Soreness, increase in size, and more sensitive nipples are all common symptoms. Some women will notice some leaking of yellow colostrum during the third trimester, but this is not at all an indicator of what your milk supply will be later on.
The first days postpartum
The first milk your body produces for your baby is colostrum, a thick yellow liquid packed with rich fats and nutrients for the newborn’s first days. Because colostrum is so nutrient dense, it is only produced in very small amounts, which can make it easy to wonder if your baby is actually getting enough. A newborn’s stomach is very small, and while your newborn baby will need to nurse very frequently, they won’t be taking in a large volume at once and that’s ok! The best indicator of getting enough to eat is wet diapers – if baby is peeing frequently, they’re taking in enough! If you do have concerns about their intake, a lactation consultant can help you do a weighted feed, weighing baby before and after feeding with a very sensitive scale, to see exactly how much milk baby took in during the feeding. It’s normal for baby to lose a little bit of weight in the first 24 hours after birth, as they adjust and start to eat, but generally, we don’t like to see baby lose more than 7% of their birth weight so your pediatrician will be paying attention to this. Some babies can take a while to figure out latching effectively – especially if they are premature at all – so in some cases hand-expressing colostrum and giving it in a syringe can be a good option.
The first week
Anywhere between 2-6 days postpartum is typically when your breastmilk transitions from colostrum to mature breastmilk. This is what most people refer to as your milk “coming in”. Hormones in these first days trigger your body to ramp up the volume of milk produced, so many mamas will notice their breasts becoming full, warm and hard, with more easily expressed milk – that sometimes leaks out on it’s own, especially when your baby cries! The milk itself changes from the thick yellow colostrum to a whiter, more watery-appearing liquid. Over the next few weeks, your body will begin to regulate the amount of milk to just what your baby needs, but in the beginning it is easy for your breasts to become uncomfortably full (referred to as engorgement). It’s important to keep emptying them consistently, whether by breastfeeding or pumping, to prevent clogged ducts from forming. During this time, your body is learning how much milk your baby needs. The more that is taken out, the more it will produce. Sometimes it can feel like baby never stops eating in those early days – most babies will eat at least 8-12 times a day! – but that’s because it’s their job to stimulate that milk production!
As always, if you are starting out your breastfeeding journey and are struggling at any of these points, please seek out a lactation consultant or support group early. They can help troubleshoot any issues, as well as reassure you about what’s normal!
We all have family rituals, whether we realise that is what they are or not. In a larger family these rituals start to take on a life of their own, becoming a sort of adhesive that binds the family together. They might take a little bit of effort to set up, but if the fit is right, I reckon they become the things kids grow up and remember as part of themselves, helping them feel they belong. They communicate a sense of collective belonging that is one of the key ingredients to intrinsic wellbeing. Our household of six has a number of rituals for daily life, weekly rhythm, and marking special occasions and holidays. In the nationwide lockdown currently in place in New Zealand, holiday rituals and sabbath-rest-days have taken on an even greater importance as a way of marking time and fostering a sense of security in all the weirdness and anxiety.
Family ritual as spiritual discipline
Why use the world “ritual” rather than routine?Well, for me it connotes a sort of spiritual discipline aspect to the activity, where the value is in the repetition built up over time, not the amazing quality or planning or special oomph of just one event. The discipline is continuing to show up and trusting that the showing up will be enough to make connection and growth happen. Like meditation or a commitment to others forms of spiritual practice, family rituals are a commitment of the mind that takes some discipline to undertake. Rituals are a stable, embodied, repeated action, where something is done in a certain way to represent a deeper meaning.
So what kind of rituals am I talking about here? And how does this relate to large families? Some examples of rituals we use include the following:
None of these rituals are high energy, and none are in themselves ‘necessary’, but they all say something about what we value. They also communicate to each child that they are part of those values, and that they themselves are also valued as part of the family. The commitment to repeating these rituals communicates reliability and care for the family as a unit. If it were not for these rituals, it is possible in a larger family (especially with an academic mother) that a child might be overlooked for a period of time, and of course feel neglected and even start to withdraw or act out.
Dyed eggs for Easter breakfast
Sabbaths as spiritual discipline
One ritual I find hard to practice the Sabbath. Now we don’t really practice Sabbath in the Jewish sense, but we do try to hold on to the weekends as special somehow, as times where the family can expect me, as the earner, to be present in home life and not working. Saturday is the day we care for our house and prepare ourselves for the week, including getting washing done, cleaning chores, meal planning and shopping for food or other provisions. By setting aside time for this and participating in it weekly, the message is that these task are important and are not the job of one person. I therefore consider this a sort of feminist spiritual practice! It also communicates that each member of the family is important and contributes something. This is important to communicate so the children do not foster their self-worth only on academic work or other achievement oriented values. Even chores done imperfectly are a blessing and contribution to the family – it is the ‘turning up’ that counts.
Sundays are days of community and self-care. We usually go to church as a family, and we then go pick up lunch from the supermarket deli on the way home. (We used to go out for lunch when we only had two kids, but now that is unaffordable!). My daughter and I are regularly rostered on to the band, and my husband to the creche. Church can be pretty boring, but by continuing to show up, we communicate that we value this community and what it stands for (in our church, that includes social justice and environmental sustainability). Relationships are built through this ritual of showing up. When my husband had a stroke earlier this year, members of the church community rolled into action with support for us — babysitting, food, help with chores, check-in phone calls and more. The kids knew these people coming into our home and had reliable adults with whom to process what was happening, when I had to be at the hospital. Sunday evenings, I go to my weekly yoga class, and the kids are responsible for cooking dinner. This is framed as a contribution of care because it is dad’s ‘day off’ (he cooks much of the week) and mum’s self-care time. Some years, I might have early morning Monday lectures, which demand a Sunday afternoon work time. Or occasionally I might be working on something with an imminent due date that cannot be put off. I try to at least put it off until the afternoon when everyone is doing their own thing so it doesn’t impinge on family time.
Even harder is taking a Sabbath rest during a public or religious holiday. Work is very important to me, and I think about it all the time. If left to myself, I absolutely would work every weekend and public holidays too. So I am grateful to my children for providing a structure to my life that forces me to take a break and rejuvenate my mind. The cognitive dissonance of home labour, community time and rest certainly increases my desire to work come Monday or the next work day. And I believe that the balance truly creates an efficiency that draws on the balance and focus cultivated through Sabbath-like practices. It is a spiritual practice in that it provides this rejuvenation and because it relies on a certain discipline of ritualised behaviour that builds habits of rest over time. Occasionally, I develop a little niggling concern that I’m missing out somehow by not working on the weekend regularly like my other academic colleagues. Sometimes I suspect that my kids don’t actually even care or seem to notice if I am working or not. But I think this reiterates again that this is a spiritual discipline, put in place to ritualise wellbeing and balance.
Chores and maintenance are an essential part of our ‘Sabbath’ rest days
Rituals, Sabbaths and Larger Families
Finally, what does this have to do with large families, and why is this still important during times of pandemic and lockdown where I am continually present at home anyway? To answer the first, I think as our children develop their own interests and personalities, and the differences between them become more acute over time, there is a danger that little family factions will develop or that certain forms of interaction become hardened over time. For example, I’m pretty sure my teen would stay in her room 90% of the time rather than 70% if we didn’t have these things in place. She might roll her eyes that she has to stay at the table with us until everyone has finished eating, but being present with us even a little bit longer makes less real the belief that ‘nobody understands me’ and ‘I am alone in this world’ that is common at this age. I’m pretty sure my husband and I would just take turns with the baby and let the others run a bit wild since technically they can care for themselves. This would encourage the belief that ‘middle children don’t matter’ and ‘the baby is more special than me’ that often inadvertently develops in busy families. I don’t think we can necessarily prevent these beliefs from forming and developing, but we can make sure there are regular times where every individual is acknowledged because everyone is present and needed.
Family rituals also work to connect the family together and create a sense of ‘us’ that translates into a sense of belonging. In my father’s large family, traditions such as singing certain songs or telling certain bad jokes create a sense of belonging, even if it is punctuated with groans. In our everyday rituals, a minimum engagement with the family is communicated, and a flexible rigidity puts in place the kind of boundedness that helps a healthy attachment relationship and community grow. The stability of knowing rituals – pancakes come on Saturday and everyone must be present at the table for mealtimes – communicates that ‘our family is important’, and likewise, ‘I am important’.
Public holidays and religious holidays are important here too. The reason they are important is that everyone gets a day off on the same day, which is the perfect opportunity for collective family rituals to develop and be maintained. While technically as an academic with 5 weeks of paid annual leave per year, I could just take a rest day at any time I was not teaching, the fact that we all get holidays at the same time on certain days fosters the sense of togetherness, affiliation, belonging in community that contribute to intrinsic wellbeing at both social and individual levels.
Rituals and Sabbaths in times of collapsed boundaries
In times of collapsed boundaries as workplaces move into the homes, I reckon it is important to keep these rituals in place to provide that same sense of secure boundedness. When we work from home, we often have to enforce false boundaries in order to get work done — for example, putting off the requests of our children for attention in order to pay attention to a screen and incomprehensible tasks that don’t seem very important. Constantly saying ‘no’ and/or ignoring children can really become hard for them to bear, and they will certainly start letting you know in a variety of passive and direct ways! By having a commitment to our usual rituals, we are communicating that our children are important and that they matter, that we will fulfil our commitments to them in the same way that we do with our colleagues. I am all for fostering independence in the children, but I think that really only happens when they are secure that they will get what they need from us.
Two days ago was Easter Sunday. I could have spent the day reading a colleague’s 12,000 word article and preparing for an Easter Monday Zoom meeting scheduled. I did consider it, because I do care about my colleagues, but I also knew that my 6 year old had been counting down the days to Easter and that something special better happen.
In the end, I gave my apologies for the meeting on the grounds that it was a public holiday, and then we made a special Easter in Lockdown happen. We reminded ourselves of the Easter story. We boiled the eggs, then dyed them in food colouring. Each egg was different when peeled. After breakfast we had an Easter egg hunt in the backyard. Then a walk followed, to count the Easter eggs people are colouring and taping to their windows as a Lockdown activity. Then everyone did their own thing until dinner was served at 1pm. We had a tablecloth and napkins, fancy glasses and drinks, roast lamb and vegetables. We took family photos. Then everyone doing their own thing until the next meal: a collaborative starter and dessert meal. The eldest made the dessert. The second made the soup with supervision. The third learned how to make scones. Dad set the table and cleaned up. Baby enthusiastically sampled everything. We finished with listening to an audio book of Harry Potter before bed. While we couldn’t fulfil all the Easter rituals we usually have (we often travel to see family or go to church if we are home), it was enough to show that the day was special, that it was not a work day, that the story of new life and hope is important to our family.
So that’s my thoughts on this. I wonder how much of this is idiosyncratic, how much is how I was brought up, and how much is cultural? I do know that the longer I do this parenting thing, the more I find rituals and Sabbaths provide opportunity to define and shape our family, helping each person to find a place and belong. What rituals do you have in your family life? What challenges do you face in committing to regular rest-times?