Taking a break

I am going to take a break, a month or so while my husband and I undergo fertility treatment. At this rate & after all the information I'm getting, I should start another blog! Thanks to those who read my blog, I will be back :)

Questions and answers

A fellow doula, and a wonderful one at that, asked me an incredibly thought provoking question this morning. It really made me think in what I truly believe in, and what I would justly fight for.

Curious question - how would you feel about a movement in to stop elective caesars (basically by law) - as in for no apparent true medical condition?

Would love to hear your gut reaction and your thought about it reaction.

My instincive response to your question - knowing the risks and so forth of elective c-sections is to say good and it's about time.

THOUGH my experience tells me differently and I feel that I believe more in informed choice rather than pushed choice. I feel that hospitals, healthcare professionals, and medical aids should rather spend their time educating mothers as to the risks of c-sections and the pro's of completely natural birth (none of this epidural stuff) than spending time trying to outlaw elective caesars.

I feel that if ALL mom's are completely educated about birth (and I mean COMPLETELY) then they would intuitively choose natural home based birth. There is so much stigmatism, mystery and mostly FEAR around birth - that if we took that away with education and revelation, then mothers would want to use their primal need to birth naturally.

So if we take away the choice of elective c-section, then I feel mothers would fight for it more - because they want the CHOICE. But education is the key for me!

Primal Mothering in a Modern World by Hygeia Halfmoon

While I comfort my current emotional standing with smoors and a cup of tea, I am thinking about credit due to the above book.

Hygeia addresses the issues of natural pregnancy, our emotional addiction to cooked foods and therefore the solution – fruitanariasm, unassisted childbirth, emotional addiction to destructive relationships, breastfeeding, home-schooling and such. All in all, the whole book is probably the most controversial I have ever read. I am not one to scare away from controversy but somehow this book made me wonder how one can argue by only giving one side of the story.

True, there are many parts of this book that I adore but more often than not, if there is a writer that I adore – I would match my viewpoints to their own. Though in this instance I am somewhat disillusioned in some of the arguments presented not because they are wrong – but they were not correctly debated.

Such as unassisted childbirth, though this would be my ideal birthing situation, unfortunately though it is not a reality. I thought homebirth wasn’t a reality until very recently, though I have thought long and hard about unassisted childbirth, and I believe in the village – I believe in women helping other women to birth. Therefore I believe in my midwife, doula and husband being available to me whilst I am in labour. Truthfully I shall ensure that I am the one to “deliver” my child but should my precious miracle need a little oxygen, I’m not against the midwife working some of her well trained magic.

I love the idea of primal mothering and I will use it in every circumstance that I can – I believe women should have more faith in their bodies and instincts and not rely so much on the medical institution. We are born to be mothers, and everything we need to care for our children is inside of us. Our own mothers need to help us to believe this, as well as our husbands – and most importantly you. Like I say, go against the flow.

Too posh to push – addressing the myth of bad sex after a natural birth

This foundation forms from fear and misinformation.

I was reading a pregnancy magazine last night and was quite surprised that a certain mother was so uneducated that she assumed that women would put themselves in a situation that would doom them into a disastrous sex life after they have had a child "naturally". The problem is, she didn’t know the difference between a natural birth - where a mother is allowed to push in any position she wants to and WHEN she wants to, and a vaginal birth - the situation where most Sandton’ers find themselves in – strapped to a monitor, with an epidural and they have NO idea when their body is telling them to push... pushing to the count of 10 on the nurses or doctors demands, over extended periods of time - over 1.5 hours, where blood vessels burst in your face – so imagine what is happening to your vaginal muscles. Natural birthing is gentle, you push when your body tells you, and you will very rarely push for longer than an hour, and a count past 6-8. If you; in conjunction with your midwife; have properly prepared the birth, most first time mom’s will push for 40 minutes. Second time mom’s, 20 minutes.

Let’s address the topic of incontinence. Vaginal or natural birth does not cause extended incontinence – IF it does happen (which it rarely does in natural birth cases), it will generally heal within the first few weeks after the birth. Where extended incontinence plays a part, is from the actual pregnancy itself. So whether you have a caesarian or a natural birth, the damage is already done. The number one way to heal this, is through doing your vaginal exercises – your antenatal teacher or midwife wasn’t joking when she said you should put a sign up to remind you to do your kegels, like 100-200 kegels a day! I suggest you get into the habit of it now, and your husband will thank you!

With regards to bad sex, I think the question in the aforementioned pregnancy magazine was “Why should I sacrifice my sex life for my baby?” – I don’t think one should have to, but I still feel that this kind of viewpoint is slightly selfish. Yes, sex will be different, but in many cases it is a lot better. You have a deeper connection with your husband, and as a woman you would a agree, sex is more about the emotional connection than the physical.

Know how your pregnancy and birth will affect your body. Encourage discussion between you and your husband and set your expectations where they should be. Pregnancy and birth is not a sickness, but as you would prepare and train your body for a cycling race, you need to make sure you do so for this beautiful miracle.

If Your Jugs Runneth Over

Breastmilk donation is a fairly new concept in South Africa and there are many amazing organisations that are making this life saving model a reality.

Though many mothers think they have the problem of having too little milk for their own babies, there are even more mothers who have the issue of having too much milk for their little button - and many are throwing it away. Please don't do this, your breastmilk can and will save the lives of many prem babies.

Firstly, why should you donate breastmilk? From www.health24.com

“Breastfeeding provides advantages to the general health, growth and development of an infant while significantly decreasing the risk for a large number of acute and chronic diseases,” says Nellie Koen, National Coordinator of Netcare’s Stork’s Nest. “But there are several more advantages to breastfeeding which can be linked to socio-economic factors, especially in developing countries.”

After giving birth many mothers these days choose not to breastfeed for differing reasons. Yet there are also those who cannot breastfeed, however much they may want to, due to complications resulting from, amongst others, trauma or HIV.

Important for premature babies
“One of the areas in paediatric care where the importance of breast milk becomes an imperative rather than a choice is with premature babies,” says Koen. “It is essential for premature babies to receive breast milk in order to prevent Necrotic Entero Colitis (NEC). However, not all mothers are able to produce breast milk for their newborns. This is why we want to place specific emphasis on the South African Breastmilk Reserve’s ‘breastmilk banks’, which we have set up in four of our hospitals, and the ‘Feed for Life’ initiative that has resulted from it.”

Koen explains: “Through the ‘Feed for Life’ initiative we are able to share pasteurised breastmilk from lactating mothers with babies who are unable to access breast milk from their own mothers. Mothers whose babies spend some time in the neonatal ICU (NICU) are encouraged and supported to express breastmilk for their babies. However, these infants only require small quantities of the milk and, upon their release, the leftover breastmilk in the hospital’s freezers can be put to better use rather than being thrown away.”

The ‘leftover’ pasteurised breastmilk from participating mothers, who have donated the excess milk, is therefore made available for other babies in the NICU or other hospitals - public or private. The donated breastmilk is pasteurised according to strict medical protocols and guidelines to ensure that the milk is delivered safely to the babies in need, whilst the ‘Feed for Life’ initiative is supported by the SARB.

How can you donate breastmilk? Visit www.sabr.org.za

Presently three breastmilk bank groups operate in South Africa. South African Breastmilk Reserve (Gauteng), iThembalethu, (Durban) and Milk Matters (Cape Town).

SABR operates as follows:

• We service the entire Gauteng Region.
• The South African Breastmilk Reserve is a charitable organisation that aims to bring the livelihood and safety of pasteurised breastmilk to infants. Our vision is to stimulate and support the formation of community-driven breastmilk banks and to teach HIV-positive mothers how to pasteurise their breastmilk at home, so as to safely feed their babies. We strive towards a South Africa ‘living with HIV/AIDS’, rather than ‘dying of HIV/AIDS’.
• SABR is an association registered under Section 21 of the Companies Act, registration number 2005\024165\08. The association adheres to the strictest principles of internationally accepted corporate governance and transparency. Audited financial results are published annually in the mainstream media and available to the public on request. SABR first financials, as a Non Profit Organisation, will be available with the end of financial year 2006.
• We collect breastmilk from donor moms, who are meticulously screened. Our containers are airtight and cannot be tampered with after sealing; the packaging was approved specifically for us by Clover. The milk is labelled, pasteurised and frozen. Milk banking has been practiced worldwide for over a century, and we follow accepted best practices.
• Moms are visited at home, all they need to have is copy of their negative anti-natal HIV test and access to fridge and freezer. They also need to live in a stable home environment possibly in a committed relationship with no multiple partners.
• We fill out a ‘donor screening questionnaire’ (see attachment) and they are given ‘donor protocol’ that details the way in which we recommend they handle the expressing and storage of breastmilk.
• They are given a bag containing 30 bottles and caps. The bottles are the same Clover uses for the packaging of their flavoured milk, with a peal of tin cap.
• Moms express the milk into the bottles and at the end of the day seal the cap by applying the hot iron to the top of the cap resting on the bottle.
• The bottles are labelled, dated, and frozen,
• Bottles are collected once a month, or depending on the size of the mom’s freezer.
• Bottles containing breastmilk are thawed, and placed sealed into the pasteurizer. Breastmilk is pasteurised in the bottles. Pasteurisation is achieved as follows. Bottles are placed in a water bath jacket and sit at a temperature of 63 degrees centigrade for twenty minutes (Holder method). Pasteurisation kills all external micro agents potentially harmful to infants.
• Bottles are removed from pasteurizer and rinsed in a cold water bath to aid the cooling down process.
• Bottles are then place into a dedicated breastmilk chest freezer.
• Milk is then dispatched according to demand always transported directly to the destination stored in cooler boxes, we hope to eventually raise fund for a refrigerated vehicle.
• SABR is also in the process of staffing volunteers so we want you, to help us bring breast milk to babies safely

Happy pumping!

Some snaps

Welcome baby girl
Happy Midwife - it was a quick labour!

Lily and I

One of my favourites - weighing baby.

My heart is so full

My most recent client contacted me today - I did my last postnatal visit last Thursday and I was kind of sad that that was it. This family had invited me so willingly into their home, and now it was gone forever. I love that I had that special time with them, the beautiful birth, the amazing chats, blowing kisses from their toddler... it was a space in time that was all mine.

She sent me a message today - just saying that they need a photo of me and Lily and they want to give me photographs of the birth. So I blurt out - "I miss you so much" (dumbass, who says that to their clients?!) and her reply was "I know! You were so involved and part of the birth, it felt weird to not see you again :)"

My goodness, who am I to deserve such abundance. God has entrusted me with so much, and nothing about this process has ever been close to disappointing.
Thank You!

Pain management techniques

On Monday night in antenatal classes we went through some pain management techniques - visualisations and breathing. I must say, I use my breathing ALL the time. Specially driving in Johannesburg traffic. In the middle of the night I have stubbed my toe several times on our bed base and my husband hears "hu-shew hu-shew hu-shew whooooooo". He must think I'm a loony.

Anyway, another pain management technique the midwife mentioned was singing during labour. It was kind of dismissed as a silly thing to do... but honestly it's something that I think could really work.

Take a look at this YouTube video... it's AMAZING!

http://www.youtube.com/watch?v=z3WA9iHz5ww&feature=related

It was a great day for a birth!

Mom smsed at 4.30am to say she had had 8 contractions in the last hour. Things were happening quickly. I was at her house at 6am - she had a couple of contractions and we decided to go through to Linkwood, they were getting close together very quickly. Went through to Linkwood and she was already 7-8cm dilated. She was doing SO well! I set up the pool (in 20 mins - I am an expert now) and she delivered by 7.47am. It was dad's birthday too - a great birthday present!! They hadn't decided on a name yet (they were juggling between Layla and Rosie). I held her for about an hour while mom was being stitched (she tore slightly on her previous episiotomy).

Big sister (16 months old) came to visit and kept kissing her and saying "baba". My heart could have burst!

SMS from her last night - Hi there. Just wanted to say thanks for being so incredible today. It was amazing to have that support and assistance. I really appreciate every minute you helped me, it was ten thousand times different to my first birth. And we finally have a name: Lily Sofia. Lily is of Latin origin and symbolic of purity and beauty. Sofia means wisdom.

*BEAM* I am so blessed.

Birthin from Within

A friend of mine borrowed my copy of "Birthing from Within" and so I have not read it over the past year - waiting in anticipation to get the copy back. I forced myself to finish Suzanne Arms's "Immaculate Deception" (though it's a great book) so I could start reading my newly returned Pam England book. (My husband recons you can't start a new book before you have finished the previous one). Anyway, I am completely hooked. I am craving information and there is just such a lack of education available in South Africa. I have resorted to reading course material from the WHO website - thanks WHO :)

Anyway I a feel like I have started a journey and I am wondering if all this education is a good thing or a bad thing when it comes to my babies. I am afraid I am going to be too much "in my mind" and focused on the birth experience than the final result of a baby. If I am concentrating so much on the process and perfection - can you really say it's still natural birth, primal birth?

One of mine

She's now 2.5 months old, and so beautiful! This little girl, her mom and her dad will always have a special place in my heart. Thank you for inviting me into such an intimate part of your life.

Am I subsidizing an elective caesarian?

My husband and I were having our nightly bath chat last evening. We got onto the topic of medical aids and elective caesarians (not such a difficult topic to steer to in our home) and it got me thinking that as medical aid members, we are subsidizing other members’ medical procedures. Surely then, I should have a say where my money is going? Or surely I should be able to sign up to understand how they (the MAs) with a clear conscious are spending my money?

Take this into consideration, a homebirth – with all paraphernalia and including all prenatal visits with a midwife could cost about R8 000 + a doula at a stretch. An elective caesarian (just for the operation!) costs R30 000 + hospital cover + 12 gynae visits + scans. Conclusively an elective caesarian costs 5 times what a homebirth costs – and MY money is going towards that! I am all for pro-choice but this is not the mothers choice, this is the gynaecologist getting rebates from the medical aid for choosing an unnecessary medical procedure for the mother and baby. Yet, my monthly medical aid costs are now in excess of R3000 for myself and my husband. My R3000 is subsidizing a procedure which in 70% of cases in the private sector in South Africa is needless major surgery.

Discovery (South Africa’s largest medical aid) has in excess of 2 million members (July 2007) and growing. I have absolutely no idea what the ratio is of childbearing women in that total amount, but even if we say one tenth are of the female sex and at a childbearing age – that’s 200 000 people at an average of R2 000 each as their monthly premiums – R400 000 000 (that’s four hundred million Rand a month!), consider that 70% of these women will have elective caesarians (15% over and above that will have emergency caesarians according to the World Health Organisation’s statistics) – that is R5 600 000 000 unneccessary spend – that’s R5 200 000 000 MORE than their monthly premiums added together. Who do you think is paying for those 70% of uncalled for caesarians? Mr Singh whom for his whole life has worked at a salary of R12 000 a month, and his wife has had two natural births at home. His monthly premium being in the region of R4 000 a month. Does this sound fair? These numbers are even difficult to comprehend, but obviously this is small change for the medical aids. Small change because there is no movement towards encouraging natural birth, and certainly don’t even ASK your medical aid to pay for your home birth. You will spend 9 months trying to get a single cent out of them.

Medical aids like to call their products “consumer-driven plans”, this is a bit of an redundant comment.

“Consumers have an unlimited demand for healthcare, but the resources available to medical schemes to pay for healthcare services are limited to members' contributions. Someone has to ration healthcare, and it is best if consumers do so themselves, says Adrian Gore, the chief executive of Discovery Health.

If schemes do not give consumers the power to decide how to ration their own healthcare, schemes are likely to fail, he adds.”

I would love to see this happen, pipe dreams Mr Gore, pipe dreams.

* source: www.persfin.co.za

Welcome to the world little Gabriella

I met the couple exactly one week ago to the day. Mom is stunning, and so young (2 years younger than me) and dad is studying to be a Pastor. Their faith and commitment really was amazing. She was only 38 weeks today, but dad knew that baby will be here this week.

Anyway I got a call at about 11am from the dad to say that they had gone in for their weekly appointment and the midwife told them that she will be having this baby before sunset. So I agree with dad that I will be there in about 2 hours just so they can go home and get their bags etc. 5 minutes later the midwife calls me and says that I should get there quickly, she is dilating quickly and its going to be a very quick birth. So I get into Fourways traffic, takes me about an hour to get there. Luckily when I arrived the birth pool was set up already by the granny (hehe) and the midwife said that I had to needed to make an effort to connect with the mom (considering we had a very short week to do it in). I walked into the room and she didn't want ANYONE touching her. Within an hour I was rubbing her back and comforting her through the contractions. Their was a song playing on the radio that we all loved and the dad and I laughed and said it would be funny if the baby was born to that song. I was with her for about an hour before the midwife came in - she got to about 7-8cm dilated within this time. This girl, this amazing woman, managed her contractions so so well. She did cry, but she was so strong and so incredible that I am just in awe.

Baby was born in the birthing pool (with dad in it) at 15h05 - to the song that we laughed about earlier - a miracle I believe! (lyrics below). Gabriella weighed in at 2.85kgs. I helped mom take a bath after the birth, and baby latched absolutely perfectly first time. Mom and dad are amazing, and I would be blessed if my own birth went half as well as hers did. She had a slight nick, but nothing that needed to be stitched. It was a quick labour, about 8 hours in all.

The midwife let me put her first nappy on her and show mom and dad how to use the wecesan powder on the umbilical cord. I felt SO HONOURED to be asked to do that!

She was named after the Angel Gabriel, and this is the song she was born to (it is the most beautiful song, and I just cry when i think about it):

[i] verse 1

i see the king of glory coming on the clouds with fire the whole earth shakes the whole earth shakes.

verse 2

i see his love and mercy washing over all our sin the people sing the people sing.

chorus

hosanna hosanna, hosanna in the highest. hosanna hosanna, hosanna in the highest.

verse 3

i see a generation rising up to take their place with selfless faith with selfless faith.

verse 4

i see a near revival stirring as we pray and seek we're on our knees we're on our knees.

chorus

hosanna hosanna, hosanna in the highest. hosanna hosanna, hosanna in the highest.

bridge

heal my heart and make it clean open up my eyes to the things unseen show me how to love like you have loved me. break my heart for what breaks yours everything i am for your kingdoms cause as i walk from earth into eternity.

chorus

hosanna hosanna, hosanna in the highest. hosanna hosanna, hosanna in the highest. (x2)[/i]

Thank you Lord for another miracle.

I'm a happy doula

Had THE MOST AMAZING birth today! I feel so blessed! Will update tomorrow... still on too much of a high to put a comprehensive sentence together.

WOW WOW WOW!!!

My First Birth as a Doula...

... but technically my second. I still often think about this birth, it was amazing and one of the best experiences of my life. I don't think I helped much, but I was so grateful to the parents and the midwife for letting me be there. I cried my eyes out after that birth and if mine can be anything like it, I would be very blessed.

My Choice

Today I was asked what my birth choice would be, and I think the response really surprised my friends.

My first choice is to have a completely natural unmedicated home birth, with zero intervention. If I do not get this, I will have a caesarian. No middle ground for me – no dripping, inducing, medicating, cutting, salad server-ing me thank you very much!

I think I am so vocal about natural birth that people seem to assume that as long as the baby comes out of my vagina, I would be happy. But it’s not that way at all. Most of the horror or “birth rape” stories that I have heard have been about vaginal births gone wrong… gone wrong because they have been augmented, strapped to a bed with a baby monitor, baby has gone into distress and they have either been cut and and forcepted or the baby was taken out the “sun-roof”. I think people do not understand that interventions themselves are more emotionally damaging than a scheduled caesarian at 38 weeks.

So it’s all or nothing for me.

Doula/Advocate

Dictionary: Advocate (noun)

To speak, plead, or argue in favor of.

1. One that argues for a cause; a supporter or defender: an advocate of civil rights.
2. One that pleads in another's behalf; an intercessor: advocates for abused children and spouses.
3. A lawyer.

Thesaurus: Advocate

verb

To aid the cause of by approving or favoring: back, champion, endorse, get behind, plump for, recommend, side with, stand behind, stand by, support, uphold. Idioms: align oneself with, go to bat for, take the part of. See support/oppose.

In South Africa, a doula is a fairly new concept. Certainly with an actual “job title” and specifically within the private sector hospitals. The majority of women who birth at home, or in the rural areas, would have a support person who would be their “doula” – not having a specific qualification to do so but having the most important aspect, which would be experience and the understanding that what this woman is doing is a completely natural thing.

So, I suppose when being a doula became a career – where a qualification would thrust you into this amazing (most midwife births) and devastating world (most gynae births). It was now a job where you get paid for (albeit not much) and you could run your household on this income. There are guidelines to being a doula, and these are the guidelines that a mother and father would specifically hire a doula to assist with during the prenatal, birth and postpartum period. These are what she can “sell” her services on – which means she needs to deliver.

One of the most important services of being a doula, is to be an advocate for the family, specifically the mother in the birthing room. When she is at her most vulnerable, it is very easy for her to be bullied by her medical caregivers into “choosing” certain interventions that she previously did not want and were not part of the birth plan and would essentially change her recollection of what her birth could have been. This causes major issues with bonding with the baby and many other things that I will need to spend another time writing on.

So what do we need to do to ensure that the mother gets what she wants? We need to buy time from the doctors, we need to educate the parents on what the pros and cons are on each intervention. Then who tells the doctor that the mother would not actually like an epidural, but will moan through her pain – which would make a noise in the hospital and “unsettle the other mothers” according to the doctors? Who will tell the obstetrician that she wants to birth upright (hopefully this would be discussion beforehand though)? Who will tell the very pushy nurses that the mother is exclusively breastfeeding and she doesn’t want to top up? The definition of advocate is specifically defined as one who “argues for a cause; a supporter or defender; pleads in another's behalf; an intercessor”. To me that means that we need to be the one in-between the mother and the caregiver? The buffer, the middle-man? Do we live up to this? Do you as a doula live up to this?

When I did my doula programme, we were specifically told not to “kick up a stink” or “get yourself kicked out the hospital”. We were told that we were not allowed to frankly speak to the staff and that we would need to speak to the mother and father, help them make their decision, and then it was their responsibility to then tell the staff what they choose. In a way, I completely understand why a doula would be required to do this, specifically in the situation that doulas stand in this country and specifically within the private healthcare hospitals. If we get kicked out the hospital or upset the staff, we mess it up for every other doula who would have potentially worked in that hospital. So do we work for the “greater good” and our colleagues or do we work for our mothers and ensure that EVERY single one has the birth experience that she wanted? Who do we protect? Ourselves – our pride – and our colleagues?

I know how difficult it is to speak to a doctor/nurse/midwife in a birth situation – seeing as they are the medical professionals. But a mother and a father are not medical professionals either – they are expected to know best how to raise their children, so would the mother now know best how to birth her child? A should doula be the person that encourages her to believe in her inherent ability to give birth to a child perfectly. The mother is not medical, the doula is not medical, but the caregiver is – and ofcourse they are the be all, end all and all knowing!? I don’t buy it, but in a corporate world we are to trust them as we should god, otherwise risk losing your career, losing integrity on behalf of your colleagues, tarnishing all doulas whom have worked so hard to even be able to enter a private hospital. If we did not have our predecessors who prepared the path for us to even practice in that environment, we would not even have that client. But that client is a mother, a labouring beautiful mother who deserves the best birth because it may be one of only a couple for her, but one of maybe hundreds in the career of a doula. We may as well become obstetricians if we are not going to be advocates for our mothers.

Michel Phelps at a Young Age

This really made my day - hee hee :) :)

***Got it over email, so I am not sure who to credit it too. If this is your cartoon, please send me a message and I will be SURE to credit you with regards to this. ***

My Birth

My mom went into false labour a week before I was actually born. Then the evening before I was due she went into labour, about 11pm. She said she knew it was labour because it was painful (LOL). She stayed in bed and waited until the contractions were 5 minutes apart, and eventually woke up my father at 3am to take her to the hospital. When she arrived the nurses were very nice to her. They measured how dilated she was and told her she would have to wait a long time – she was 5cm dilated. Her waters had already broken at this time. At this stage they did not know that I was breech at all, they had not picked this up in any of the scans and the midwife/nurse/gynae did not check this whilst she was in the early stages of labour or during her prenatal care.

There were medical students, her mother-in-law and various nurses and doctors in the room with her whilst she was labouring. She did not have a choice who was with her or not. By 10h00 she was fully dilated and told to push, only once my bum was coming out first did they realize that I was breech. She had a third degree tear and during the whole labour/birth was not given any option of pain relief. As soon as I was born they put me on her chest and she immediately told the nurses to take me off as she was in too much pain.

After the birth, she was stitched up and left alone. The placenta had still not come out – not that anyone had noticed. She sneezed and it came out, she burst into tears because she thought that she had had another baby.

The nurses did try and encourage her to breast feed, but because she was in a lot of pain from the tear she could not sit comfortably and therefore did not breastfeed at all.

When asked to think in retrospect about her birthing experience, she said all in all it was completely off-putting. There is nothing affirmative about the birth that she can recall, even though she speaks about it in a chit-chat way. She said that she didn’t feel supported by any of the staff in the hospital and was constantly left in the dark about it being a breech birth. It was a completely uncontrollable experience according to her recollection. The doctor’s panicked and in turn made her panic.

I think the saddest thing is that she said her birth experience influenced her decision to not have any more children. She said without a doubt she would have had a caesarian if she had fallen pregnant again though she did not plan to have any more children because of the traumatic birth experience she had with me.

It's Just a Laundry Problem

In South Africa, reflux – like cephalopelvic disproportion – is over diagnosed. The majority of babies posset, and many of those majority spit up A LOT!

When does reflux become “gastro-oesophageal reflux disease” (GERD – in the states oesophageal is spelt esophageal) where it needs to be treated with medication and surgery?

Babies spit up because they have small stomachs and because they have a weak or under-developed gastro-oesophogeal sphincter. As long as baby is happy for the majority of the time, has plenty of wet and soiled nappies and is gaining weight it is a completely normal natural thing.

It becomes a medical problem when the ‘spit-up’ contains stomach acids, baby doesn’t sleep, the baby is in pain and always inconsolable, arches back and neck (most babies do this – remember we are looking for symptoms that are around for the majority of the time), spits up blood, breathing problems and the baby is not gaining weight at all.

Babies who don’t vomit, can also have reflux. When GERD is present without vomiting or spitting, it's referred to as silent reflux. Symptoms would be as above.

As mentioned before, most of the time it is normal – but there are situations where one can make it worse:

- Formula feeding

- Babies lying on their backs

- Swallowing air (causes distention)

- Teething (baby swallows saliva – its unnatural to have a HUGE amount of saliva in the stomach, therefore baby will vomit it up to get rid of it)

- Colds and a runny nose (baby swallows mucous – same as above)

- Food sensitivity to what mother eats which does follow through into breastmilk

- Overabundant milk supply

- Rapid let-down (baby swallows lots of air)

What can we do to assist in making this a little easier, before we go the medication or surgery route?

- Frequent nursing (small amounts of milk consumed at a time)*

- Ensure a good latch (which minimizes air swallowing)

- Skin to skin contact (this encourages frequent nursing and will calm your baby when it panics from possetting)

- Upright nursing and posture for mom

- Baby can also sleep on its stomach during the day if it is going to be SUPERVISED the whole time, this will also sooth the stomach

- Put baby in a baby carrier or a sling but not in a car chair – this makes the problem worse because it compresses the digestive tract

- Encourage comfort suckling (at the breast)

- Eliminate tobacco and caffeine from your diet

- Consider mother to child allergies (cows milk, wheat etc.)

- DO NOT THICKEN FEEDS! Baby is not ready for solids anytime before 6 months. This is not as harmless as it seems and studies are showing that doing this is causing lung complications in some children. It works in a sense that there is less spitting up, but the baby still has reflux on the inside (silent reflux)… this will increase the chance of perforating the oesophagus and the pain is terrible for baby.

If your child is truly diagnosed with GERD (in SA, Doctors will just call it reflux – but it needs to be medicated when it is TRUE GERD) there are ways to treat it, there are the following options:

- Antacids (Telement Drops)

- H2 Blockers & PPI (Zantac & Losec)

- Prokinetics (Maxallon)

- Cytoprotective Agents (Alsanice & Gaviscon)

Surgery is the last possible step – they will perform a procedure called “Floppy Nissen Fundoplication”. In some hospitals they are now doing this via laparoscopy but this does not reduce the risk that your child will need to go under general anaesthetic and it is major surgery. Please get a second opinion before your child is operated on.

There is no cure for GERD. Medication and surgery only serve to hopefully ease the pain and symptoms.

In conclusion, is spitting up bad? No, God created babies this way. The majority of the time, it’s just a laundry problem!

* science tells us that it takes 1.5 hours for a baby to digest breastmilk. So keep your feeding as close to these times as possible to relieve the symptoms of reflux and/or GERD

Bittersweet-ness

Yesterday it was really bittersweet for me, it was one year since we started TTC (exactly one year since the visit with the evil gynaecologist) and it was A’s christening. She is now 4 months old and the most gorgeous child. She smiles ALL the time, is breastfeeding like a pro, blows raspberries and reaches out for things she wants to touch. She honestly is such a friendly little baby and I think mom has an easier time than she thinks.

A's dad walked me out to my car yesterday to say goodbye after the celebratory braai and I told him that J and I are really honoured to be A’s godparents. He looked me straight in the eye and said “we wouldn’t have it any other way”. I kind of got all tongue tied after that, I didn’t expect it at all. Here’s a little baby; the most beautiful baby girl on earth; that we have been entrusted with should her parents not be around for her. Her parents are the only people who can give her exactly what she needs, and J and I have been blessed with that amazing gift! Wow! My goodness, it’s a bigger responsibility than I thought and I don’t know how one would even choose godparents.

J called later that evening to tell me about Sweden and I told him the story of the day. I think he was quite sad that he couldn’t be there and kept apologizing – even though he is having the most wonderful time in Hudiksvall – just like Canada he says.

It seems quite a solemn day: everyone moaning its Monday, there’s a heat wave and all sorts of horrible things happened over the weekend in SA. But I think of Little A and want her to believe in the good of life and never know that there is evil. Reverend Shaw said yesterday that we should praise the Creator not the creation – but when the creation is so perfect you cannot help but be in admiration.

Fight or flight response in a labouring woman

Many things can “cause” the fight or flight response in a woman’s labour. One of the most common would be moving into unfamiliar surroundings after a successfully progressing labour, such as moving into the hospital environment from your home or associated would be a new staff shift within the hospital. Another thing that could cause this response would be a person whom you are not comfortable with in your birth space or not having support in your choice of birth (home birth etc.) and hunger can also cause you to physically move into this response – in a hospital environment you are connected to a drip and you are not allowed to eat or drink in case of an “emergency” caesarian. And lastly one of the most common causes of the fight or flight response is fear – fear of a caesarian, fear of forcepts, fear of an episiotomy, fear of dying and even the fear that your child will not be born healthy. Your nervous system does not know the difference between real or imagined danger or fear and so will respond in the same way to both.

This response causes labour contractions to slow down or stop and they would not resume until you felt safe or became familiar to the environment you are in. This fear activates the nervous system to produce adrenaline (danger hormone), which gives you the power to prepare to fight or to run away. Your cervix tightens (to prevent your baby from being born where it is not safe) and the increased level of adrenaline neutralises the Oxytocin (the hormone responsible for stimulating your uterus to contract) and endorphins (pain killing hormone), so that the body naturally slows down or even stops the birthing. Experiencing fear during labour leads to your heart rate increasing, your breathing becoming shallow and faster (so reducing the amount of Oxygen in your body and your baby), your heart pumping blood faster around your body so raising your blood pressure and blood being directed away from your Uterus (and your baby) to your limbs, essentially to prepare you for action.

If you go into the birth feeling and being frightened, your system will respond accordingly. This fear will lead to increased adrenaline in your body, which leads to increased tension in your muscles and your cervix with less contraction hormones (Oxytocin) being produced, so that your uterus is having to work much harder to flex and tighten. This subsequently makes contractions far more painful, in the same way that if you tense up when you are in pain, the pain becomes far greater.

No matter how negative the above sounds, some traditional cultures have used this fight or flight effect to help women having difficulty with the delivery by surprising or shouting out at this stage. It makes sense; at this point-of-no-return; for fear or danger to speed up the birth, so that a mother can gather up her newborn baby and run for safety. Though obviously this would not be the best experience for the mother and can cause negative feelings about her child’s birth.