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.