One Autumnal Day with a Doula

A day in the life of a Doula.

www.thedoulaelement.co.uk

I wake at 5am to a text message from a new dad. “Placenta was in the cool bag within 12 minutes of arrival, all cooling instructions followed and it is safely on it’s way to our house to go in the fridge.” 
I reply that I’ll collect it after my visits this morning.  
A placenta needs to be in an appropriate container and cool bag to be chilled in the first 30 minutes after birth. The reason for this is to ensure it is chilled quickly after birth and safe to consume after preparation. The parents have very clear instructions on how to do this and I send out a kit they can use at homeor hospotal. 

I grab a coffee (or three), and head out to my first job at 6am. It’s a half hour drive and it’s icy this morning – first frost of the year. 

As their postnatal doula, I arrive to support a family after they’ve had a sleepless night. I pop a sling on, ready for a baby to snuggle in should I need it whilst I fold up the dry cloth nappies and replace them on the drying rack with freshly washed nappies. 

Mum is feeding the baby when I arrive and once he’s fully satisfied with his milk, she hands over the smiley baby so she can grab a shower and some breakfast.  Making use of my time is important to her family. She is exhausted and tells me she’s not had time to brush her teeth in the past 24 hours, let alone grab a shower. I continue to tidy around, sort any baby paraphernalia out around the house and make a tidy nest again on the sofa, complete with snacks and water for the day. I chop some root vegetables ready for roasting and pop them in the oven with the timer on as I’ll be gone when they’re ready to come out. As mum comes down I hand her a cup of tea and pop a sleeping baby down out of the sling and into his crib so I can head out again.

My next visit is to a mum struggling to feed her baby. She has called me the evening before and wondered if she was doing anything wrong because her baby would latch and then sleep very quickly, not drinking much at all and then come back twenty minutes later. This cycle was leaving her and the baby without any rest. 

I arrived and made us both a cup of coffee. I listened to mum explain what she’s been experiencing so far and a little about her birth story. We discovered that baby was being held a little away from mum’s body, baby needed to stretch and crane to reach the breast. This quickly tired the baby out and so she fell asleep after a couple of minutes of active drinking. I supported mum to change her position a little and hold baby close. She was a little hesitant because of her sore nipples. Once baby was tucked in close and able to latch on quickly, she took a huge mouthful of breast and drank well for 20 minutes, falling off the breast fully satisfied. Mum couldn’t believe the baby was so relaxed and full! Such a little tweak can make all the difference.

Off I go again to collect this morning’s placenta. It’s 12pm and I am aware I need to eat. I know my kitchen will be out of bounds for a few hours so I grab a salad from a cafe as I drive towards the new family’s house. Being a Doula quite often means skipping meals and protein bars, dried nuts and fruit seem to be my go to snacks throughout the day. 

I arrive to collect the placenta and congratulate the new parents who are now at home after their birth in the middle of the night. I pop on some gloves, check the temperature of the placenta to ensure it is sufficently cooled and after showing the parents the amazing placenta and all of it’s fascinating functions, I take off a piece for the smoothie. My smoothie kit (and a brand new hand blender) is already at their house and I leave dad with the piece of placenta to blend with fruit for his wife as he gets his gloves and apron on – he has been very excited about preparing this for his wife. The remaining placenta is safe in the cool bag and I head home to process it. 

Placenta Encapsulation amazes me everytime. They tell a story and I feel amazed everytime I have one in my house as I turn them into wonderful remedies. This placenta will be a smoothie which dad has made, capsules and a tincture. 

I have a couple of hours to keep the placenta in the cool bag and it’s a good job there is time allowed! My daughter has been baking and so the kitchen is a little worse for wear! I clear every side including the sink area of everything. Every side needs to be clear, clean and disinfected to abide by food safety guidance and ensure the safety for my clients. I don my gloves and scrub the area.  I spray down with hospital grade disinfectant and leave for the required contact time before wiping down. I then unpack my Placenta Preparation Kit and dehydrator. This first step of preparation for the placenta takes around 1 hour. 

A piece of placenta is taken first and prepared for the tincture. This will stay in the cupboard for 6 weeks to develop. The rest of the placenta is sliced and popped into the dehydrator, the cord long enough to make a keepsake heart. I can’t even start to tell you how many pairs of gloves get used in the process!! 

I turn the dehydrator on and begin to clean everywhere down again and disinfect. All of my equipment is cleaned, rinsed and put into a bucket of hospital grade disinfectant so it can be reused once again. 

The kitchen area used for placenta encapsulation is now out of bounds. I prepare dinner on the other side of the kitchen, placing all food equipment directly into the dishwasher and avoiding the sink other than for clean water to wipe the sides down.  

I settle down with a coffee to check my messages and emails. I organise my diary and set up some games with the kids who have been with their dad at home today. Dinner will be ready soon and I have some admin for my volunteer roles to do too. 

I am aware throughout the day that I’m on call for a birth too. This is always an acute awareness of the possibility of leaving everything with very short notice. Parents keep me updated with any changes in how they feel, or any signs of labour and I often have very little notice before the time comes to jump in the car. No babies today, so I continue my evening with emails, follow up calls and texts and relax with my children after dinner. I aim to sleep early so I can start over again tomorrow with the next placenta encapsulation step – Doula Last Words – “unless I’m at a birth.” 😀

Doula-ing

I have worked with some amazing midwives in the past few years  Midwives who put their neck on the line in the name of informed choice. Midwives who can work in the dark with a small torch, without a cry of how she cannot see to do her paperwork. Midwives who can read a birth preferences document and understand it in it’s entirety and not cherry pick the bits she will ‘allow’ in the policy and procedure driven environment she works within.

Doula-ing helps me to be gentle with midwives. To support them in their work as I support my clients wishes for their birth. As I protect the birth space, I thank them for being by my side as well as my client.

Doula-ing means whilst keeping a birth space warm and dark and free from disturbance,  I may also need to have my advocacy hat on. This does not mean I am choosing sides. It means I am doing my job as a doula, protecting my clients’ choices, choices which have been carefully made with a sound evidence base, on an individual basis. What’s right for one, isn’t for another. 

Doula-ing is eating energy bars at 3am and keeping ground coffee in my doula bag to avoid the crappy instant stuff in the hospital and share with a tired midwife or partner.

Doula-ing is waking five times a night for upto four weeks or more, imagining you may have missed that important phone call and feeling the sweet relief that you haven’t as you drift back to sleep with a smile.

Doula-ing is hugs and amazement about the spectacular parenting achievements you’ve made after a tricky start.

Doula-ing is walking alongside and listening to Doula colleagues as they walk their own path alongside the families they work with. Doulas need doulas too. 

Doula-ing is making it up to my family for being AWOL for hours or days after sneaking away in the dead of night.

I wouldn’t have it any other way. Doula-ing is the path I’m on and I believe I’ve always been on this journey in one way or another. Across dark, gravel paths and sunlit woodland, I’ve accepted my destination. 

 

Your baby’s latch is GREAT…..

Is your breastfeeding latch great (or bottle if that’s your chosen method)? This is a little different to my usual blog musings. It’s a little close to heart for many of us working in the infant feeding realms you see, and we witness these things happen in our day to day work. Infant feeding is such an important part of our parenting journey and due to the cuts and lack of funding in infant feeding, this leaves so few people trained in basic breastfeeding support, let alone the complex stuff which comes up, parents are often left wondering what they might be able to do to improve their situation without the support to do so.

Breastfeeding support

Facebook groups are full of peer support in the form of mum to mum groups offering words of encouragement, support and chat 24 hours a day which is great for moral support and a virtual hug at 3am when things are just exhausting, because somebody else is also on the twilight shift, trying to crack that perfect breastfeeding latch. What we also witness in these groups is parents and babies who need individualised support, face to face and from a specialist. One example, quite frankly a scary one, is to see parents of extremely underweight babies told to “just breastfeed, hun”, with no concern or request for review from a healthcare professional, breastfeeding counsellor or IBCLC.

What often happens far too frequently (just reading Facebook groups is enough to gather evidence on this) is that across the UK, no real assessment occurs, any of the parents concerns are not listened to and are often dismissed or trivialised, and you just have to continue because your baby’s latch is fine…….
More and more frequently we hear of peer supporters, Breastfeeding Counsellors,  IBCLCs, midwives, health visitors and even dentists telling parents to “feed feed feed”. This information is all fine and well for a term baby who is drinking well at the breast and having frequent wet and dirty nappies and gaining weight. Feed the baby is always the first rule, but fed is not best as Dr Amy Brown discusses here………..

On the other end of the spectrum, blanket infant feeding information is not so ok when the opposite is happening and the signs parents are reporting show a baby who isn’t transferring milk as well as they could. What are parents to do? Where do they turn when they’ve already consulted *insert infant feeding person* and been told all is well when the actual evidence says differently?

Is baby drinking well and regularly – 8-12 times a day? Are you and baby comfortable and attaching well at the breast in a position that works for you?
Has anybody observed a full feed to check this and reassure you and explain how to recognise the signs your baby is transferring milk well? How many wet and dirty nappies? Are you and your baby getting sleep between feeds? Are their hands relaxed and open, and does your baby sleep after a feed?

As a general rule of thumb, a newborn baby in the first 6-8 weeks of life who is hydrated and feeding well will:

  • have 6-8 wet nappies per day,
  • a minimum of 2 dirty nappies per day (3/4 or more is also normal),
  • show signs of relaxation (hands unclasped and floppy) towards the end of a feed,
  • sleep well between feeds or remain peaceful and calm if they remain awake for a time afterwards.

Feeding plans written by lactation consultants are sometimes put in place where babies have a tricky start because of adverse birth situations, delay in milk coming in or anatomical issues like tongue tie or cleft palate. Where a large weight loss in the early days occurs, those short term combination feeding plans are valuable in protecting milk supply and reduce the risk of deydration and the problems that could occur. Pumping and breastfeeding, an element of topping up with expressed breastmilk or artifical infant milk can support the dyad when early signs of problems haven’t been recognised

Sometimes babies will be finger feeding and breastfeeding or bottle feeding, syringe feeding or using an SNS. A combination of all of these methods is sometimes used –  which can be utterly confusing for somebody who isn’t trained in using supplemental support and may dismiss their validity.
Which qualifications are held by the people providing you with infant feeding support? There are several examples in other blogs about the difference between a peer supporter, a Breastfeeding Counsellor and a IBCLC. And even between all of those roles, there are vast differences across the country in the training and experience each individual may have. It is important to note that whilst some areas have specialist trained midwives and health visitors, many areas do not and parents with infant feeding problems should be referred to somebody who can assess infant feeding where a problem arises because it is not all about the latch.

As a new parent, you and your baby are learning, you are getting to know each other and how these things work for you personally. Knowing where to find the correct support for individual situations, tailored to you, as well as the basic information about infant feeding is important to your journey. As funds are cut and services are overstretched in maternity and community health visiting, it often results in nobody being qualified, no specialist training in infant feeding or assessment (and remembering that experience and training are not equal across the country). Throughout the training it is often relayed to us that should we see something that is beyond our remit, referral pathways to somebody else who can provide additional help should be the next step.

In an ideal world that’s how it should work…..instead a quick peek is had and parents are often told “you’re baby’s latch is GREAT!” because the subtle differences between a baby hanging out at the breast receiving very little and a baby feeding effectively are missed by the untrained or inexperienced eye. Parents then believe they’re doing all they can and when things don’t go to plan they have no explanation because somebody told them things were perfect.

Below you will find highlighted some of things we see and hear in our work with parents and babies in lactation support.

Your baby’s latch is great…..

  • Your nipples look like a brand new Heather Shimmer and feel as though they may fall off if you ever feed your baby again, yet your baby’s latch is great.
  • Your latch is great when you feel like a cheese grater is attached to your breast and you are convinced a vice would be less painful.
  • Bleeding, agonising, lacerated nipples – your latch is great!!!
  • Your baby’s red book shows slow or static weight gain, and baby’s latch is great.
  • Your shoulders ache as your baby feeds for an hour and comes back to nurse again after a 15 minute break, the latch is great!
  • Your baby hasn’t slept in the first 72 hours hours of life for more than 5 minutes at once, your baby’s latch is great.
  • Your baby has slept soundly for 8 hours and fed 4 times today, your latch is great.
  • You’ve seen no dirty nappies for 3 days, your latch is great.
  • Wet nappies are few, but your latch is great.
  • Five minute feeds and hour long naps before hunger strikes again, your latch is great.
  • You’ve only eaten once today and had no rest between feeds, you’re doing great!
  • After a big, wide attachment which you’ve nailed with military precision, your baby slips to the end of your nipple, and so your latch is great.
  • No swallowing and lots of sucks, your baby’s latch is great.
  • Nipple in babies mouth? Your latch is great!

From Alice: your breast is so swollen-full of milk that your nipple won’t fit in your babies mouth, but your latch is great.

    You might recognise some of these scenarios or feel you’d like to add to this list, contact me if you’d like to add your own. 

    Finding the support you need can be difficult and sometimes confusing for new parents who are not sure who is and is not qualified to provide basic support or when things might need more specialist help. Some areas are a postcode lottery with infant services being cut and training stopped. There are some great places to find support across the UK from online resources, national breastfeeding helplines and asking parents for reviews of those services local to you. Effective feeding signs are the key to success, not what your breastfeeding latch looks like to somebody else.

    Placenta Encapsulation Manchester

    I Am Doula

    placenta encapsulation cheshire

    Placenta Encapsulation Cheshire I Am Doula… Doula-ing is probably something I have done my whole life. In primary school I remember being the person who supported my friends in times of need. I would let my own work slack and … Continue reading

    A day in the life of a doula

    cropped-New-logo-1.jpgA day in the life of a doula!

    This year I noted one of my days for a local network group. Here is a rough idea of what I might get upto as a doula, so hopefully you will get the jist

    My working days include various work related tasks. I have started to use a Bullet Journal to my advantage as I can prioritise appointments and personal stuff all in one space! It has been a revelation!

    4.30am – Home from birth-SLEEP!

    7am – Coffee (x3!) and catch up with emails

    8am – Sort out the kid’s schedule for the day which varies depending where I am working (as we’re HE first job is to sort everyone’s schedule for the day, one of the pros of home educating is flexibility!)

    9am – Postnatal visit…..make mum a coffee whilst she feeds baby after the lovely, hot shower she managed to grab when I arrived. Tidy around and prepare lunch for mum and older siblings and pop in the fridge to be grabbed later. Ask if any niggly tasks need doing that mum hasn’t managed whilst getting to know her baby. Sit and have some tea and cake with mum and listen to her story.

    11am – Postnatal visit for breastfeeding support. I support a mum who’s struggling to breastfeed following her Caesarean, and we cover tips on how she can get comfortable and work around her wound.

    13.30pm – Midwife visit. Mum wanted me by her side to support her as an advocate whilst dad-to-be is at work. She is struggling to get her birth preferences agreed at the hospital and is meeting with the Supervisor of Midwives to ask for some support from the Midwifery team.

    2pm – Home again for a nap, prepare dinner and cuddle the kids (and the husband!)

    5.30pm – Facilitate birth choices group and set up a pool demo for new parents exploring their options and considering a home water birth

    8.30pm – Catch up telephone calls with other healthcare professionals who I am currently working alongside with a family with complex needs to update them on this week’s visits.

    9pm – Dinner and Bedtime!

    11pm – Called out by parents to a postnatal ward for urgent support

    4am – SLEEP!!!

    I love my work as a doula, and all of the planned and unexpected work it entails. I love the families I support for the short time I am with them. Being a doula is much more than my job, it is who I am. It is most likely something I have done most of my adult life, without realising-many doulas report this experience themselves.

    Doulaing is not always planned, on a schedule or even predictable. And I would not have it any other way, especially when I arrive home on some days,  I am treated to a view of the sunset  <3

    doula day

    Closing the Bones

    Rebozo RelaxationClosing the Bones is one of the many ancient traditions women usually participate in during the weeks and months following the birth of their babies. This kind of ceremony, which are upheld in various countries across the world, sacred rituals handed down generations, skills passed through the birthlines of women in communities far and wide, welcoming women in their journey to motherhood.  Closing the Bones as a postnatal ritual originates in Ecuador and involves the use of blended essential oils, soothing massage of the abdomen, pelvis and hips blended with the relaxating rhythm of rebozo and using the soft fabric of the rebozo, you may be gently wrapped afterwards to complete the massage. This gentle combination of massage, rebozo techniques and wrapping can help to nurture a new mother and encourages the closing of her body which have been opened up both emotionally and physically during the journey of pregnancy, labour and birth.

    Closing the Bones is a lovely postnatal session that I would like to share with you. Available at anytime after the birth of your baby, even many years after, you can benefit from this healing ritual as part of your journey. If you feel you would benefit from Closing the Bones, I am available to provide you with this wonderful, nurturing postnatal session. Please get in touch for more details.

    Closing the Bones in Cheshire, Greater Manchester and surrounding areas.

    Six Reasons to Hire A Doula

    Six Reasons to Hire A Doula

    Cheshire Doula Nikki Mather-Six Reasons (and countless benefits) for Investing in a Doula. Have you thought about having a birth doula or postnatal doula but are unsure whether you need one? Your partner is fantastic, your mother or mother in … Continue reading

    Just ‘Being’ A Doula

    Cheshire Birth and Postnatal Doula Nikki Mather, talks about her visit to Paramana Doula with Michel Odent and Liliana Lammers and just ‘being’ a doula.

    I am not always known for being the quietest of people around friends and family and can have some wildly wacky and opinionated thoughts and discussions when it comes to topics I am passionate about. In a stark contrast, when I am with women and their families, I am calm, quiet, relaxed and just ‘be’.  I listen well, I support wholly and my aim is to enable informed decisions to be made by the women I support. That does not make sense for most people who know me, they cannot understand how I can be so different in my doula role and with the women I have supported over the years with breastfeeding and I guess it is just my way of dealing with the energy flowing around and within me that allows me to direct that energy appropriately.

    When I did my first bout of doula training, or preparation course, what totally resonated with me is that one key ability a doula needs to hold in her toolbox is to just ‘be’, sit quietly, inconspicuously be present but not make a fuss, not make a noise and literally just protect the birth space. I enjoy quiet, I enjoy peace and often ‘switch off’ whilst knitting or crocheting, using tools to turn off my active mind help me to relax and is important to me when supporting families that I am present for them. Birth needs an uninterrupted space, protected space, sacred space, families to feel safe. When women are able to feel safe, birth can move forward efficiently. A doula can hold that space for a family.

    This weekend I have been very blessed to experience many hours of another doula course, Paramana Doula, with Dr Michel Odent and Doula Liliana Lammers, and everything about just ‘being’ was reinforced. Women *need* different things during labour and childbirth, however a common theme to enable smooth transition is quiet, peace, darkness….and for their support network to just be all of those things, facilitates that transition.

    While Michel talks about the physiology of birth, (in his dreamy French accent which almost makes me want to sleep!) which humans have been doing for centuries, he also speaks of the very many things that society has brought into childbirth via cultural changes which inhibit the normal, physiological process of birth. Intervention, forceps, synthetic oxytocin; instead of supporting women in labour can hinder and prolong the biological processes that physiologically, women are born with and have the instinct to use, if allowed. Cord clamping is an example if another process which has been done for many, many years but which does not allow for the physiological process of birth to be completed naturally and research shows optimum cord clamping, or even lotus birth should be favoured where at all possible.

    Listening to Liliana speak of her 400+ births over the past 15 years whilst working as a doula in London only fires me with more energy to support women with their choices; support them to make informed choices and allow them to experience the physiological, biological norm in childbirth. Be by the side of women who are fired up to do more research, ask more questions, find the answers *they* need to support their decisions. Listening to concerns and ‘being’ that calming presence can make a huge difference to a woman’s birth experience and that of her whole family. Undisturbed birth needs to make a come back!

    I feel one weekend with Michel and Liliana was not enough, I feel I could listen to them both for an eternity because everything they spoke about resonated so well. I do hope our paths cross again in my time as a doula, I do hope I can only take a segment of what they offer, from their course, and apply it to my own practice. Women deserve to have the births they want amd wish for, the births in which they are very capable of facilitating in whichever way that is, wherever that may be, from a natural birth to a caesarean, I can just ‘be’ there to support their transition into motherhood.