“We didn’t have dinner.”

30 August 2013
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In our flip-flopped family of a stay at home dad and a breadwinner wife who works days, overnights and weekends, we try to make evenings sacred and prioritize dinner time where we all sit down (or at least the kids attempt  to sit down), say grace, and share a meal together talking about our day.

Recently on a night when we had an evening event, my husband picked up fast food on the way for the kids. When I later asked my 7 year old what she had for dinner, she replied, “We didn’t have dinner.” “Then what did Daddy feed you?” I asked. “We just had tacos Mommy, but we didn’t have dinner. Dinner is when we all sit down together, not Taco Bell.”

I was touched. With all the guilt that I feel going to work all odd hours and not being the stay at home mom that I expected to be, this warmed my heart that my child already has memories of dinners shared with the family where we all sit down together.

Hoping that sentiment was shared by my son, I asked him recently what he liked best about going to Nana’s (who is a great cook, and routinely does special things with my kids although she lives 5 hours away). He said his favorite thing about Nana’s house, even over Christmas (!), is “having everyone together and eating meat!”  (This coming from a 12 year old boy who loves new Legos at Christmas as much as life itself.)

Both my husband and I grew up in families where our mothers stayed at home and made a warm dinner for us every night. Although our family structure differs considerably from this model, we have tried to give our children the stability and security of a nightly dinner together to reconnect, bedtime routines that involve reading stories, and tuck in times that are some of my most precious times. I am glad that my children see the value in this time together, too.

Client favorite: Refrigerator Quiche

29 June 2013
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This is what it looks like right out of the oven, but it only lasts a few minutes puffy like this.

This is a quick doula meal I can make just about anywhere. Most families have eggs, and an assortment of tired looking veggies that were meant for something but got overlooked by a new baby in the house. This is a great way to build a whole meal out of a rag tag team of odds and ends, and give a new family something beautiful to eat that lasts beyond one meal.

Veggies and seasonings (vary by season). You can add meat as well (bacon, sausage, bits of ham, etc) but often we don’t have those items on hand, so whatever is available becomes the ingredient list.

The most common arrangement I make is to take an onion and a red pepper, sauté in some olive or coconut oil, seasoned with salt and pepper until caramelized, then deglaze just slightly with 1 T water/broth. Mushrooms are often a hit as well, but you can use anything; cooked broccoli, potatoes, asparagus, etc. I use greens as well, but I don’t precook them.

Mix the egg portion while you cook the veggies:

6 eggs (you can use a higher ratio of yolks to whites for mamas who are building blood as well)

1 pint cottage cheese or ricotta

1 c milk, soymilk, or almond milk

1 ½ c shredded cheese (cheddar, pepper jack, etc)

Tomatoes for topping, sliced to ½ inch thickness

I take a baking dish (pie plate, casserole dish, etc) and grease the bottom and sides. Add the sautéed veggies evenly to the bottom. Add any raw greens you want (I use baby spinach) and pour the egg mixture over the top evenly.

Top with sliced tomatoes, pressing them into the mixture with a fork, to get a bit of egg on the top (bakes in nicely this way).

Bake at 400 degrees for 25 min, then 20 min at 350 to finish off. Done when the middle doesn’t jiggle, or is browned the way you like it. It will come out of the over puffy and amazing, but settles in just a few minutes (get your camera out fast!). Makes a lovely potluck dish as well, and reheats great for leftovers (so essential for those postpartum days with a newborn). Can be eaten warm or room temp, although a few moms admit they eat it cold out of the fridge when desperate!

On the Edge…

4 May 2013
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The postpartum sleep crash in the early weeks can take mamas by surprise. This is not a mama I referred to in the blog; she just provided a great picture of the exhaustion of early motherhood!

I don’t mean to be self serving. Just can’t help but mention how many families lately are TIRED. Not your average, ‘let’s take a pick me up nap in the afternoon or have some coffee ASAP’ type of tired. I mean bone weary, decisions blurred, logic failing, body achy, emotional basket cases tired.

As doulas who offer overnight care, gentle sleep consults, and of course a host of handy mom-helping services, we often hear the worst stories. (Like the moms who freeze their purses and call us because they can’t find their keys! True story–and not just one!) But lately I am hearing stories about  moms who put off their need for sleep long enough to really feel like they are having a breakdown. Like losing their mind, and not just for that moment when you ‘forget’ you had a baby and then suddenly realize you have been a mother for 3 months (not uncommon!). But the kind that feels desperate, clinging to any kind of support they can possibly trust.

We get these calls, but I am sure only a small handful of the moms who experience this. We assume that partners, grandparents, friends, or co-workers are getting the bulk of them. And hopefully those are the folks that are helping these mamas find solutions by providing some good sleep support for them, or at least a listening, empathetic heart.

But I am going to suggest something; moms are worth getting more sleep support. Partners, don’t be afraid to suggest that not only do moms need more sleep, but you are going to take the baby for a few hours and provide mom the opportunity to do just that. Grandmas, you can offer to stay with a baby whose mama is on the edge. Friends can even come over one afternoon and hold, cuddle and play with baby while mom crashes in the other room.

You don’t have to interrupt breastfeeding to get sleep support. Babies can be brought to mama to nurse while mama barely wakes, having the caregiver do everything but feed the baby and leaving moms in bed. Moms can pump a little milk earlier in the day and take a long stretch of sleep while partner bottle feeds baby at midnight. And baby can be well attended to by a Grandma or other loving caregiver while parents snuggle and have some relaxing pillow talk without worrying it will wake the baby before getting a few solid hours of sleep at the SAME time. Babies stay bonded to their parents; they just have a better rested parent in the morning who is more creative with their play, and enjoys the process of early parenting more because they got more rest.

I know all the arguments. I know babies do better sleeping near their mothers at night, especially if they are a breastfeeding pair. I am a lactation consultant; I support breastfeeding with an almost religious sacredness. But Motherhood is supreme to me; feeding is only a part of mothering. And here is what happens when I hear from moms who let the tiredness go too far.

Had a mom hospitalized against her will this year so she could be medicated to sleep for 4 days while she gathered up her self care and went back to full time mothering (successfully). This is an expensive way to catch up on sleep, and one that carries a lot of stigma. Needed sometimes, but a pretty hard experience for everyone.

Had another mom who woke up recently and couldn’t make decisions or figure out what was actually ‘real’ and what felt like was just in her mind. She was scared…but thankfully, she had heard the story of this other mama, and told herself that she would be better if she just had some sleep. She was right. After some partner support, some doula support, and some wonderful family members helping out, she got rest, found her sense of reality, and went on happily back to mothering her little one full time.

So when I see moms week after week putting their sleep needs last on the list, or I see a breastfeeding mom who is so dedicated that she is losing beyond her pregnancy weight, hasn’t taken a shower in a long time, and cries every time someone looks her in the eye…I get a bit more serious. Serious about advocating for mom’s needs. (Babies never get neglected in the families I see; they typically have multiple people who love them who are happy to help out anywhere they can.) I write this not to help motivate others to rescue moms who are over the edge (although by all means, jump in and help when requested!) but to help PREVENT other moms from hitting that wall.

I want moms, partners, and anyone who loves them to TAKE THE INITIATIVE. Ask the mom if she wants more sleep…then figure out a way to get her more sleep! Not by changing the baby’s behavior (not so easy actually!) but by changing the support mom has available.  But having mom catch up on the weekend mornings by sleeping in; I know Dads and partners like to do this too! Negotiate…

I only share this to avoid the breakdown that I am all to familiar with. I know early parenting is tiring, and that is a badge we often wear for much of our kid’s early lives. But no one gets a medal for parenting until you are wasted tired and possibly not making safe decisions behind the wheel, or picking fights when you don’t even mean to! Please, just find a way to get more rest. If you have to take medication to shut off your brain if you are experience anxiety, allow yourself the guilt free experience of brain rest.

Yes, of course we provide this rest almost every night of the week. But if you have been in my classes or groups, you know I am going to encourage you to GET ALL THE FREE HELP YOU CAN before you hire anyone. Families figure this stuff out, and can get through it safely most of the time. Just don’t neglect yourself…sleep is important. And YOU are important. Not just because you are a mother to this baby. Because you are YOU, and well loved by many.

Top 10 Things I Learned from Moms Group

27 January 2013
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The long awaited top 10 is here! Jordann graduated recently with a twist: a top 10 list of all the things she acquired on her journey through the first 6 months (coming to moms group almost every week). She is our guest blogger, and shares some good stuff!

I am going to take them 3 at a time (not to make you wait, but otherwise it might be a bit too long to read in one sitting with a squirmy baby).  Check out more wisdom from this mama at www.intuitivemamablog.com.

  1. It’s okay to stop reading the books.  A mother with a two year old and a newborn said this during group once and it was shocking and liberating at the same time.  I don’t have to read the books and I can just trust myself to know what to do?  Learning to trust our mama intuition is a hard step but absolutely necessary.
  2. Showering with your baby is easy and good for everyone.  A close-to-graduating mama once got up and demonstrated how easy it is to shower with a baby.  It seemed like a simple thing to figure out without a demonstration, but there was something so helpful about seeing this pretend shower scene.  You just take the baby in the shower, make sure you have a good hold (in case the soap makes her slippery) and there you go!  The baby becomes very familiar with water splashing in his/her face, which then helps later when swim lessons start.
  3. Bat Wings.  Kimberly made up the name, so I give her full credit.  Bat wings helped our sleep tremendously.  When baby was unable to get her hands out of the swaddle, she actually slept.  Here is a video demonstration:  http://www.youtube.com/watch?feature=player_embedded&v=6Yki68oV4RU.

[A quick caveat about the bat wings. I don't recommend this technique for brand new babies. Bat wings are for babies who sleep well in the swaddle, but get their arms out. Usually we see this working better after the first month.

The you tube link shows a couple from one of my classes using this with their 3 month old. Great for that age. Not so good for tiny babies who are not gaining weight quickly. Better for chunky Houdini babies who have tired parents. (There is a variation for smaller babies who are eating well; I need to get a you tube video up on that!)]

4. Week 7 is Hate-Your-Husband-Week (HYHW).  I heard this during my first week at Mom’s group and didn’t believe it could be the case for all moms.  Maybe it isn’t the case for all moms, but it sure was for me.  Everything became increasingly frustrating in our relationship during week 7.  What got me through it was remembering that it was normal and it was likely going to be a temporary feeling.  And sure enough, it was temporary.  My husband is a great man and a great father.  One day, maybe there will be some studies showing that there’s something biological about HYHW.

5. You do what works until it doesn’t work and then you change it!  There is nothing more anxiety-producing than talking about sleep patterns with someone who is a diehard Babywise-believer.  Or knowing that you let your baby cry-it-out while conversing with an Attachment Parenting mama.  But thanks to this motto from mom’s group, I calmed my anxiety by repeating this to myself over and over, “I will do what works for me, my baby, and my family until it doesn’t work any longer.  At that point I will try something else.”

6. Don’t try and make a happy baby happier.  I didn’t learn this one at Mom’s Group.  My friend with three older children passed on this gem.  When Baby is content playing by herself, why do I always feel the need to give her a new toy or move her to a new place?  Just let a happy baby be!  This is the time to go make your bed, answer an email, or nourish yourself with an actual meal that doesn’t come in a wrapper.  Let go of the guilt of not interacting with your child 100% of their waking hours.  Don’t try and make a happy baby happier.

7. You don’t need a title for how you parent.  Before I had our baby, I asked a co-worker, “So did you do Attachment Parenting or Sleep Training.”  She answered back, “Huh?  I guess I never put a label on what I did.  I just did it..”  WHAT??  YOU CAN DO THAT??  Who knew!?!  And this is the type of attitude I experienced at Mom’s Group.  Every mom is just trying to figure out the best way to take care of her baby and it truly isn’t necessary to put a label on it.  It goes back to that mama-intuition thing.  If you feel that it’s right, do it. http://www.huffingtonpost.com/jj-keith/new-moms_b_1850227.html)

8. This next one comes from a great article passed around the internet.  “All the seemingly divisive decisions — pain meds in labor/newborn sleep arrangements/feeding — are often phrased as moral imperatives from both sides. Screw that. Take care of your kid. Do what works.” I wanted a natural birth and it did feel like a moral imperative.  I ended up with an experience free of complications, but I asked for pain medications toward the end of the birth.  I struggled with that decision for weeks afterwards.  When I showed up at Mom’s Group and heard all the different birth stories it made me realize that I am one lucky mama to have a healthy baby with no complications at birth.  And now when I talk to other pregnant mamas, I have to remember that everyone’s story is going to be different and it does not need to be approached as a moral issue.

9. My husband and I are going to parent differently at it does more harm to try to “correct” his parenting style than to let it go.  He does a whole lot better with #6 than I do.  He can catch up on sports, answer emails, and clean the house while the baby plays happily by herself.  And he doesn’t have an ounce of guilt.  And sometimes this drives me crazy.  I want to give him all kinds of suggestions of things her can do with her (ie read a book, tummy time, etc.)   But in the end, I have to remember that a naggy wife and mom is going to do a lot more harm than letting him parent the way that he wants to parent.  So I just have to let go of control.

10. And the last one…Get in the photographs.  Yes, we’re all in very unfamiliar bodies at this point in our lives.  Yes, we have NO time to do our make-up, fix our hair, or put on a cute outfit.  But we must get in the photographs.  Our children will cherish these photos of their mamas and they’ll never see the faults that we see.  So put that camera on self-timer and take a few #selfieswithbaby now and then.   Or how about NOW… go grab that camera!

Small packages

10 August 2012
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These are frozen (nice for August!) but just an example of a 'small package' of food that looks just yummy enough to eat to a new mom.

This week I was with a client who has to take a certain medication with food at intervals throughout the day strategically to reduce the affect on her nursing baby. After making her food this week, she said something I just loved. “Every time I go to take my medication, I think to myself, ‘I need a little snack.’ Then I look in my fridge and I say, ‘Yay, a little snack my doula left for me!’”

It made me think of how often we need a little something, but don’t take the time to nourish ourselves. We don’t feel like a big meal, and don’t want the hassle of chopping and slicing, heating, or creating more dishes for ourselves to have to manage while we are managing a tiny little one’s various needs. So we grab a bar or some other packaged food to tide us over. But how often have you found yourself nearing dinner and all you have consumed all day is a bar or packaged item, a few drinks and maybe a handful of almonds?

I can tell you that as a doula I find a lot of neglected fruit and veggies in the fridge that my clients are thrilled to eat; they just don’t have the time to prepare it for themselves. All it takes is chopping it up, slicing it and serving it to them to perk up their energy and their spirits. So of course we do (sometimes every time we visit!).

However, I think spreading the word to other helpers would be great as well. Moms need food. They don’t take the time to serve themselves, and I think there is this sense that they don’t want to go to so much trouble for just them. So I have a solution. Small packages.

When I am with a family, I often take the time just to wash the grapes and put them in separate serving sizes ready to grab. Yep, grapes. Those wonderful bags of sweetness that mold in the bottom of your fridge because no one got to them in time. (You know you have done this.)

I also make snack size bowls of all kinds of dishes. Roasted veggies, rice or pasta dishes, snack plates with hummus dip, even plating up that casserole that someone else brought that is covered in foil (that no one has opened in a few days). Just taking the time to get out the serving dishes and putting the food in easily accessible places–that you see when you open the fridge–allows a mom to get the nourishment she needs without having to live off an energy bar.

So dads, partners, grandmas, friends…think small packages. Because moms rarely refuse a little bit of something, especially nursing moms. The result might be a more energetic, positive outlook from the new mama, and that makes everyone happy, right?

(I will admit that this uses more plastic wrap that some families are used to, so please let me know if anyone has a solution for small packages of food that you can see when you open the fridge…)

Summer is coming…Grill Bread season!

27 March 2012
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You can grill them directly on the BBQ, or use a grill pan to get the distinctive grill marks. Fine without too; but these look more authentic!

Have you ever grilled bread along with that meat or veggies? It is a yummy addition to anything grilled…and usually there are few leftovers when these come warm from the grill.

We like to use whatever dough we have on hand. There are many recipes online for this, and you can use purchased dough too (a lot of people like Rhodes frozen dinner roll dough).

Today I made the dough from:

1 pckg yeast

1 c warm water

1 c ww flour 

 1+ c white flour (more for rolling out or if the dough is too sticky)

2 T olive oil

3 T brown sugar

1 t salt

I like to get the yeast going in the water before adding everything else, but I usually just throw all the rest in the Kitchen Aid to mix for a few minutes and then let it rise for about an hour.

I piece the dough into golf ball sized pieces and roll them out on floured board to about 1/4 inch. They need a few minutes to rise a bit;  then you can throw them right onto a hot grill for about 90 seconds on the first side once they puff a bit), and 30 seconds on the 2nd. The thinner they are, the faster they cook (thicker is yummy too, you just get less surface area to put yumminess on).

Usually we just stack them in a folded kitchen towel as they cook and then serve them right away with butter, or to scoop up something fantastic with the meal. But you can make them into little pizzas, use focaccia toppings, make into tacos, or tear pieces off for an Indian style dish. (Gotta love the versatility.)

So if the kitchen is too hot to bake bread, but you want that fresh from the oven taste, give grill bread a shot. It might become your new favorite…

Gassy, fussy baby question

18 February 2012
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Gassy, fussy baby

This is a question I received a while back, and also get asked about  a lot. Thought some of you might find it helpful. (Beth Yohalem-Ilsley also adds her expertise to this one.)

My baby is 3 weeks old, and as of this past Monday evening she started grunting through the night, consistently. She sounds like she is trying to push out a poo or gas. I have since started giving her gas drops (Little Tummies), colic calm, and gripe water, none seems to be doing the trick. She gets relief, at least for a short while, when she has a big release of gas or poo, but it doesn’t last long.

She is no longer sleeping peacefully.  When I lay her down, she grunts, and moans herself to sleep, even though she was sleeping peacefully in my arms. She is restless and gets her arms out of her swaddle while sleeping. When feeding (BF) she gets over amped up and white knuckles her fists, kicks her feet, and grunts. I have to stop her every 3-5 minutes to burp her because she is sucking too much air.

I have been able to get good burps out of her, but she still remains fussy. I am finding that she is throwing up about 1 meal a day… and its not from her gut because its not curdled, it still the milk she just ate.

I went to a naturopath yesterday and they tested me and found that I am sensitive to dairy, gluten, chocolate, and coffee, so I have eliminated those. My ped recommended the Mylicon gas drops, which we have tried, but with little success..

I have been putting her on her tummy, laying across my lap, and massaging her back, which is also massaging her belly on my legs.. I would get a little bit of relaxation from her at times, but in most, it just irritated her more.

Any suggestions or thoughts would be greatly appreciated.

Answer

Dear Mama,

Your experience sounds similar to others that I have heard from. Babies around 3 weeks of age often start to become more gassy and fussy, and parents often are mystified by this. However there are a few things you could try to ease this time for her.

You mention the feedings being difficult for her to manage. Sometimes a lactation visit can help with this, as you could work with some positioning that might help (and it is hard to think of new positions when you are brand new to nursing!). You might try a position that uses gravity to slow the flow of milk to your baby (often when they white knuckle like that they are struggling with the flow being too fast, and just trying to hang on and get what they need—kind of like drinking from a garden hose!). They suck air because they are trying to suck, swallow and breathe (in that order, usually) and they are just getting hit with milk too fast to breathe slowly. So they gulp, and in turn it causes burps and gas that need a lot of management afterward. (There are other things it could be as well, like reflux, but I think your Ped would be a good person to take a look at that, and there are so many ways to work on the breastfeeding first before we start to diagnose anything else. You can find a lot of different nursing positions on http://www.kellymom.com.)

It might take up to 3 weeks to get the allergens out of your system (and hers) completely, so sometimes there is just the waiting period. In the meantime, try using the baby yoga hold with her, either in arms or in the sling/wrap. This can be done by placing her back to your chest and holding her legs in a flexed position at the hip level. Keep her back straight, but allow her legs to be bunched up. You will be surprised how much easier it is to get gas or burps out in that position.

You can also use some baby massage to ease her digestion. Baby massage is wonderful for so many things (including good sleep patterns and weight gain!) but can be done with just some tummy strokes to relieve some gas. There is too many details to go into here, but there are baby massage vides everywhere, as well as classes around PDX that would go into more detail with communicating with your child as well as easing her body discomforts.

Regarding the sleep grunting, I would say that many babies this age do a lot of grunting while asleep. Ask at a local moms group about this and a huge show of hands will illustrate how many babies start really grunting at 3 weeks. (I host 2 of these per week in the Providence system, all new mamas with babies under 6 mo old are welcome; http://www.providence.org/classes for more info.) Swaddling can make a big difference with this, but you might have to use the bat wings to keep the arms tucked in (arms out really doesn’t help much with swaddling until they are much older, and can suck on their hands for comfort). If you don’t have a source to teach you the ‘bat wing’ technique (we teach it at Providence so many new mamas know how to execute this technique) consider getting a postpartum doula or other professional to show you. (There is a you tube clip on the bat wings now.) You might also try having her sleep at an angle or use some movement at night to ease the grunting. (Many moms use a bouncy seat/vibration chair or use a vibration unit on the baby’s bed to allow the parents to get some sleep while baby is still being “moved.”)

It sounds like you are trying many things already that will help, and hopefully some of these suggestions can ease her way as well as yours! I do think you would benefit from the help of a postpartum doula, as they are specialists in this early age and transition into parenthood when you are learning how to interpret your newborn’s behavior. There are many wonderful postpartum doulas in PDX, and they can really make a big difference when you are learning so many new things all at once.

Congrats on welcoming your little one and I hope things resolve for you soon!

Kimberly Bepler
ABC Doula Service

Dear Mama,

Sometimes little ones who seem so calm and peaceful for the first 2 weeks start showing signs of soft tissue injury right about then and the next few weeks. The “injury” is caused from the crazy process of being born but it take a few weeks before the soft tissue forms enough to show signs of damage (even slight amounts). I’m not sure what the birth story of your baby is but the manifestations usually show up as discomfort in certain positions, difficulty in eating comfortably, vomiting after eating and some signs of general discomfort. Infant craniosacral therapy is a wonderful and gentle way to relieve areas of muscle and fascia tension and can be done at any point.

There are also some more specific treatments if the vomiting is due to food sensitivity from your milk and affecting your baby’s digestive tract (since you mentioned learning about your own food sensitivities and it is possible your baby will be affected by what is in your milk). Hopefully your new knowledge about that will help. Another option for you is Shonishin. This is an excellent non-invasive technique that involves tapping and rubbing along the skin of acupuncture points and meridians with small metal tools. There are also Chinese and western herbs that can be given to babies 1 month old and older to assist with digestion. There are a few of us here in Portland that practice eastern medicine for children and also several practitioners who do infant craniosacral therapy. Best of luck in getting through this very difficult transition.

Beth Yohalem-Ilsley
Mississippi Health Center

Choosing a Birth Doula?

3 December 2011
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Thinking about a birth doula for the big day?

Many families ask me the following questions about choosing a birth doula: Do we need one? How do we pick one? And who do you recommend?  I suppose as we are a postpartum doula group that doesn’t offer labor support, we are in the category of being fans without being biased towards our own offerings.

Here are some of my guidelines for answering the birth doula questions:

Do we need one?

The biggest question here is what you really want from your birth. Are you birthing at home, in a birth center, or in a hospital?

Homebirth and birth center midwives often have assistants or apprentices that can sometimes act as your doula and many of them do births in teams, so a labor doula isn’t always needed. However, some of them welcome doulas at the birth and appreciate the emotional support that doulas can provide as they care for more of the physical/clinical concerns around the birth.
If you birth in the hospital, even though you often have one nurse assigned to one patient during labor, the role of a nurse and a doula are very different. Nurses used to provide many aspects of doula care, but now their time is buried between charting, running all the equipment used in a hospital birth, and carrying out the orders from the doctors or midwives. Certainly nurses can be a huge source of emotional support, but their work also runs in 12 hour shifts, and you are likely to get a few different nurses during your labor process—this usually is not a good continuum of care for the laboring mother.

Do you have women in your family that have experienced birth who can be present with you to meet your needs during labor? Sometimes mothers, sisters, and other female relatives or friends can be great doulas, trained or not. It is important that they know your desires for your birth and are operating on your agenda, not their past experiences or biases.

The main reason I see a lot of women hiring birth doulas is to avoid some of the interventions that make birth more difficult and often surgical. Yes, the Cesarean rate is still way too high by anthropological standards (over 30% in some hospitals in PDX) and having a doula at your birth reduces the chance of a cesarean by 50%. It also reduces many other often unnecessary interventions. Unless you have the doula role covered by other professionals (not your doctor or midwife, they rarely will sit with you throughout labor) or other family members/friends who you confidently feel can meet your needs in a calm way, I would recommend you look into getting a birth doula. I have had one birth with a doula, and one birth without a doula, and I will tell you it does make a big difference!

How do I pick one?

Here again, the question to you is: what do you want from your birth? Are you looking for a medication/intervention free birth? Do you have a Cesarean planned where your partner might be torn in different directions as you and the baby could be separated after surgery? Are you looking to delay an epidural for as long as possible? Are there concerns about your family members wanting to help but your gut tells you that they might not be the best person for the job?

All of these are great reasons to have a birth doula, but I would recommend different people based on the circumstances!

The beauty of the doula is that she should be there for you. Your needs/desires should be at the top of her list. If your doula has an agenda about “saving birth” or “changing the system,” you also need to feel strongly about this before going into labor as you don’t want to be caught in the middle of a conflict between your healthcare team and your doula.
The best recommendation I have for choosing a doula is to talk to several on the phone, get a feel for their care, and then interview at least 3. You should follow your instincts when making decisions about who to have at your birth. You will likely be naked with this person, and make funny sounds and have this strange primal behavior—you need to feel VERY comfortable with whomever you chose. If you have a twinge of hesitation, move on. There are hundreds of birth doulas just in the Portland, Ore. area, and you are bound to find one that meets your needs perfectly.

Do you want a student doula (one with less experience but also charges little to nothing) or an experienced doula (where the fees can range from $300 to $800, depending on the package that your doula has to offer)?

Is this your first birth? I would probably recommend an experienced doula that can reassure you when you have questions (as there are MANY the first time around). If this is a subsequent birth, then it depends on your first experience and what you are looking for this time. The studies on doulas report that having a woman quietly staying with you throughout labor can reduce interventions and empower you in many ways, even when she doesn’t have a bag full of tricks that help you cope with labor and work together with your partner. I have met many women who want to be “good patients” who prefer to follow what the doctor decides about their birth. These women would benefit from a quiet doula that can help fill in the gaps of knowledge when the primary caregiver is busy doing other things.

Families who are looking for more of an advocate to their care will want a doula with a lot of experience, a strong knowledge base, and a good ability to read you in stressful situations.

And finally, whom do I recommend?

Yes, I do have a favorites list, but even within that list, there are variations based on the client’s needs. And there are so many wonderful doulas that aren’t listed as well. I would probably recommend looking at http://bsnnorthwest.org/ first for their list of caring doulas. There are many doulas listed there who have received rave reviews for the past several years and some new doulas who are getting involved with the community of birth supporters and can offer services for low or no cost.

You can also contact http://www.birthingway.edu and look for their list of trained and/or certified birth doulas, as they are a local midwifery college and have a long list of women looking to do births at low cost for experience. Many women check out http://www.dona.org, http://www.cappa.net, or http://www.icea.org to find their list of certified or trained doulas. This does insure that your doula has gone through the initial training requirements, but these are often overwhelming lists to work from with the numerous options.

Most women tell me that their birth doula was invaluable during their birth. I have heard a few stories reporting otherwise though, and I would want to caution you against compromising your goals.  Also make sure to budget for help after the baby arrives. Many women tell me that the help of a lactation consultant, postpartum doula, home-chef or a postpartum massage was as helpful, or even more helpful, as the services a birth doula provides.

I hope this has helped you figure out what would be best for you as you plan for your birth. As I am certainly a fan of birth doulas, I hope you find someone who is a perfect fit for you and that you have a great birth! Birth and early postpartum is a time that women remember for the rest of their lives, so it pays to have really wonderful people surrounding you to help you make the best memories!

Much requested: Warm Spinach Salad recipe

17 November 2011
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This recipe is a client favorite, and so welcome this time of year.

This time of year we doulas are often whipping up warm and nurturing soups, baked dishes, hearty stews or roasts (in the crock pot sometimes!) and filling breakfasts for our tired and hungry clients. Fall is such a fun time to cook and eat, and the food is so nurturing that it fits in super well with doula support.

I have been asked to share one of my most requested recipes for a warm spinach salad. My mom shared it with me, and I am happy to share with others. What I love about this dish is that it is full of iron rich spinach (so good for rebuilding blood after all the loss of childbirth) and it is warm and delicious. A great way to get those amazing greens into your recovering body.
As with all my recipes, most of the items can be adjusted or omitted, and the amounts can be tampered with to your liking. The only thing that is essential is the ratio for the dressing (1/1/1 is the best combination there).
Warm spinach salad (with bacon)
large bag of spinach leaves (I use a 1 lb bag of baby spinach; this can also be  halved or easily doubled for company)
1 lb of bacon (less for the calorie conscious)
1 lg onion (I prefer sweet, but you can use red or white as well), thinly sliced
1 lb mushrooms (your choice, I like the brown button kind), sliced
4 hard boiled eggs, peeled and sliced
seasoning (I like to use Montreal Steak Seasoning)
Cook the bacon until it is done to your liking (crispy works best), save the bacon grease. Cool and crumble bacon and add to the spinach. Add sliced hard boiled eggs to spinach as well. Make sure you have a big enough bowl to be able to toss the salad; you might want a mixing bowl and another serving bowl to keep it pretty after it wilts a bit.
Cook the onion in the grease until golden and soft. Remove with a slotted spoon and set aside. Use remaining grease to cook mushrooms, seasoning as needed. Combine onion and mushrooms.
Dressing:
1/3 c sugar
1/3 c water
Combine and heat until sugar is melted (microwave is easy for this)
then add 1/3 c apple cider vinegar (red wine vinegar works as well, haven’t experimented beyond that yet)
To serve I usually heat the dressing and mush/onion mixture and pour over the spinach mixture. Toss a couple minutes to get everything coated and distribute the warmth to all the leaves. Serve quickly, and finish the bowl (not a hard thing to do). This does not keep well, and you will be able to eat more of it than you think.
Ok, this is why it takes me so darn long to write down a recipe! Have to include all those bits and pieces that you probably would have figured out on your own. But there, it is done. And forever when a client says, ‘I would love this recipe,’ I can now say…”It is on my blog.”

New guidelines for safe sleep

18 October 2011
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Swaddling seems not to be mentioned, although we know as long as the blanket isn't loose it is usually recommended.

The updated guidelines from the AAP have just been released on safe sleep for babies. Some important changes are:

  • Breastfeeding is recommended and is associated with a reduced risk of SIDS.
  • Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent.
  • Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment.

Here are the other recommendations:

  • Always place your baby on his or her back for every sleep time.
  • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
  • The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
  • Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
  • Wedges and positioners should not be used.
  • Pregnant woman should receive regular prenatal care.
  • Don’t smoke during pregnancy or after birth.
  • Breastfeeding is recommended.
  • Offer a pacifier at nap time and bedtime.
  • Avoid covering the infant’s head or overheating.
  • Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
  • Infants should receive all recommended vaccinations.
  • Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).

Source: http://www.healthychildren.org/English/News/pages/AAP-Expands-Guidelines-for-Infant-Sleep-Safety-and-SIDS-Risk-Reduction.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

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