Welcome!

Welcome to my Doula Blog! I hope you find it interesting and informative.

My name is Natalie. I am a wife, a mother of almost five boys, a doula, and a Hypnobabies Instructor! I'm passionate about childbirth and hope to help women realize the power that is in them to birth more normally and naturally. It's my goal to help women feel confident and comfortable during pregnancy, labor, and delivery. Yes, it is possible! It's also amazing, incredible, wonderful, empowering, and life changing.

As a doula, I am a trained professional who understands and trusts the process of birth. I provide continuous care for the laboring mother and her partner. Studies have shown that when doulas attend births, labors are shorter with fewer complications. I attend to women in labor to help ensure a safe and satisfying birth experience in both home and hospital settings. I draw on my knowledge and experience to provide emotional support, physical comfort and, as needed, communication with the other members of your birth team to make sure that you have the information that you need to make informed decisions in labor. I can provide reassurance and perspective to the laboring mother and her partner, make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for comfort.

Feel free to contact me at doulanataliesue@gmail.com.
Thanks for stopping by!

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Thursday, July 3, 2014

How to Breastfeed Appropriately

http://www.huffingtonpost.com/bunmi-laditan/how-to-breastfeed-appropriately_b_5530806.html?ncid=fcbklnkushpmg00000037

How to Breastfeed Appropriately

So you've decided to breastfeed. Fantastic! Breastfeeding is a wonderful way to nourish your baby while establishing early bonding. Unfortunately, breast milk comes out of breasts so there are a few ground rules that we need to cover.
As you know, (female) modesty is a highly protected value in modern society. Unless you're a magazine cover model or in a music video, exposing your female udder flesh is entirely inappropriate. Science has proven that breasts are basically large vaginas. Only you and your partner should ever see them. Just because your breast-ginas are full of milk, doesn't mean you get to wave them around.
"I don't expose much when I breastfeed." This is a common excuse made by exhibitionist mothers. Just knowing that your nipples may become visible at any time is offensive and a temptation to married or newly engaged men.
Real life stories:
"I saw a woman breastfeeding in a park and was overcome with desire. I left my wife the same day." - John, 34, Nebraska
"I was a married man with eight kids. Last month I saw a woman nursing her infant at a park. I am now married to her." - Luke, 45, South Dakota
"Two years ago I was a successful business executive handling important transactions. Then I saw a breastfeeding mother. I became obsessed with nipples and lost my job. I can't make ends meet." - Anthony, 45
None of us would urinate in public (sober), so please show us the same courtesy and release your mommy nectar out of sight.
Note: Peeing in public and breastfeeding in public are identical because in both cases liquid is coming out. Crying in public is different because it's happening above the neck. If you can breastfeed out of your eye sockets, be my guest.
Here are a few tips that mothers should and need to adopt to help the rest of us feel comfortable.
Tip #1: Use a cover. Every time. There are many fancy ones on the market. Damask. Lace-trimmed. Or how about a swaddling cloth (if it's good enough to warm the baby Jesus, it's good enough for your kid)? Statistics show that human beings love being in confined spaces. Babies are on their way to becoming full humans, so this applies to them as well. I personally eat many of my meals under a loosely draped fitted sheet in my bedroom and find it quite enjoyable.
Please do not use summer as an excuse to flash your flesh-toned milk bags. Just last week I ate an entire Italian sub under a handmade quilt in 90 degree weather skin-to-skin with a close friend to simulate summer breastfeeding. Were we hot? Yes. Were we uncomfortable? Yes. Did one of us briefly lose consciousness? Yes. Did we subject anyone to seeing nipples? NO.
Do not be fooled, the importance of air circulation has been exaggerated by politicians. Ten out of 10 babies reported loving the sensation of breathing repeat CO2. There are women who can breastfeed without anyone knowing what they're doing. If they can do it, so can you because all babies are the same.
If you have a rebellious/bad child who pulls your cover off in a desperate attempt to breathe fresh air and see the world around them, consider some home training. It's your job to teach them right from wrong. Should your original sin infant not respond to discipline and still reach out for new oxygen, place two little straws in their nose scuba-style so that cool air can be retrieved from under a burlap cover without making us all barf from the sight of your boob flesh.
Care about decency? Go the extra mile and prevent wind from flying up and exposing your naked nipples by sewing small weights into the corners of your nursing cover.
Tip #2: Use a bathroom. Who doesn't love a public restroom? They're full of exotic scents and sounds! The next time your needy baby starts fussing for a taste of chest drippings, run to the nearest stall or city outhouse.
Nursing standing up while trying to avoid bacteria and holding a wriggling child has the added benefit of strengthening your core muscles. That postpartum tummy will be gone before you know it, making you more attractive to the general public. It's summer, after all -- bikini season!
No hook for the diaper bag? Put it on the floor or in the sink. When you get home, wipe it down with a bleach and water solution to remove any fecal matter.
If you've used your uterus more than once and have a second, or worse, third child in tow, ask the critters to join you in the stall for their safety. It's like a party! Don't worry, if you've raised them right they won't touch anything.
Considerate babies nurse for between 10-15 minutes, so you'll be out of there before you know it. If you've been cursed with a baby who nurses for 20 minutes or more at a time, cut them off when you see fit. That will teach them to speed things up. Keep track of their best times on your iPhone and give them small rewards (like a hug or kiss on the temple) for shaving off minutes.
Children are meant to be seen and not heard, but if you're rude enough to bring a baby to a public eatery, it's your responsibility to leave the table for the bathroom to nurse. Your meal will be waiting when you return. If your appetite is affected by the smell of light sewage, consider the fantastic weight-loss ramifications and be grateful. You're going to look great in that bikini!
The message is simple: whatever you are doing in public, drop it to move to a private area. Shopping? Return to your vehicle. At a remote park? Find an abandoned train car. Think about others.
Tip #3: When you leave the house, switch to bottles. If your baby hasn't used them before, shame on you for not preparing your infant for the real world. Everyone knows that it is very simple for babies to switch between the breast and bottles and won't at all impact his or her ability to continue breastfeeding in a socially appropriate setting (your bedroom in the dark).
Pumping breast milk is simple, fast and easy. Capable moms know how to squirt out a gallon of milk in under seven minutes. When you need to leave the house, just grab some of your fridge emissions! If your breasts become painfully engorged or hard to the touch from skipping feedings, take comfort in knowing that you're doing this for mankind's comfort level.
Formula is also available and not expensive.
Bottles also give other people a chance to feed the baby. Stop being selfish and hogging all of the feedings with your teats. Having a baby is about letting other people feel good. Pass it around like a football and watch the compliments roll in!
If your baby refuses the bottle, just keep pressing. You'll break their spirit eventually. If not, see tip #4.
Tip #4: Stay home. It would be easier for you and all of us if you just spent the day in your private dwelling. Not forever. Just until your baby learns to take a bottle or eat food that doesn't come out of your privates. There's lots to do in a home: television, hanging out in the backyard (don't nurse there unless you have a high enough wall -- again, RESPECT), cooking, cleaning, laundry and of course, Facebook. Please don't post photos of yourself breastfeeding on the Internet. The last thing anyone on the Internet wants to see are female breasts in an innocent context. We find this disgusting.
Tip #5: Get some morals. Do you have sex in public? No. Then why would you pull out your SEX BREASTS for your baby in public? Just because something is natural, doesn't mean we all want to see it. Yes, we will tolerate a celebrity nip slip or areola display. Yes, there are breasts splashed all over magazine racks and on television bouncing up and down to pop music, but that's different. We're OK with boobs if money has been exchanged. Has your cheap baby paid you? No? Then wrap it up.
In conclusion, breastfeeding in public is for lazy, exhibitionist, thrill-seeking, husband-stealing mothers who have nothing better to do than to make the rest of us shrivel in disgust. So cover it up. Love, Us.

Disturbing Breastfeeding Trend

http://www.huffingtonpost.com/julia-wykes/the-disturbing-trend-i-noticed-when-my-breastfeeding-story-went-viral_b_5551589.html

Disturbing Breastfeeding Trend

You may have seen my photo on your Facebook newsfeed recently. In case you missed the story attached to it, here's the five-second version: I went to Starbucks with my 5-month-old to grab a coffee. He started to fuss, I sat down to nurse him to calm him, and a middle-aged woman asked a teenage barista to get me to stop breastfeeding, loudly calling it "disgusting." He took care of it -- by offering me a free refill, a voucher and an apology for the unpleasant experience as the complainer fled the scene. Yes, I'm the woman who shared this positive breastfeeding story with my local parenting group. It went viral in 24 hours. 

At first I was excited that there was such an overwhelmingly positive response to my story. Friends told me that it popped up on their newsfeeds all over the world, usually with a caption like "Awesome!", "Go, Barista!", "Good job Mama!" or "Someone raised that kid right!" How lovely, I thought, especially since, as a midwife (when I'm not on maternity leave), I work hard to ensure my clients who choose to breastfeed have the best chance to successfully do so. Then I made the mistake of looking at some of the reader comments. The vast majority were positive, but there was a much darker side as well. 

That side ranged from the absurdly uninformed ("Neanderthals breastfed in public, we should evolve up not down!") to the sickeningly misogynistic ("Yeah, I'd stare at those titties if they were flapping around in Starbucks") to the needlessly crass ("I don't pull my pants down and piss in public, why should you whip out your tits and breastfeed? Attention seeking b*tch"), with a whole lot of "Why don't women cover up when they're breastfeeding?" in between. It took me a few hours to sort through my feelings about all of this, but now that I have, I wanted to share some of my thoughts with you.

What shocked me most in all of this is how many of these negative voices came from women. From the original complaining customer to those posting their comments online, I am truly afraid of what it means for our society that adult women find it acceptable to insult and belittle other women for breastfeeding in public -- basically for having breasts and using them as nature intended. On the topic of breastfeeding, the science is clear: Healthy for babies, healthy for mothers. Natural. Nutritious. Nurturing. The best way to encourage breastfeeding is for a generation of children to grow up actually seeing mothers nurse. If women put up barriers to this, how will this normalizing ever happen? But even more than missing out on the potential health and bonding benefits of breastfeeding, here's what worries me: many of these women are mothers already or will be one day. What are their kids going to learn from them posting these vitriolic anti-boob comments? That cyberbullying is OK? That disapproving of a woman for being a woman is fair game for online mockery? That feeling uncomfortable with public breastfeeding means it's open season for digital abuse? Those comments are circling around the globe right now, just like the original story did, and they will leave their footprint online for years, even decades to come, even for their own kids to look up years later. If women are jumping on the hate-fest over something that is so very much a women's issue, how on earth can we expect to raise a generation of kind, gentle, thoughtful and inclusive boys and girls?

For me, more insidious than the outright written abuse was the barrage of comments saying that a woman should cover up when she's breastfeeding. Or go to her car or the bathroom -- or not leave her house -- if she thinks her child will get hungry. Part of me wanted to answer these with some snappy comebacks: Cover up, you say? It's 39 degrees C (102 F) here in Ottawa today; I am not going to suffocate my child to save you from the potential glimpse of side-boob. Go to my car? Oh, you mean my portable oven? Did I mention 39 degrees? Breastfeed in the bathroom? Gross. Stay home? Wow, now who's evolving down? You're telling all nursing mothers that we shouldn't leave the house in case our babies get hungry. Let me just hang out barefoot in the kitchen until my husband comes home from work to get me pregnant again.

These comments made me angry. Not just because they treat a nursing breast like a sexual object (which is by itself pretty disturbing when you are likening feeding an infant to what's going on in your pants), but because they suggest that women should hide themselves away during certain periods (pun intended) of their lives. What you're saying when you tell a woman to cover up is that her body offends you. This to me isn't so far removed from sending women to the Red Tent (and I don't mean the store in Toronto) when they're menstruating. The vast majority of these comments came from women. Other women, with the same hardware I have and who are or may one day become mothers. Are you so upset by the thought of your own body that you can't even contemplate seeing a small part of another woman's? If you have a daughter, is that how you want her to feel about her body? That it is only fit for public appearance provided it is doing nothing distinctly female? If you have a son, is that how you want him to think about women, about their bodies, about motherhood? As so dangerously sexualized that they must be feared and derided, even deliberately hidden from the world? As parents, you have the greatest influence over your kids and what kind of people and parents they will become. You are writing a blueprint for the next generation. Please think about the message you send before you suggest that women, en masse, should hide themselves away for fear of being seen for exactly what they are.

For the record, here is what I looked like on the day I nursed my son in Starbucks, and how I look every time I nurse my son. It is natural and absolutely non-sexual and it's also a legally protected right. I have nothing to hide. Neither do you.
rebecca balfour

Swollen Feet!

http://www.birthologie.com/pregnancy/why-in-the-world-are-you-so-swollen/

I got a desperate call from my pregnant niece today,
“My feet are huge!  And my lower back aches all the time.  HELP!”
You know, everything you can find about swelling during pregnancy really….does not go far enough or take it seriously enough.  It took me until my 5th pregnancy to really figure out the cause and real life effective treatment!  Meanwhile, during my other 4 pregnancies my feet were like overstuffed sausages and it was incredibly painful to stand for more than 3 minutes at a time. And if you do have bad lower back pain, that is your kidneys as well!
While articles like the one I posted below give good suggestions, I want to give you GREAT suggestions to eliminate swelling during pregnancy.

WHY YOU SWELL?

Because your kidneys aren’t functioning optimally.  They aren’t removing waste products efficiently.  This goes for any type of swelling, pregnant or not, including the puffiness under and around your eyes.

HOW DO YOU FIX THAT?

Besides all the standard “put your feet up and wear compression hose” suggestions, let’s get to the root of the problem.

FIX YOUR KIDNEYS!

1.  Eating about a 5 lb watermelon everyday will completely flush your kidneys, and reduce or eliminate the swelling. Other foods that works well is parsley, onion, celery, fish oil ( LOVE Barlean’s Lemon Swirl), garlic and peppermint.
2.  Take kidney supporting herbs.  I like Happy Backs from Herbalogie.com, but anything with uva ursi or gravelroot is great.  Also, many herbal preparations have parsley in them, it’s a great addition.
3.  Lemon, Rosemary, Peppermint or Cypress essential oils, rubbed on the lower back region and on the feet work really well to nourish your kidneys and get them working well.  You can use them neat (aka put them straight on) or put a few drops in carrier oil like olive oil or apricot oil and massage it in.  Again, Herbalogie.com is a great resource as well asButterflyExpress.com
4.  Drink a lot of water or tea, such as pregnancy tea or uva ursi tea.
By the way, toxemia and pre eclampsia, which are very serious conditions, are both kidney problems.  While not all women that swell end up with these ailments, it’s a good idea to incorporate these suggestion to help stave them off.

Saturday, November 9, 2013

Pregnancy Exercises

Did you know that you can do prenatal exercises to help your body and baby be in optimal shape for a quicker, easier natural childbirth?
While it’s certainly no guarantee, prenatal exercises can open our pelvis and position our baby optimally. Truth is, for most of us mamas, natural childbirth is a marathon. We wouldn't show up to a race like that without training and the same can be said with natural childbirth.
Ideally, we would start these exercises once we discovered we were pregnant however ANYTIME you start will be beneficial. DISCLAIMER: DO NOT ATTEMPT ANY OF THESE EXERCISES WITHOUT APPROVAL FROM OB-GYN, MIDWIFE OR DOCTOR.
Okay, ready for the exercises?

7 easy #exercises for an optimal #pregnancy and #labor via http://MamaNatural.com1. Walking

Yes, simple walking can help keep your body in balance as you approach your big day. Aim for at least 30 minutes a day, preferably outdoors for the fresh air, sunlight and natural surroundings.

2. Proper Sitting

While some may argue that this isn’t exactly “exercise,” I would disagree. When you’re carrying around 20 pounds of extra weight, and practice proper sitting, you’ll be strengthening your core and stabilizing your pelvis. The key is you want to avoid reclining in big couches, gliders and beds. As tempting as it is, it’s best to sit upright with your pelvis slightly forward. Sitting on an exercise ball is wonderful for pregnant mamas. Be sure your ball is firm enough and high enough so that your hips are higher than your knees.
After 30 weeks, to keep pelvis aligned and baby in optimal position, try sitting on an exercise ball as much as you can instead of a reclining in big couches or chairs. If you work on a computer, use this instead of your office chair. Many employers will even purchase this “chair” as an alternative.
Another great way to sit is cross legged. Sitting this way pushes the uterus forward, stretches the legs, and opens the pelvis more. The thing that’s great about this exercise is that you can do it in nearly any situation and people won’t even know you’re in training for a natural childbirth.
Spend as much time as you can sitting this way, especially once you hit that 3rd trimester, rather than on a big recliner or couch. Your body and baby will thank you come delivery time :)

3. Leaning

To counteract all the time we are leaning back each day, it’s important to lean forward as a pregnant mama. Leaning on counters, tables and people all work :) . An old wives tale was to flip a posterior baby, you were to scrub all your floors on hands and knees. Gravity would pull the baby’s back forward and get him/her in optimal position.
Of course, an exercise ball can be a pregnant mamas best friend for this exercise not only pre-labor but during it. Draping your arms and upper body over exercise ball and roll around while your pelvis moves in midair can prepare your lower body for the work of natural labor.

4. Pelvic Rocks (aka Pelvic Tilts or Cat Cow Stretch)

These are a simple exercise that keeps the pelvis loose and the lower back limber. You can begin these from day one and continue through labor.
If after 30 weeks, you want to try to flip a posterior baby to anterior position, do the pelvic rocks when you feel your baby move. She/he may be trying to get into a better position for birth and you can facilitate that process by doing Pelvic Rocks. I would recommend doing them 3 times a day for up to 20 minutes total time daily once you’re in third trimester.

5. Butterflies

This simple exercise opens your pelvis and keeps your lower back limber. You can do these from the moment you’re pregnant till you deliver. Sit on bottom and put soles of feet together. Pulse your legs up and down till you feel the stretch. You can even have your partner add resistance for a deeper stretch.

6. Forward Leaning Inversion

This powerful move helps to untwist lower uterine ligaments. Because of our poor posture and sedentary lifestyles, our uterus can be twisted and cramped, leaving less room for baby to settle into the optimal position. Additionally, if we’ve been in any type of accident or like to carry an older child on our hip, this exercise is essential.
You want to kneel on the edge of a couch or bed. Slowly lower yourself to your hands on the floor and then to your forearms. Elbows out, hands close. Use a stool or a partner if you need help. Let your head hang freely. Your chin is tucked. Your bottom should be highest. Flatten your lower back. Hold for 30 seconds. Come back up on your hands. Then lift yourself up to a kneeling position again, using stool or helper.
Do 1-3 times a day. Please note: If you’ve had any abdominal or uterine cramping, have high blood pressure, or feel excessive baby movement, do not attempt this exercise. Check with your doctor or midwife before doing this or any of the above-mentioned exercises.

7. Optimal Sleeping Position

Once you hit 20 weeks, most doctors and midwives will dissuade you from sleeping on your back because it can cause problems with backaches, breathing, digestive system, hemorrhoids, low blood pressure and decrease circulation to your heart and your baby.
Obviously, we want to avoid sleeping on our belly so side sleeping is our best bet.
Sleeping on our left side is most optimal because it may in the amount of blood and nutrients that reach the placenta and your baby. It also works with gravity to get your baby in the most optimal position for birth, generally speaking, which is Left Occiput Anterior.
Be sure to use extra pillows for support… particularly one between your knees to keep pelvis balanced and aligned as well as one for your tummy and or shoulder. Some swear by these pillows for full body support.
So, there you have it 7 exercises that can help improve our labors.

Thursday, September 5, 2013

Review Finds No Evidence for Restricting Food, Fluid in Labor

http://www.empr.com/review-finds-no-evidence-for-restricting-food-fluid-in-labor/article/309605/#

Review Finds No Evidence for Restricting Food, Fluid in Labor
Review Finds No Evidence for Restricting Food, Fluid in Labor
(HealthDay News) – For women in labor there is no evidence of benefits or harms of food and fluid restriction, according to research published online Aug. 22 in The Cochrane Library.
Mandisa Singata, RN, from the University of the Witwatersrand/University of Fort Hare/East London Hospital complex in South Africa, and colleagues conducted a systematic literature review to examine the benefits and harms of oral fluid or food restriction during labor. Five randomized controlled trials or quasi-randomized controlled trials, including 3,130 women, compared outcomes for women randomized to food and fluid restriction vs. those who were free to eat.
The researchers found that there were no statistically significant differences identified in cesarean section, operative vaginal births, and Apgar scores <7 a="" and="" any="" assess="" assessed="" at="" carbohydrate="" cesarean="" compared="" consuming="" did="" drinks="" during="" five="" fluid="" food="" for="" in="" increase="" labor.="" labor="" minutes="" nor="" not="" nutrition="" of="" one="" only.="" other="" outcomes="" p="" receiving="" restriction="" s="" sample="" sections="" seen="" significant="" size="" small="" studies="" study="" the="" there="" views.="" vs.="" was="" water="" with="" women="">
"Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labor for women at low risk of complications," the authors write. "Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women's views."

Tuesday, September 3, 2013

Why Are America’s Postpartum Practices So Rough on New Mothers?

Why Are America’s Postpartum Practices So Rough on New Mothers?

America is hyperfocused on mothers bouncing immediately back after childbirth, yet most other cultures allow for an extended period of pampering and rest. Hillary Brenhouse on why U.S. moms are missing out.
Some hundreds of years ago, Colonial Americans thought it fit for a woman who had just given birth to keep to her bed for three or four or more weeks. For the length of the “lying in” period, as it was called, the new mother would rest, regain her strength, and bond with the baby as her womanly attendants kept up the household. Several of these ladies would be relatives, and others not; none were paid, and all expected to be similarly cared for following their own deliveries. Then, in the 19th century, the last free land was settled, and everyone retired to her own room. As Richard and Dorothy Wertz write in Lying-In: A History of Childbirth in America, “The era of social childbirth, with its volunteer woman-to-woman help, passed with the disappearance of the American frontier.” The “lie-in” wasn’t adapted or modified. And it certainly wasn’t replaced with anything.
This country is one of the only utterly lacking in a culture of postpartum care. Some version of the lie-in is still prevalent all over Asia, Africa, the Middle East, and particular parts of Europe; in these places, where women have found the postpartum regimens of their own mothers and grandmothers slightly outdated, they’ve revised them. The U.S. seems only to understand pregnancy as a distinct and fragile state. For the expectant, we issue reams of proscriptions—more than can reasonably be followed. We tell them what to eat and what not to eat. We ask that they visit the doctor regularly and that they not do any strenuous activity. We give them our seats on the bus. Finally, once they’ve actually undergone the physical trauma of it, their bodies thoroughly depleted, we beckon them most immediately to rejoin the rest of us. One New York mother summed up her recent postpartum experience this way: “You’re not hemorrhaging? OK, peace, see you later.”
The Chinese traditionally adhere to 30 days of restful confinement—another week for a C-section—during which time moms are meant to consume lactation-inducing soups and herbal tonics and abstain from sex and cold water. In Mexico, the ritualized interlude, or thecuarentena, goes for 40 days, or long enough for the womb to return to its place. Balinese women are not allowed to enter the kitchen until the baby’s cord stump has fallen. Dutch maternity nurses make postpartum visits every day for the eight days after childbirth, and in France, as elsewhere, new moms spend nearly a week in hospital. Always, the mothers are educated as they convalesce; they’re taught to breast-feed, to manage baby rashes and bath time and sore nipples. Rarely are they first to respond to the infant’s shrieking. In 2011 I visited a luxury postpartum center in Taipei, where women of means (and who would rather not call on their mothers-in-law, as is custom) spend a month in recovery. When I asked Tsai Ya-hui, who had given birth to her first child three weeks earlier, what she did all day in her high-end suite, she answered: “Internet and sleep. That’s about it.” She looked more refreshed than I did.
There are elements of these postpartum practices (the consumption of foods rich in iron) that are common-sensical, and there are others (tightly wrapping the belly with a postnatal girdle; consuming distilled rice wine in place of water; extremely limited exposure to the sun in the first month), the usefulness and safety of which are debated by the medical community. But the thing to focus on here is the idea of a culturally recognized and accepted postpartum rest period. With these rituals comes an acknowledgment, familial and federal, that the woman needs relief more at this time than at any other—especially if she has a career to return to—and that it takes weeks, sometimes months, to properly heal from childbirth. An acknowledgement that overexertion after labor could lead to depression, infection, increased uterine bleeding, or prolapse. An acknowledgment that the postpartum stretch shouldn’t feel, as it did for so many of the American women who took part in my informal survey, like one long sleepless night.
“A culturally accepted postpartum period sends a powerful message that’s not being sent in this country,” said Dr. Margaret Howard, the director of the Day Hospital for Postpartum Depression in Providence, Rhode Island. “American mothers internalize the prevailing attitude—‘I should be able to handle this myself; women have babies every day’—and if they’re not up and functioning, they feel like there’s something wrong with them.” A colleague of Howard’s, the daughter of a pediatrician, brought her prepregnancy jeans to the delivery room, expecting to slip into them once the baby was out.
I spent part of an afternoon with some new mothers in Park Slope, an affluent Brooklyn neighborhood that is frequently and teasingly associated with over-the-top urban parenting. As a group, they’d received probably the best postpartum care that this country has to offer, which they detailed over the squeals and sighs of their nursing infants. Sophia Sotto had hired a postpartum doula, but didn’t feel comfortable “asking her to do the dishes in the sink.” She remembered: “I still couldn’t manage when to shower, when to eat.” Sarah Hake had an episiotomy and still, like every woman in America, was asked to come in for a 15-minute checkup six weeks after leaving the delivery room. “Six weeks is too late,” she said. The rest murmured their agreement. All had cooked; all had cleaned. Asked Emily Lillywhite, “If you don’t get up and do it, who will?” One woman had taken an especially long walk two days after delivering, because she wanted to “feel normal again.” Most had been afraid to survey the wreck between their legs, and those who did look hadn’t been able to tell if they were healing well or not. “Google became my very good friend,” said Ruth Margolis. “Yes,” Sotto broke in. “Your postpartum support is the Internet.”

Thursday, August 15, 2013

America's Postpartum Practices

130814-Brenhouse-postpartum-tease
Jaime Razuri/AFP/Getty

PARENTING

Why Are America’s Postpartum Practices So Rough on New Mothers?

America is hyperfocused on mothers bouncing immediately back after childbirth, yet most other cultures allow for an extended period of pampering and rest. Hillary Brenhouse on why U.S. moms are missing out.
Some hundreds of years ago, Colonial Americans thought it fit for a woman who had just given birth to keep to her bed for three or four or more weeks. For the length of the “lying in” period, as it was called, the new mother would rest, regain her strength, and bond with the baby as her womanly attendants kept up the household. Several of these ladies would be relatives, and others not; none were paid, and all expected to be similarly cared for following their own deliveries. Then, in the 19th century, the last free land was settled, and everyone retired to her own room. As Richard and Dorothy Wertz write in Lying-In: A History of Childbirth in America, “The era of social childbirth, with its volunteer woman-to-woman help, passed with the disappearance of the American frontier.” The “lie-in” wasn’t adapted or modified. And it certainly wasn’t replaced with anything.
This country is one of the only utterly lacking in a culture of postpartum care. Some version of the lie-in is still prevalent all over Asia, Africa, the Middle East, and particular parts of Europe; in these places, where women have found the postpartum regimens of their own mothers and grandmothers slightly outdated, they’ve revised them. The U.S. seems only to understand pregnancy as a distinct and fragile state. For the expectant, we issue reams of proscriptions—more than can reasonably be followed. We tell them what to eat and what not to eat. We ask that they visit the doctor regularly and that they not do any strenuous activity. We give them our seats on the bus. Finally, once they’ve actually undergone the physical trauma of it, their bodies thoroughly depleted, we beckon them most immediately to rejoin the rest of us. One New York mother summed up her recent postpartum experience this way: “You’re not hemorrhaging? OK, peace, see you later.”
The Chinese traditionally adhere to 30 days of restful confinement—another week for a C-section—during which time moms are meant to consume lactation-inducing soups and herbal tonics and abstain from sex and cold water. In Mexico, the ritualized interlude, or thecuarentena, goes for 40 days, or long enough for the womb to return to its place. Balinese women are not allowed to enter the kitchen until the baby’s cord stump has fallen. Dutch maternity nurses make postpartum visits every day for the eight days after childbirth, and in France, as elsewhere, new moms spend nearly a week in hospital. Always, the mothers are educated as they convalesce; they’re taught to breast-feed, to manage baby rashes and bath time and sore nipples. Rarely are they first to respond to the infant’s shrieking. In 2011 I visited a luxury postpartum center in Taipei, where women of means (and who would rather not call on their mothers-in-law, as is custom) spend a month in recovery. When I asked Tsai Ya-hui, who had given birth to her first child three weeks earlier, what she did all day in her high-end suite, she answered: “Internet and sleep. That’s about it.” She looked more refreshed than I did.
There are elements of these postpartum practices (the consumption of foods rich in iron) that are common-sensical, and there are others (tightly wrapping the belly with a postnatal girdle; consuming distilled rice wine in place of water; extremely limited exposure to the sun in the first month), the usefulness and safety of which are debated by the medical community. But the thing to focus on here is the idea of a culturally recognized and accepted postpartum rest period. With these rituals comes an acknowledgment, familial and federal, that the woman needs relief more at this time than at any other—especially if she has a career to return to—and that it takes weeks, sometimes months, to properly heal from childbirth. An acknowledgement that overexertion after labor could lead to depression, infection, increased uterine bleeding, or prolapse. An acknowledgment that the postpartum stretch shouldn’t feel, as it did for so many of the American women who took part in my informal survey, like one long sleepless night.
“A culturally accepted postpartum period sends a powerful message that’s not being sent in this country,” said Dr. Margaret Howard, the director of the Day Hospital for Postpartum Depression in Providence, Rhode Island. “American mothers internalize the prevailing attitude—‘I should be able to handle this myself; women have babies every day’—and if they’re not up and functioning, they feel like there’s something wrong with them.” A colleague of Howard’s, the daughter of a pediatrician, brought her prepregnancy jeans to the delivery room, expecting to slip into them once the baby was out.
I spent part of an afternoon with some new mothers in Park Slope, an affluent Brooklyn neighborhood that is frequently and teasingly associated with over-the-top urban parenting. As a group, they’d received probably the best postpartum care that this country has to offer, which they detailed over the squeals and sighs of their nursing infants. Sophia Sotto had hired a postpartum doula, but didn’t feel comfortable “asking her to do the dishes in the sink.” She remembered: “I still couldn’t manage when to shower, when to eat.” Sarah Hake had an episiotomy and still, like every woman in America, was asked to come in for a 15-minute checkup six weeks after leaving the delivery room. “Six weeks is too late,” she said. The rest murmured their agreement. All had cooked; all had cleaned. Asked Emily Lillywhite, “If you don’t get up and do it, who will?” One woman had taken an especially long walk two days after delivering, because she wanted to “feel normal again.” Most had been afraid to survey the wreck between their legs, and those who did look hadn’t been able to tell if they were healing well or not. “Google became my very good friend,” said Ruth Margolis. “Yes,” Sotto broke in. “Your postpartum support is the Internet.”
“It took me a good eight to nine weeks to be normal—I mean, physically able to not wear disposable underwear. But you’re supposed to be Facebook-ready two days after labor.”
I heard stories of women vacuuming upon arriving home after a day and a half in the hospital; of new moms waiting until the six-week checkup to make their postnatal complications known; of visitors turning up and instantly asking for coffee; of lactation consultants who were meant to, but did not, take insurance; of a postpartum doula who, when she was summoned by a mother one month postlabor, said, “You’re too far along to need me.” A popular site that advises women on how to find and work with a baby nurse counsels: “Ask your baby nurse what she likes to eat and stock up at the supermarket.” It is true that hiring a postpartum helper is far less expensive in, say, Hong Kong than in the U.S. But the problem is not one of money. The problem is that no one recognizes the new mother as a recuperating person, and she does not see herself as one. For the mourning or the injured, we will activate a meal tree. For the woman who is torturously fatigued, who has lost one 10th of her body’s blood supply, who can scarcely pee for the stiches running up her perineum, we will not.
A number of things have changed since the American frontier closed: women work outside the home, and the U.S. is the only industrialized nation not to mandate paid maternal leave; families are geographically scattered; childbirth has become medicalized, and medical treatment, costly. Still, immigrants to the U.S. and their children have found ways to observe a period of postpartum repose. There is, in Flushing, Queens, more than one Chinese confinement center, and the institutions run a fairly brisk business. I met with an Argentine woman, Andreina Botto, who kept some version of the cuarentena for two straight months. A South American nanny looked after her other children and prepared endless batches of fatty soups for Botto to sup. Botto was visited weekly by a Chinese doctor ($150 per rather lengthy visit), and by his instruction stayed in her pajamas most days, made sure to keep warm, and consumed fish oil. She sure didn’t diet; she ate in order to lactate and froze the excess milk.
If Botto hadn’t been able to afford hired postnatal help, she would have called on a family member. If her relatives had been outside the city and unable to make the trip in, she would have called on a friend. Full-time jobs are no impediment. In her book The Immigrant Advantage, Claudia Kolker visits a new mom, a Mexican woman living in Ohio, whose sister-in-law would come straight from the factory to administer care. For weeks, as the woman relaxed, her sister-in-law barely slept. This kind of arrangement is far from ideal, but, for those who subscribe to a system of postpartum support, the alternative isn’t an option. “In an airplane crash,” Botto said, “you need to put the mask on yourself first, not your kids. Only then can you be a good mother, a good wife. First you need to take care of yourself and recover. It’s key that in this 40 days you heal—it’s not like you can do it later.”
Put the mask on yourself first? In the States, a woman is looked after, by herself and by others, only so long as her body is a receptacle for the baby. Attention then transfers to the needs of the infant. To ask for respite is to betray not only weakness and helplessness, but selfishness. You should be prepared for the emotional and physical demands of your new motherly role and you should like them, too. “People are always asking, ‘Do you love it? Is it everything you dreamed?’” Brigita Jones, a new mom, told me. “Actually it sucks right now. But other women would be horrified if you said that; even the ones who’ve been through it. I was shredded after giving birth. The hospital flung me out. I had a colicky baby with feeding issues, and I had to take care of myself, which you can’t do when you’re not sleeping. It took me a good eight to nine weeks to be normal—I mean, physically able to not wear disposable underwear. But you’re supposed to be Facebook-ready two days after labor.”
America might begin by conceding that the postnatal period ought to be a formal, protected, well-monitored term and that any woman who does not adequately and restfully observe it is putting herself and her infant at risk. Increased paid parental leave and insurance policies that include longer hospital stays and regular postnatal visits would be helpful. So would a national discourse that does not stop at postpartum depression, which is the consequence and not the cause. Perhaps if we started talking about the time and energy it actually takes to recuperate from childbirth, women wouldn’t feel the need to return as quickly as possible to “normal.” A number of things have changed since the frontier closed, but the female body is not one of them.