Moved over to main website blog:Begin your pelvic floor rehab

Hi to all the wonderful families connecting with Doulacare Ireland. My name is Louise Murphy and I’m a doula and a physiotherapist specialising in pelvic health. 

With the current Covid19 emergency, I’m really conscious that many women in Ireland at the moment won’t have access to pelvic health physiotherapy. This is obviously particularly difficult if you have an acute issue like a large tear after your baby's birth or urinary or bowel leakage or urgency.

So I wanted to reach out to share some tips on how to manage these problems and begin your pelvic floor rehab. 

1. Try not to panic. Not getting to your physiotherapist immediately doesn’t mean that things will necessarily get worse or never improve. If you have a lot of urgency or urge incontinence (leaking as you rush to the toilet), going to the toilet regularly (about every 2 hours) is advisable. This makes sure that the bladder isn’t over filling and overflowing.

2. Keep any stitches dry and clean. Don’t apply anything to them except water. Rinse the area or sit in a shallow bath after using the toilet and gently pat the area dry.

3. For the dreaded bowel movements:

   1. Take advantage of the gastrocolic reflex. This reflex means you’re most likely to have a bowel movement if you go to the toilet half an hour after breakfast, regardless whether you feel an urge or not. Try to make this part of your routine.

   2. Take your time. We all know how it is with a new baby – we run into the bathroom, sit down and push out the pee as fast as we can to get back to our (usually crying) as quickly as possible. So I want you to take your baby with you. Maybe in a bouncer or moses basket or even in a wrap if you have to. Aim to spend 5-7 minutes sitting on the toilet to allow things to happen.

   3. Use the correct position on the toilet. We are designed so that our bowels empty best in a squatting position so feet up on a stool, lean forwards, elbows on knees and entertain your baby, read a book or just enjoy some quiet time!

   4. Use your hand wrapped in tissue to support any stitches if it hurts to them to empty the bowel. 

   5. Take any laxative prescribes for you, hydrate well and eat healthily.

4. Start some pelvic floor rehab. I usually start this by making sure my patients can breathe well and have some awareness of their pelvic floor muscles and what they’re doing. This sounds simple but many, many people find this bit the most difficult part of their rehab. 

Breathing

So make sure that you can do:

• Upper chest breathing – hand on your upper chest and breathe in so that your chest rises towards your chin.

• Lateral (rib) breathing – hand on the ribs on each side and breathe in so that your hands move outwards on your ribs.

• Abdominal breathing – one hand on your chest and one on your tummy. Breathe in and concentrate on allowing your tummy to move outwards while minimising movement in your chest.

If you learn better from observing, just pop the different types of breathing into YouTube and lots of demo videos will come up. 

Practice these different types of breathing in different positions – lying, sitting, standing and practice being more mindful about how you normally breathe. 

Awareness

Once you’ve got the breathing mastered and can do it without having to concentrate too much, I normally move my patients on to working on their awareness. So while practicing your different types of breathing, pay attention to what’s happening with the pelvic floor. 

Just paying attention to begin with. At first you might not really notice anything but stick with it. 

Look out for:

• What the pelvic floor feels like when you breathe in.

• What it feels like when you breathe out.

• What are your tummy muscles doing?

• What’s your bum up to? Nothing? Tightening? Relaxed?

Ideally, we want you to be able to feel a subtle release of the pelvic floor as you breathe in and a gentle (not conscious) tighten or lift as you breathe out.

If you’re aware of this happening, you’re ready to move on to co-ordination.

This is pretty simple but takes practice. So: 

• Breathe in slowly

• Begin to breathe out

• Add a gentle pelvic floor squeeze as you continue to breathe out

• Release

You should be able to feel the squeeze and also the release. If you can’t feel the release, let you a little sooner as your muscle may not yet be strong enough to hold for the full breath out. 

Repeat this 5-10 times a few times a day. If you can, make your squeeze a little bit smaller with each repetition. This improves your control and sensation and reduces squeezing of the other muscles around the area which we want to keep to a minimum.

If you’ve got as far as this, you’re doing great! Keep working on these exercises in different positions and improving your control and sensation. 

If you’re struggling, please don’t feel alone. I’m available through Doulacare Ireland for a chat and will get back to you as soon as I possibly can. There are some online resources available to you that might also help and I’m linking to them below.

My online course: https://mindingmums.teachable.com/p/resetting-your-pelvic-floor (Coupon Code MARCH2020 for 30% off)

Free online Womens Health After Motherhood course:

https://www.futurelearn.com/courses/womens-health-after-motherhood

Videos from the Rotunda Physiotherapy Department:

https://rotunda.ie/knowledgebase/physiotherapy/

This link is about constipation and while you might not necessarily be constipated, a lot of the same information applies:

https://www.evidentlycochrane.net/feet-up-constipation/

Some information about dealing with bladder urgency:

https://www.ucsfhealth.org/education/bladder-training

Some physiotherapists are also doing virtual consultations for clients so chevk in with your local physio to see if they’re able to facilitate this for you. 

Good luck, 

Louise x

Many thanks to Louise for putting this blog together. You can read more about the support Louise offers here https://www.doulacare.ie/louise-murphy

Moved over:What is all that white stuff on my newborn? (Vernix)

What is all that white yucky stuff on my baby?! 

The vernix caseosa is a greasy, cheese-like coating that covers babies’ skin during their time in the womb. It may not look pretty but the vernix actually serves an important function: It protects your new baby's skin from getting pickled by amniotic fluid in utero. (you know when you're in the bath too long?)

Vernix usually develops around 19 weeks into pregnancy and continues to thicken until around week 34. By week 40, the vernix is mostly gone.

Babies born earlier tend to have more vernix than those born later. Babies born a few weeks before their due date might still be well coated. Babies born at term may only have a little bit of vernix left in the folds of their skin or under their nails. Babies born after their due date might not have any vernix left at all. Occasionally their skin might be wrinkled or peeling as a result, but don’t worry — it’s temporary! (remember the being in a bath too long reference?)

The vernix caseosa helps form a barrier between your baby’s skin and the surrounding amniotic fluid. Its main role is to protect and hydrate

It does have other benefits too:

🤰During pregnancy: The vernix can help to nourish developing gut bacteria (as your baby swallows some in utero) 

❤️During labour: Vernix’s greasy, oily texture could serve as a natural lubricant as your baby makes their way down the birth canal.

👶After birth: Vernix can continue to protect your baby’s skin by helping it retain moisture and stave off bacterial infections as they adjust to our outside world

🤱Breastfeeding: Vernix help babies latch on too. The smell of vernix and amniotic fluid triggers neural connections in babies’ brain needed for breastfeeding. 

🧕For Mother: Vernix contains compounds thought to promote perineal wound healing, so it may aid in recovery for vaginal births. 

So try to resist the urge of washing or rubbing it off. Rub it into baby! Evidence shows delaying your baby's first bath can help with bonding, breastfeeding and protection. WHO (World Health Organisation) recommends leaving the vernix on your baby for at least six hours, and preferably 24 hours after birth. As for an upper limit? There’s no official recommendation. Many parents wait days.

Did your baby have much vernix at birth?

Moved over to main website blog:Why I donated my placenta to search dogs

Why I donated my placenta to search and rescue dogs

What happens to your placenta after you give birth? Well women in Ireland have a number of options

1. Let the hospital dispose of it

2. Bring it home and plant a tree over it in your garden

3. Get it encapsulated or consume it raw (in a smoothie)

4. Pop it in your freezer to keep

5. Donate it to search and rescue dogs

On both of my sons births I never put much thought into what happened to my placentas. I don’t remember seeing them or being asked. They simply were mentioned and then disappeared. 

So with my last pregnancy I put thought into what I would do with my placenta this time. I didn’t want to just dump my placenta. It had been this amazing source of life to my daughter for 9 months. My body had created this perfectly tailored organ to help my baby grow. It provided oxygen and nutrients to my baby and removed waste products from my baby blood. I am fascinated by placentas, can you tell? LOL 

I contemplated a nice cherry blossom tree in the garden to symbolise my daughters birth. I did think it would be lovely.

For me personally, I did not want to consume my placenta. Being a doula and antenatal educator everything I present to my clients is evidence based. I spend a huge amount of time researching topics relevant to pregnancy, birth and early parenting.  With placenta consumption (either via capsules or raw) there is no concrete evidence. There are lots of antidotal findings, both for and against but until there is a scientific study done I was not willing to take the risk. 

So for me I felt it was fitting for my placenta to be useful and to go to a good cause. I donated my placenta to Irish Search Dogs.They use the placenta tissue to train their dogs in finding human remains. While this is a heart breaking situation - my hope is that by donating my placenta, it is helping a family to find a loved one and to lay them to rest. 

My husband is a Garda and we both know only too well the horrible situations many families find themselves in. When a loved one dies, giving that family closure can mean so much. Irish Search Dogs give this to those whose loved ones are missing. It is an unbelievable service provided. While this is not a situation people like to think about much, it is invaluable to many many families nationwide. 

When I decided to donate my placenta I spoke with the chairman Glen who was absolutely lovely. He was so kind and understanding and made the process so easy. He put zero pressure on me and simply said if I decided to go ahead and remembered on the day that would be brilliant. My husband brought my placenta home from the hospital and popped it into our freezer (in the bag the hospital had provided) I then contacted Irish Search Dogs and they even had one of their volunteers collect it from my home! Making it totally hassle free!

So if you are unsure what you would like to do with your placenta, please do consider donating it. During your pregnancy it was a gift of life and afterwards it can continue to give so much to families by helping to train these amazing dogs!

If you would like to learn more about Irish Search Dogs their website is

 http://irishsearchdogs.com/About.html

Glens email is glen@irishsearchdogs.com (A total gentleman)

Jen x

So Meghan Markle hired a Doula? What is that? Part 2

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 2.

There are two main types of doula. A Birth Doula and a Postpartum Doula. There are also Doulas who specialise in supporting families through loss and other niche areas

In this blog we will focus on Postpartum Doula support.

In times past (and indeed today in many cultures around the world) parents were not sent home from hospital with a new baby and expected to know what to do and manage on their own. We would have had the support of families, neighbours, friends - minding us, feeding us, helping us adjust to the changes in our lives and allowing the new Mum to rest and recover from birth and support her during the first few weeks of life with a small baby. Today we are often lacking this support and just expected to cope. People do call in to visit but don’t think to bring a cooked meal for the Mum, let her rest, load the dishwasher or ask how she is doing. The focus is often on the baby and the Mum is just expected to get on with it. However, we are not hardwired to manage in this way. We need the support of others in those first few weeks and months and in lieu of support from our community the postpartum doula can step in and offer this support.

A Postpartum Doula begins work with their client as soon as they book in. For some, this is during pregnancy (the forward planners!) and for others this is after baby is born. If it is during pregnancy, your doula will help you to prepare for your new arrival and the huge shift your life will take. If it is after birth, your doula will slot right in to your new routine (even if you don’t think there is any form of routine) As with Birth Doula support, your Postpartum Doula comes with many layers of support. We help you to debrief and process your birth experience. We nurture you while you recover from birth and find your new normal. We help your older children adjust to having a new dynamic in the family. We support your partner, adjusting to their new role and debriefing their own experiences. We offer knowledge, encouragement, information and support every step of the way - as each new day brings new challenges. Above all, we help you to savour the good moments between the chaos :)

Knowledge: Doulas are information junkies. We love reading, attending study days and growing our knowledge base. In DoulaCare Ireland all our Doulas must attend at least three CPD days per year. - which ensures the building of knowledge as evidence changes and new research is undertaken. We also learn from every interaction, with each individual client. We bring that knowledge base to you when you come home with your new baby. No matter what comes up, with your recovery after birth or your babies needs - chances are we have seen it before (or we know who to call if not).

Encouragement: Anyone who has had a baby, knows that surreal feeling of being left in charge of this new tiny human. Many parents feel “they are not seriously letting me home alone with this baby? I don’t even know how to bath him or tell if he is hungry” Don’t fear. It is normal to feel that way. The truth is no parent has the answers. Babies don’t come out with an instruction manual. We all learn on the job! The great thing is, with your Postpartum Doula by your side - you have a calm presence helping you every step of the way. So nothing feels overwhelming. You and your baby learn together, with a helping hand from your Doula.

Information: To new parents this is invaluable. The number one question we get asked… “Is this normal?” Rest assured, your Doula will have all the latest evidence and research at hand to help you make informed decisions when the fog of parenting clouds your brain. It can be hard to process information when you are recovering from birth and haven’t slept more than an hour in 2 weeks. Your Doula will give you the information you need in bite sized chunks so you can fully process it as required. She would also be delighted to tuck you up in bed, with clean sheets, after a hot shower and home cooked meal - and after a nice nap it is easier to think more clearly and have perspective on the changes in your life!

Hands-on tips and tricks: A Postpartum Doula passes on all the parenting tips and tricks they have picked up through their training and working experience. They help you to simplify your daily life. Sometimes it’s a gentle suggestion on where to keep the changing table, that you hadn’t thought of (like having a second one in that corner downstairs to save you running up and down the stairs 20 times a day) Sometimes it is demonstrating different methods of helping baby to get wind up - which can be a tricky skill to master.

Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. In parenting, it can be helping them to figure out how to put a baby grow on baby (which way is up? Are these the arms? We all know how hard it can be to get a new baby dressed!) It can be explaining the hormonal rollercoaster women ride after giving birth and to expect highs and lows. It can be a listening ear for them to debrief or to gush about their beautiful new son or daughter. Sometimes it is offering gentle suggestions to help them adjust to their new role and see what part they can play in supporting their partner and adjusting to their own new role.

With DoulaCare Ireland you have a full team of support. Each client is matched with the perfect doula for their needs. In the bigger contracts (100+ hours) you will usually have two doulas offering support. You have the opportunity to meet both beforehand. Both doulas will know your parenting style and wishes. This means that if for any reason your doula needs to change your scheduled hours you have the option of your second doula covering so you are never alone! Our co-owners Jen and Mary are always on hand too. We offer phone and email support to our clients and our doulas so no question is ever left unanswered.

We know from neuroscience that our brains are not hardwired to manage on our own in those first few weeks of adjusting to life with a new baby. All so often when we arrive at a new Mums house, they disclose that they feel they are doing something wrong as they struggle to cope. So few of us talk about how hard it is, that many are left feeling not good enough. The postpartum doula steps in to fill the gap. We are there to build confidence and make those first few weeks a positive memory for years to come - in other words to help a family thrive and not just survive the early days of parenting

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Moved over to main website blog:Care and Recovery After a Caesarean Birth.

Care and Recovery After a Caesarean Birth.

You have a brand-new baby — and you also just had surgery. Whether you knew you would have a caesarean birth or not, dealing with both at the same time can be rough. Here are some helpful tips to get your recovery and parenting journey off to a great start. 

Keep on top of the pain medication!

Expect the caesarean incision to hurt for a while. The medicine used in the epidural/spinal ease pain immediately after birth. After they wear off, you’ll be given oral anti-inflammatory medication or suppositories. There are options for these medications that don’t interfere with breastfeeding, so take them. If you can keep pain at bay, it’s unlikely to get out of control. But if you let it go, it’ll hit you like a ton of bricks. It is important to mind yourself during your recovery.

Many new mothers get tummy cramps after birth. These are called "after pains" and are similar to early contractions. They are your uterus’s way of shrinking to its original size. Sometimes having that incision will make it more intense for you. Also know that breastfeeding can trigger those cramps and make them feel a little more intense. As crazy as it sounds, this is actually a positive thing! Breastfeeding releases oxytocin which will assist your uterus to shrink back down the way nature intended. Talk to your doctor or a lactation consultant if you’re having severe pain or other problems breastfeeding. Or remember your doula is always at the other end of the phone.

Move at your own pace!

You probably won't feel up to walking the room rocking your new baby straight away after birth, but you should be able to get out of bed and walk around within a day. You obviously have to wait for the epidural or spinal medications to wear off fully but you also may need extra time to regain your energy. Once the catheter is removed (it emptied your bladder so it wouldn’t be damaged during delivery), you’ll be able to get out of bed. Take those first few days at your own pace (often similar to a 100 year old tortoise).

Moving around allows normal body functions to get back to normal, as well as decreasing the chance of complications from your surgery. For example, walking even small amounts helps to avoid constipation. It can also lower the risk factor of forming a blood clot. Plus as hard as it seems, you will feel better if you go and brush your teeth or take a shower. Slowly and with help!

Of course, you’re not expected to get up and go for a 10k run anytime soon but it is recommended to gradually increase the amount of activity you do from around two weeks postpartum. That can mean starting by walking around the garden and gradually going longer distances and becoming more active. Increase the intensity around six weeks postpartum. By that time, you will be due your 6 week check with your GP, who will let you know if you are ok to drive and answer any questions you have. Take it at your own pace, follow what your body is telling you.

Get help lifting baby

I know - All you want to do is lift that gorgeous baby up and cuddle her, but you’re always better to ask for help. It could be painful or difficult shortly after surgery. This is normal, and pain medication, as well as a hand from your partner, doula or a nurse, will help. Lifting a baby out of the crib may be a challenge, but sitting and holding a baby in your bed or a chair and nursing isn’t. So go ahead and breastfeed your baby, but ask for assistance from the nurses or your partner during your hospital stay.

Eat lots of fibre

Constipation can be an issue for women after caesarean birth. Gas also gets backed up. This can be uncomfortable in the obvious ways but in surprising ones as well, like shoulder pain. If your bowels are distended, they can irritate the diaphragm, and that can be a referred pain that goes to the shoulders.

Don't be shy,  speak to your care provider about laxatives and anti-gas meds if required. Remember to eat fiber-rich foods like fruits and vegetables, drink lots of water, and move around as much as possible. And don’t be shy — let that gas pass.

Care for your incision

In the shower, let the water run on the wound (don’t scrub). Try not to use soap on the area. Once you are done you can pat it dry. If your skin folds over the incision, put a cloth pad on it to keep it from getting sweaty. Your nurse will check it regularly to make sure everything is healing well and may put a dressing on for protection.

Look out for signs of infection, if any develop call your care provider:

• High Tempature

• Skin around the incision turns red

• Oozing green or pus-coloured liquid

• Incision becomes hard or painful

Self care is vital!

So now you are a mam with a round-the-clock new responsibility. It can be easy to get distracted with your adorable new baby and push your body too far. It is important for both you and baby that you recover quickly. You can help speed recovery by eating a balanced diet, getting as much rest as you can and start gentle exercising once you get the go-ahead from your doctor. Don’t be afraid to ask for help so you can get some extra sleep, take a long shower or eat a full meal. (see my blog on ‘Self Care’) 

I wish you the best of luck with your birth experience.

Doula Jen x

Jen Crawford,

CO-OWNER DoulaCare Ireland

www.doulacare.ie