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?

A Wonderful Partnership with Irish Life Health

Did you know DoulaCare Ireland have an exclusive partnership with Irish Life Health? 

At DoulaCare Ireland we offer true continuity of care and our focus is supporting families as they transition into parenthood. This is not always an easy journey, but it is one that can be fulfilling beyond words. We support women and their partners throughout pregnancy. We offer continuous support during labour and birth (home and hospital birth).  We will wipe your brow when hot, keep you calm and focused. We support your partner to feel in control offering them tips and tricks too. We stay by your side, after birth. We go to your home. We nurture you as you find your new normal We cook home cooked meals, catch up on laundry, keep the house running so as new parents our clients can slow down and enjoy those early days. We offer evidence based information. We are an independent support person, without the same emotional attachment a family member can have - meaning unbiased care. We pass on years of knowledge around pregnancy, birth and parenting. Helping our clients to make informed decisions about their care and that of their baby/babies.

We don’t want our clients to. drift through their pregnancy, unsure of their options and frightened of their birth.

We don’t want our clients to muddle through in a sleep deprived fog in those early weeks of parenting.

We want them to feel supported, heard and validated.

We want them to feel cared for, safe and confident.

We ensure our clients thrive in every aspect of this journey, not just survive! 

We chose to partner with Irish Life Health for their forward thinking and family centred plans. They have a huge focus on well being (physical, emotional and mental) which we felt sits with our own ethos. What makes Irish Life Health different to other insurers is that their support doesn’t end when you leave hospital. They know that becoming a parent is a life-changing journey that goes far beyond your hospital stay. Their benefits are there to support you emotionally and physically every step of the way.

Irish Life Health can help you access the support you need for whatever stage you’re at on your parenting journey. They have created an incredible Maternity and Parenting Path package. With DoulaCare Ireland you can now claim up to €200 off Birth Doula support plus up to 18 hours Postpartum Doula support in your home to set you up for success!* 

This is all available exclusively with DoulaCare Ireland. Irish Life Health only work with our Doula Agency.  Why choose Doulacare Ireland above an independent doula? 

Because DoulaCare Ireland are a professional national doula agency. 

• Our doulas are the only doulas in the country that are Garda vetted for their role. 

• All of our doulas carry insurance. 

• All of our doulas are trained by a reputable organisation. 

• All of our doulas attend a minimum of 3 CPD days per year.

• All of our doulas have access to mentorship & counselling sessions if required.

• All of our doulas have opportunity to debrief.

• All of our doulas sign up to a code of ethics.

• All of our doulas know their scope and practice within this at all times.

• All of our doulas are passionate and caring. 

• Mary and Jen are two of the most experienced doulas in their fields and bring that knowledge and support to our doulas and to our clients.

Our Doulacare Ireland national team

But there is more! Irish Life Health are offering their members support in many areas to ensure they have a positive parenting experience. You may be entitled to healthy meals delivered to your door with Gourmet Fuel. A midwife visit in your home. Access to the GentleBirth App https://www.gentlebirth.com A beautiful food hamper. Some home cleaning hours. Access to mental health supports with Nurture Health, another of our working partnerships. They are a nationwide counselling service specialising in the care of parents from fertility issues, conception, and pregnancy right through to postpartum and parenting. You can find out more on their website https://nurturehealth.ie/about-us/ You could have access to a Dietician or Nutritionist Consultation. You could have some Acupuncture sessions or take yoga or pilates classes and so much more!

We are delighted to be a part of this amazing care. We feel parents in Ireland are under so much pressure to get it all right when pregnant, partners are expected to know how to support a Mum during labour (without ever having been near a labour room before). We are expected to just  ‘bounce back’ to ‘normal life’ after having a baby. The big secret no one tells you is you will have to adjust to a new normal. This can take some time. With all of the outlines supports, parents can do this without feeling like they are losing control. Every pregnancy is unique. Every birth experience is unique. Everyone parents in their own way to meet the needs of their unique baby. Babies do not pop out with a manual. New parents have to find what works, one day at a time. Our doulas will be right there, offering encouragement and support every step of the way. 

Any questions?

Please give `Irish Life Health Customer Care team a call on 1890 714 444 or email heretohelp@irishlifehealth.ie to check your plan and see what you may be entitled to!

You can read more about some of these fantastic benefits here

https://www.irishlifehealth.ie/the-parenting-path/redeeming-maternity-benefits

https://www.irishlifehealth.ie/the-parenting-path/the-big-day

For direct enquiries about our benefits with Irish Life Health pop us an email irishlife.health@doulacare.ie or

info@doulacare.ie for general enquiries

*Each policy plan is unique so you can check with their customer care team if your policy is covered or you can make amendments to ensure it is included

A response to Barbara Ellen’s “Meghan Markle’s home birth should not blind us to the risks for most women” published on The Guardian, 13th April 2019.

A response to Barbara Ellen’s “Meghan Markle’s home birth should not blind us to the risks for most women” published on The Guardian, 13th April 2019.

I am deeply disappointed in The Guardian for publishing Barbara Ellen’s ill-informed, fear-mongering article on the dangers of Meghan Markle’s decision for a home birth in influencing us, common plebeian women, who couldn’t possibly have a safe home birth without the royal treatment she will receive.

Based on research and reliable medical evidence, the World Health Organization (WHO) states “It has never been scientifically proven that the hospital is a safer place than the home for a woman who has had an uncomplicated pregnancy to have her baby.” No evidence that the hospital is safer for uncomplicated, low-risk pregnancies. You can also find, on the NHS website, information regarding revised guidelines issued by NICE (National Institute for Health and Care Excellence) which “recommended that women with low risk of complications in childbirth should be encouraged to either give birth at home or at a midwife-led unit.” The HSE, here in Ireland, also states that “research shows that a planned home birth is an acceptable and safe alternative to a planned hospital birth,” again, for healthy women with uncomplicated pregnancies. The HSE itself offers a homebirth scheme as one of its maternity care options, as does the NHS.

I could stop here. But I won’t.

I’m offended personally by the assumption that we, common women, wouldn’t carefully plan a home birth, or any kind of birth for that matter, as we have learned to do so from horrific hospital experiences. Anyone who has been listening to Joe Duffy lately would know all about that.

Among the inaccurate information contained in the article, I’d like to clarify a few:

• Homebirths are not attended by one midwife, but two. That’s how it works under HSE guidelines. Besides, with a midwife, at home, you get continuity of care, which hospitals fail to provide due to the way they are structured. This continuous care, provided by one person who you have come to know and trust, is associated with shorter labors and lower rates of intervention; hence the ever-growing popularity of birth doulas (in all birth settings; hospital, birth center, home, etc).

• When women who are giving birth at home need to transfer to the hospital, they don’t get there by “any means possible”; they use an ambulance service which has already been notified of the start of their labor and has coordinates to their home.

• The article mentions the “risks to most women”, which is also untrue as high-risk complications occur in less than 15% of all pregnancies, as stated by UC San Francisco Health.

Furthermore, if Barbara knew anything about the physiology of childbirth (because yes, newsflash: it’s a physiological process, not necessarily a “serious, bloody business”, as she hauntingly states), she would understand that in fact “splashing about in a birthing pool […] surrounded by Jo Malone candles […] and Enya on Spotify” makes an enormous difference to the progress of labor and can be the crucial difference between a straight-forward, uncomplicated delivery and a cesarean.

Our Co-owner Mary Tighe seen supporting her doula client during a home birth

That is because the physiology of childbirth is dependent on intricate, sophisticated hormonal dynamics. The driver’s seat is taken by oxytocin. They give you a synthetic version of said hormone in the hospital to start or augment labor. They also give it to you to facilitate the delivery of the placenta and to prevent hemorrhage. Oxytocin also aids in bonding with baby and the start of breastfeeding, both of which the synthetic version can’t do, by the way. But how is oxytocin brought about naturally then? Well, it’s the hormone of love and intimacy. So it’s raised through touch, massage, kissing, being in a safe, quiet, intimate place, with dimmed lights and privacy, with freedom to move around, have some water, eat something if you so wish; with no strangers walking in and out, asking a million questions, poking and probing at you. And for some people that might very well be a warm tub of water or shower, surrounded by candles, with Enya on Spotify. Delivering a baby is much more like making a baby than we seem to want to recognize. So, the answer is: whatever floats your boat, as long as it’s a safe option for you. Feel safer in a hospital? Then by all means, have a hospital birth! Have a complication that may require medical attention? Again, the hospital is probably a safer option for you. But this commonplace, ignorant discourse demonizing something you obviously know very little about is unacceptable. As a woman, I find that adding even more fear to this process, which can be a beautifully empowering one, is unacceptable. It’s like bullying women, more than they already are in this “serious, bloody business”.

There are various, researched techniques, or methods, that can attest to the efficacy of supporting this hormonal interplay, as they usually translate into calmer, quicker labors, with less unnecessary intervention (which means less risks for mother and baby), and better memories to cherish forever, because you will. forever. remember. that day. They are the likes of Lamaze, HypnoBirthing, and Ireland’s very own GentleBirth techniques, devising an informed birth plan, or hiring a birth companion, such as a doula, all of which work to empower and support the laboring woman and her baby, her feelings and desires, and in turn, this miraculous hormonal process.

You might wonder how you may benefit from having a doula, a hired birth companion, at a home birth, like Meghan is said to be doing. Doula support might indeed look a bit differently at home, because they can focus on you and your partner completely, and not have to deal with the hospital environment. They arrive before your midwife and are by your side the entire time. It gets to a point sometimes where midwives actually need to rest, to make sure they are well able to identify your medical needs, while a doula, in quite a different mindset, will still stand by you. Additionally, should you transfer to the hospital, they will accompany you and provide invaluable continuity of care. 

General areas in which doulas focus their support include: emotional and psychological preparation, guidance, and ease; physical comfort, positioning, and nurturing touch; supporting you in your confidence, decision-making, learning, gathering information and understanding your preferences. Although doulas and midwives both value those components as part of a satisfying birth, doulas get to focus on them entirely, while midwives are tending to clinical tasks. So together, at home, they are a wonderfully powerful team.

Of all the fashionable trends out there, I think this would be an absolutely lovely one to get informed about—and yes, if it’s a suitable option for you and your specific circumstances, maybe even follow.

Anita Petry

Birth and Postpartum Doula with DoulaCare Ireland

Member of the Doula Association of Ireland

Originally from Brazil, Anita now lives in Dublin with her husband David.