Moved over to main website blog: Obstetric Cholestasis

Obstetric cholestasis

It has a number of names : Intrahepatic cholestasis of pregnancy (ICP), obstetric cholestasis, cholestasis of pregnancy, jaundice of pregnancy, and prurigo gravidarum.

What is it?

Obstetric cholestasis is a disorder that affects your liver during pregnancy. The main symptom is itching on the palm of your hands or soles of your feet. Another symptom is persistent itching of the skin (anywhere on the body) when there is no skin rash.

How common is it?

Takes from the RCOG : Obstetric cholestasis is uncommon. In the UK, it affects about 7 in 1000 women (less than 1%). Obstetric cholestasis is more common among women of Indian- Asian or Pakistani-Asian origin, with 15 in 1000 women (1.5%) affected.

Iching is a really common part of pregnancy, caused by the stretching of skin as your body accommodates your growing baby/babies. However, it can be one of the warning signs of cholestasis. It is important to flag any concerns with your care provider (midwife or obstetrician). They can preform a simple blood test to rule out any concerns of cholestasis. 

So what happens if you are diagnosed with obstetric cholestasis? 

Once diagnosed with obstetric cholestasis, you will be advised to be under the care of a consultant and have your baby in hospital with a neonatal unit (NICU). 

There is no cure for obstetric cholestasis but all symptoms generally disappear once your baby is born.

Most women will then have additional antenatal checks. This will include regular liver function tests, until you have had your baby. You will also be offered additional monitoring of your baby. Often this will involve extra ultrasound scans checking growth and measuring the amount of fluid around your baby.

When you are in labour, you will be offered continuous monitoring of your baby’s heart rate. There is some evidence that it is safer to birth your baby early if your symptoms are severe. You will have an opportunity to discuss the option of having labour induced after 37 weeks. 

Early induction (before term, 37 weeks) may carry an increased chance of having interventions such as assisted birth (forceps etc) or having a caesarean birth. It also carries an increased chance of your baby being admitted to the special care baby unit (SCBU) with complications of preterm birth. Your care provider or obstetrician will discuss what they feel is best for you and your baby in your individual situation so that you can make an informed choice.

Remember to take time to ask lots of questions. It can be helpful to have a notebook and pen ready to take notes as in unexpected situations it can be hard to take in all the medical information you are being told. 

Take time to weigh up all the pros and cons and understand each step before making your informed decision. 

Our doulas are an amazing support through this process - walking the journey with you - offering emotional and physical support. If you would like more information on how we can best support you pop us an email on info@doulacare.ie 

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

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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Meghan Markle has hired a doula, what is that? Part 1

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 1.

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 Birth Doula support. 

A Birth Doula begins work with their client during pregnancy. Supporting them throughout pregnancy, labour and birth. We don’t clock out at 8pm. We are there by our clients side every step of the way. Offering continuity of care throughout pregnancy, labour, birth and postpartum. We then visit our clients at home, offering support with all those early parenting questions.. We offer knowledge, encouragement, information and hands on tips and tricks of the trade. 

Knowledge: We help our clients to understand their chosen place of birth (most commonly a hospital) policies.We compare the different hospitals policies, statistics and what the National Clinical Guidelines say. We also chat about International Guidelines and help our clients to make informed decisions about their care. We also cover the physical process of labour and birth and common things that come up. We can assist our clients to create their birth preferences for their unique journey. After baby arrives we share all the latest evidence on infant care, recovery after birth and anything else you’re wondering about too!

Encouragement: We build up our clients. A huge part of our role is to help our clients (the birthing mother and her partner) to feel confident. We are like their coach or cheerleader from the sidelines, reminding them of all the skills they have gained throughout their pregnancy and the strength they have within. This does not stop once baby arrives. We build you up again after birth and remind you of that strength and knowledge.

Information: Apart from the mentioned topics, doulas also answer any questions that happen to arise with each client. It may be they read an article online and wonder does that happen in Ireland? Or they are told they have a condition (such as gestational diabetes GD) and would like information to help them feel informed and confident on how best to manage it.

Hands on tips and tricks: Doulas are not afraid to get in there and help out. During pregnancy we show our clients different massages, counter pressure and comfort measure to help during labour. We teach these skills to the birth partner so they feel fully involved in the process. On the day of labour often doulas and partners work really well together - tagging in and out (counter pressure can be really tiring after a few hours!) This support continues on into parenting. From showing you how to change and dress a newborn (which is surprisingly tricky at first) to helping you find a comfortable position to feed in - your doula will be right there. 

Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. Partners often say things like “I didn’t know what to do to help my wife” or “I felt like a spare tool in a scary unknown setting” but with a Doula supporting them - they have a full tool kit to draw from. They also get encouragement and a helping hand along the way. After they become a Dad/Mam we are still there. Helping them to adjust to their new role and offering guidance on how best to support you.

With DoulaCare Ireland you have a full team of support. Each client is matched with two doulas. You have your primary doula and your back up doula. You have the opportunity to meet both. Both doulas will know your birth preferences and wishes. This means that if for any reason your doula needs to take a break (such as a long birth, where your doula may need to grab some sleep), you have the option of your back up doula joining you 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.

In next weeks blog we will discuss Postpartum Doula support.

Until then… Doula Jen x

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Postnatal Depression, when love doesn’t come as a thunderbolt.

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Postnatal Depression, when love doesn’t come as a thunderbolt.

I was 21, and diagnosed with Poly Cystic Ovarian Syndrome (PCOS), on a hot June day, in the consultants room, in a Cork hospital. One minute I was worrying about my parent's car being clamped, and the next minute I was being told,  if I was ever going to have kids, do it now in my early 20s. He closed the folder and stood up, as I sank into the chair. Fast forward to 23, going out with my husband, and about four weeks into the relationship, the clock now ticking so loudly, I sit him down and tell him. In September 2011, my daughter was born. Five years after my PCOS diagnosis. A greyness descended, initial happiness replaced with fears, thoughts, overwhelming feelings. My brain telling me that I’m not good enough for her. My husband was beaming, but my heart was breaking, because, after five years of hoping, wishing, endless sticks to wee on, I didn’t get that thunderbolt. I was in shock. 

I stayed in the hospital for four days, because I didn’t want to go home until I felt ‘right’ . That thunderbolt didn’t come. Over the following days and weeks, I lied to friends and family who were enamoured by her. I was staying awake all night, afraid, and dreading the moment she would need me again. Would she be better with someone else as her mammy? I envied my husband's love for her. I envied how happy he was. I loved her, but felt that I wasn’t enough for her. What if she didn’t like me? Friends kept telling me how lucky we were to have a happy, healthy baby. I didn’t feel lucky, I felt guilty, ashamed that I wasn’t enjoying the baby I had longed for. I was lucky to find a breastfeeding support group,  that allowed me to cry, talk openly, and not be judged. It became my lifeline. I found Kathy Kendall-Tackett's book, The Hidden Feelings of Motherhood, and it was eye opening, and reassuring. Dr Andrew Mayers from Bournemouth University, has done some interesting research about partners developing postpartum depression too.

I had heard some myths about PND , and medication, and I had fears about asking for help. What if they take her off me? What if, what if, what if? I became numb, and comfortable in my numbness. I hit rock bottom in 2016, when my neighbour passed away suddenly. A few days later, at my doctor's for something else, I broke down. He gave me some options, and I chose a referral for counselling. It was amazing. A weight lifted. The shame and guilt could be put down. I could breathe. 

I now work as a postpartum Doula, with Doula Care Ireland. One client described me as “a wonderful calm presence amidst the chaos" .I am not a health care professional. I am not there to tell you what to do. I give you the information,  and allow you to make an informed choice that works for you and your family. There is no one magic cure for PND, but , with calm, clear, informative support you can begin your journey out of the greyness. I am continuously working on being the best version of myself, and it is a continuous process. Sometimes I see glimpses of how I felt, in my clients, and it reminds me that the process of being mentally well, is something we need to keep working on.

Written by one of our doulas Dee Burke. You can fins out more about Dee and the support she offers here https://www.doulacare.ie/dee-burke-1/

If you or someone you know is suffering with a postpartum mood disorder these resources may help

https://www.nurturecharity.org

http://www.pnd.ie

https://www.cuidiu.ie/httpwwwcuidiucomsupports_parenthood_postnatal

https://www.hse.ie/eng/services/list/4/mentalhealth/mother-and-infant-health/#Finally,%20support%20services%20for%20those%20with%20Poatnatal%20Depression

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Things are not always as they seem on Social Media!

Things Are not Always as They Seem on Social

Media!

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Things aren’t always as they seem!

Social media like Facebook portrays an image of happiness and beauty. Everyone full of smiles, surrounded by friends and family, women with perfect make up, children looking sweet, even their house looks clean and decorated so beautifully in the background!

I have sat with so many parents who feel inferior and genuinely upset when they compare their life to their Facebook or Instagram friends (some of whom they may never have actually met in real life!) 

Well guess what? No one has a perfect life. Who do you know that told you about their toddler having a massive melt down on the floor of the super market?  It’s happened to us all! Now ask yourself this, have you ever seen them post a photo of said event? The probable answer is of course no. They may even have got through that hiccup in their day and gone on to post a video that evening of their little one singing a sing, full of smiles. This often leaves us all thinking “Look there is Sally’s little girl singing, she is so sweet. Why are my kids such terrors? I can’t even bring them to the shops to get milk and bread without a melt down!”

Social media is where people document their happy moments. It is well thought out before anyone posts a photo. They will find the clean corner of their house, hold the camera to its most flattering angle, nudge their partner to smile or do silly faces to coax a smile from their little ones. It is where we can look back and say “That was a brilliant day” or “Look how much my baby has grown since then!”

I encourage you all to enjoy social media, like Facebook and take inspiration from others. See another twin Mum getting out to a play group? Never thought you could? Maybe that was the photo you needed to see to give it a go ☺ 

Social media is a great way to stay connected to people, get peer support and find out about local resources. Remember to take off the rose tinted glasses and see behind the staged scenes of family photos. Reality is that there was probably shouting or bribery (or both) to get everyone in and smiling. If we capture that moment we can feel proud posting it, banking that moment in time for the future. 

So your life isn’t perfect, your kids are a pain in the backside most of the time, your house is a mess and your partner is a nightmare. Whose isn’t? Feel comfort in knowing we are all in the same boat ☺ Reach out to friends to chat. Go to peer support groups. Have a moan, then have a cup of tea and a biscuit, take a deep breath and enjoy the rest of your day.

Because even if your life isn’t perfect, you will never have this moment again. Your little ones will never be at this stage again. Sometimes the days can feel endless but the weeks disappear so quickly so savour every precious moment and breath through the hard ones.

Doula Jen xx

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