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?

The Irish Maternity System - Birth Trauma (Joe Duffy stories)

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DoulaCare Ireland have (like many others in Ireland) been listening to the stories that have been shared by families in Ireland on the Joe Duffy show over the last week. They have made very emotional listening at times. Unfortunately as doulas and childbirth educators we have been privy to similar stories over the years from women who have reached out to us, looking for someone to talk to. To know that women finally have a public platform to share their stories and to truly be heard is one of the positives to come out of the show. 

At DoulaCare Ireland we support clients nationwide, and of course some will have had past birth trauma. These women and their families often feel they cannot speak about their experiences or they will be treated badly on subsequent pregnancies. Those who do speak out often feel they are brushed aside or their trauma is belittled by hospital staff. 

There is very little support within our maternity service for those who have had challenging birth experiences and need someone to talk to. Many of these women often apologise for feeling upset about their experience. After all, they have a healthy baby. Shouldn’t they be OK with how things went? Everyone else seems to think they should be grateful that all is well with baby and move on. But just because you are thrilled to have a healthy baby doesn’t mean you don’t get to grieve for the birth you had hoped to have. It is OK to be upset at how you were treated during your pregnancy and labour. It is such a vulnerable time in a woman’s life and while we may be nervous about the unknown, most of us don’t think that this will be compounded by being spoken to harshly or mistreated by the people we are supposed to trust. 

At DoulaCare Ireland we work closely with other supportive organisations and refer our clients to available services. 

If you have an experience (negative or positive) within the HSE care you can leave your feedback on their site called Your Service Your Say. This information does get reviewed and will be brought to the person in question. 

https://www2.hse.ie/services/your-service-your-say/your-service-your-say.html

We feel it is important to highlight the fantastic work that AIMS Ireland have done since 2007. They are campaigners for safe and respectful maternity care for the women of Ireland and they work tirelessly on a voluntary basis to do so. If you need advice or supports please do contact them on www.aimsireland.ie

We are also proud partners with Nurture Health, who are a national counselling service. They specialise in the care of women and their families during pregnancy and the postnatal period. They have counsellors nationwide who offer space and time to women who have traumatic experiences or have postpartum mood disorders. Irene, the CEO, always ensures their clients are seen quickly and matches them with the best counsellor for their needs www.nurturehealth.ie (and some of your hours may be covered by health insurance - Irish Life Health for example, offer hours with Nurture Health through their Parenting Path packages for new families.)

Some women find it helpful to get their notes from the hospital. They can be requested by writing into the Freedom of Information Officer in the hospital attended, with Name, Date of Birth and any other relevant details. The applicant must mention that they are requesting their notes under the Freedom Of Information Act in order to receive them free of charge. They will write back  with a standard letter saying they will give a response within 28 days, before sending on the notes on. If desired and the Mum feels able to do so they can then request to meet with the Head of Midwifery or with your Obstetrician to have a review of your notes (AIMS Ireland also offer this option). 

Many of the stories shared over the last week have mentioned women being alone and frightened or not understanding what was happening. With DoulaCare Ireland these situations never arise. With our agency model, each client has their chosen doula but also a back up doula. They also have the support of our full team of 35 doulas - all fully Garda Vetted. This means no matter how long a labour and birth lasts (4 day induction for example) our clients will have constant support from a known doula. They also have the knowledge and experience of 35 doulas to tap into at any point. We have women with diverse backgrounds in our team, from women health physiotherapist, midwives, nurses, yoga instructors, antenatal educators and much more. While our role is not to speak for you during labour we are there to help facilitate conversations between client and their health care provider, encouraging the Mum to ask questions if it looks like there is a lack of understanding on their part. 

Doula support is scientifically proven to reduce traumatic experiences and postnatal mood disorders. A Cochrane Review 2017 showed:

Women who had doula support were:

• more likely to have spontaneous birth

• more likely to have shorter labour

• less likely to use pain medication

• less likely to have Caesarean birth

• baby less likely to have low Agpars

• Lower levels of Postpartum Mood Disorders

Women who had doula support had:

• 31% decrease in use of Pitocin

• 28% decrease in Caesarean

• 12% increase in Spontaneous Vaginal Delivery

• 9% decrease in use of pain relief med.

• 14% decrease in baby going to SCBU

• 34% decrease in risk of being dissatisfied after birth

We welcome the discussions on Joe Duffy show and thank the team in RTE for opening up the space for these women to share their story and finally be heard. It is shocking how many women have experienced trauma and remain silent. We hope that women will be able to find their voice, to speak up for their rights and to get the support they deserve. We also hope that those working in the maternity system listen and work to implement change. It must be hard for anyone who works in this area who actively supports and cares for women in kind and compassionate ways to hear these stories, as this is not how they would ever treat anyone in labour themselves. However, the myriad of stories from all over the country show that there is a systemic approach to treating women that needs to be addressed and changed for things to improve. 

Sharing these stories is the first big step. Well done to every single woman/partner/supporter who has spoken out. Your strength will be a part in driving change for all the women and their families who will be entering into the Irish maternity system. 

We are here to support all women and their families. Get in touch if you need compassionate care postnatally to help you recover from a traumatic experience, or if you are embarking on a subsequent pregnancy. Your voice will be heard.

info@doulacare.ie

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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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How do I know my baby is getting enough milk?

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You will be learning together. Breastfeeding is a skill that can be learned, so take that time in the early days to relax and focus on getting to know your new baby. Your job is solely to cuddle and feed him, everyone around you needs to care for you! So snuggle up in bed, snooze, smell the top of his gorgeous head, cuddle, study his adorable face and tiny little finger nails. Savour every moment. Follow your instincts, you are his mam you will know if he is getting enough milk. Granted, you will be flooded with hormones and perhaps haven’t slept for a while so here are some basics to get you off to a great start! 

How does your baby appear? A baby who is getting enough milk will be alert and active during wakeful times. He will appear bright and healthy. He will have a good colour (not too jaundiced or pale) and have moist lips. He will be gradually growing in length and head circumference, your PHN & GP with keep track of this.

How often should my baby feed? A new born tummy is tiny, only the size of a marble. A full feed is 5-7mls (a tea spoon) this gradually increases to the size of a hens egg by one month old, about 80-150mls. Because they can only take in these tiny amounts, they need to feed often. Most new babies feed 10-12 times in 24 hours, some feed more! Follow your baby’s feeding cues. Don’t watch the clock thinking “It has only been an hour, he can’t be hungry again!” Those first few days and weeks are all about learning. Your baby has never breastfed before so he needs to find his rhythm (along with learning to breathe, smell, taste, see and process his new world) Offer encouragement and support as you both learn this new skill together!

How long should feeds last? A feed can last from 5-30 minutes on one side, once you can audibly hear your baby swallowing – he is still extracting milk from that breast. So leave him to work away! Once the rhythm slows to about one swallow every 7 sucks it is a good idea to switch sides. When he is finished that side you can change his nappy, wind him a little (most breastfed babies don’t suffer from much wind) and then offer the second breast. He may not be interested, take a small feed or sometimes feed on that side for 30 minutes again! Trust that your baby knows what he is doing. Relax and enjoy those new baby snuggles. 

What goes in must come out! If your baby is having lots of wet and dirty nappies then there must be milk going in to create it. You are looking for about 5 or 6 wet nappies per day and one dirty per day of life (ie one dirty on day one, two dirty nappies on day two and so on up to day 4) Your baby’s poo should change from the black sticky meconium to a greenish colour and then mustard colour by around day 5. Some breastfed babies have a poo after every feed!

Weight gain. Many new parents can become obsessed with their baby’s weight. Don’t worry too much about it, however it can be a good guide as to how your baby is doing. Weight loss of 5-10% is normal after birth. This can be higher if you had a lot of IV fluids during your labour and birth. You would be looking for your baby to regain his birth weight by about 2-3 weeks old. A rough guide is for your baby to gain about 5-7oz (or 150-220 grams) per week. Remember weight is just one part of the picture, it is not the sole focus. 

Remember breastfeeding can be tender for some in the early days but it should NEVER hurt. If nursing your baby is painful there is something wrong. Remember it is a skill that can be learned together so seek support. Ask your nurse to assist you, reach out to supports around you (listed below) or of course, have a Postpartum Doula by your side!

Doula Jen x

Jen Crawford

Co Owner & Founder of DoulaCare Ireland 

Further reading & helpful resources: 

http://kellymom.com/hot-topics/newborn-nursing/ Tips for the early days breastfeeding your baby. 

http://www.breastfeedinginc.ca/content.php?pagename=vid-reallygood Great video clip from Dr Jack Newman & IBCLC Edith Kernerman page ‘Breastfeeding Inc’. This clip shows what a good latch & drinking looking like. 

https://www.breastfeeding.ie/First-few-weeks/Guidelines-for-mothers/ Great chart with guidelines for first few weeks. 

Breastfeeding Supports:

Association of Lactation Consultants Ireland http://www.alcireland.ie/find-a-consultant/ 

Cuidiu, Irish Childbirth Trust http://www.cuidiu-ict.ie/supports_breastfeeding_counsellors

Le Leche League Ireland https://www.lalecheleagueireland.com/groups/

Friends of Breastfeeding http://www.friendsofbreastfeeding.ie/wp/support-2/

National HSE Breastfeeding support https://www.breastfeeding.ie/ 

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Power Pumping

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Increasing Breast Milk Supply-Power Pumping

If you are exclusively expressing for your baby, for any reason it is important to replicate normal infant growth spurts. Baby’s who feed at the breast will naturally increase their feeds when they are due a developmental leap or growth spurt. However, a pump cannot recognise these millstones, so you will need to mimic your baby. This triggers an increased release of prolactin from the pituitary gland – the ‘make more milk!’ message.

Because breasts work on the principle of supply and demand, using a breast pump is often recommended once your milk has come in (around day 2 or 3 after birth). Before this it is best to use hand expression, as colostrum is made is small quantities and is thicker – thus harder to bring out with the manual pump. Regular pumping delivers to the brain a ‘make more milk!’ message and can be very effective in increasing supply. However despite regular pumping sessions many women do not see results as quickly or as effectively as they had hoped. Enter power pumping!

How do I power pump?

Firstly it is important to set yourself up with the right equipment. Ensure you are using a hospital grade, double breast pump. Most Irish hospitals use the Medela Symphony. Ask a member of staff to check that the flange (bit that goes over your nipple) is the correct fit. The standard size is 24 but many Irish women will need the 27. Get into a comfortable position, with your bottle of water, a snack and items from your baby (like photos, or something that smells of them)

Power pumping is not a replacement for regular breast pumping to increase supply. Instead, power pumping is intended to boost your progress by replacing one regular pumping session with a strategically designed alternative. It works by repeatedly emptying the breast, signalling the body to make more milk, more quickly. This is mimicking a baby’s ‘cluster feeding’, many do this in the evening time.

To power pump, pick one hour each day or night (eg. 8pm every night) and use the following pumping pattern:

Always begin with a good breast massage. Some coconut oil can help to minimise friction.

1. Pump for 20 minutes; then rest 10 minutes, massaging again.

2. Pump for another 10 minutes; rest for 10 minutes, massaging again.

3. Pump again for 10 minutes; finish.

This means you will have 40 minutes of active pumping in a 60 minute period. During the rest phase, massage your breast, look at photographs of your baby, smell an item that has been with your baby and relax.

You can watch a movie or read a book if it helps you to relax, do not focus on the pump and how much milk is coming out. This is not the aim. You are trying to trigger your body to make more milk tomorrow. You are not aiming for increased milk volume today. Try to view it as an hour each evening for you to put your feet up, have a nice treat and cup of tea and maybe watch a TV show. 

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