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

Mothering a baby who has Down Syndrome

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My name is Gillian Phelan. I was invited by Doulacare Ireland to talk a little bit about my daughter Elliah who was born with Down Syndrome and my experience with all that comes with it, and also what we are doing to help her develop at as normal a rate as possible.

Firstly a little back story... Elliah is my first child, born thanks to IVF (after many failed attempts and surgeries) in October 2018. I had an excellent pregnancy up to 34 weeks when my placenta rather suddenly shut down leading to a real emergency c-section. A movie-worthy dramatic scene. But that’s a story for another time.

Baby had to be taken to Special Care because she was small (4lbs), but breathing on her own and otherwise doing pretty well. As soon as I saw her I said to myself that her eyes looked ‘Down Syndromey’... Tests went off and we waited and waited and waited... Every day the consultants were hopeful that the results would be back “tomorrow”, or “ by the end of the week”. There really was a doubt in our minds. Some of our nurses said they didn’t think she had it. Others were less sure. Her eyes were literally the only tell tale - she didn’t have any of the other signs on the checklist. It took 17 days for the diagnosis to come back from Crumlin - 10 minutes up the road from The Coombe where we were. It was confirmed that Elliah has Trisomy 21 - which means that she has a third copy of her 21st chromosome. Nobody knows why it happens, but in 1 out of 800 births it just does.

So we were told what is to be expected of our daughter, and quite honestly, from the get-go it seemed very limited. We were being told not to expect much. That there isn’t much hope that she be independent or have a fulfilling life in the usual sense. Well, I absolutely reject that. Their limitations, not ours. Putting a child in a box labeled ‘limited’ will only encourage them to be just that. This is not acceptable for me. Additional needs or not, each child develops at a different rate, and faces their own individual challenges.

Needless to say, once the initial settling in period had passed, we looked into alternative therapies to help ‘wake up’ her senses so to speak. Basically we were interested in anything that would help bridge the gap between herself and other babies of the same age. Our goal will always be that she be as close as possible to doing the things that her peers are doing. Whether that be sitting up unassisted, crawling, walking, talking and all those other key achievements down the line. We are linked up with St Michaels House in Ballymun now and everyone is great. They do a fantastic job, they really do. But relying on that one Physio or Speech therapist visit a month and going one morning a week to the pool just isn’t enough. Physical and mental development go hand in hand, and we have now found a set of daily stimulation exercises that work for us and are giving good results.

We travelled to France to meet with an ex Montessori teacher who has a 5 year old daughter with DS. She has become an alternative consultant on all things DS, and sees families to build a personalised program for their children. Her daughters name is Marie, and she is quite exceptional. Her speech and motor skills are pretty much those of an average child of her age. She is at the same level as all her friends and attending mainstream school without a Special Needs Assistant. Emmanuelle started out with her solid Montessori background and has done extensive research and training to complement that. She saw Elliah over 2 days and gave us a program to follow based on her particular strengths and weaknesses.

We were highly recommended to read Glenn Domans (horribly entitled) book ‘How smart is your baby?’ Domans research stretched over 40 years and he worked with thousands of children and their families - for the most part the babies and children in his studies had brain damage, not DS. Specific exercises and hyper-stimulation techniques are used to override the problem and wake up the affected senses. Now I’m not going to lie, some of this stuff is totally counter intuitive for the mother of a small baby, but his results really do speak for themselves. So after reading the book, and seeing Emmanuelle in France, we had a specially adapted exercise and stimulation plan for our baby.

We have built her a crawling ramp to encourage as much movement on her tummy as possible. Children with DS tend to have issues with their muscle tone, so strengthening those all important neck and back muscles is vital.

We also had to ditch the traditional play mat which was not at all adapted to her needs. It has been replaced with a large gym mat - exactly like the ones we used to have in school (the navy blue yokes).

We also have a Dayvia light which is on constantly during her sessions. The very bright light is recommended for sensory stimulation of course, but also for helping with the distinction between day and night. Not to mention luminotherapy in our dark winter months.

The last ‘big’ thing we invested in after reading the research is an electromagnetic machine called an Earth Pulse. Designed to help athletes and Racehorses recuperate better, it emits a field adapted to the individuals needs so their rest is optimised and thus their performance enhanced. During their testing process they realised that all of the people partaking in the trial who had thyroid issues gradually stopped needing to take their medication. This is a key factor in DS. Our expert in France insists that ALL children with Down Syndrome have an issue with their thyroid. Even if a blood test says it’s functioning, ie producing satisfactory levels of thyroxin, there are no further tests done to check if that thyroxin is doing its job as it should in the cells. It really is one of those things where you believe it or you don’t. We thought that we have nothing to lose and a whole lot to gain. It’s been a few weeks now and Elliah is definitely more alert, more interested in her surroundings, more of a sparkle in her eye. She’s even sitting up in her highchair which is a big milestone and around the same time as an averagely developing baby.

Emmanuelle has been using the machine under Maries bed for a couple of years now and she insists that she started to see a difference in her capacities after a few weeks. Since we seem to have a similar timeline, I’m certainly inclined to agree.

It’s a lot. It’s very time consuming. But seeing Elliah improve every day is all the motivation I need

(I’ll have a shower when she’s 2 🤪) I’m also exclusively pumping which doesn’t help time-wise, but that’s my choice. It’s not a chore though. Elliah is not a burden. We feel as much love, and pride as any other parents. DS comes with the innate capacity to truly be oneself. To find joy in the simplest of things and to love without conditions or judgement. She is funny and sassy and an absolute ray of sunshine. I simply cannot imagine life without her smile.

Hopefully we are putting in place a foundation that will help our daughter be her best self and have more choices in her future. We will at least know that we gave it everything we had.

Well done if you’ve gotten to the end of this post 😂

What we wouldn’t do for our kids.

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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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Moved to New Blog They never told me about the Second Night!

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They never told me about the Second Night!

Why is it that when we are pregnant everyone has an opinion. They want to share their experiences and what items we should or shouldn’t buy to be prepared for our babies arrival. So why is it then, while we are being bombarded with information and stories of woh – that not one person mentions the horror that is night 2 of our babies lives?

Let me explain.

So the first 24 hours are bliss. We are on an oxytocin high. We have given birth, become a new family and have our new tiny baby/babies. We can count their toes, smell their gorgeous baby smell and kiss their cute button noses. All the while our beautiful baby is content to cuddle in and sleep, only really waking to eat. We are led into a false sense of smugness...that yes I have the perfect baby. This parenting lark is amazing.

Then, as the sun sets on day 2 our beautiful sleepy baby disappears and seems possessed with a different baby spirit, who does not sleep, cuddles/rocking and singing don’t help and they never seem to be full.

This is where it can so easily go wrong. Doubt creeps in. Do I not have enough milk? Is my baby starving? Why won’t he stop crying? He keeps fussing at the breast, does he not want me?

The answer is, your baby is doing EXACTLY what he should be doing! Don’t worry – it is nature driving him to behave like this and it will be over soon.

So what is going on? Well on day one your baby was sleeping off the birth. Remember you and your baby were a team, going through labour and birth together. They are tired too. Not only that but it can be a shock to their system, entering our crazy world from the cosy and safe surroundings of your tummy.

Your baby has to breathe for the first time. Regulate their own body temperature, feel hunger & eat. They are hearing, seeing and smelling so much more. Your babys senses are on overload. However, on night two they have had time to settle in, get used to their surroundings. They have slept off their birth and now nature is telling them they have an important job to do – get your milk supply in so they have a food source. So how can a new baby do that? They can feed like crazy, signalling to your body they have mastered suck, swallow & breathe and are ready to take on bigger volumes.

This does not mean your baby is starving and needs bottles. It does not mean your baby wants someone else. Your baby is being driven by instinct to help your milk come in. Plus lets not forget – you are their home! You have been their whole world since the second they were created, you are where they want to be.

“Nothing an infant can or cannot do makes sense, except in the light of mothers body”

Dr Nils Bergman

Help your baby by keeping them close. Your body will keep them warm. Your heartbeat is the most familiar sound in the world. Your breasts will make the perfect amount of milk for them as they grow. Follow your babys signals, don’t watch the clock. You both know what to do if you can switch off your thinking brain ;)

So batten down the hatches. Prepare for it. Stock up on food and snacks that can be eaten with one hand and have them at easy reach. Charge up your phone or tablet to have something to keep you sane at 3am. Take a few naps when you can with baby (yes the old tale of sleep when baby sleeps is turu, but also important for survival!) But above all, enjoy it. No I am not insane. Your baby is only this size once. You only have this moment in time once. While it may not be picture perfect, it is your new normal and it is amazing. Be in awe of your body for creating this little human being. Be proud of yourself for getting through your first 24 hours as a parent. Watch in amazement as your baby feeds from your breasts. You are a goddess right now.

So hold your baby. Feed your baby. Feed yourself! And (yes I am going to say it)

This too shall pass.

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Moved to New Blog Where do pumping mothers fit in?

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Anyone following my story over the last year knows my gorgeous baby Kayla Rose was born in March with an undiagnosed cleft palate. She has a very severe cleft, missing all of the roof of her mouth, hard and soft palate. This meant separation at birth, a SCBU stay and set me on a new journey of full time pumping. (You can find my blogs and videos on DoulaCare Ireland social media & on our website under Jen's Pregnancy Diary

I am 3 months into my pumping journey now and while I have gotten over my loathing of the pump, I am still struggling to find my “place” in mothering labels. Many a nurse and doctor have been made to feel awkward when they ask how Kaylas feeding is going, as I erupt into a blubbering mess about not being able to breastfeed. Paul has started to put his arm around me when they start running through the questions, in anticipation of the dreaded question.

At all of Kayla's hospital appointments I am asked “breast or bottle fed?” I mean, after my first few emotional break downs I would have thought they’d have it written on her file not to ask me this any more...but alas they break it out each time. I can now calmly say “she is breast milk fed in a bottle” (I tend to follow it up with a “she can’t feed at the breast because of her cleft” like I am making excuses to them or something. Just so they know it’s not that I don’t want to breastfeed, because I really really do.)

“It has me thinking where do pumping mothers fit in? Are we breast feeders or bottle feeders? Or do we occupy a status all on our own in some kind of middle ground? ”

Anyway, I digress. It has me thinking where do pumping mothers fit in? Are we breast feeders or bottle feeders? Or do we occupy a status all on our own in some kind of middle ground? 

I have worked with many mothers who chosen to pump for different reasons and were 100% happy with that choice and thrived on the set up. I am pumping out of necessity (if you haven’t already got that) so perhaps that is why I am writing this blog. To hear others point of view on the topic and open the discussion.

I have always been a breastfeeder. I am proud of that and enjoyed every aspect and the beautiful bond. I now find I am not sure of my identity any more. I almost want to write “containing breast milk” on Kaylas bottles for fear of breastfeeding mothers judging me. This is of course ridiculous as I never once think anything bad of mothers who bottle feed (formula or breast milk) as it is their choice for their baby. It is a totally idiotic thought process and yet a real one for me right now.

One thing I will say is that pumping is a full time job, the washing and sterilising is unreal and you still have to feed baby the milk in the bottle too. It is no joke. I have supported hundreds of pumping mothers over the years and have always admired them for their dedication and hard work but living it has opened my eyes to the incredible emotional journey and physical exhaustion that comes with it. I am so proud of myself (cringe I know) for getting this far and giving Kayla 100% breast milk to date. While it is not the feeding journey I longed for, it is ours - and we are finding our way. My heart still longs to breast feed but I love cuddling her into me and gazing into her eyes while she has her bottle. Feeling her little body tucked into mine and knowing she is getting all the goodness of my milk – that is tailored to her needs. 

So I open up the discussion. Where do us pumping mothers fit in? Remember to be kind to all feeding choices – you never know the journey that family is on or why they chose their feeding method. 

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