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 

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

Why I donated my placenta to search and rescue dogs

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

1. Let the hospital dispose of it

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

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

4. Pop it in your freezer to keep

5. Donate it to search and rescue dogs

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

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

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

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

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

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

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

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

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

 http://irishsearchdogs.com/About.html

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

Jen x

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

Moved over to main website blog:Adjusting to life with a toddler and a newborn

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Adjusting to life in the early days and weeks.

It is important to acknowledge that it will be hard at times, but it won't be impossible. It is all an adjustment but the love you will feel will make everything worthwhile. Of course as your Postpartum Doula I will assist you with adjustment and daily tasks. Here are my top tips on how to set yourself up for success and make each day easier.

• Cook extra portions of freezer friendly meals (like bolognaise/shepherds pie/fish bake etc) while you are pregnant or if baby is here then at the weekends so you've a good supply of nutritious food to see your family through week ahead. This is also something family and friends could do to help out.

• Shop online for now if a grocery shop seems unimaginable. 

• Buy preprepared fruit and veg as handy snacks to grab on the go.

• Don't be too proud to accept offers of help and don't be afraid to suggest chores (unload the dishwasher, hoover the stairs, clean the bathroom etc)

• Lower your expectations of how the house will look during the first few months. You've got a lot on your plate, and it doesn't really matter if the dusting doesn't get done or you have to wear un-ironed clothes for a few days, or years even.

• As soon as you can, try to get out for at least a short walk every day it's amazing what a boost it is to get out of doors. If that seems too epic right now, sit in the garden and play with your toddler.

• Take all offers of taking your toddler out for a while (once your toddler is happy of course!) Granny wants to take her out to the playground? Great, don’t feel guilty and try to go too - grab a nap with baby while you can :)

• Make your toddler aware from the very start that the baby is interested in her, is watching her and loves her. Say things like, "She's following your game with her eyes" and "She's very interested in what you're doing".

• Involve your toddler in games with the baby from the earliest days, and always tell your toddler how much you value her help with tasks such as handing you a nappy for the baby.

• Have a ‘special feeding box’ Fill the box with little toys and books, colours or activities for your toddler. This box only comes out while you are feeding the baby and is your toddlers special treat.

• Babywear. Using a sling gives you the ability to meet your newborns needs (to be warm, safe and close to you) while still playing, reading with or just spending quality time with your toddler. I would recommend attending a sling meet or get a sling consultant to your home to find the right sling for you.

• Take photos, because while the days seem endless right now, the weeks and months will fly past and you will appreciate the memories ☺

• Be gentle with yourself. No one is perfect. This is all learning on the job, take each day as it comes and remember you are doing your best and that is all anyone can do!

Enjoy the madness! Doula Jen x

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

Care and Recovery After a Caesarean Birth.

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

Keep on top of the pain medication!

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

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

Move at your own pace!

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

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

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

Get help lifting baby

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

Eat lots of fibre

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

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

Care for your incision

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

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

• High Tempature

• Skin around the incision turns red

• Oozing green or pus-coloured liquid

• Incision becomes hard or painful

Self care is vital!

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

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

Doula Jen x

Jen Crawford,

CO-OWNER DoulaCare Ireland

www.doulacare.ie

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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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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What's the story with Kaylas Cleft?

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Anyone following my journey over the past year will know Kayla was born with a cleft palate (but not lip) Many people don’t quite understand what that means, and to be honest I struggled a bit at the beginning too! So I thought a blog would help :)

There are many different types of clefts and no two are the same. A baby can be born with a cleft lip, a cleft palate or both a cleft lip and cleft palate. Essentially what a cleft is, is a hole or gap in the area. 

The following stats are taken from (http://www.cleft.ie/?page_id=25) The incidence of cleft lip and/or palate in Ireland is between 1 in 700 and 1 in 1,000 births. Incidence of cleft palate occuring alone is about 1 in 2000 births. More than 70% of babies with cleft lip also have cleft palate. 

Parents who have a child born with a cleft, have a 5% chance of the next born also having a cleft (so a 1 in 20 chance). If a second child is born with a cleft, the likelihood increases further for any subsequent child. 

The chances of a parent who was born with a cleft having a cleft baby is approximately 7 in 100. So Kayla will have roughly a 7% chance of having a baby with a cleft (of course if she chooses to be a parent but we would love lots of grandchildren!). 

Types of Cleft Lip

• Forme fruste unilateral cleft lip
  A subtle cleft on one side of the upper lip, which may appear as a small indentation.

• Incomplete unilateral cleft lip
  A cleft on one side of the upper lip, which does not extend into the nose.

• Complete unilateral cleft lip
  A cleft on one side of the upper lip, which extends into the nose.

• Incomplete bilateral cleft lip
  Clefts on both sides of the upper lip, not extending to the nose.

• Complete bilateral cleft lip
  Clefts on both sides of the upper lip, extending into the nose.

Types of Cleft Palate

• Incomplete cleft palate
  A cleft in the back of the mouth in the soft palate.

• Complete cleft palate
  A cleft affecting the hard and soft parts of the palate. The mouth and nose cavities are exposed to each other.

• Submucous cleft palate
  A cleft involving the hard and/or soft palate, covered by the mucous membrane lining the roof of the mouth. May be difficult to visualize.

Kayla is linked in with the cleft team in Temple Street. They have been amazing. Big shout out to Jane the cleft nurse specialist who takes families under her wing and walks the journey with them. She gives us so much time to ask any questions we may have and checks in regularly to see how Kayla is doing.

In Ireland, the cleft teams grade the palate or lip cleft from 0-3. 0 being very mild and 3 the most sever. Kayla has a grade 3 cleft palate. She has a complete cleft palate, but instead of just being a gap or a hole Kayla is missing all of her palate (hard and soft)

Kayla also has a condition called Pierre Robin sequence (or syndrome) PRS for short. This is a condition in which babies are born with a smaller than normal lower jaw, a tongue that is small and bunched which often falls back in the throat, and difficulty breathing. It is present at birth but not always detected in pregnancy ultrasounds. Most babies with PRS have a U shaped cleft palate like Kayla. Again the team will grade PRS 0-3 and Kayla scored a 0, as luckily she does not have many issues with her airways. Kayla does well once she is on her side or raised. Another positive is that nature gave her a helping hand with a tight posterior and anterior tongue tie to hold her tongue in place, so her tongue does not flop back to block her airways (who would have thought it? A helpful tongue tie!!)

Other common issues in babies/children with PRS are problems with their eyes (Stickler Syndrome), problems with their inner ears and dental issues. Kayla will be under different teams for each and so far they have been wonderful.

Kayla will have her first surgery to create a soft palate when she is around 9 months. This will hopefully help with her speech development. She will most likely be 3 years old before her palate is completely closed but for now it seems the only long term issue she will have is a speech delay – which she will catch up on by the time she is 10 years or so. So while her first few years of life will be hard, with surgeries and hospital appointments it is something that won’t hold her back and she can put behind her!

I hope this blog helps to explain things a little? Please feel free to ask questions :)

Again thank you to everyone for the love and support since Kayla was born xx

If you or someone you know has a baby with a cleft or PRS these are helpful resources:

Websites:

http://www.cleft.ie/

https://www.clapa.com/

www.cleftlipandpalatebreastfeeding.com

https://www.breastfeeding.ie/Resources/Publications/ The booklet I co created "Breastfeeding and Expressing for your preterm or sick baby" has lots of information on getting off to a good start, maintaining your milk supply, storing milk, skin to skin and more. It is available free to download or order. All Irish maternity units should have copies also. 

The Australian Breastfeeding Association (ABA) has two booklets (both e-booklet -released during 2017 and hard copy)  The cleft breastfeeding booklet: https://goo.gl/ZnoFqc has information about breastfeeding - and expressed breast milk feeding, lactation aids, type of feeding methods including - cup/spoon/supply lines/ bottles/teats. As well as some of the experiences surrounding feeding from families.  The second booklet is all about expressing and storing breastmilk: https://goo.gl/ft7gDp. 

Facebook pages: 

cleft lip & palate association of ireland

Cleft Lip And Palate Association

Cleft Lip and Palate Breastfeeding Support Group

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What is the Fourth Trimester?

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What is The Fourth Trimester?

Imagine what the third trimester of pregnancy would be like for a baby: tightly cocooned in a warm, dark, comforting place. There are no hunger pains or thirst, no need to pass painful wind, no strange smells, no feeling the hot or cold — just a perfect environment tailor made for a baby.

I’m sure you can also imagine suddenly being born into a world with of all these things can be quite a rude shock!

A new baby isn’t born being able to fend for themselves and still has much developing to do – they can’t escape if they sense danger or fear, go and find mum or dad for security or a cuddle, nor can a baby chase mum for a feed whenever hunger or thirst calls… they completely rely on us for every single need.

A gentle adjustment into their new world in the form of a fourth trimester (which is named that way in order to be perceived as an extension of the third trimester) can make a huge difference to how baby feels and how mum and dad cope with parenthood.

Babies cry because it is their only means to alert their parents that they have a need to be met (and they will not stop crying until it is met), which can in turn make parent’s self esteem and confidence plummet if nothing seems to work. This is because they start wondering what they are doing wrong and if they are useless parents (they’re not).

Giving your baby a fourth trimester can make for such a more enjoyable, soothing time for all involved – so how can you give your baby a fourth trimester? Here are some simple ways to recreate womb life.

• Use a sling/wrap

Baby wearing can be a life saver in the early days. Using a sling can recreate several conditions from when baby was in the womb. Feeling tightly supported all over, close to mum’s heartbeat, warm and cosy. Both parents can use a sling to offer comfort to baby and strengthen your bond.

Make sure you choose a safe and suitable baby carrier – www.babywearingireland.ieis a great source of information. You can even get a sling consultant out to your house!

• Skin to skin!

Whether you are breast or formula feeding, skin to skin is a great way to increase bonding with your baby. Skin to skin contact offers the following benefits for your baby at birth (and beyond):

• Regulates his body temperature better even than in an incubator

• Maintains his heart rate, respiratory rate and blood pressure normal

• Has stable blood sugar

• Feels safe and calm so is less likely to cry

• Receives good bacteria from your body to promote good gut bacteria in baby and boost immune system.

• Is more likely to breastfeed exclusively and breastfeed longer

• Baby is more likely to latch on

• Baby is more likely to latch on well

• Will indicate to his mother when he is ready to feed

• Bath time!

Many babies absolutely love being in a nice warm bath. Some babies may not like a bath at first, as they don’t enjoy the air or cold on their skin as their clothes come off, but they soon grow to love them! If you’re not confident on how to hold a baby in a bath, you can ask your midwife, doula or PHN for a demonstration – or you can just jump in the bath with your baby for added skin to skin benefits. The soothing water surrounding your baby creates an environment similar to what he or she would have been used to in the womb.

Dim any bright lights and jump into that nice warm bath together – even dad can do this one so he can enjoy bonding time with his baby too.

• Bed Sharing or Co-Sleeping

Just like with cot sleeping, there are also safe co-sleeping guidelines. Both sleeping methods have risks if not practiced sensibly. Le Leche League have a 7 step guideline to safe co-sleeping. You can find the information here http://www.llli.org/sweetsleepbook/thesafesleepseven 

By bed sharing or co-sleeping (which includes specially designed cots which attach to the side of your bed, to give baby their own safe space), your baby can sleep in safety knowing that mum is close by. He can smell you and even touch you, without insecurity. Its also a great way to make sure mum gets her much needed rest. 

We’ve all heard the saying ‘sleep when baby sleeps’.

Especially in the fourth trimester, focus only on what you and your baby need – and it’ll make such a difference to how you feel when you’ve had more sleep. Sleep deprivation is one of the leading contributors to anxiety and depression in new mothers, so take care of yourself and enjoy those sleepy cuddles.

• Feed on demand for breast and bottle fed babies.

Offer The Breast If Baby Wants It : Breastfeeding is something your baby will become familiar with very quickly, from the moment she is born. It provides her with a great sense of comfort. She will feed often, especially in the early weeks, as she tries to establish your supply. It is important to follow your baby’s lead to allow her to create a milk supply to meet her individual needs. 

There are lots of places to get support with breastfeeding. (Cuidiu, La Leche League, Friends of Breastfeeding, Postpartum doulas) or the most qualified experts in breastfeeding – IBCLC’s (International Board Certified Lactation Consultants). 

You can find breastfeeding support in the following places:

• Cuidiu www.cuidiu-ict.ie

• Le Leche League www.lalecheleagueireland.com

• Friends of Breastfeeding www.friendsofbreastfeeding.ie

• Association of Lactation Consultants in Ireland www.alcireland.ie

• Irish Premature Babies www.irishprematurebabies.com

• Irish Multiple Birth Association www.imba.ie

• Doula Association of Ireland www.doula.ie

• KellyMom www.kellymom.com

If you choose to bottle feed remember your baby has been fed constantly throughout pregnancy. A three or four hour routine can be difficult for a new baby to adjust to. Also it is helpful to remember that a new born tummy is the size of a small marble/malteser and so they thrive on little and often. Paced bottle feeding can ensure your baby takes as much food as they need, without being forced to drink more to ‘finish the bottle’ Trust your baby to take what they need and this will help to avoid lots of spit up and tummy pain.

You can find more information here: http://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/ 

• Getting Out and About

Once you have recovered from birth it is important to try to get out and about. Every baby is different so trial and error will find the best way for you. Lots of babies love the motion of the car but some do not like the car seat so this can cause you stress. Some babies love the buggy for the ride, others would rather be worn or in a parent’s safe arms. Make a date with a friend to meet for a cupa somewhere or just take a gentle stroll around the block. The fresh air will help to lift your mood and may help baby to sleep.

• Coping With An Attached Baby

You may be reading this thinking it all sounds great, but it seems a little exhausting. Yes, it can be sometimes. But always remember: nothing is permanent, everything is temporary. Even when it feels like it’s going to last forever — it’s not.

Remember ‘This too shall pass’.

Sleep deprivation and discomfort is part of the job of being a parent, but it can be made much easier by:

• Sharing the load where possible – accept and ask for all the help you can

• Make sure your partner spends time settling baby too (he/she needs to learn – and baby will learn how daddy/mammy does it!)

• Seek out a postpartum doula if you can afford it

• Making sure you get a break/time out. Even a trip to the supermarket, coffee shop or 5 minutes in the garden

• Check your expectations. Are you expecting too much from yourself and/or your baby?

Your baby does not behave in these way to manipulate or annoy you, but to teach you what he likes and needs – and what makes him feel most safe and loved. By being open to the lesson and remembering that ‘this too will pass’ (a great mantra when things get a little tough) you’ll be an expert on your baby in no time.

Hang in there – it WILL get easier. Savour the good times & breathe through the tough ones. Take lots of photos ☺

Doula Jen   x

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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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