10 Questions with a Homebirth Midwife

1) Moms planning a home birth are planning for a low intervention birth. Is the same true for their breastfeeding goals? Do women delivering at home plan to exclusively breastfeed and avoid formula intervention?

Yes. Most women who are planning natural birth also plan to exclusively breastfeed. However, there are situations where a mom chooses not to breastfeed. She may be a victim of sexual abuse or was unable to breastfeed a previous child. We ultimately want women to make the decisions they are most comfortable with after having been provided with as much education and support as possible.

2) What kind of support can a homebirth midwife provide to breastfeeding mothers that is different than a midwife in a hospital or birth center setting?

We offer a lending library that includes breastfeeding books. We offer a one hour prenatal visit so the mother has ample time to discuss her questions, goals, and fears about breastfeeding.

3) What role do you take in prenatal breastfeeding education?

In addition to the support and information provided prenatally, we also suggest the utilization of outside resources like breastfeeding classes, lactation consultants, and La Leche League meetings.

4) What aspects of homebirth uniquely facilitate breastfeeding initiation and establishment?

We are adamant about the necessity of skin to skin contact between mom and baby, with as minimal interruption as humanly possible.  Every aspect of the postpartum experience works better when you just leave them alone. Moms heal faster and babies want to nurse when they are not being poked, prodded, and taken away from mom for reasons that could, in most instances, wait.

5) Describe your breastfeeding-specific training. Does it differ from the training hospital midwives have?

I am not familiar enough to speak on the training of hospital midwives. My experience has grown through living and learning. I nursed all four of my babies at various lengths, based on my education and abilities at the time. I am learning all the time through my clients’ experiences ranging from no intervention to the necessity of an IBCLC or pediatric ENT. I also continue to learn through the support of my peers.

6) Describe the well baby care homebirth midwives give in the first 48 hours. How does this care screen for breastfeeding obstacles?

We usually stay with the mother after birth until baby has latched and is nursing well. If this doesn’t happen for some reason, we are in constant contact until it does. We listen to what moms are describing and make the call for further help based on what they are reporting. We may make another trip back to the house, or, if it seems like an issue that is out of our scope of knowledge, we will refer first to an in-home lactation consultant who is willing to assess mom and baby while maintaining the need for skin to skin contact in their own environment.

7) Do women with gestational diabetes, PCOS, or other endocrine disorders birth at home? What special feeding support do these dyads receive from a midwife?

Yes, and we don’t tend to do anything special unless we are finding it to be an issue. The premise is that it is normal and natural unless it’s not. We aren’t in the business of fixing things that aren’t broken. If we need to refer out for these things, we will.

8) Do Homebirth midwives facilitate informal milk sharing between clients? Why or why not?

Yes. However, not all moms are comfortable with that and we support that, too.

9) What signs or symptoms of feeding challenges do you refer out to an LC?

Baby not gaining weight, latch that just isn’t getting better despite our suggestions of different feeding positions,  mom in extreme pain with cracked, blistered, and bleeding nipples.

10) If a client chooses not to breastfeed, what alternative feeding do you recommend and why?

I usually don’t do much recommending of formula, but I suppose an organic formula of some type if they must. It is extremely rare that a client of ours comes to their six week postpartum visit and is not still exclusively breastfeeding. If they are supplementing with formula, they have already been working with a lactation specialist and have made those decisions together.

Bonus question 11) Share your favorite nursing memory.

I remember a moment nursing my last baby. I nursed all four, but I think I was in a hurry for a lot of that time. Hurry up and quit nursing. Hurry up and walk. Hurry up and potty train. With number four, I knew she was my last and I was thankfully in a place in my life where I didn’t want to hurry anymore. I wanted everything to slow down. I am grateful that I was able to have the awareness to enjoy every single stage with her. I squeezed every last drop. Nursing her one afternoon, she was holding my finger and resting her hand on my chest, while staring into my eyes. I felt in the depths of my being, at that very moment, what an amazing gift to be given the ability to nurse my baby, and I wasn’t going to hurry.

 

Rachel Hart I am a traditional midwife and CPM. I moved to Atlanta from Las Vegas with my husband and four children in 2008. I am a graduate of the University of Nevada, Las Vegas with a Bachelor’s degree in English. I began my midwifery journey through an apprenticeship training program in 2005 and began my own practice in 2007.  All four of my children were born at home, the last birth unassisted. I joined Beth at Birthing Way in 2010.

Helping women realize their true power and potential as a woman and mother through the birthing process has been a privilege. I have really enjoyed attending births with the lovely families here in Georgia. I also support the birth community as Secretary of the Georgia Midwifery Association and as Membership Director of the Georgia Birth Network.

 

www.birthingway.com
rachel@birthingway.com
770-597-4478

10 Questions with a Doula

1) What is a doula?
         A doula, also known as a birth companion, is a nonmedical person who is trained to assist women before, during, and/or after childbirth as well as her spouse and/or family, by   providing physical assistance and emotional support.
2) Why hire a doula?
        There have been numerous studies that show the benefits of hiring a doula include a decrease in the chance of C-section, decrease in the amount of time a woman spends in labor, decrease in the use of interventions like forceps and vacuum, decrease in the use of epidurals or need for pain medication, decrease the chance of postpartum depression, and increase the satisfaction a woman feels about her birth experience.
 
3) How does having a doula impact initiation of breastfeeding at birth?
        All doulas should be equipped to assist moms with the initiation of breastfeeding after birth. Often times in a hospital setting, nurses might have to leave to attend to another patient leaving the new mom to figure it out on her own. Some hospitals do not have on-site lactation consultants on call around the clock. Having a doula ensures that a knowledgeable person will be there to help if/when needed. 
4) What barriers to breastfeeding does a doula help reduce or eliminate?
    1. Educational barriers: misinformation about breastfeeding, milk production/supply
        2. Emotional barriers: lack of confidence in ability to breastfeed, embarrassment of feeding in public. A doula provides support if the mom is lacking support from family/friends.
        3. Physical barriers: learning how to prepare for breastfeeding, postioning mom and baby for comfortable and sufficient nursing/bonding time.
        4. Medical barriers: Breastfeeding while recovering from c-section, helping to identify potential medical issues such as tongue ties and lip ties and refer to specialists
5) Does a doula come in handy after birth?
        Yes. Doulas routinely remain in close proximity to moms immediately after the birth of their baby. This is to help facilitate the mother’s wishes for skin-to-skin care, breastfeeding initiation as soon as possible, and to answer any questions about newborn care and postpartum care. Many moms also benefit from the services of postpartum doulas. Postpartum doulas contract with the mother and her family for a specified amount of time (hours/weeks) once the family is settled at home after the birth. Postpartum doulas assist with baby care, sibling care, light household chores, and meal prep to help parents acclimate to having a new baby in the home. It can be a great help to have someone onsite those first days/weeks after birth to help with breastfeeding issues among other things, when needed.
6) What do you think are the 3 biggest factors in a birth that impact breastfeeding?
        1. Medications administered during labor and their effects on the mother and the newborn.
        2. Type of birth. If mom has interventions such as forceps, vacuum, or caesarean and baby has a medical issue due to this and they must be separated for an extended amount of time after birth.
        3. The length of the birth. A mom who has a lengthy labor may be extremely fatigued and unable to breastfeed right away.
7) How can moms find a doula friendly care provider?
        1. Moms can ask their care providers how they feel about having a doula in attendance at the birth. Most providers will have a definite opinion one way or the other.
        2. ICAN of Atlanta has a provider review section on their website. Anyone can join ICAN. You do not have to have experienced a c-section. The forums provide excellent information for all expectant moms.
        3. Word of mouth. Ask your friends,  who have used a doula, who their provider was and what the experience was like. If you have already hired a doula, most can tell you of the more popular doula-friendly practices in the area.
8) How can moms find a doula in their area?
        Resources for finding a doula in your area include www.doulamatch.net, www.gabirthnetwork.com, (or local birth networks) asking your provider if they have a list of doulas that they work with, websites of doula certifying organizations such as DONA, CAPPA, and ProDoula, and again referrals from friends/family/mom’s group members who have used a doula’s services before.
9) What skills does a doula have to help with long term breastfeeding success?
       Many doulas have taken breastfeeding classes to assist their clients in the early stages of breastfeeding. For long term breastfeeding success, doulas assist moms through emotional support and encouragement. Many moms give up just because they do not have the support needed to continue. Doulas provide practical information and solutions to assist with challenges associated with breastfeeding. We are knowledgeable about common problems like engorgement, symptoms of clogged milk ducts, mastitis and can refer you back to your care provider or a lactation consultant for added assistance.
10) Do moms need a doula for birth center or home births?
         I believe all moms could benefit from the support of a doula no matter where they choose to give birth. Birth is a very beautiful, but physically and emotionally draining experience. Having a person who has walked the journey before can make it easier by helping to reduce or eliminate the obstacles of fear, anxiety, lack of information, and more because they are a trusted, trained and experienced individual who is there just for the mom.
Bonus Question! 11) Share your favorite nursing moment?

My favorite nursing moment was probably the first time my daughter latched properly. I was unable to successfully breastfeed my older son due to lack of education and support. I became engorged and had painful, cracked, and bleeding nipples. After 3 days of crying (both of us) I gave up. After I had my daughter, I was able to get help from the buses at the hospital. They explained what a good latch looked like and should feel like. They gave me tips for sore nipples, too. So once at home, when she latched with little help from me and with no pain to me, I was very excited. I went on to breastfeed her for 14 months.

Elysia Douglas is a wife, mother of 4, and a professional, certified birth doula in the Metro Atlanta area. In her first 3 years as a doula, she has assisted over 50 families as they prepared for and welcomed their little ones into the world.  She offers attentive, nurturing, and compassionate support during pregnancy, labor, birth, and beyond. Elysia is passionate about equipping, encouraging, and empowering women to achieve their birth goals by providing unbiased, evidence-based information, emotional, and physical support throughout their pregnancy journey. She fully believes in your right to know your options and make decisions that are best for you and your baby. When Elysia is not at prenatal visits, facilitating a childbirth education class, or attending a birth, she enjoys sewing, painting, volunteering in children’s ministry at her church, and spending time with her family and friends.

www.mother2motherlaborsupport.com
http://doulamatch.net/profile/6020/elysia-douglas
www.facebook.com/mother2motherlss
www.instagram.com/mother2motherdoula

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