Mom's Nutritional Needs

The importance of good nutrition during pregnancy is probably not new to most people. Most doctors have started talking to their pregnant patients about prenatal vitamin supplements. But did you know that there are some nutrients that are particularly important for your growing baby? And that there are other nutrients that are particularly important for helping your body to recover after birth and for supporting your milk production? Here are some nutrients and foods that our doulas recommend for momma to stay healthy and happy through pregnancy and during the postpartum period!

Prenatal Needs

Folate, Iron, and Calcium

I group these together because most people are recommended to take them, so hopefully you already are eating foods rich in them, and most prenatal supplements contain them. These nutrients are really important for baby’s growth and your health, too. Vitamin C supplements or foods will help you to better absorb your iron.

Omega 3 and Vitamin D

Once again, grouped together because they are often in supplements together! A good quality Omega 3 supplement is great for baby’s brain and overall development. Vitamin D is made in the body via sunlight, however deficiency is common. Oily fish is a really good source, but quality is important with this one and it needs to be free from damage via air or light.

Here are a few others that are often not mentioned in day-to-day conversation:

Choline

It’s extremely important for baby’s brain and nervous system development, and it nourishes the placenta. It’s abundant in eggs, organ and muscle meats, soy beans, wheatgerm, and sunflower seeds. It’s also in lecithin, which can be added to foods.

Iodine

It’s vital for baby’s brain and for your thyroid. It’s found in seaweed and seafood, potatoes, many green vegetables, and is in iodized salt.

Magnesium and Zinc

Abundant in green foods, nuts and seeds, these 2 minerals have a huge list of functions in the body and in growing baby!

Postpartum Needs

Baby is here! Now your body needs to heal, rest, and recover. If you’re lactating then you need the extra nutrients to support your milk production. Keep taking your Omega 3 and Vitamin D, but here are some other nutrients and foods that may help your body to heal and rebuild.

Vitamin C

It’s found in most fruits and vegetables but abundant in kiwifruit, peppers, citrus, and berries. Vitamin C is super important for your body to heal and rebuild.

Iron

Replenish that vital blood supply! Abundant in meat, but also found in blackstrap molasses and leafy greens.

Zinc

Once again, this amazing mineral can help your body heal and recover. Especially good if you have tears, scars, or cracked nipples. Remember, if you’re taking iron also take it at a separate time from zinc, and always have it with food (it can cause nausea on an empty stomach).

Ginger

A warming anti-inflammatory! Have it fresh as a tea, or grate and add to foods. A small ginger grater is a good investment!

Collagen

Collagen is a protein that forms the building blocks in the body. It can be taken either as a supplement (powder for shakes or unflavored in soup, or tablets), by eating foods that contain it, or by having foods that help the body make it. It is found in bone-broth and gelatin. Vegetarian alternatives include seaweeds and agar-agar. Cabbage is a rich source of the ingredients that the body uses to produce it.

Not sure where to start or what meals to make that will incorporate these important nutrients and foods? Here are some fantastic recipes for momma, prenatal and postpartum!

15 Healthy Recipes for Pregnancy

10 Best Folic Acid Foods to Eat During Pregnancy

9 Nourishing Meal Ideas for New Moms

Real Food Postpartum Recovery Meals: 50+ Recipes and Freezer Tips

And, of course, the Nouris(her) e-book, which you can find here!

My Dirty Little Secret

Yep, that’s right… I’m just going to come right out and say it…

Right now…

Any second now…

Okay, I did it.

I bedshared with my daughter.

There is so much controversy around bedsharing that I have gone back and forth many times on writing this blog. However, the research doesn’t lie and it’s these two blurbs from an article I read that made me finally want to do it.

If a mother’s afraid to nurse in her own bed, her most likely options are a sofa, recliner or upholstered chair - all riskier places to sleep with a baby. One study found that 44 percent of mothers who nurse in those places at night fell asleep there at least once.

Even though most new breastfeeding mothers today don’t plan to bedshare, studies show that eventually 60-75 percent of them will, at least some of the time.

There are so many reasons I didn’t want to admit to bedsharing. Mostly, because I love my daughter and I didn’t want anyone to think that I would risk her safety, simply because I was undisciplined or lazy. I had great intentions of following ALL THE RULES. I had a bassinet beside the bed for her to safely“room in” with us. But at no time was I going to risk her safety by bringing her into bed with us.

Until I did.

Well, sort of.

My daughter was one of those babies that startled a lot. The startle, or the Moro reflex (named after German pediatrician Ernst Moro), is one of several involuntary movements in newborns. It’s a baby’s response to the sensation of falling or stimuli in their environment such as loud, potentially threatening sounds or bright light. And it was the bane of my existence.

I’d have my girl swaddled (poorly) in her bassinet and she would go from what looked like a deep sleep to a startle. It was like a jolt, her arms and legs extending, her fingers spread apart and her back arching. As a result, her arms and legs would hit the side of the bassinet and she would wake up crying.

I can’t tell you how many nights I would sit by the bassinet, barely able to keep my eyes open, wondering if she was in a deep enough sleep for me to rest as well.

And then one day, I just cracked. I couldn’t do it anymore. I was breastfeeding my daughter every two hours, so what would it hurt to bring her into bed with me.

Just for a few moments.

Just long enough to close my eyes for a few minutes.

I mean, I was going to be awake to feed her in 30 minutes anyway…

So, I pulled my crying daughter from her bassinet, propped myself up on a bunch of pillows so I was almost completely upright, and placed her on my chest. I wrapped my arms around her and finally closed my eyes.

I did this for four months. Why four months? I think any new mom reading this right now already knows why. Because I’d read somewhere that after four months, a baby’s risk of SIDS drops significantly. It is also around that time that the Moro reflex disappears.

So, what’s wrong with this picture?

1. I never intended to bedshare, but at my most exhausted and sleep deprived moment, it seemed like a good idea. Had you asked me after a full night’s sleep if the risk outweighed the reward, I would have looked at your like you had a third eye… OF COURSE NOT!

2. Because I never intended to bedshare, when the moment arrived, I didn’t know how to do it safely. I propped up pillows, held my daughter in her swaddle blanket against my chest, beside my husband, in a bed full of blankets… all no-no’s when it comes to safe bedsharing.

It wasn’t until many years later that I supported a client (a new momma of twin boys) who chose to bedshare and that’s when all of these memories of my perceived failure came back to haunt me. Other than my husband, no one knew that I bedshared with my daughter and I would never tell anyone.

I was ashamed.

Momma and her twin boys. Read her blog, Mom Uprising, here!

But here was this new mom, setting up for bedsharing from the start! I was fascinated and I wanted to know everything about what and how she was doing it. It led me to look into safe bedsharing and that totally changed my mind about it.

Momma’s twin boys and older daughter sleeping while bedsharing.

At the end of the day, bedsharing is a VERY personal choice. And it’s something that each individual needs to research and then weigh the risks and rewards. That being said, I can personally say that I think SAFE BEDSHARING is something that should be taught to new families (it’s not only moms who bedshare), as a safety measure for those late night, sleep deprived moments when you’re exhausted and your barometer for measuring risk/reward might be off and your resolve might be easily influenced. Even the American Academy of Pediatrics understands that bedsharing is happening more often, planned or unplanned, and has given guidelines for safe bedsharing.

La Leche League International created the Safe Sleep 7, a set of rules for safe bedsharing. They were designed to help new breastfeeding parents tackle the exhaustion of frequent feedings through the night and the logistical nightmare of moving baby in and out of a separate sleeping space.

THE SAFE SLEEP 7

If you are:

1. A nonsmoker

2. Sober and unimpaired

3. A breastfeeding mother and your baby is:

4. Healthy and full-term

5. On her back

6. Lightly dressed, and you both are:

7. On a safe surface

Indulge me, I’ll cover here why, if I’d only been counseled in safe bedsharing techniques, I would have had a less sleepless and guilt-ridden first four months of my daughter’s life.

1. Both my husband and I were nonsmokers. This is so important on so many levels outside of safe bedsharing. Little was known about the dangers of third hand smoke when my daughter was an infant, but now so much is known and the dangers are frightening.

2. I was a breastfeeding mom, so sober and unimpaired CHECK! It’s important to note that this goes for anyone sharing the bed with baby, not just momma.

3. I was exclusively breastfeeding. You might wonder why this plays such a large role in safe bedsharing. Anyone who has had me as their doula has heard me tout the benefits of nursing in the side-lying position. It’s the BEST of all the positions, in my humble opinion. In this position you are on your side, your baby’s head in line with your breast, your knees are bent at 90 degrees and your arm against the bed is extended above your baby’s head while the other arm is behind your baby’s back, pulling her close to you and onto your breast. Imagine cuddling in the reclining position with your baby as she nurses. It’s magical. In this position, you are in what’s known as the cuddle curl. It’s in this position that you’ve created a protected space for your infant. Because your legs are bent, there’s no way for you to roll toward your baby. And no one else can roll into your space because your knees and elbows are in the way. And because a lactating breast is the center of an infant’s universe, they will stay in a position, even when not latched, that will keep them close to the breast and not outside of that protected cuddle curl space.

4. Healthy and full-term. My daughter was 10 days past her estimated due date and weighed almost 9lbs at birth.

5. On her back. For nursing moms, it’s a natural move for baby to roll onto their back after breaking the latch. I can’t tell you how many moms who nurse share with me the beauty of waking to find baby on their back, a drop of milk rolling down their cheek, fast asleep.

6. Lightly dressed. Just one more fascinating thing about the bond between moms and their baby. When a baby is placed skin to skin with mom right after birth, a mother’s body heat helps to regulate that of her baby’s. A baby who is bedsharing doesn’t need all the extra clothing or swaddle, because she will have the added benefit of mom’s body heat.

7. On a safe surface. What constitutes a safe surface?

THE SAFE SURFACE CHECKLIST

Avoid these possible smothering risks:

• Sofas and recliners

• Soft or sagging that rolls your baby against you or keeps her from lifting her head free

• Spaces between mattress and headboard, side rails, or wall where a baby could get stuck

• Pets that could interfere

Clear your bed of:

• Unused pillows

• Stuffed toys

• Heavy covers or comforters

• Anything nearby that dangles or tangles

Check your bed for possible hazards:

• Distance to floor

• Landing surface

• Sharp, poking or pinching places

Looking back to those first four months with my daughter, I wish I would have known some safe bed sharing techniques. I can’t say for sure that I would have done it every night, but I do think on occasion or during daytime naps, knowing how to safely bedshare would have made those times less stressful and much more enjoyable.

And, if you’re not comfortable with bedsharing but want to be prepared, the Co Sleeper and In Bed Co Sleeper are great options, even if you never use them.

***This should not be misconstrued as a recommendation to bedshare, but rather a resource to help reduce the risks if you’re someone who might eventually, if inadvertently, bedshare.***

Foremilk vs. Hindmilk - Fact or Fiction

For anyone who knows me, they know I am incredibly passionate about breastfeeding. It’s almost a little scary how much I could sit and talk about breastfeeding with just about anyone. I mean, when you think about it, your body has the ability to feed and grow an ENTIRE human being! That’s pretty amazing! I’ve often said that if men birthed babies or even breastfed babies, it would be on TV every Sunday, sponsored by some big car company.

We as women are fascinating creatures and I think deep down we all know that. Yet, we are told at every twist and turn during pregnancy, labor, breastfeeding, and postpartum to question this. Think about it: your body was built to create, grow, and feed a human being. Despite that, women are being scheduled for inductions at 37 weeks, and treated like someone who is “sick” the moment they arrive at the hospital. After delivery there is someone there to “teach” them how to breastfeed, when, if they were just given the time to do the Breast Crawl (something we’ll talk about in an upcoming blog), they could easily have a successful breastfeeding relationship. And don’t even get me started on friends and family during the postpartum period with their guidance, suggestions, and opinions.

Today we’re going to focus on one of the questions I get the most from breastfeeding mommas out there… and one that proves, once again, that women are given WAY TOO MUCH unnecessary information when it comes to breastfeeding their babies, fostering only doubt and anxiety.

“A little knowledge can be a dangerous thing. This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding. The misunderstandings around these concepts have caused anxiety, upset and even led to breastfeeding problems and premature weaning.”

- Nancy Mohrbacher, Breastfeeding Made Simple

“How do I know if my baby is nursing long enough at each breast to get the important hindmilk?”

Ahhh… the good ole FOREMILK HINDMILK debate…

If you type the words foremilk and hindmilk into Google, the first predictive search that shows up is “foremilk hindmilk imbalance.”

It’s true.

Go ahead, try it!

I’ll wait…

Scary stuff, huh?

If you take the time to look at one of those myriad articles you will find it is no wonder that new moms are completely stressed out about breastfeeding. I mean, I would be too! Because we all want is what’s best for our babies, so we want ALL THE INFORMATION! But we have to stop looking outside of ourselves, our babies, and our maternal instinct for answers.

So, let’s talk about FOREMILK and HINDMILK.

Do they exist?

That’s a tricky question.

We have come to know both as something that shows up at a particular time during a nursing session. How many times have you been told my nurses, family, or well-meaning friends that you have to nurse for at least 15-20 minutes per breast to make sure your baby gets both? Yes, it is true that the milk that comes at the beginning of a nursing session typically has a higher water and sugar content, and that the milk that comes at the end of a nursing session has a higher fat content. However. there are exceptions to this rule. And more importantly, what we’re often forgetting is babies need BOTH.

Foremilk does come at the beginning of a breastfeeding session and is also power-packed with antibodies and glyconutrients (healthy sugars that kill cancer cells and feed the developing immune system). And as your baby begins to nurse, that milk gradually changes. It becomes more and more dense in healthy fat which feeds the cells of the rapidly developing brain and body of your baby.

So, we’re back to the question…

“How do I know if my baby is nursing long enough at each breast to get the important hindmilk?”

Well, here’s my answer to new mommas:

If you are emptying your breast, then your baby is getting both foremilk and hindmilk. And remember, foremilk doesn’t flow from your breast for a certain amount of time and then is abruptly switched over to hindmilk, so you can’t watch the clock to know when this happens. It’s fluid (literally), so at any time, depending on your supply, your nursing frequency, etc., your baby can be getting fore- or hindmilk.

Breastfeeding is a closed system, so it makes it hard to know what is happening and when there are changes in consistency. It’s one of the things a lot of breastfeeding moms struggle with when nursing.

“If I could only see how much he’s getting.”

“If I could only see if it’s thin milk or thick milk.”

This is something we can’t control. What we can control is HOW we choose to feed our baby.

Allowing your baby to feed on demand is the best way to ensure your baby gets both foremilk and hindmilk. There will be times when baby will nurse for just a few minutes, and this can be for what we refer to as a “snack” or for comfort, getting only foremilk. And there will be times when baby will nurse for close to 20 minutes and empty your breast, getting both fore- and hindmilk. There will also be times (new moms ALWAYS reach out with concern about this) when it seems like baby is nursing around the clock. Cluster feeding! And these times, depending on how close the feedings are (more often than 2-3 hours between feedings), your baby will be getting fattier (hindmilk) at the beginning of their feeding.

Your baby is the only one who knows what’s going on in this closed system and should drive the process.

My pumping moms know this because they can see how milk is ever-changing. From day to day, moment to moment, and for breastfeeding babies, swallow to swallow.

Just like the picture below… Look at how different those two bags of milk look! Taken only a few days apart.

Your milk’s ever-changing consistency is why I suggest the 3-bottle system for pumping moms.

3 Bottle System for Pumping Moms

The bottom line is this; if your baby is nursing 8-12 times a day, having the appropriate number of wet diapers, and is gaining weight, then the best thing you can do is stop worrying and enjoy the special time you have with your little one. Breastfeeding is such a beautiful relationship with precious memories and feelings that will last with you for a lifetime. Don’t try to micromanage it by keeping track of every feeding, duration, and nursing side. Just bring your baby to your breast when you see one of their early feeding cues and trust the one thing you gained the moment your baby was placed in your arms: your mother’s intuition.

Baby’s Early Feeding Cues

How to DOULA in the age of Covid-19

“Did you know that providers are telling their patients, because of COVID-19, to avoid having anyone into their home a month before and two months after their baby arrives?” 

This was the text I received from one of my doulas last week and it immediately caused me great concern. 

 

The Covid-19 pandemic has taken so much from so many already.  People have lost their jobs and any sense of normalcy in their lives.  Students have lost their social lives, graduations and senior year functions.  And most importantly, so many have lost family and friends to this global pandemic. 

 

All the while everyone seems to be in a tailspin trying to keep up with the latest findings about Covid-19 and are changing protocol, sometimes daily, to ensure they are doing what’s best to keep themselves and anyone they come in contact with safe.  While I understand the idea of keeping the home a safe space for pregnant women and their families, I also know that the month before and two months after birth are some of the most important times in which our doulas support women.  

The time leading up to birth is when we meet with our clients, go over birth plans and discuss any questions or concerns regarding their upcoming birth experience.  This time also allows us to develop a stronger bond with these families who have trusted us enough to invite us to be a part of this most sacred moment in their lives.  Right now we are able to do these prenatal visits virtually, but it definitely makes things difficult when trying to demonstrate the techniques in which we would use during labor and delivery, exercises moms can do to help get their baby in the optimal position for labor and, honestly, meeting in person is just so much better for creating a bond of comfort and trust.  

 

While handling the month prior to an estimated due date is workable, the part that REALLY concerns me as a doula are the two months after the birth when women, even prior to this pandemic, need the most support.  One can also make the argument that because of this pandemic, our clients have lost the support of their parents or extended family, in order to reduce the risk of infection.  Whether you’re having one baby or twins (or even triplets) every new mom needs support during this very vulnerable time.  Add onto this the fact that when women give birth, they do not see their doctor for a follow up for SIX WEEKS postpartum.  So many things can happen in those weeks.  As doulas we are trained to not only provide breastfeeding support (something that is so lacking in this country), infant care support (something every new mom can use), but we also are trained to know what normal healing looks like during the postpartum period.  And while we would never diagnose, we would most definitely be there to inform a new mom if there was a health concern for which she should be calling her provider.  

 

Another way in which we support new moms as postpartum doulas is overnight support.  I can’t tell you how many of our clients find this was just what they needed to make it through those first few, challenging months with a newborn.  

 

Just a few weeks ago I had a client say to me,

“If it weren’t for you, I’m not sure our marriage would have made it through that time.”  

While I know this was said tongue in cheek, I also know the stress the sleepless nights with a newborn can put on a family.  

The following is a testimonial from a mom who was working with us before covid and how she came to the conclusion to work with us during the pandemic.

 

“As physicians during covid with premature infants, we were acutely aware of covid risks and worried about how to get the help we needed without putting our babies in harms way.  Tracy and her team were great to work with and were very proactive with precautions while allowing us space to come to the decisions that were right for us.  They wore masks the whole time, changed outfits when coming in and were vigilant about hand hygiene.  I really felt like Tracy cared just as much about my children’s safety as I did.  Despite the situation not being ideal, we felt comfortable in her hands and relieved to have great help amidst such stressful times.

-Snigdha A.

 

Because we know how essential doula support is to women and their families, we at Doulas of Berks County have put into place some new COVID-19 protocols which all of our doulas follow.  Prior to any shift with our clients, all doulas fill out a Covid-19 Screening Questionnaire and take their temperature to ensure they do not have a fever.  This questionnaire is kept on file with the agency and can be forwarded to clients upon request.  

Upon arrival at a client’s house, all doulas change into a clean pair of clothing that is either laundered the shift before at the client’s home or at the doulas home, depending on our client’s request.  

We also continue with our standard handwashing and sanitizing, as this is something all doulas were diligent about pre-covid.  

Additionally, when our clients sign with Doulas of Berks County, they are provided with a questionnaire that allows them to give us direction on any other protective measures they’d like use to follow when being in their home.  This includes where and when they’d like us to wear masks, how they’d like us to arrive, etc.

We also ensure that each client only works with one doula when possible (depending on the number of hours requested) and that each doula only works with one client/family at as time.  Our clients appreciate knowing that the doula they’re working with is working solely with their family as it minimizes additional risk of contracting covid. 

 

“As first-time parents, we were so thankful to have a doula during the uncertain times of COVID.  We were undecided at first, as our daughter’s safety was of utmost concern.  However, several factors made us feel very comfortable with the decision.  First, we knew that each doula was only working with one family at a time.  We were able to discuss our preferences at length with our doula, prior to making a decision or spending any money, to ensure that we all were on the same page on such things as wearing a mask, what to do if anyone experienced any of the COVID symptoms, whether we anticipated travel, etc.  We were given the option to cancel and receive a full refund should we change our minds- this was important as the COVID situation changes daily.  Our doula also completed a health questionnaire prior to every visit.  We’re so thankful that we had the expertise of our doula, she not only answered all of our questions but also advised us of developmental or growth changes that might be coming.  She gave us peace of mind and a great nights’ rest on many occasions- which is beyond priceless for new parents.”

                                                                                                                                     -Akiko S.

 

So, while we are all trying to figure out just what to do to navigate safely though this pandemic, I encourage you to please reach out to Doulas of Berks County if you need any support before, during or after the birth of your newborn.  You can do this knowing that we are doing everything possible to reduce risk of exposure, while ensuring that our new moms and their families continue to feel supported in a way that is paramount and so beneficial during the sacred time in a family’s life.