Adding a Member to the Family

When a baby is born he or she creates parents, grandparents, aunts, uncles, brothers, and sisters. Each and every person in the family now has, sometimes for the first time, a new role.  Wanting to write about this came back to me recently and is encouraging me now as I contemplate that my eldest grandchild is15 as of Jan 21. With none of his earlier birthdays did I pause to think about or celebrate that his birthday is also the anniversary of me becoming a grandmother and the significant new role that has played in my life. As I reflect how my life has changed and my personal journey, I am reminded of my desire and plan to look at how huge it is for each and every person in a family when a new member is added.

While I’ve considered the subject for some time it has clearly been a difficult one for me to write as well to post – my guess is that it’s a sensitive area. My personal perspective seems to have gotten in the way of clearly approaching the professional one.  Life changes, of course, most dramatically for the parents especially if it’s the first time and they become mom and dad – roles they haven’t had before. We spend a fair amount of time focusing on preparing for these roles. However, most of the preparation is almost incomprehensible during pregnancy and only bits and pieces are really absorbed.  Most of us can’t imagine what life will be like and the majority of learning is experiential so it doesn’t really begin until the newborn actually arrives.

Parents of another child generally consider how a new baby will be accepted.  One of the first notes I made when thinking about this topic was after a pregnant mom called me.  Her first question was, “Do your services include teaching siblings how to hold the new baby?” There has been quite a bit written about and for older siblings of a new baby – there still isn’t enough attention, however, to not only the impact but to including them in the planning of the event of birth, as well as to the adjustment – both for the family as well as for others. I witnessed just the other day a woman rushing over to a mom, her toddler, and her newborn. The woman cooed and fussed over the baby totally ignoring the toddler and I saw real sadness in the young boy’s eyes.

We also have some literature for grandparents, however, do we really acknowledge how challenging and perhaps even difficult at times the adjustment may be? The reality I’ve experienced and observed is that it is almost as difficult an emotional adjustment to each of the new roles. And, I certainly give homage to the transition as it effects new moms and dads, otherwise I wouldn’t be as passionate about my profession as I am. As a new “Nana” I had to learn to respect my kids as parents which often has meant keeping my thoughts to myself. It hasn’t always been easy to realize I have absolutely no direct control as regards to matters effecting my grandchildren. We each have to navigate this new terrain and learn as best as possible what the new family dynamics are.

I would really like to think that those of us in the childbirth community could assist in providing a safe and educational place for everyone effected by the newest family member(s) to explore, learn, and gain support for the wide range of emotions that occur. There is no question that for most adults – grandparents, aunts, uncles, cousins, etc – it is a thrilling, exciting, and blessed event. It is less obvious that there are also challenges in adjusting to each of those roles as well. I expect to continue to learn about the full scope of this subject, to gain new/additional insights, and to bring more to the discussion going forward.

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Mayor Bloomberg’s Breastfeeding Initiative for NYC Hospitals

Thoughts (My 2 cents) on Breastfeeding Initiative in NYC (Aug. 22, 2012)

This subject has gotten a great deal of national, perhaps even international, attention over recent weeks – in the written media as well as radio and television and the widespread internet.  The blogosphere has had many blogs. While I doubt that I have anything original or unique to add to this heated and somewhat wild storm, I do feel that I want my “2 cents” added in. I want you out there to know how I see it!

This is a subject so close to my heart and the very core of my philosophy. My mission and direction since my earliest days as a mother, and becoming a La Leche League leader 3 years later, was and has continued to be focused on informing, educating, and supporting women who want to breastfeed.  Those objectives come from the best information and support available from women who breastfed before me. My intent has not ever been to convince a woman or to pressure anyone who chooses to bottle feed and give formula to her infant. I always believed that my plate was full focusing on those who want to!

Do I believe strongly that certain procedures from the earliest moments after the birth of a baby can make all the difference? I do indeed. So, how does this relate to the Initiative and the stand that Mayor Bloomberg has taken in New York City? It completely aligns with what I think the Initiative is all about. I might add that (and may contribute to my wholehearted support) I am a native of New York and I am very proud that this strong advocacy and support of breastfeeding is coming from the Big Apple.

The bottom line is that I support every effort being made to encourage and support moms who choose to breastfeed especially as they begin their journey as new moms. I cannot tell you how many women have told me that in the often less than 48 hours they were in the hospital they heard many conflicting opinions on what they needed to do.  They came home with a 2 day old newborn totally confused and insecure.

This is not only incredibly sad to me but strikes me as inexcusable. In 2012 we certainly have the knowledge and the resources to be 100% behind any woman who chooses to breastfeed.  Healthy babies in the first couple of days require very little other than their mothers warm arms and bodies and the ability to suckle at her breasts whenever he/she seems interested. Most newborns will sleep much of the first 24 hours and what mom has to offer is the most perfect sustenance.

Consequently to even think it necessary to offer a baby a bottle of anything is beyond me. What I understand is incorporated in the Initiative by locking up formula in the hospital is to force hospital personnel and parents to think at least twice before moving in that direction. Stopping to think about and to be totally informed, requiring a second opinion or the approval of a physician or lactation consultant, only insures that it will only be under “emergency” conditions. As I’ve heard said as relates to “locking formula in a cabinet” every hospital requires a specific order for even an aspirin! Why would we demand less for formula?

My hope is that more women and men come to understand the many nuances of this issue and find a way to truly support those who breastfeed.  I drafted this article last week and over the weekend I saw two articles that touched me and I find very articulate and powerful on this topic. I hope you will read them both:

–          **  Jennifer Margulis, Ph.D., is a senior fellow at the Schuster Institute for Investigative Journalism. “Women Who Don’t Breastfeed Shouldn’t Feel Guilty…”

–          ** Sara Newman, IBCLC, PCD(DONA) Posted on August 19, 2012 “My Letter to Cari about Bloomberg and Infant Formula”

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Postpartum Depression…Can a Postpartum Doula Help?

As this is a frequently asked question I thought it important to discuss briefly.  It certainly is a profound and complicated issue.  There are many concerns today about postpartum depression and the need for professional help and support may be indicated.  According to U.S. National Library of Medicine, “Postpartum depression is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 3 months after delivery.”

Postpartum Doulas are not trained to provide in depth support in this area.  However, the presence and reassurance of a Postpartum Doula can assist in some incidences of preventing postpartum depression.  She will be providing a safe environment and listening to the mom’s concerns.  She is also prepared to identify signs of depression and to supply resources available with medical information as well as professionals specifically trained to support Postpartum depression.

More specifically, I would like to quote from DONA (Doulas of North America): “Unlike therapists or psychiatrists, doulas do not treat postpartum depression. However, they will help by creating a safe place for the mother emotionally. The doula will provide a cushioning effect by accepting the mother within each stage that she passes through. They relieve some of the pressure on the new mother by helping her move into her new responsibilities gradually. By mothering the mother, doulas make sure that the mother feels nurtured and cared for, as well as making sure she is eating well and getting enough sleep. In addition, DONA International certified postpartum doulas are trained to help clients prepare themselves for parenthood, maximizing support and rest. These doulas will help their clients to screen themselves for PPMDs and will make referrals to appropriate clinicians or support groups as needed.” <The italics are mine as they are key in my mind and provide major distinctions between a Postpartum Doula and other professionals, i.e. a therapist or psychiatrist.>

For more information, see @FAQ (DONA) “Do doulas help mothers to deal with postpartum depression?” <>

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Have you seen a baby breastfeed?

“A picture is worth a 1000 words”…”Seeing is believing” 

Both of these sayings have recently come to me as I attempt to share about something that I have wanted to articulate for many years.  What was so special about the education and support I received and subsequently provided to others starting over 40 years ago?  This question has puzzled me and the answer(s) have evaded me until I attended a workshop in the spring of 2010.  It was then something hit me as the question was posed and there was some discussion about “How many current day moms (and dads) have actually ever seen an infant at the breast?”

Most of us remember images and diagrams better than words. I won’t bore you with the research references, but the numbers are pretty straightforward on that. Not only do we remember better, but when words are accompanied by illustrations, we even understand the content better.  I looked into this a little over the last year as I have pondered the impact of new parents facing being handed their newborn, with the  expectation that they know what to do.  I think if we consider the concept of knowledge and what to do, what parents are able to visualize is very important when it comes to breastfeeding.

I have been a strong advocate of nursing mothers support groups and became active in La Leche League after the birth of my first in 1966.  The pieces of the puzzle are still coming together.  While I had read almost anything I could get my hands on including the manual written by the seven founding mothers of La Leche League, The Womanly Art of Breastfeeding, before the birth of my son, I remember feeling very much on my own.  I was extremely excited and it didn’t occur to me that I wouldn’t breastfeed.  As I reflect back on those early days I can only say that I am very grateful that very soon after becoming a new mom I met some other ‘nursing’ moms!’

So, what I would like to impress on all expectant couples, moms and their partners, is the huge value of simply observing nursing couples, the nursing dyad, mom and baby.  No doubt that if you are expecting you are living a busy life these days and much of your energy is consumed with thinking about what to expect at your birth – labor and delivery.  I truly hope you are considering your birthing options and learning as much as you possibly can about what they are.  There are many things you will want to do to plan for the arrival of your newborn.  However, I can’t urge every parent-to-be strongly enough to attend a La Leche League meeting or any other gathering of nursing mothers and babies at least once before their baby arrives.

The discussion at such a meeting isn’t the important thing.  If at the end of the meeting, you find that your mind wandered and you aren’t sure you remember anything that was said, that’s OK!  What being there will do is fix in your mind a visual of breastfeeding.  Most likely once you have your own infant and you begin to build your own relationship some of what  you actually heard will also come back to you.  In addition, you will have at least one person who you met that if you do have questions, doubts, concerns (and, as parents, most of us do from time to time!) you will hopefully feel comfortable calling that one person.  However, my real hope is that that visual will be imprinted so that when your infant is handed to you after your birth you will comfortably, and with some assurance, hold him or her on your chest and joyfully begin your breastfeeding relationship.

P.S. Yes, it’s true that today we can find most anything on the internet and, indeed, there are YouTube videos with good examples of breastfeeding.  I do think these are helpful and once your relationship has begun and you perhaps have a question, you will find these helpful.  However, I don’t believe anything replaces a roomful (!!) of moms and babies and it is that visual that I wish for the pregnant mom – the person expecting – BEFORE her baby is born.

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Determining what support YOU need postpartum?

Almost without exception I hear from couples when I first meet them, “we don’t know what we need in the way of support.”  This is a totally individual thing to sort out and generally a question that most expectant couple don’t know how to answer. DONA (Doulas of North America) provides a very helpful Postpartum Plan that I review with pregnant mom and partner. It can provide answers  by assisting couples in assessing what support they can expect and/or may already have and the areas in which they need to supplement. It is still extremely helpful to discuss possible additional areas of support with an experienced postpartum professional.

There are several areas that parents want to consider and then determine what level of support they have in each (see the Postpartum Plan mentioned above.)  These are, the need:

  • for rest in the early weeks after giving birth
  • to have friends who are also parents of young babies
  • for nutritious meals and adequate hydration
  • for knowledgeable, empowering breastfeeding support
  • for support for older siblings
  • for ‘Mommy and Daddy time’- maintaining our sense of ‘self’ and ‘us’

The key here is to spend some time together while still expecting to carefully identify who is available in each of these areas and realize that these things have actually occurred to parents beforehand.  For some there are going to be helpful grandparents or other family members, friends and/or neighbors, and/or community or organizational support. Some couples or possibly a single mom will gain awareness that there is some support but only for a short time period or there really isn’t much that she/they can rely on for those early critical weeks. Also, sometimes the support that may be available will cause stress that parents to be realize negates the benefit of the possible assistance.

In general, when I meet with couples or the pregnant mom-to-be we spend some time going over the areas mentioned above and I recommend completing the DONA Postpartum Plan.  We then discuss what makes most sense also reviewing any budget considerations.

I found one of my earliest experiences with Postpartum Doula clients to be so successful in determining the amount of my services.  I often share how this couple structured it as a useful example of one way to look at it and decide.  This couple, who I will refer to as Mom and Dad, are working professionals and were expecting their first baby who was determined needed to be delivered by c-section.  As the Dad is in sales, he knew that with the exception of the first few days immediately after birth, once Mom and baby were home, he would need to return to work.

Mom would definitely need assistance and support from the day she got home from the hospital and for some weeks to follow.  Even though there were loving grandparents who all wanted to be there, they were all out-of-state.  Mom and Dad realized that for them having that much excitement from the beginning wasn’t what they felt would be helpful.  They really wanted to have some time to determine together how they wanted to parent their new baby – what they would feel comfortable with.  They believed that they would be in a better position to spend time with their own parents and share how ‘they like things to be done’ after being home for a week.

What we agreed upon – and worked out very well – was that I would spend full days for the first week, Mom’s Mom would come to spend the second week, Dad’s parents the 3rd week, and I would be there again for week 4.  Another positive thing we agreed on was that I would spend half a weekend day between each grandparents’ visit with Dad. We arrived at that when the Dad realized he wasn’t going to be home when I was there and he said, “when do I get to learn from Joan?”

The above is an example of how one couple decided to structure postpartum support.  There are probably as many ways as there are new parents.  One thing most, if not all, of my clients found to be very helpful is to agree with a Postpartum Doula that she be available the day they come home from the hospital if they have a hospital birth.  Most important, however, what I hope the message is here, is that some time be spent BEFORE the baby arrives assessing what support there is and what additional support may be beneficial.

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What is a Doula?


It is a unique word!! It happens to be a Greek word, and it means “woman’s servant.”  In ancient times, the doula would attend to the needs of the woman of the house.  Today, we find a doula may provide birth and/or postpartum care. Let’s differentiate between the two types of doulas:

Birth Doula • (birth comes first :) )

birth doula is a person professionally trained to provide support to the woman and her partner during labor and childbirth, while a postpartum doula is a supportive advisor and helper professionally trained to provide support to the mother and her family after their baby arrives (the postpartum period is generally considered to be the 3 months or 12 weeks after birth.)

The birth doula has a pretty specific routine, meeting with parents-to-be at least twice prenatally, prior to labor and birth, and reviewing what parents can expect during labor and the actual birthing of the baby.

They go through and discuss what the parents have maybe already thought about or experienced, what they have heard about, and try to clarify any of their questions, helping them establish what is referred to as a birth plan. This allows everybody to be on the same page including all birth professionals the expectant parents have chosen to assist them with the birthing of the baby.  Ideally the birth doula and couple begin their relationship by the last trimester of the pregnancy. The two prenatal visits can take place during the last three months so that they are all comfortable with each other prior to the birth.

The birth doula will then also be available for consultations by phone or email throughout the remainder of the pregnancy. She will be there for support when actual labor begins, going to the couple’s home if they request, accompanying them for the birth wherever they have chosen to deliver. She will stay with them until the baby arrives and usually for at least a couple of hours after.

Birth doulas will also make at least one postpartum visit with a couple, just to make sure that everything is going well.  It is an opportunity to see how the new family is doing – how the baby is, how the mom is feeling, and allows the mom and doula to review together the mom’s experience with her birth.

Postpartum Doula

Being a Postpartum Doula is where my focus and passion lies. The  function may change from day to day and from family to family. It depends on the actual needs as a postpartum doula’s role is to do whatever a mother or father needs to best enjoy and care for their baby – mostly education, providing and sharing information about general infant care as well as teaching siblings and partners how they can help in mothering the mother. It is that support and general knowledge which can help everything go so much more smoothly in the transition to becoming a parent.

The postpartum doula will assist with breastfeeding education and make sure that the mother is well-hydrated, well-fed, comfortable, and is hopefully getting as much rest as possible enabling her to conserve energy and nurture her infant.

The postpartum doula focuses on areas of support the couple anticipates they will need once their baby arrives. The better someone can understand the individual or the individuals involved, the better able they are to support them, and so to do their best, both birth and the postpartum doulas want to spend some time with the expectant parents. Discussions ideally take place about whatever the expectations are and what the expectant couple believe their requirements may be. This way, what can make a tremendous difference is having somebody from the beginning who is objective and calm, assisting and supporting everyone from the nuclear to extended members of the family.

Postpartum support doesn’t need to be for an elongated period of time. It’s not a matter of how much time the postpartum doula spends with the family.  It’s a major transition for all – while there’s only one member that has been introduced, it shifts the dynamic.  Everybody’s role has now changed to some extent.  Having someone there who is impartial and able to provide anecdotal as well as evidence based information has been shown to make a tremendous difference in how everybody adjusts to their new role.


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