TENS machine in labour... with love from a doula-to-be

 

Another blog in response to a message from a friend. Admittedly I know very little about this machine, and my midwife never suggested it, though I had read about its benefits. I just assumed it wasn't something people used much in SA for birth and I'd read that one couldn't use it with a water birth anyway. Nevertheless, my friend is a doula in training, so I guess she would know. Here's what she had to say about...

The TENS Machine

Courtesy of http://www.labourtensmachine.co.uk/

My dearest leila.
This is not the article we spoke of, but it is some amazing device I wish I had known about earlier so that I could have invested in it when I was pregnant...

A TENS Machine: Transcutaneous Electrical Nerve Stimulation (TENS) stimulates the release of endorphins & uses the gate theory of pain relief as researched by "Melzack & Wall". TENS machines have been in use since the 1960's and over the years have become smaller, portable and easier to use. The TENS unit is an advanced, small, battery powered device which sends a pulsed electrical stimulus via pads to the skin.

So these little machines assist the body in releasing natural pain killers (endorphins and encephalins) and blocking out pain messages to the brain. They provide a sense of control over labour pain and it gives you an alternative focus.

Why use TENS ?
1)It's a drug free system for pain control

2)Quick & effective pain relief

3)Easy to use, light weight and portable

4)Does not cause drowsiness

5)Can be used for as long as pain relief required

6)There are different pulse settings, you control it

7) Normal- boost mode controllable using light weight seperate boost button

8)Can be used in the comfort of your own home when contractions start or later at hospital

9)Can be used with other methods / prescribed drugs

10)Non invasive and gives you the freedom to move and walk about


What does TENS feel like ?

It is a pleasant tingling sensation on the skin where the pads are placed.

When do I start using the TENS machine?

Recommend you start using the TENS machines at home at the onset of contractions. Early use of TENS promotes the bodies production of endorphins and encephalins - the bodies natural pain killers.

How long should the TENS be used ?

The TENS machine can be worn as needed for as long as desired but a minimum 30 minute duration is recommended for childbirth.

Can I practice with the TENS machine?

It is recommend that you try the TENS machine beforehand so that you are familiar with the operation. You may place the pads on your lower back as you would during labour or you may place them on the inside of your forearm to test. If you are earlier than 36 weeks then limit the test to a short period (less than 1 minute). The pads are self adhesive and re-usable. Re-apply the plastic film to the sticky side of the pads when finished and store in the plastic bag.

When to Not use TENS?

Do not use over broken or desensitised skin. Do not use before 37 weeks unless approved by your doctor. Do not use if you have a pacemaker. Seek advice from doctor if you have epilepsy.

I would like a water birth - can I use TENS ?

Yes, but NOT while you are in the water. Use during the first stage of labour which may take several hours. The midwife will not usually ask you to enter the water after you are 5cm dilated. You need to REMOVE the TENS machine BEFORE you enter the water.

Can I use a Tens machine with other pain relief methods ?

You may continue using the TENS machine with other methods such as pethidine and gas and air.

Can I use the TENS machine after the birth ?

Yes, it is effective for reducing the pain of uterine contractions after birth. The TENS machine can even be used whilst breastfeeding after birth.


Can I take the Labour TENS unit into hospital with me ?

The midwives and doctors are usually very happy for women to use labour TENS. Check with your midwife or doctor if you are unsure. You may need to turn the labour TENS unit off temporarily whilst using electronic monitoring equipment.

Hope it helps

"Friend"

 

With that I hope that some of you encounter this seemingly miraculous machine on your preggi pain travels, and if you do, or if you already have, please share with us your experience....

My Rite of Passage... the day my baby was born

"Your children are not your children.
They are the sons and daughters of Life's longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you..."
 Khalil Gibran

The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will always have the power. 

Heather McCue Childbirth educator and doula

I feel there is a necessary prologue to my fairytale (which this is by the way, in case you didn't notice), and this is how it goes... The morning of my baby's birthday I woke up from a very vivid dream about being in labour on a plane. I remember it clearly but won't bore you with details of flight destinations etc. What I will say is that I was on a plane with my husband when I suddenly felt very real, very painful contractions. The general theme of the dream was that I had to face the threat of giving birth without him, and for the first time, it felt terrifying. Hmm seems my subconscious knew what was in store better than I did. 

MY BIRTH STORY

Membranes rupture

  

This begins like all good stories... with a wet spot. I woke up from my very vivid dream at 5am, completely pain-free surprisingly and rather flustered. I lay in bed for a few minutes trying to remember what the pain was like and whether I could handle it in the dream. Failing miserably, I rolled over to hold my husband who, unlike the man in my dream trying to get off the plane without me, was fast asleep and not going anywhere. As I turned I felt a damp patch between my legs. Now, even though I knew the Hollywood-type fountain of water wasn't a common occurrence, I still felt that water breaking would be a little more in your face than a 5x5cm inconspicuous wet spot. So I woke hubby and we proceeded to poke, feel and even smell the spot. Yielding no obvious conclusions, I deduced that if my bladder was still full, I couldn't have wet my pants, and it must be amniotic fluid. So off I went to the toilet... and peed... a lot. As I came back to tell my now fully awake hubby that today may be the day, another few millilitres of fluid spilled out. It was confirmed, my water had broken.The next few hours was spent trying to get some sleep to prepare for the exhausting day ahead. I confess I was far too excited to sleep and lay in bed fantasising about holding my baby for the first time. Not once was I afraid for what was about to happen. 

 Contractions begin

We waited till 7am before calling my midwife to give her a heads up and the hospital to book a private room. At 8am I started feeling pains in my lower back, which felt suspiciously like period cramps. They were mild and fleeting and disappeared completely for about 30minutes. Sr Ciska's advice was to come to the hospital when the pain became really unbearable, and to forget about timing the contractions. (note that this was safe advice as, because I was a first time mom, labour would progress fairly slowly. Please make sure you discuss with your caregiver before doing the same) I busied myself with repacking my hospital bag and readying the nursery. I had planned to go for a walk but the amniotic fluid kept coming in gushes, and I went through a pack of maternity pads before I even left for the hospital. I also planned to have a bath with my homeopathic BirthBath drops but once your water breaks you need to try and stay sterile down there, so I had a long shower instead. 

I was drying my hair when the contractions really started in earnest. I remember having to stop what I was doing and fully concentrate on the few seconds of pain, while doing deep long Yoga breaths. Done properly these contractions last about as long as 2 breaths, and this was totally bearable. I walked around the garden a bit after that (I'd read that walking helps bring baby down and aids contractions efficacy) and each time another contraction started I shouted for my husband so I could hold onto him. Its hard to explain what they felt like, as you've no doubt heard, the brain deliberately erases memory of birth pain so that we can continue reproducing I suppose, but I do remember that it came in waves of increasing then decreasing intensity. So the beginning and end is easy to ride, and there's enough warning to get ready to brace yourself for the crescendo. We practiced a few positions in antenatal classes to aid the pain during labour, and the ones that worked best for me were initially standing and holding onto my husband when the pain came then later squatting between his legs, letting him hold me through the pain.   

http://www.qcmb.org.au/news_details/news/upright_positions_in_labour_and_birth

I must emphasize that between contractions you really are completely functional and totally pain-free, and at that stage there was more than enough time to move around and do what I had to do between pains. When the pain became really intense and I could no longer walk or talk through it, we got into the car and made our way to the hospital. Incidentally contractions were now 6 minutes apart and it was midday, 4 hours after contractions began. When you're in labour, time is measured in contractions, and 4 hours is really nothing if you look at it that way.

Arriving at the hospital

By the time I reached the hospital, they were so bad, I had to wait till a contraction passed before getting out of the car. As I got to the reception desk another one hit and the porter came rushing with a wheelchair. I had 2 more contractions before we reached the labour ward. My mother met us there with snacks and energy drinks and I spent some time rocking on the birth ball before my midwife arrived. 

When Ciska assessed me I was already 6cm dilated and she suggested we get straight into the birthing bath, which is simply a really big bath. Having her there was like having the conductor at an orchestral performance, completely indispensable. She knew from my facial expressions how far I was and she knew exactly what would relieve my pain at which time. In the bath she got hubby to pour hot water onto my lower back during contractions while mom sang lullaby's in my ears between them. She urged me to drink all the time and eat if I could (which I couldn't) When the warm water started slowing the contractions too much she got me to get out and walk for a bit. The gravity made the contractions come really powerfully so she assessed me again and found that there was a lip of cervix not completely dilating. The most painful part of all was when she had to manually move that piece of cervix over baby's head at the most powerful part of a contraction. I screamed till my throat was raw, which made the pain in my pelvis a lot more bearable. I screamed so much during my birth that the lady in the room next door opted for an epidural before her pain even started. I moaned, I sang, I swore, I screamed... and I will do it all again, because sounding your pain is the best way to let it go, and I let it go till the cows came home! 

On the bed Ciska offered me some laughing gas, which I grabbed thinking "what the hell, it's something to do" I took a few deep sucks on the mask and felt absolutely no different. She also showed my husband how to put his whole weight on the side of my pelvis while I lay on my side. Either the way that this moved my pelvis helped the baby move down or the pain of his weight distracted me from the contraction, but this really did help me and I felt strong enough to get back into the bath. Ciska showed mom and hubby how to massage me in different places at different point in labour and I can't tell you if this made a major difference or not but they used Heavenly Labour aromatherapy oil throughout, and the smell was at least a distraction from the clinical birth room.


There is a point in your labour, if you're lucky enough to experience it, called the transition phase. It is essentially the last 2 to 3 hours of contractions and a period where baby really settles deep in your pelvis. My own experience of this phase was that just as you get used to the pain (a kind of intense, deep lower back / period pain), it changes and suddenly its a whole new kind of pain (something more like your lower pelvis widening) I also felt myself go into a more trance-like state, during which everything else in room disappeared, and it was just me and the pain and the moaning. It was at this point that I very bravely told my mom to "shut the f*** up!", as every sound or movement or sensation takes you out of your trance and you feel the pain more intensely. Ciska's advice during this phase was to hold onto a pole, stand up in the bath and gyrate my hips with the pain. My mother (who forgave me quite easily thank heaven) later described the scene "like watching an Amazonian princess do a strip dance in a trance" I remember looking at my husband while feeling my eyes roll backward in my skull, and seeing tears in his eyes. All he could do was mutter "wow, you're amazing...

PUSH!!!!

Throughout all this otherworldly type drama, Ciska kept asking me if I was feeling like bearing down. I really didn't know what that was supposed to feel like till I felt it. Its such an obvious urge to push, you can't imagine. My plan was to have a water birth and have my baby be delivered through the water. (Benefits of birthing this way has been demonstrated for years and there is endless amounts of literature to this effect online) As soon as the urge to push began I knew I had to get out of the tub. You see, Vincent Palotti's baths have no handles and therefore there's no traction against which to push. I knew that I was going to push with all my heart and there was no way I could do that in a slippery bath. So I got out the bath and Ciska pulled out a marvelous invention that I had never seen before... a Birth Stool. 
 

Birth Stool: Courtesy of http://inspiredlivesobrien.blogspot.com/

It basically allows you the benefit of squatting (gravity, compressed abdomen, open pelvis) plus it's less physically exhausting and has handles to provide counter traction. To me, in my Amazonian trance, it seemed like it had built for what my body instinctively wanted to do. I sat down, got my feet up onto the stool (which Ciska said she'd never seen anyone do before) held onto the handles, and with my husband squatting behind me and holding me tight we waited for the contraction to come so I could push. 

When that urge comes it can only be described as an unbearable urge to pass a stool. It literally feels like there's a brick up your bum, and if you don't push it out, your bum will explode. (forgive my bluntness, I was in a trance) What happens when that urge begins is that you find all the energy you can muster after being in labour for 8 hours, which isn't a lot, and you press like you've never pressed before. This is where most epidurals fail a patient... without that unbearable urge, there's little motivation to find that hidden little pocket of energy deep in your soul, and you find that doctors have to do episiotomies, vaccuum extractions or forceps deliveries to get the baby out. 

My mom placed herself right in front of the action so she could be the first to see her grandchild and Ciska opened the delivery tray and put on her gloves. It took about 3 pushes before my mom started crying and saying "I can see the head baby, I can see the head!" I then fought my way through another 3 before baby's head was completely delivered. Mom was at this point sobbing her heart out and I was about ready to pass out from exhaustion. I knew the shoulders still had to come, but that essentially the worst was over, and that overwhelming sense of imminent relief motivated a final surge of energy.

What I had forgotten was that there is a brief moment when you really shouldn't push and that moment is to allow the baby to rotate its body so that one shoulder is delivered at a time. As Ciska screamed "OK Leilatjie, now pant when the pain comes and DON'T PUSH", I couldn't help myself, and screamed "I have to!!!!!" Had she said that it only takes a second or 2 and that I would probably tear if I pushed, I may very well have fought the urge and bitten back for a few more moments, but all I could think was "I can't go on any longer" and pushed with all my might... so at 4:35pm... my beautiful baby was born.

A baby is born

The feeling for every mom as they hand you your baby must be the greatest in the world, or so I thought. I remember feeling like I was a million miles away, what I imagine a near death experience to feel like (I'm sure there's an irony in that, but its too deep to delve into in this forum) and all I felt was an overwhelming relief for the longest time. The baby in my arms was mine and I instantly loved it, but it was still a "it" for quite a while. We let the cord stop pulsating before the clamps were applied and my husband 'cut my baby from me'. Again there is lots of literature for and against delayed cord cutting but I weighed up my priorities and decided to wait till nature was ready for me to let go. The placenta delivery happened effortlessly and soon afterward.

If any of you meditate deeply, you will know that eating something settles the energies and kind of 'brings you back to earth', well I experienced that first hand when I suddenly felt myself slip back into myself the minute I took a bite of the sandwich next to my bed. I suddenly became aware of the fact that the baby in the room belonged to me, and that the person who had been growing in my womb was finally here to meet me. That moment was the greatest in the world and I almost wanted  to do it all again, just to feel that high one more time. 

An unfortunate side effect of coming back into one's body is of course feeling pain again. And a strange stinging was happening between my legs. The one thing I didn't prepare for, and the one thing I most expected to happen (talk about manifesting your reality), I tore. It all happened in the moment that I pushed instead of panted and I didn't feel a thing until that moment, which was actually Ciska injecting anaesthetic to sew me up. It wasn't a bad tear thankfully, but did interfere with me getting up and walking out of that labour room. Ciska had mom run me a new bath and baby and I had our first bath together before facing the world.

So there I was, smiling more in my soul than on my tired face, being pushed in a wheelchair to my hospital bed, holding my little newborn tightly to my chest... proud to have earned the new title of "Mother".   

 

Comments, questions, criticism? 

Please feel free to share

"In the beginning..." My birth plan

The beginning is the most important part of the work.

Plato (BC 427-BC 347) Greek philosopher.

Today my blog is dedicated to a friend who wrote the following message:

Hi leila.
Was reading your blog, very useful:) I'm 24 weeks preggies, looking forward to my little guy/girl. Please detail your labour, I would really like to know what I can do to prep for it, etc. And discuss your own experience, did u use a midwife, where u gave birth, what u did for pain relief, did you tear, how can you prevent tearing, would you recommend a midwife, etc. Would really like to learn all I can:))

So in reply as promised, even though I did say I didn't wanna write about it...

Dear anonymous friend :)


The following story is mine. Each and every step detailed was taken by me, because of who I am, because of my beliefs and what knowledge has come to me by the grace of God. Your story is your own, and the choices you make will depend on your life story, please don't let mine influence yours and don't ever let someone else's make you feel as though you should have done differently. I hope that by sharing with you, all I do is illustrate that there is much more to your birth than you are led to believe, and that every step is yours to choose, as long as you are equipped with the right knowledge. So without further ado here is...

MY BIRTH PLAN

(They call it a birth "plan", because like all plans, its completely hypothetical and very rarely has much to do with reality) The first thing I did was think about what I wanted in the following salient points, in no particular order:

• WHICH HOSPITAL
• WHICH OB GYN
• DID I WANT A MIDWIFE, IF SO WHO
  
• DID I NEED ANTENATAL CLASSES, IF SO WHO
• WHAT KIND OF BIRTH
• WHICH INTERVENTIONS
• WHAT KIND OF PAIN RELIEF
• WHO WOULD BE WITH ME
  

I started, like most people do, with a gynae. As a GP myself, I know its the first thing you suggest to a newly pregnant mum. I now know that this is completely the upside down order of things. Nevertheless, I had an excellent gynae, Dr Elmarie Basson. She works from City Park hospital, and I was quite happy with traveling to town to deliver. We saw her for most antenatal visits and I loved her. I already knew that I didn't want a C-section, which everyone seemed  to be very surprised about. Apparently medical professionals historically prefer Caesarians (horror of horrors, though who am I to judge) because they've seen what natural birth does to a woman. I've seen what an operation does to a woman too, and I'm still sure I chose the path of lesser evil. Seeing the intense pain and difficulty moms have to endure after Caesars, just makes me more sure. I'm also a au naturale kinda doctor and in my mind the 'rite of passage' is beneficial in more ways than simply the randomised-trialed-scientifically-proven kind.

I also knew I wanted to give birth in a hospital. As much as I believe in the will of God, I believe that we have to be as prepared as we can. My lounge just didn't feel like the place I could be prepared. Ideally I would have liked to have all the women in my family present, but that number of women talking about the intimate details of my birth for years later scared me a little. The people who finally won the toss was of course my mother (who already had experience in happily delivering 3 children in exactly the way I wanted... quick and easy) and my dear husband (who was mostly chosen because he would have cried if I didn't choose him). To be honest I truly believed that he would faint in the first few minutes, before actually getting a chance to say something useful like "Are you a man or mouse?!" or "Pain is your friend!".

Things took an odd turn when we started talking to my gynae about the birth (this oddly only happens quite late into the pregnancy, for me it was around 24 weeks) I really wanted my own midwife as I'd heard that laboring with a midwife had better outcomes for baby and mommy, and I've delivered enough babies to know that things would be a lot more pleasant if you had a friendly, familiar (professional) face helping you through. 

Problem number 1, Dr Basson does not work with midwives at all, ever, full stop. I was willing to overlook this issue, and as one does with plans, started working on plan B. The plan without a midwife.

Problem 2 arose when I went and visited City Park hospital. The staff were incredible and as I'd worked in their trauma unit, I already felt at home. But the labour ward itself was in a bad state as far as private hospitals go. It was 2 or 4 women sharing a ward, with dirty windows and dodgy 1980's floral curtaining. The labour room was dark, small and scary, the passages were really narrow and there was only one bathroom on the floor. I hope I'm not coming off as a snob, but hospitals are expensive, I didn't wanna feel like I was staying in a cheap hotel during the most important event of my life, not at that price. I also wanted to feel that I could relax in hospital for a day or 2 before entering into the great abyss of mommyhood. Sharing with 3 other women and crying babies is not my idea of relaxation.

I visited Cape Town mediclinic that same afternoon, and in sharp contrast it had all the makings of a good homely hotel, but it also felt a little too homely and I was sceptical about the clinical care. Speaking to Dr Basson later that day, I discovered that the clinical care at mediclinic was indeed not up to scratch and she had had too many bad experiences at that hospital. She refused to deliver my baby there and we made a decision together that I be transferred to Dr Jacky Searle at Vincent Palotti.

Dr Searle was incredible. She saw me quickly, we got along really well and as luck would have it, was happy to work with a midwife. I was over the moon about delivering at Vincent Pallotti as it was almost my second home, having worked in their trauma unit for years, and also because my practice is right next door. 

I really started researching birth options in earnest at this point, having learned my lesson for leaving it to the end. I also knew that my midwife would want to know what my plan was in more detail. 

Having spoken to every mother and pregnant woman who walked into my practice doors while I was pregnant, I knew that most women have epidurals. I also knew that most women are offered epidurals before they've even really felt the pain of labour. What I learnt in medschool was that epidurals increase your chances of needing some sort of assistance in labour eg episiotomies, vacuum extractions, forceps delivery, Caesarian sections... all of which I knew for a fact I did not want, and that like anything, they do carry risk, sometimes with devastating consequences. Of all the female patients I'd spoken to, only 3 had natural births with no epidural or other pain relief... only 3. 

Armed with this knowledge I marched off to meet Sr Ciska at Birth Options in Plumstead. You know when things happen in your life that change your life forever? That's what happened when I met Ciska. She was so wonderful and so calm and so confident that I suddenly felt I could do anything. For the first time in my life, I considered having natural birth without pain relief at all. I say no pain relief because I knew that I didn't want anything that could harm the baby in any way from the start, so medical pain relief was out anyway. Just because I considered it, doesn't mean I believed that it would happen, but I did start to think about how wonderful it would be if I really could labour my child like our mothers and grandmothers did... screaming with all their hearts!

Both Ciska and Jacky recommended I go to Emma Numanoglu's antenatal classes, called Me a Mama in Rondebosch. I hurriedly dragged my hubby off to the first available class and once again felt like everything was going to be different from that moment. I could go on forever about how fantastic these classes were. I mean I thought I knew it all and was just going so my hubby wouldn't be a blithering idiot in the labour ward. Turns out she taught me more useful information about birth than I ever learnt at med school... and my hubby definitely wasn't a blithering idiot, he ended up being completely indispensable!

The thing that Emma said though, that made the greatest impact, was something I really already knew... THE PAIN ENDS! I mean, I know it ends eventually, but it comes in contractions. So each contraction is a tiny little bite sized, manageable fraction of pain. OK that's over simplifying it, but the little detail that I was missing is that you only have to be strong for a minute, then God lets you rest and get your strength back. Granted it gets stronger and closer together as time goes by, but by the time its on top of each other, you're almost ready to push. To give you an idea, contractions can be 20 minutes apart and last 30 seconds at first, increasing to about 60 seconds long and 5 minutes apart in active labour.
 
 I mean that's doable right?

Yea I thought so too, so I started focusing on having a pain killer free birth. What I learned was that women who go to hospital too early have a greater chance of needing intervention... so I planned to go as late as possible. I also learned that the breath is the most important factor in relieving pain... so I learned how to breathe properly in labor. (Funnily enough, and remember this, panting is only effective when you have to hold back the urge to push, the rest of the time deep, slow Yoga breaths really do wonders to make contractions seem shorter and milder.) I learned that warm water has amazing pain relief qualities... so I made sure that Vincent Palotti had a laboring bath. I also let Ciska know that she was not to even mention pain relief to me during birth.

 The next hurdle I wanted to overcome was the dreaded vaginal tear. My big fear was having a third degree tear (that means right through to the bum :( ) and I knew this was one thing I couldn't prepare for... or could I? I discussed my fear with Ciska and she said, "oh yes you can", and lo and behold she pulled out a little torture device called an Epi No, birth trainer. This little device is essentially so you can practice 'giving birth' to an increasingly larger balloon, meant to mimic a baby's head. The balloon is inserted and then pumped up gradually more and more each day till it actually gets to the size of a baby's head (yes you can scream now), and after allowing it to stretch inside you, you then exercise your pelvic floor muscles by pushing it out.

Readers, I'm game for anything, in Survivor I'd be the one eating the snake testicles... but this I could not do. I tried though... twice. It is as painful and uncomfortable as it sounds, and even more embarrassing. I found myself thinking, I'm gonna go through this once with the reward of my baby at the end, why would I wanna put myself through it 20 times before? (with the reward of a big blue balloon no less) I also couldn't go through with asking my husband to assist with the delightful 'perineal massage' suggested in antenatal classes, as attractive as the hairy vagina was in the 1960's diagramatic representation (that's not very, in case you were wondering) So I decided to let this one slide, and leave the laxity of my perineum up to fate.

The next glitch came as I patiently waited for my due date to arrive. The glitch part happened when the day came and went, and I still had no sign of imminent labour. I had many friends and patients who were induced because of going past their due date and I'd seen many of those have to have an epidural because the pain is so much more intense, or worse, move to Caesar because of failure of labour to progress safely. I also feel more than know, that a baby and a mother should be ready to bring that child into the world, and science doesn't have the capabilities to assess that readiness on every level yet. So, knowing that I didn't want to be induced into labour, the passing of my due date came with a bit of anxiety. I spent the last few of my uncomfortable, bloated pregnant days first googling "natural labour inducing methods", and the rest of the time, swimming furiously, eating Basil, getting acupressure massages and swallowing Evening Primrose Oil capsules.(This was the most comprehensive list I found btw - http://wrylilt.hubpages.com/hub/Ways-to-induce-Labour-Naturally) It was somewhere in this time that I also came across some homeopathic aids to labour. I bought the Feel Good Health labour remedies:Birth Drops (to drink during labour to assist the process); Heavenly Labour (a massage oil to encourage contractions and assist in pain control); and BirthBath oil (a bath oil to add to the birth water in first stage, to facilitate labour)

So finally, a week later than expected and the day after spending an entire day in the pool, swimming for my life, I woke up with a suspicious wet spot on the bed...


to be continued...

 

If your birth plan was similar or completely different, or even if you didn't have one, please share your comments for our readers...

Mother's milk - Breastfeeding 101 - Part II (Cracked Nipples)

BREAST FEEDING 101

When things start to go awry, as they do and eventually will. Remember this...

"This too shall pass... 

only to give way for the next crappy thing to happen... but eventually that too will pass and you'll be breastfeeding with the best of them!"

With that I will attempt to draw from the deepest trenches of my memory all the things that went wrong first on the path to breastfeeding my baby...

CRACKED NIPPLES

 

 

hypothetical pictures of cracked nipples... not mine thankfully

This horrible affliction started rearing its ugly head around day 4. It isn't easy to recognise at first because new mom's tend to feel like sore nipples are a right of passage and so don't act at the first warning sign of pain. A baby's suck should not be painful, and if it is, you are about to get cracked nipples. Someone did tell me this before but I think the difficulty arises when you're really not sure what to do or when the pain is bad enough to start panicking.

These are the steps I was taught to follow eventually:

1. Correct your latch Correct your latch Correct your latch (see http://hushabymom.blogspot.com/2012/03/mothers-milk-breastfeeding-101-part-i.html )

2. Start using the correct nipple cream. Not every nipple problem will be sorted by using a bit of Lansinoh or Bepanthen, though most will be helped, sometimes you need an antibiotic cream, a cortisone cream or an antifungal cream. What I needed was a combination, a cream called All Purpose Nipple Cream  It has to be prescribed by your doctor, though most have never heard of it. I sent the recipe to my doctor and had him write me a script. I used the cream after every feed till my nipples started healing then alternate feeds and eventually once a day. There is no need to wipe it off before a feed as the dosages of steroid or antibiotic is so low, it won't affect your baby. I also used Calendula pillules in homeopathic concentration as well as homeopathic Herbaforce Graze and Weeping powder (usually used for keeping baby bellybuttons clean and dry)

3. Try to feed baby on the other side for a bit first, before feeding on the cracked nipple. Babies will suck more gently if they're less hungry, easing the strain on the nipple.

4. Air your breasts. I spent the better part of 2 weeks walking around my home topless, holding a bra under my breasts to catch the leaking milk. At night I slept topless with a towel around my waist and linen savers on the bed. Alternatively buy something called breast shells. They cover your nipples under your bra and even catch milk to be used later if you want.

5. If it is unbearable and you're bleeding everywhere, including your baby's mouth. rest your nipples by using a breast shield while feeding. Do not be tempted to buy a cheap one. I tried 4 different kinds and eventually the best one was the large Medela brand. Wearing it is supposed to take the pain away completely but cannot be worn for too long. So after about 3 days rest, take the shield off for alternate feeds for a day or 2 before weaning completely off.

6. If you are able to, get to a physiotherapist or get one to come to you with a lazer machine. I had mine lazered twice in hospital before I was discharged and then again after the cracked nippled recurred a few days later. Feeding will be painless after lazer, but if you don't correct that latch, it will be back in full force very quickly. My physiotherapist was Ruth Katzman, as you will read, I recommend her with all my heart.

7. Alternative feeding. Obviously you want to avoid this as long as you can while you baby is still learning to latch correctly, but if things get so bad that you become depressed or can't handle the pain, give your nipple a break for a day or 2. Luckily I only had one cracked nipple so I fed with the good side then at the next feed I rested and gave expressed milk, then fed the good side again at next feed. ask dr sears has an excellent article about alternative feeding methods. Remember that all equipment used to feed must be sterilised first.

I started by cup feeding, using the top of a small bottle. Baby really struggled and fought the cup. We also tried a proper feeding cup that was given to me by our physiotherapist, that was only slightly better. I then tried to feed her with a syringe, the difficulty with that was that I couldn't control the amount of milk being forced out and ended up spilling most of the milk and baby nearly choked. If you do try syringe feeding, I would recommend using a very small syringe, even an insulin size one (without the needle of course) and feeding slowly through the corner of baby's mouth.I also attempted spoon feeding, but it took too long and we spilled so much of the milk that I had to express more than double what I needed. I finally resorted to having to bottle feed, but only did this once a day and used a nipple shield for the rest of the day. Please read my entry on bottle feeding before choosing this route, as tempting as it may be, be sure it's something you want to risk.

8. Take drugs! Pain restricts healing and is a definite trigger for depression. The best kind of over-the-counter relief is Ibuprofen. Don't be tempted to use anything with Codeine, it's favourite side effect, constipation is a fate worse than death at this stage (especially if you've had an episiotomy or vaginal tear) Ibuprofen is fine in lactation and is a very effective anti-inflammatory. I used Voltaren in conjunction with Paracetomol every 8 hours.

9. Try different feeding positions. Another position could ease the strain on your nipple, but that still doesn't mean you shouldn't work hard at correcting your latch!

9. If things still don't get better, see your doctor. You may have a deep nipple infection that the antibiotic ointment cannot sort out. This could lead to mastitis so don't ignore it if you have pus or a lot of redness around the crack.

Remember this....

Cracked nipples are no reason to stop breast feeding! It won't harm baby, not even if you or have an infection and not even if she's swallowing some blood, the only thing that may harm her is if she isn't getting enough milk, so be sure to get the help you need when you need it.

Don't forget to share your breastfeeding make or break moments in the comment box

“I know what I have given you... I do not know what you have received.”
― Antonio Porchia

Happy Mother's day!

Happy mother's day to you new mothers and new mothers to be!
Today is my very first mother's day and to be honest, it doesn't really feel as dramatically earth shatteringly wonderful as I expected it to all these years. We've been so conditioned to believe that its about the gifts and the flowers and the breakfasts in bed that when our babies are too small to do any of those things (and we have the kind of husbands that ask you to make them breakfast and leave you to change nappies and dress babies - I'm very sorry about that by the way *big hug* and *fat smack* to the neanderthal hubbies) then it seems as though mothers day really is just another day to be annoyed at everyone else with flowers and restaurant reservations (maybe thats just me but Valentines day reaaaaaaaaally gets me going!) 

But writing this, while holding my sweet little angel face in my arms today and seeing her smile and coo up at me, I realise that she loves me just as much as she did yesterday and every other day since she was born (which more than anyone in the whole world right now), and that she is so blissfully unaware of this day and its etiquette, makes it all the more precious.

Today mother's day for me is about loving my daughter and being grateful that I have the pleasure of dressing her and changing her nappy at all... and let me take back what i said earlier... it IS completely earth shatteringly wonderful!!!!!