Establishing a Good Breastmilk Supply: Part One

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Even before a baby is born, many people worry about breastfeeding. Some common concerns we hear from both our doula and lactation counseling clients at Bravo Birth DFW are whether they will have enough milk to feed their baby, whether their baby will be able to latch properly, and whether they will experience pain while nursing. It’s normal to be concerned about these things, but knowing what to expect ahead of time is one of the first steps to successful breastfeeding. Gaining confidence through education and avoiding common mistakes from the very start can help set you up for a positive and long-term breastfeeding relationship. We are here to ease those fears as we explore methods for establishing a plentiful milk supply in a two part series.

First, in order to understand what steps to take to establish a good milk supply, we need to understand the basics of how breastmilk production happens. There are two hormones in the body that control lactation: prolactin and oxytocin. Prolactin makes the milk and oxytocin allows the milk to flow. Both hormones are controlled by the pituitary gland. Outside stimulus can either inhibit or encourage the pituitary gland’s production of these hormones. The following suggestions can be used as a guide to positively affect an increase in the hormones that create a solid milk supply after birth.

Immediate & Regular Skin-to-Skin Contact
Skin-to-skin contact is extremely beneficial both to parents and babies for many reasons. The myriad of benefits that skin-to-skin provides are deserving of a blog post of their own, but for now we’ll focus on the specific benefits as related to establishing initial milk supply. Immediate skin-to-skin is done simply by placing the baby directly on the birthing person’s bare chest or abdomen after birth and remaining together, with minimal interruptions, for at least an hour. This promotes an increase in oxytocin, which is necessary for milk production.

Additionally, although a newborn’s eyesight is generally poor at birth, they do have a well-developed sense of smell. They are very receptive to their own mother’s scent, so being in close proximity to the scent with direct contact to the skin can help attract and guide them to the source naturally, without much coercion. Babies who are immediately placed skin-to-skin have a higher chance of latching to the breast soon after birth, and suckling within the first two hours after birth is positively associated with an increased milk production throughout the duration of the breastfeeding relationship. Those early moments really count; however, skin-to-skin is highly recommended and continues to offer many advantages when practiced as frequently as possible.

Self-Attached Latch
Proper positioning of the breast in the baby’s mouth is essential to stimulating those milk making hormones. Prolactin is increased with nipple stimulation and oxytocin is increased with nipple stretching. Both of these actions are accomplished with a correct latch. But, how is proper latch achieved? In our experience, it seems most people have been taught to hold their breast a certain way, wait for the baby to open wide, then shove the nipple in their mouth and hope for the best. This isn’t the best plan of action to get a proper latch. Luckily, a “less is more” approach is generally more effective. Healthy, full-term infants are typically born with the innate ability to latch without a lot of assistance.

To begin, hold the baby and inch or two from the breast with their tummy turned toward you, keep their shoulders and hips aligned, and their hips flexed. Ensure that your hand is supporting the base of their neck, not on the back of their head, inhibiting their movement. Allow their hands to move freely and touch the breast. Position the baby’s nose, not their mouth, in front of your nipple. As you draw your baby closer to the breast, their natural reflex response is to tilt back their head and open their mouth wide. If the baby does not gape their mouth, this step should be attempted again. As the wide gape happens, allow their bottom lip and tongue to reach the breast first, before the top lip. The nipple should fill the top half of their mouth. Keep their nose and chin close to the breast during the feeding.

There are several things to look out for when checking for a proper latch. The top and bottom lip should flange outward, creating a seal around the breast, rather than curl under. The angle of the corner of their mouth should be wide, not pursed. More of the lower part of the areola and breast should be drawn in and their cheek line should be rounded. Their chin should rock back and forth, toward and away from the breast, not up and down. Every 1-3 sucks, the baby should swallow.

It may take some practice, but, allowing the baby to utilize their reflexes and self-attach, rather than manipulating the latch, can be highly beneficial to achieving proper positioning, preventing pain and nipple damage, and low milk supply issues. In some cases, a poor latch can be the result of an underlying issue and continued problems should be evaluated by a qualified lactation professional, as soon as possible.

Nurse on Cue, Not on Schedule
Even though babies can’t yet speak at birth, they can communicate their needs in a variety of other ways that often go unnoticed. Being able to identify these early feeding cues is important. The best time to begin a nursing session is when the baby is exhibiting feeding cues while in a state of REM sleep. They should not be woken from a deep sleep, only during lighter, REM sleep. In this phase, their eyes are closed but they may exhibit eye movements, eyelids fluttering, suckling motions of the mouth, and subtle body movements. If a feeding isn’t initiated during this phase, the second best time to begin is during the quiet-awake phase. Generally, when a newborn first wakes, their bodies are still, their minds are alert, and they are quietly observing the sights and sounds around them. This is another cue that it may be time to breastfeed.

If the opportunity to nurse is missed during REM phase and the quiet-alert phase, infants may begin to demonstrate more overt feeding cues. Some of these cues include rooting- turning the head with searching movements of the mouth, lip licking, hand to mouth movements, sucking on fingers or anything within mouth’s reach, fidgeting, and sporadic fussing. Crying is a late hunger cue and doesn’t usually begin unless other feeding cues have been missed. It can be difficult to achieve a proper latch when a baby is agitated, so it is best to begin before this stage. Additionally, stress for the nursing parent and the baby has a negative effect on oxytocin. If your baby is crying and upset, soothe them first and begin the feeding when they are calm.

Recognizing these early feeding cues requires staying near to your baby. This is why keeping your baby out of the hospital nursery when possible can be very beneficial to breastfeeding success. Many hospitals have made rooming-in the standard, and because of that, breastfeeding rates have improved.

In order to establish a plentiful supply, infants need to nurse a minimum of 8-12 times a day. When feeding cues are disregarded and a feeding schedule is implemented early on, prolactin levels decrease, which inevitably means less milk is produced; therefore, putting babies on a feeding schedule, while sometimes convenient, may override your body’s signals to produce milk, resulting in low supply, poor weight gain, or even premature weaning. Feeding schedules are not recommended until milk supply is fully regulated, which generally occurs between 6-12 weeks.

While there is more to consider when creating a positive breastfeeding experience, these initial steps are key to success. Stay tuned for Part Two in our Establishing Breastmilk Supply Series! So much more important information is to come. If you are in need of a lactation counselor in Fort Worth, Dallas, or the surrounding areas, we are here to help. Please feel free to explore our lactation counseling page or contact us to set up an appointment.

What’s in My Doula Bag?

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Doulas have all sorts of tips and tricks up their sleeves to make pregnancy, labor, and postpartum a smoother process for birthing people. The majority of the work I do for you comes from my heart, my head, and my hands. In order to provide support, knowledge, and comfort, I don’t necessarily need a Mary Poppins-style bag with tons of trinkets; however, there are a few tools I occasionally use at births to improve your labor experience. Here is a private look into what items I keep in my doula bag.

The first item on the list is a rebozo. A rebozo is a traditional Mexican cloth woven by women for women. My gorgeous, authentic, deep purple rebozo is very special to me, as it was hand woven by local doula, womb care, and rebozo expert, Mayte Noguez of Womb Centered Care and her grandmother. I had the opportunity to take a workshop with Mayte where she taught about the uses of rebozo, as well as the history and cultural significance. The rebozo has many uses in the Mexican culture. It is worn as clothing, can be used to carry babies, and is often used in certain cultural ceremonies. During labor, a rebozo can be used in a variety of ways to help support the abdomen, put pressure on the hips to relieve discomfort, open up the pelvis, and much more. During prenatal meetings with our doula clients we discuss and practice the many uses for this extremely versatile tool.

The second and third items on the list are a rice heating pad and an ice pack. Heat and cold therapy both have benefits during labor. A warm rice pack can help relax muscles and increase blood flow, while a cold pack can help numb areas of discomfort and reduce swelling. A rice pack warmed in the microwave often feels good when placed on the lower abdomen or on the neck and shoulders. An ice pack may feel good on the lower back when experiencing back labor. Depending on the situation, we may alternate heat and cold, or just stick with one.

Item number four is an Elle TENS Unit. As a part of our doula support package, all of our clients are loaned a TENS Unit in the third trimester and we demonstrate how it use it properly. This device has a hand held control panel and four electrode pads that can be placed nearly anywhere on the body. Typically in pregnancy and labor, people choose to place the electrodes on their lower back. When the TENS Unit is turned on, it sends a very small electrical current into the electrodes. You can turn the strength up and down and change the electrical current to pulsate in bursts or a continues at a steady pace. It may sound frightening; however, it is very gentle, safe, and effective at reducing pain. The frequencies put out by the unit help block the transmission of pain messages to the brain. The electrical impulses also stimulate your body’s natural pain relief hormones. This offers a drug free alternative to pain medication, with less side effects.

Massage lotion is number five in my bag of tricks. Having a doula who is also a professional, licensed massage therapist can be a huge perk for Bravo Birth DFW clients. Massage is proven to increase labor hormones and decrease stress and pain hormones. Whether its a back and shoulder rub, foot rub, or a gentle hand rub as you drift to sleep, we want to provide an experience that is relaxing and as stress free as possible. The massage lotion we use is hypoallergenic, unscented, paraben free, and contains arnica extract, which is another all-natural pain relief substance. During prenatal meeting, clients are able to read the label of our massage lotion and even test a small sample to be sure there will be no negative reactions. If preferred, we can alternatively use good old fashioned coconut oil, or the lotion or oil of your choice.

Number six is a handy emesis bag. This one I always hope we won’t have to use, but it’s no secret that labor often causes nausea and vomiting. When I arrive at a birth, I generally take the emesis bag from my doula bag and put it right into my pocket. Nobody wants to be sick, but if the urge to vomit comes on quickly, I am ready and prepared to swiftly pull out the bag and hold back your hair or rub your back.

Number seven and eight: ponytail holders and unopened chapstick (not pictured) are a must in every hospital or birth center bag, but if you forget yours, no worries! I always have back ups. These always seem to come in handy at the right moment.

The only other things not pictured in my doula bag photo are my own personal items. I always bring a full change of clothes. You never know when you might get splashed from a birth tub or shower, or even other birth fluids! I bring personal care items like a toothbrush, mouthwash, and deodorant. There’s nothing more distracting than your doula trying to speak encouraging words in your ear, but all you can focus on is her coffee breath. I also bring my phone charger, a protein drink, healthy snacks, and a giant water bottle. I promise to never eat in front of you, but I do want to maintain my own stamina and strength to help support you during labor, no matter the length of time I’m with you.

So what’s missing from the bag? I used to tote around a birth ball, a peanut ball, and a pump to air them up. While I still believe these are extremely useful tools, the majority of hospitals and birth centers in Fort Worth and Dallas keep a full stock of them on hand. Using the balls they provide is a lot easier than traveling everywhere with my own. If you are planning a home birth and won’t have access to a birth ball during labor, I highly recommend purchasing your own. Not only will you most likely get a lot of use out of it during your pregnancy, but your baby will probably love to be gently bounced on it as a newborn as well. The other items I don’t keep in my birth bag that other doulas might are essential oils. I am happy to utilize whatever oils you provide, in whatever way you wish to use them. I think they can benefit birthing people in a lot of ways, but I prefer not to dispense my own. Everyone reacts to oils differently, and because I don’t want to cause any allergic reactions or respiratory issues for my clients, I only use what you provide.

All of these tools can be beneficial during birth, but even without them, having a birth doula by your side can provide an invaluable level support for you and your partner. To set up a free consultation to discuss how we can support you in your desires for childbirth, contact us here.

What’s Up With The Image Descriptions?

If you follow us on Facebook or Instagram, you may have noticed that we very recently started adding image descriptions in the captions of all of our posts containing photos. You, understandably, may have been wondering why. We have received some questions regarding our choice to incorporate this practice, so here is a simple explanation to clear up the confusion.

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Since the founding of Bravo Birth DFW, we have made it our mission to support, without judgement, all varieties of clients in the birth and parenting choices that are right for them. We strive to be inclusive regardless of race, color, religion, creed, sex, sexual orientation, gender identity, age, and ability. Part of this inclusivity involves making our online content accessible to anyone who wants to access it.

Thanks to the guidance of Inclusive Birthworkers of Tarrant County, we have learned that including descriptions of photos in the captions allows visually impaired social media users to utilize software that reads these captions for them. Without the description, the written caption may not clearly explain what is pictured in the photo. We believe everybody who wants to access these social media platforms should be able to, even the visually based ones such as Instagram, so we are willing to take this simple step to make someone else’s life easier.

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According to the Inclusive Birthworkers of Tarrant County Facebook page, this is a collective of various providers who have committed to practicing in an inclusive manner and support and hold each other accountable to this principle. It exists to provide competent, respectful care to all people during their reproductive years, and journeys to parenthood with a special focus on serving populations that are frequently marginalized in birth work, such as people of color, members of the lgbtqia+ community, people with disabilities, and people who may feel unsafe or uncertain seeking care related to pregnancy, conception, postpartum health, and parenting. Count Bravo Birth DFW in!

Because we haven’t always included image descriptions in our social media content, we are making it our goal to go back to our older photos and edit three captions per day to add the description. Do you have a suggestion on other ways for us to be more inclusive to a marginalized or underrepresented community? We want to know. We are always looking for ways to improve our business practices.

Delicious Pregnancy Green Smoothie

Leafy green foods and protein should be two very important aspects of a pregnant person’s diet; however, during pregnancy, it can be difficult to incorporate all the nutritious foods our bodies need every day. Not only do many people experience food aversions and have little to no appetite in the first trimester, you may also be low on energy and not entirely motivated to plan out well balanced meals. Combine that with the fact that the majority of us live incredibly busy lives that don’t allow for a lot of extra time to cook each meal from scratch and it can be a recipe for unpleasant and unwanted health problems. Enter this delicious green smoothie recipe that doesn’t taste like freshly mowed lawn clippings. Bonus: you don’t have to be pregnant to enjoy it!

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I will be the first to admit that if you want to stay fuller longer, its best to eat your greens instead of blending them up to drink them, but if you find yourself struggling to meet the recommended daily intake for vegetables or protein, this green smoothie can help tremendously. The nutritional benefits are still abundant and here’s why:

Kale
Kale is low in calories but high in fiber, vitamins A, C, and K, and calcium. Fiber can improve the dreaded pregnancy constipation. Vitamins A and C are important for a well-functioning immune system, that is generally weaker during pregnancy. Vitamin K strengthens your blood vessels, which is necessary when your blood volume increases.

Spinach
Also low in calories, spinach is rich in folate and iron. Folate is an essential nutrient in pregnancy because it can prevent certain birth defects and decrease your chances of premature labor. Iron can help prevent anemia, which is common during pregnancy. Spinach also contains calcium which is important for you and your growing baby’s bones.

Cucumber
Not only does cucumber greatly improve the taste of this green smoothie, it’s made up of 95% water, as well as magnesium and potassium. All three of these work together to keep you well hydrated. Cucumbers also contain several antioxidants, which have a variety of benefits relating to organ function, disease prevention, and your overall health.

Avocado
Just like many of the above green foods, avocado is high in Vitamin K, folate, Vitamin C, potassium, and fiber. What makes it unique compared to the other ingredients is it’s high fat content. This type of “healthy fat” is shown to reduce inflammation and lower cholesterol. It’s a key ingredient to this smoothie recipe because it’s going to help keep you feeling full and satisfied longer.

Mango
Mango adds a touch of sweetness to the recipe, but it won’t spike your blood sugar levels because of its low glycemic index. The enzymes in the fruit help to improve digestion.

Coconut Water
Coconut water is another excellent way to ensure hydration and prevent constipation. It can also help treat heartburn because it neutralizes acid in the body. It’s preferable to using juice in a smoothie because it is lower in sugar.

Lemon Juice
The lemon in this recipe really helps to neutralize the bitterness of the leafy greens without adding a noticeable sour taste to the drink. Lemons are powerful detoxifiers and promote a healthy immune system.

Protein Powder
In pregnancy, experts recommend 75 to 100 grams of protein a day. Protein is essential for fetal brain development. Any type of protein powder should be fine for this purpose, but if you don’t already have a specific brand you’re partial to, Rainbow Light makes a great plant-based, vegan protein powder formulated for pregnancy and postpartum.

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Recipe
Yield: 2 Servings
Serving Size: 8-10 ounces

1 cup kale, packed
1 cup baby spinach, packed
1/2 cucumber, sliced
1/2 avocado
1/2 cup frozen mango
1 cup coconut water
1/2 lemon, juiced
2 scoops of protein powder (optional)

Put the ingredients in your blender in the order they’re listed and blend until smooth! This recipe makes two 8-10 ounce servings, so you can share the other portion with your partner or children or you can save it in the refrigerator for yourself for the following day. It still tastes delicious, just make sure you stir it first, in case the protein powder settles.

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Pregnancy can be extremely depleting on the body. It’s crucial that we care for ourselves so we’re functioning at our best. Eating well by incorporating green foods and protein is a great way to help us thrive in pregnancy, postpartum, and parenthood.

Alexandra Bravo LMT, CLC
Owner, Bravo Birth DFW

Early Labor | What I Wish I Knew

Welcome to part three of our blog series entitled What I Wish I Knew. This series explores various topics related to pregnancy, birth, postpartum, and parenting that parents wish they would have known more about before they experienced them. You can find part one here and part two here. Our first two installments of this series addressed common postpartum issues, but today we’ll be addressing birth, more specifically early labor. When we asked our doula clients and social media followers about what they wished they would have known more about before going through labor, many parents expressed their uncertainty in knowing how to identify early labor signs, as well as what they should do when it begins.

What is Early Labor?
Early labor is the first stage in the labor process, during which your cervix begins changing. It is also sometimes referred to as pre-labor, or the latent phase. During pregnancy, a normal cervix is firm, closed, long, and pointing toward your back (posterior). In early labor, the cervix begins to soften (ripen), open (dilate), thin (efface), and move forward toward the birth canal. This begins to occur through a complex series of chemical and hormonal changes in the body. Early labor is defined as the period of time that your cervix is between 0-3 cm dilated. It is generally the longest and least physically demanding stage of labor.
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How Do I Know if I’m in Early Labor?
Oftentimes, early labor is so mild that you may not even notice it. Other times, you may experience some of the following symptoms:

• Menstrual-like cramps
• Low back ache
• Increased pressure in pelvis or vagina
• Fluid leakage from vagina
• Inconsistent contractions or contractions 10 or more minutes apart
• Increased vaginal discharge
• Bloody show
• Loss of mucous plug
• Nausea, vomiting, or diarrhea

If you think your water has broken, notice more bleeding than light spotting, experience severe pain, or a decrease in fetal movement, be sure to contact your healthcare provider.

What Should I Do in Early Labor?
Birth is often likened to a marathon. In a marathon, you want to avoid exerting all of your energy at the very beginning, so you will have the stamina to make it through until the end. The same is true for birth. If your mind and body become too fatigued early on, labor may become more difficult than necessary. So if birth is a marathon, rather than thinking of early labor as the beginning of the race, it may be helpful to think of early labor as the day or two leading up to the race. You will want to hydrate, eat well, rest as much as possible, and go about your life as usual. Don’t get caught up in the idea that you have to do anything to get active labor to begin. The time for that may come later on, but this is likely the only stage of labor that you’ll have the opportunity to rest comfortably through, so be sure to take advantage of that as much as possible. Although the thought of finally being done with the discomforts of late pregnancy and meeting your baby may be exciting, try to avoid doing too much physical activity which could exhaust you before the more strenuous work needs to be done.

In a high-risk or special circumstance pregnancy, you will want to discuss with your provider during your pregnancy what you should do in early labor. Some conditions may necessitate monitoring or intervention.

Doulas and Early Labor
If you have hired a birth doula, it may be a good idea to touch base with them during early labor. Although you likely will not need them to come to you right away, your doula can still be of importance during this time. They can help you differentiate between early and active labor, offer support and encouragement, and answer any questions for you. Communicating with your doula also allows them to begin to prepare themselves to be with you in a timely manner when you request them further along in labor.