Relactation: Can you breastfeed your weaned baby again?

November 2, 2020November 2, 2020Leave a comment

Just how easy is it to stimulate milk supply after stopping or induce lactation as an adoptive mother? Charlene Yared West explores the topic of relactation and induced lactation to find out more.

Firstly, what is relactation?

According to Leana Habeck, La Leche League Leader (llli.org/southafrica), there is a difference between relactation and induced lactation. “Relactation is about re-establishing of milk secretion after weaning baby from the breast,” says Leana. “Adoptive breastfeeding, also called induced lactation in a woman who was not pregnant with the current baby, may involve hormonal preparation (oestrogen and/or progesterone – simulating a pregnancy) followed by sudden cessation of the hormones (simulating a birth) and then the commencement of pumping or suckling and a galactagogue that increases prolactin secretion.” Internationally Board Certified Lactation Consultant, childbirth educator and midwife Emma Numanoglu explains the protocols for inducing lactation, developed by Dr. Jack Newman and Lenore Goldbarb, as involving a regime of taking the contraceptive pill together with domperidone. “A few weeks before the expected arrival of the baby the mother stops taking the pill, continues with domperidone and starts expressing milk (this mimics the process of pregnancy and lactogenesis after birth). This method has been used successfully and safely for three decades by many women who induced lactation,” she says. “A mother who is planning to apply one of the protocols will need to find a doctor who is supportive of breastfeeding, can explain risks and benefits of taking the medication, and is willing to take responsibility for prescribing domperidone in doses that exceed guidelines for licensed use.”

Commitment to breastfeeding is key to success

Relactation, explains Emma, is also an option for those mothers who have have decided to bottlefeed and have then changed their minds and wish to go back to breastfeeding, or even for those mothers whose babies are not tolerating formula well. “In my practise, this is the most common reason for relactation and the reasons are important as it requires quite a commitment from the mother. For example, if the baby is intolerant to the breast milk substitutes being given, the mother may be more committed to resuming breastfeeding,” she says. “It is important not to place emphasis only on her milk as evidence of success, as this can cause anxiety and thereby inhibit her milk production and ejection reflex. For these reasons it is important to discuss with the mother the benefits, the concerns and problematic elements of relactation.” Emma sees the most success in relactation with babies under three months, but older than that is not impossible, it may just take more effort. “Induced or adoptive lactation is becoming more popular. Mostly adopting couples and lesbian couples seek assistance in breastfeeding their adoptive baby.”

The aim is bonding and creating a milk supply

“For both adoptive breastfeeding and relactation, the aim is to bring about (or back) a milk supply and bring the baby back to the breast. These two are interconnected endeavours, as the best thing for a milk supply is to have a baby breastfeeding frequently and a baby is more likely to breastfeed or return to the breast if there is plenty of milk there,” says Leana. “The difference between the two is such that with a natural pregnancy the milk making tissues are built, whereas with adoptive breastfeeding (if a mother has never been pregnant) she may need hormonal preparation. For many adoptive mothers it may be more about connecting deeply with the new baby through breastfeeding, than producing large volumes of breastmilk.” Emma adds that relactation can fail if mothers are not given the correct support and professional advice preferably from an IBCLC or SACLC trained consultant and La Leche League leader. “Success also depends on quite a few other factors, such as the determination of the mother, no underlying medical conditions and the baby’s age.”

How the breasts work

Leana describes the anatomy of the breast as 10 to 20 branches (milk ducts), heavy with clusters of grapes all intimately bound together by interweaving vines and vegetation. Each single grape an alveoli or milk sack where milk is made and each alveoli is surrounded by a basket of muscle cells that squeezes the milk out into the ducts when it contracts. The 10 to 20 branches are all rooted in the nipple, though each nipple has only between four to nine openings through which the milk is excreted. “Baby’s suckling acts as a stimulus to mom’s body – sending a message to the brain to release the milk producing hormones, prolactin and oxytocin into bloodstream,” she says. “Prolactin, released with the Milk Ejection Reflex (MER), acts on the alveoli to produce milk and Oxytocin, released with the MER, acts on the muscle cells around the alveoli causing them to contract and squeeze out the milk towards the nipple.” It is important to note that large amounts of milk are not stored in the ducts before the MER and that the rapid sucking action of the baby stimulates the let down of milk. The most important thing is to ensure a good latch to help the MER during breastfeeding as well as a good breast pump to stimulate the production of milk too.

Methods of relactation

Emma recommends holding your baby skin to skin as often as you can, in a calm relaxed environment such as lying in your bed, in a comfy chair or even carrying them around in a sling at home. Directly feeding your baby from the breast is the most effective way to increase your supply or relactate. Offer your breast to your baby frequently when they are happy! Do not try breastfeeding when your baby is upset or irritated as it will be nearly impossible to latch them on. “This is an extremely important step. Although it sounds so simple, often this is how babies get interested in breastfeeding again.You can start pumping if you find your baby does not want to breastfeed for very long, or is not interested in taking the breast. Since you are trying to build your supply back up or induce lactation again, it is important to pump frequently,” she says. “If you can pump every two to three hours, that would be ideal. At night you can go for longer between pumping but try to get at least one pumping session in per night. When you start pumping you might not get any milk at all or just small amounts, just keep on going! Some women find it takes a couple of months to really get their supply going again, especially if their babies are not breastfeeding or are only occasionally breastfeeding.” She adds that women who have had an extended period of time since breastfeeding might find they do not build up enough of a supply to exclusively breastfeed, but most women will at least be able to partially breastfeed their babies and many women will eventually be able to exclusively breastfeed their babies.

What is a supplemental nursing system?

A nursing supplementer is a device that allows a baby to receive extra milk at the breast rather than by bottle and teat. It consists of a container that is worn on a cord around the mother’s neck. Fine tubing carries expressed breastmilk or artificial baby milk from the container to the nipple. When the baby sucks at the breast, milk is drawn through the tubing into his mouth, along with any milk from the breast. “Most mothers who have problems getting breastfeeding started will solve them without using a breastfeeding supplementer. Often all some mothers need is information and support. Talking the problem over with someone who understands and supports your wish to breastfeed and who knows a lot about breastfeeding can help you work through any problems. Often they will be able to suggest new ideas to try,” says Emma. “Sometimes, you can solve your own problems by learning more about how breastfeeding works. It is important that the baby is able to suck well at the breast, even if he tires easily, in order for the breastfeeding supplementer to work. A baby with a poor or abnormal suck may not be able to get the milk through the tubing any better than from the breast itself.”

I breastfed my adopted babyDanielle Bischoff is a photographer and storyteller and lives and works in Cape Town with her husband comedian, Rob van Vuuren and their six-year-old adopted daughter, Bijou.
“Rob and I both have adoption in our families and when falling pregnant became increasingly difficult and a cause of huge distress for us, the doctors said the only option was to go the IVF route. We both felt like we needed to take a breather from the whole thing and put the baby plans aside for a few months. We didn’t want to rush into a whole IVF mission. We felt that we had been through enough of a wringer just trying to figure out what the problem was. So we left it for a while. After a couple of months we both felt that adoption was the best way forward. I can’t describe it in any other way than I just new our baby was coming to us through adoption. I felt a deep connection and I had even chosen her name before our first meeting with our social workers. There was just this indescribable knowing that baby was on the way and I had to get ready. I didn’t even know that inducing lactation was a thing, but I was so determined to make it happen. So you can imagine the relief I had when contacting Internationally Board Certified Lactation Consultant Jean Riddler, who immediately promised she could help me. It was important to me for two reasons, because I didn’t get to experience a pregnancy I felt like I didn’t want to miss out on the experience of breastfeeding. I had also done some reading on all the amazing benefits. Strengthening the bond was a huge reason and because Bijou was adopted I felt like I had some catching up to do as I hadn’t carried her.I started on the birth control pill to mimic a pregnancy. I wasn’t really happy about going on the pill but as I mentioned before I was pretty determined about it. Once we got the news that a birth mother had chosen us and we had Bijou’s due date, we sped up the process by taking the vomidom (domperidone) and using a double breast pump to stimulate the breasts. This was honestly the hardest part of the whole business. There were moments while sitting there with pumps on my breasts with nothing happening where I really questioned my sanity. Anyway just over a week later the milk started coming out! I was totally amazed and in awe of the human body. I wasn’t able to produce enough milk to purely breastfeed which I was initially quite sad about, but after sometime I was just grateful for the opportunity. I soon realized that being able share the feeding duties with my husband was beneficial for all of us. So in the end we mainly bottle fed her and did top ups with breast milk. I breastfed Bijou until she was about two-years-old. It was a bit of a roller coaster ride to be honest. I felt emotions that I didn’t know I would have. The feelings of inadequacy I felt when I realized that I wasn’t able to purely breastfeed did overwhelm me. I felt like I had let her down and how could I be a mother if I couldn’t feed her. Obviously in retrospect I realize how irrational all that thinking was. Luckily my husband was there to help me through all that. It was totally worth every second on my mothering journey with my precious daughter.”

<Sidebar> PATIENCE AND PERSEVERANCE!Many women who keep persevering and gently encourage their babies to breastfeed while doing heaps of skin to skin with their babies do get results, says Emma. “Don’t give up. It just takes a lot of patience, perseverance and time. It will not happen overnight. Support helps too and is very important. Ask for help with cleaning, laundry, cooking and other household chores, while you focus on just being with your baby. Rest and just “hang out” with your baby.”

<Sidebar>Amazing motherhood hormonesAt every stage of motherhood there are hormones present to facilitate the changes taking place. In addition to a very long list of natural ingredients, breastmilk also contains the following amazing hormones: Prolactin is the hormone of milk production. The suckling newborn increases prolactin levels which physically works in creating more milk, and emotionally, prolactin encourages the mothering instinct of nurturing and selfless devotion to the baby’s health and well being. Oxytocin is known as a shy hormone and is present in orgasm, labour, birth and breastfeeding and causes the Milk Ejection Reflex (MER). Emotionally it is a bonding hormone, also known as the love hormone because it occurs at intimate, private moments of family bonding and love. Physically it is a contracting hormone and as such contracts the uterus in orgasm, facilitates contractions in labour and birth and allows for the milk let down as the milk ducts are contracted and squeezed to allow for milk to flow. Endorphins are the body’s own natural painkiller and can create euphoria and are released during sex and breastfeeding.

<Sidebar> A word on galactagoguesGalactogogues are medications or other substances believed to assist initiation, maintenance, or augmentation of the rate of maternal milk production. Human milk production is a complex physiologic process involving physical and emotional factors and the interaction of multiple hormones, the most important of which is believed to be prolactin, explains Leana. “One should caution against inappropriately recommended galactogogues prior to emphasizing the primary means of increasing the overall rate of milk synthesis, such as frequent feeding and regular draining of the breasts.”A galactagogue may be helpful to speed up the process but are not magic bullets, she adds. They provide building blocks for milk production but effective removal of milk is essential since milk supply seem to be calibrated based on how well the breasts are drained. “If baby is not breastfeeding (well) yet, it is advisable to double pump with a good quality electric pump using the hands-on method.” According to Leana, the currently available pharmaceutical galactogogues are all dopamine antagonists and will increase prolactin levels. Herbal remedies have been used throughout history to enhance milk supply. Some herbs mentioned as galactogogues include fenugreek, goat’s rue, milk thistle (Silybum marianum), oats, dandelion, millet, seaweed, anise, basil, blessed thistle, fennel seeds, marshmallow, and many others. “Although beer is used in some cultures, alcohol may actually reduce milk production. A barley component of beer (even non-alcoholic beer) can increase prolactin secretion, but there is no hard evidence supporting this,” she says. “Mothers wanting to make use of a galactogogues should contact their doctor for a prescription since La Leche League Leaders or International Board Certified Lactation Consultants are not allowed to prescribe any medication be it natural or pharmacological.” Emma points out the most important thing to remember is that an herbal or prescribed galactogogue will only work if you take it while actively trying to build your supply at the same time. “You will not see an increase if you do nothing but take a galactogogue.You should only take a galactogogue if your doctor is in agreement and all side effects and contraindications have been discussed,” she says.

Own your birth: Why you need a birth plan

November 1, 2020November 2, 2020Leave a comment

The birth plan: a tool pioneered by childbirth activist and midwife, Sheila Kitzinger in the 1970s, who believed that women and not their caregivers, should be the focus of childbirth and be able to advocate for themselves with this document, which detailed their wishes for the delivery. In the wake of birth plans, the Better Births Initiative was formulated as a way of educating caregivers on the general care of women in labour. The initiative was also rolled out in South Africa and expected to be adopted by all hospitals by 2015. Amongst the guidelines, it encourages respect, privacy and companionship for women in labour, pointing out that women should be able to labour and birth in whatever position they feel most comfortable, with as many birth companions as they choose to have. By Charlene Yared West.

Birth plans inform and educate

“Birth plans have become common practice now, as expectant mothers are more informed about their birth choices,” says Marié van Heerden, midwife and hospital manager at Genesis Maternity Clinic. “It is a good exercise for each expectant parent to inform themselves of their options through compiling a birth plan, so that they understand what they can expect, as well as benefit and risk of procedures and medication – and know where they can make certain choices. This applies to any type of birth, whether it is for a natural or planned caesarean section.” Laura Sayce, doula and lactation consultant at Genesis agrees; “I help my clients to compile their birth plans as a way of helping them make informed decisions. It also encourages them to do their own research into each element of the birth and then to make choices based on this information.”

What should a birth plan include?

According to a research paper Birth Plans, the good, the bad and the future by J.Lothian (2006), the focus of birth plans should be to answer three patient-focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labour, and what will I need from them? “I encourage all my patients to write out their birth preferences and to make copies of it, one of which is placed into their file at the hospital and extra copies for the hospital midwife on duty for the day they go into labour,” says Dr Sean Drew, gynaecologist-obstetrician at Life Hilton Hospital. “It helps everyone onto the same page about what the parent’s intentions are for the birth, but it must also leave room for what happens in the event of having to resort to ‘plan b’ option, which is often not detailed in the plan, but should be.” Dr Drew explains that as medical professionals, their first obligation is to the safe and healthy delivery of baby and mother. “First we want to ensure life, then we can look at incorporating all the ‘quality of life’ elements from the birth plan. This is not to say we don’t observe what is written in the document. It is quite the opposite. We do try to fulfil the mother’s wishes to the best of our ability, within our scope of practice.”

Most important birth plan elements

Life Hospitals aim to work in an evidence-based way. Sister van Heerden points out that it is helpful to speak to your care provider and to do a hospital tour, so that you have a clearer insight into how the births are conducted at the hospital you have selected to birth at. “Once you have done that, you are ready to write your birth plan. There are so many templates on the internet, but here are some important factors to include,”:

Labour and birth: freedom to eat and drink in labour, play music, dance, make labour sounds without inhibition, use aromatherapy oils (safe for labour and birth), have freedom to move into any position and birth in any position on the floor, or the bath or the bed. A mother should be allowed access to a doula or birth companion of her choice, who will provide non-medical pain relief options, including hypnobirthing, massage and general encouragement. Delayed cord clamping after the baby has emerged to allow for all the baby’s blood to be drained from the placenta to the baby.
First hour: Uninterrupted, immediate skin-to-skin contact with the mother or the father (if the mom is unable to). Assistance with the first latch if requested, otherwise the baby should be allowed time to attempt a breast crawl. Weighing and measuring to be done after the first hour of bonding for the family. No separation of mother and baby unless absolutely medically necessary.
Postnatal: Rooming in with your baby, no formula unless there is informed consent of the mother, provision of pain relief if medically necessary and assistance with breastfeeding.
Plan B: In the event of an unexpected caesarean, there are still choices. The mother can request immediate skin-to-skin with the baby in the theatre after the initial checks by the paediatrician and no separation unless medically necessary. Early initiation and assistance with the first latch. If the baby has to go to the neonatal ICU, then the father may accompany the baby.

What are the roles of each of the professionals present at a birth?

Obstetrician-Gynaecologist: A medical doctor who is the primary caregiver for your birth and there to deliver the baby when it is time to push the baby out. He/She may also conduct vaginal examinations during labour, but this is more often performed by the hospital midwife on duty. It is also the role of the doctor to perform the caesarean sections either scheduled or emergency.
Hospital Midwife: The hospital midwife performs nursing duties during labour and ensures the medical needs of mother and baby are taken care of by checking foetal heart rate, mother’s well being,blood pressure and other medical checks. She/he may also conduct the vaginal examinations, under the instruction of the primary caregiver, the doctor. In private hospitals in South Africa, the baby is delivered by the doctor and not by the midwife, unless the baby is born before the doctor’s arrival at the birth. The midwives at Life Healthcare hospitals are however trained to conduct normal deliveries. In government hospitals, the hospital midwives are permitted to conduct deliveries.
Independent Midwife: She/he fulfils the same role as the hospital midwife, but may also deliver the baby and call on the obstetrician-gynaecologist in the event of an emergency. Independent midwives may also conduct homebirths, hospital births on low risk pregnant women, with confirmation and back up of a supporting gynaecologist-obstetricians.
Doula: A doula is employed privately by the parents themselves and works independently of the hospital. She is non-medical and is there for the mother’s physical and emotional support throughout the labour process. She may not advocate on the mother’s behalf to her caregivers. Research supports the use of a doula for a more empowered and positive birth experience, no matter what turn the birth takes, whether the baby is born vaginally or abdominally.
Anaesthetist: The anaesthetist is called in if the mother requests an epidural during labour and is also there for caesarean births to administer the spinal block and for ensuring adequate pain relief after the caesarean.
Paediatrician: The paediatrician is called in after natural births to check on the wellbeing of the baby. They are also present during caesarean sections to ensure the health of the baby.
Lactation consultant: Although the mother receives breastfeeding advice and assistance from the midwives in the maternity unit of the hospital, a lactation consultant is extremely helpful to ensure long-term breastfeeding success.

Ruwarashe’s Birth Story

August 30, 2020August 30, 2020Leave a comment

Ruwa was nervous at our first meeting. Soft-spoken, she asked about my role as a doula for her birth. I walked with her in pregnancy and birth and when she went into labour, I met her at the hospital. Her birth changed everything. She was shown how powerful her birthing body was and that she could do anything. Here is her story of the birth of her son…

My name is Ruwarashe and I am 21-years-old and I come from Zimbabwe. I’m currently studying at UCT. I became pregnant in September 2018. Pregnancy was going to be a hard journey for me, as I didn’t understand anything about birth and even worse, I was a long way from home where I had friends and family to guide and support me. In Cape Town, I have little support. So many people recommended I get a doula, especially since I felt quite isolated in Cape Town without my family near.

Choosing a doula for me was so important, because I needed someone compassionate and soft and when I went onto Charlene’s website, I knew she was the doula who would understand my fear and confusion of becoming a mother. ( I hadn’t even met her in person yet, but I just knew.)

I remember I wasn’t sure if I was going to have anyone close to me at my birth, because my family and fiancé stayed so far away… And I had so many fears of becoming a new Student mom. Charlene reminded me that she was going to be there for me – and that I would be ok, no matter what turn it took. She said this at our first meeting.

Charlene engaged with me every week reminding me to trust the process of the journey I was on, offering me her kind support along the way. I was at school from 8am to 5pm everyday and I was at school until I was 9 months pregnant.

She also made sure we were able to meet close by to where I lived, as I did not have a car. She did this without hesitation – and it was so kind of her. When I felt low, I would message her and we would chat and she would encourage me to keep my faith and to be strong.
I think what especially helped were the Relax Into Birth visualisation tracks. Listening to them regularly helped me realise that birth wasn’t just an event, it was a process – a beautiful process… Finally I was learning to trust the process – and trusting myself to do it! I felt strong enough to birth my baby boy. The strength seemed to come from within me. A deep knowing.

The Relax Into Birth classes made me realise I wasn’t just doing a duty a woman is required to do; no! My body was giving life to a soul, another human being. Although it was about birth, it also somehow helped me establish what type of mom I was going to be to my little boy.

When I finally went into labour, the emotional support for me and my fiancé was tremendous! She always made sure I was as comfortable as I could be in those circumstances. When it was time for me to deliver, I remember I was very tired – and our doula Charlene never once wavered, always trying ways to help energise me and encourage me to bring my son down to earth.

During my visits to the doctor, I was told we had to schedule an induction, because they didn’t want me going over my due date, which was the 26th of May. I wasn’t so sure I wanted an induction considering the potential complications. It was really not what I wanted.

In my 39th week, I went for cervix check to prepare for my induction. I was notified that soon I was going to be in labour – and that it was likely I would not need an induction. On Thursday 23 May, my waters broke as I was going to bed. I remember I kept my calm. I took an Uber with my fiance who had arrived from Zimbabwe, even though my contractions hadn’t kicked in properly yet. I didn’t want to stay at home after that because I didn’t want to be under pressure to rush to the hospital when it became necessary. I didn’t want something dramatic! Charlene did join us at the hospital when my contractions got regular and intense. She was there the whole time and I held onto her. She created such a calming environment in such a tense situation. I remember I had moved 1 cm in 4 hours and all I wanted was an epidural. I asked the nurses for an epidural, but was refused by them, saying it was too early to administer. In the face of that, my doula encouraged me to keep going and to stay strong as I was birthing my angel.

We used other forms of natural pain relief. We used the shower and we counted together and breathed together and finally at 7 am they decided to insert a dose of prostaglandin gel to help my cervix open. Once that was given to me, five minutes later I was standing to go poo in the toilet and another five minutes later I was walking myself to the tub in the delivery room. During that walk I definitely felt my baby was coming! I got into the tub for a few minutes and notified both my fiancé and Charlene that the baby was indeed coming.

The delivery room not prepared by the hospital staff (as they didn’t expect me to push so soon), they quickly put me on the bed, and there was my baby crowning! They quickly set up the room as I involuntarily pushed him out. A few pushes and I had birthed my baby.

My birth taught me to trust my body and trust my baby. I have never felt as strong or as empowered as I did in those first days. I was blessed to have such a positive, empowered birthing.

Petra’s Birth Story

August 30, 2020September 3, 2020Leave a comment

Petra is a very strong mama who I met when she was pregnant with her first baby. Firm and determined, she never gave up all through her two birth experiences. It was lovely getting to know her as a mama also living in the Valley and this is the story of her second birth, where she attempted a VBAC. Thank you Petra for sharing your story!

I met Charlene in 2015 while pregnant with our first. My husband and I attended her hypnobirthing antenatal course. We were very keen on a natural birth and even changed service providers from a doctor to a midwife after doing a lot of research and weighing up all our options.

Unfortunately, our baby had other plans and presented in Frank breech, which is a breech position with the legs extended straight up towards the head. We were told by our supporting gynae that there was no chance of a natural delivery, and so we ended up scheduling a c-section. Our baby had other plans again: I went into labour the night before the c-section date, and our daughter was born by emergency caesarean at 03:30 in the morning.

3 ½ years later we found out that we were expecting again and to our delight our gynae suggested a vbac without us even asking. We agreed that this would be our preferred birth option, provided that everything was favourable.

I have a deep desire inside of me to birth my babies, and not just be delivered of them, which is why I felt somewhat “left out” with the c-section birth of our first child. And this time around I was determined to make sure that this baby would not be positioned in breech!

The pregnancy progressed well, without any complications and our baby turned head down and stayed head down – I was so thrilled!

We decided to make contact with Charlene for a refresher course, and chose her as our doula, to ensure that we have someone by our side who knows her way around natural birth.

At this point I need to mention that I turned 43 about 5 weeks before the birth of this baby and, whilst I feel much younger than this, my gynae would not allow me to go over 40 weeks for possible age-related complications. This means we have a scheduled c-section booking in case I don’t go into labour by that time. He also tells us that I cannot be induced, because it is a vbac, but he can rupture membranes for me the day before the booking, which might induce labour. If that doesn’t work, then I will have to stay in hospital overnight and have the c-section the next morning.

Week 38 has me seeing a midwife for a stretch and sweep. She tells me that my cervix is 1-2cm dilated and my body is definitely preparing to go into labour. Yay!

Week 39 and my gynae does another stretch and sweep, telling my husband that our weekend plans might just be in jeopardy. Great! Monday comes without any signs of labour and the booked section day is Wednesday. Oh no! We have a final check-up with the gynae, and he tells me to check into hospital at 3pm the following day so he can attempt to start my labour by rupturing the membranes. This being a vbac, we also agree that if there is foetal distress at any stage or if I start bleeding (which can be a sign of uterine scar rupture) then we will change plan and do an emergency caesarean.

Tuesday 21 May – the day before our c-section booking
I wake up feeling calm. Too calm! Not a surge in sight. I chat to Charlene and she suggests that I ask the gynae if we can check in earlier, so that I have a better chance of not labouring through the night.

So there I am at 13h00 hooked up to the CTG, listening to Charlene’s birth affirmations and waiting to have my membranes ruptured.

The procedure is successful, my water breaks and an hour later labour has started, and I am having regular surges roughly 5 minutes apart.

My birth photographer is there and Charlene has also arrived, and worked her magic in the room, transforming it into a much friendlier place.

The surges quickly become more intense and very soon they are 2 minutes apart. Charlene and my husband take turns massaging my lower back through the surges, which is where I am feeling the most pressure.

I need to be hooked up to the CTG a lot and for this I have to lie down on the bed, which is much more uncomfortable that sitting on the birth ball or standing and swaying my hips through a surge.

At some stage I have to go to the toilet, which is outside of the labour room. It takes a lot of courage to venture out of the room and when I finally do, I take Charlene with me. I simply cannot bear to face a surge without someone by my side. (Which not-so-clever person designed these labour rooms and didn’t include a toilet..?!)

There is quite a bit of blood and we think it is a good show. As labour progresses, I can however feel that there is fluid leaking out at the end of every surge, and I assume that this is amniotic fluid.

At 17h00 my gynae comes to check up on me again, and notices that I am haemorrhaging. “Why is there so much blood?” I hear him asking the midwife. So that is the fluid that I feel at the end of every surge! He also checks the foetal monitor printout, and then comes to tell me that I am 7 cm dilated at this stage, but I am also bleeding, the foetal heart rate is declining, and he is not happy about either of this. Those are the 2 things that we agreed would mean a change in our birth plan.

A decision is made quickly and calmly that we will proceed with an emergency c-section. Both baby and I are fine at this stage and there is no panic. I keep breathing through my surges, still lying on the bed and connected to the CTG, while Charlene and my husband keep massaging my back.

At 17h40 my gynae comes back to take me into theatre and I am pleased to discover that the assisting doctor also assisted with my previous c-section, and the anaesthetist is the one we requested for our booking the following day – this helps to put me at ease even more.

Charlene once again works her magic and soon there is beautiful music playing in the theatre, which helps to create a light and calm atmosphere.

15 minutes later we’re ready to start the c-section and at 18h00 our baby is born! Because we didn’t want to find out the gender during the pregnancy, the gynae lifts the baby up for a gender reveal: it’s a girl!! My husband has tears in his eyes when he turns to me and says, “we have another girl!”.

I really try to be more present to all that is happening than I was with my previous c-section. The gynae tells me that my scar is fine and wasn’t the cause of the bleeding, and that he cannot see where the blood was coming from. We assume that it could have been from the placenta starting to detach and this confirms that a c-section was the right decision. The baby was also facing forward and that was causing my back labour.

Once the paed finishes his check-up, she is placed on my chest skin to skin and we get to cuddle a bit while we wait for the surgery to end. There is a happy atmosphere in the theatre with lots of smiles, we have a healthy baby girl and all is well!

Charlene accompanies us to our room and helps to get us all settled in before leaving hubby and me to bond with our little girl, who is breastfeeding like a pro and soon falls asleep right there on my chest.

The next day starts off well, I am up and able to take a shower. I feel fantastic, with hardly any pain at all thanks to the pain meds, and I am looking forward to our “big sister meets little sister” visit that afternoon.

It is truly one of the best moments of my life, watching my older daughter meet her younger sister, and our lovely birth photographer captures some amazing pictures for us. I love every moment of it, and in the excitement of it all, I get up far too often and move around far too much… by the time my husband leaves with our daughter, I am in a lot of pain and can hardly stand up straight. I am now very annoyed with myself, as this is not my first c-section and I should really know better than behaving like I have just done! I also need to empty my bladder but try as I may, I can’t go. It is just too painful!

The pain gets worse and eventually I am in complete agony with what feels like one large abdominal spasm, almost like a labour surge that peaks and never ends! A nurse comes to measure my blood pressure and temperature, telling me that both are raised – I get annoyed with her, because it doesn’t take a genius to figure out that all this pain is causing the raised measurements. At this stage the spasm pulls up on the right-hand side from my abdomen into my shoulder and I am desperately trying to find a comfortable position to lie in. I’m clinging on to the bed rail and moaning through the pain! Finally, after what seems like an eternity, my gynae comes to check on me. I am in tears and tell him that I think I might have torn something with all my movement earlier. I feel completely responsible and am so disappointed with myself, and I am in so much pain. He gives me a voltaren injection, the nurse reinserts a catheter and eventually the pain fades. I am able to have a fairly restful night.

The next morning my gynae pops in on his rounds and tells me, that he thinks my bladder might be punctured, and that I will need to go for a scan. Baby stays with the nurses while I head off to the radiologist. Not much later we have confirmation: my bladder is leaking and will need to be fixed.

At lunch time my gynae returns with the urologist, and together they assure me that this is not my fault and that nothing I did could have caused the bladder puncture. It must have happened during the c-section and gone unnoticed. Surgery is scheduled for 19h00 that evening. Until then I am not allowed to eat or drink anything… not great, as I trying to establish breastfeeding.

Later that afternoon I have another abdominal spasm with pain as bad as the day before, and this leaves me exhausted and more than willing to go back into theatre just 49hrs after having a c-section. My baby does an hour long feed and then falls asleep just before her daddy arrives to look after her, while I go in for surgery.

The urologist checks on me outside theatre, and once again assures me that it was not my fault and that he will fix my bladder for me shortly. I am tearful and sore, feeling very sorry for myself and heartbroken for being away from my 2 day old baby. A theatre nurse walks past and sees me lying there looking miserable. She stops to come and console me, stroking my hair and telling me not to worry, that all will be fine. Sometimes angels don’t have wings and wear scrubs instead.

Surgery takes an hour and much to my relief I really do wake up without any pain. After recovery I return to my room to find hubby sitting peacefully in the easy chair with a sleeping baby girl skin to skin on his chest. She slept through the entire thing!

I spend 6 days in hospital with 2 catheters and went home with the suprapubic catheter strapped to my leg with a “pee-pee bag” as my daughter called it. Not the most comfortable thing to have but at least I was mostly pain free. Charlene also came to visit me at home for a doula check and a long heavenly foot massage, where we talked and talked, and I had an opportunity to debrief.
The suprapubic catheter was removed after 11 days and I was mighty glad to be rid of it.

So in the end my deeply desired vbac turned into another emergency c-section. Not what I had hoped for but this whole birth experience taught me one thing: “Surrender, it is what it is.”

I kept on repeating that phrase to myself, and I also kept looking for the blessing in each situation:

I look at the photos of our daughter’s birth, I see myself during those few hours of labour, actively participating in the birthing process, and in the end, we had a calm and joy-filled c-section birth with lots of smiling faces.
I would never want to go through the pain of the abdominal spasms again, but I treasure the fact that my husband got to spend those hours bonding with his little girl, while I had to have another surgery. Precious time that he would probably not have had otherwise.

Hospitals are by no means a restful place, but I had 6 days alone with my baby, before we went home to a very excited 4-year-old sister.

I am at peace with the turn my birth took and Charlene sums this up beautifully in one of her poems:

Even when things go in the opposite way of what was intended.
It’s that most sacred of moments.
When she locks eyes with her babe for the first time…
Skin to skin now on her chest she lies.
“You must be mother. You are, this place – is my home.”
She holds her closer and adjusts her position to bring her closer to her breast.
The noise and voices and bustle of the hospital dim all around her…
Yet, she suckles… and the circle is complete.

Pregnancy Awareness Week at one of the best hospitals in town, Life Vincent Pallotti!

February 25, 2018February 26, 2018Leave a comment

Pregnancy Awareness Week takes place annually and this year’s theme was about empowering parents for their journey to birth. I was there representing Relax Into Birth, talking about doula care and relaxation techniques. Many thanks to Sister Lindsay Donnachie, Carline and Vaughanine for arranging such an inspiring event.

Sister Lindsay Donnachie opening the day’s Pregnancy Event.

Sister Donnachie reminded women about their invisible bejeweled crowns on their heads and that no matter how their births turned out – or what turn they took, natural or caesarean, that they would still, no matter what, be the queen of their own births. She emphasised that what really mattered was how the mother viewed her birth and that in order to have a positive experience, she needed to empower herself with information and to know her options. She welcomed all attendees and speakers to the event.

Sister Donnachie reminding mothers to wear their invisible crowns.

Sister Emma Numanoglu of Breastfeeding Matters was first up and is a lactation consultant extraordinairre. Her talk focused on debunking myths around the subject of breastfeeding. Emma’s heart and soul is in her teaching and consulting and those who have been touched by her kindness can attest to that. Nothing is too big or too small – Emma will help you! Did you know that you don’t have to cut out any major food groups while breastfeeding? You don’t have to go gluten free or dairy free (unless medically indicated)! And, did you know there is science behind the use of cabbage leaves for sore, engorged breasts? Also that Jungle Juice is not helpful for anything except a sugar overload and does not help with supply issues… only a good latch can ensure that baby is getting milk… and milk being extracted from the breast helps to increase milk supply. Emma shared these titbits with us and more…

Emma Nummanoglu presenting a breastfeeding talk

Sister Emma Numanoglu presenting a breastfeeding talk.

Next up was Dr Jacky Searle. One of the most gentle, aware and intuitive doctors in Cape Town, her talk focused on choice and birth. She made attendees aware of the choices available in pregnancy and birth and how to navigate the landscape of those choices in Cape Town and within the limitations of medical aids. Practical and always so encouraging, Dr Searle empowers women daily in her work life and beyond. Births with this fine doctor are always Beautiful.

Dr Jacky Searle presenting a talk on choices in the birthing landscape.

I was next in line and my talk was entitled “Empowering women through doula care and relaxation techniques”. Doula care is often misunderstood and so my talk opened with an explanation of the doula role through pregnancy and birth and how it differs from that of a midwife. I also shared some tools for relaxation, excerpted from the Relax Into Birth course.

Attendees trying out some Relax into Birth breathing techniques.

Next up was Liesl Hansen from Johnson and Johnson, who spoke about the benefits of massage in pregnancy, labour and the postnatal period in her talk; “The first touch of love.” When it came to baby massage, she handed out dolls for the parents to practice on, which was just so much fun and so informative! Who doesn’t love a good massage and these parents left feeling equipped to give their babies some extra tlc through massage. She was assisted by Lisa Townend of Holistic Baby – Baby Massage Classes, a certified infant massage instructor.

Liesl Hansen and Lisa Townsend share their learnings around baby massage techniques.

Liesl Hansen and Lisa Townend share their learnings around baby massage techniques.

Last but not least, Jenny Spiro of Nurture One delivered a very interesting talk entitled “Start out right… And sleep tight.” She emphasised the importance of catching the sleep wave to assist your baby to sleep as best as possible. She also showed parents a very clever way of using the amazing Nurture One nesting pillow to put baby to sleep. The pillow cleverly mimics a womb-like environment and gives newborns much comfort.

Jenny Spiro shares info around baby sleep methods to help new parents also get more sleep!

Here are some other pics from Saturday’s fun event:-)

And here’s one of my son and I; my inspiration to do this work in the first place… Dearest Leonardo… Funny face selfie 😍:

See you at the next pregnancy event! Wishing you a wonderful birthing day, no matter what turn it takes ❤️❤️

Milk matters needs donor milk!

January 20, 2018January 20, 2018Leave a comment

26805278_10156258026698217_2254134964824244377_n Please help….Milk Matters’ donor milk stocks are terribly low and right now they do not have enough milk to pasteurise on Monday to meet their current prescriptions, and nothing yet to pasteurise on Tuesday. They were feeding 46 babies (orders still coming in!) at 11 hospitals on Friday, plus over the weekend, and no reduction in demand is expected next week. If you have milk in excess of your own baby’s needs, please consider donating it – it can save babies lives!
#donormilk #milkmatters #savingbabies

Meet Christa Bussack

January 19, 2018January 19, 2018Leave a comment

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Here I am pictured with Christa Bussack … a little tired, an hour or two after midnight, but still looking fresh (maybe a bit too optimistic?!) 😀 Even through the early morning hours, Christa maintains her sense of humour and effervescence in the maternity ward.

If you have stayed over at Vincent Pallotti, you will know her kind face and voice and her bubbly giggle… She is one of the nurses whose focus is to help mothers adjust to life with a newborn and breastfeeding. I am always happy to see her on the floor, because I know my client will be in loving hands ❤ Christa has been at VPH since the year 2000.

“Mothers always seek help in various areas when it comes to mothering, as they are beginning to experience a newfound love for their child. Mothering comes as an instinct, but guidance is still needed, as each mother is unique. No case is the same,” she says. “I have a passion for helping new moms, as there was a lack of guidance and help in my own personal experience as a young mother. It all comes down to giving the mothers the best support possible and to help them enjoy a positive start to motherhood, which will filter through into the time they are home.” Christa is also a proud mother of four kids, all who have already completed Matric level. She also has four grandchildren and counting. So, next time you see Christa on the night shift, say hi! #relaxintobirth #charleneyaredwest #empoweringbirthandnewparents