This post is the 26th in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.

Following up on last week’s post on skin-to-skin after a cesarean, I’m very happy to share this interview with my friend and lactation consultant Joanna, who welcomed her second baby last year at a California hospital.  I trained to become a lactation consultant with Joanna, who now works as a lactation consultant in the San Francisco Bay Area.

Joanna, who had an unmedicated birth with her first son, was expecting to have a similar birth with her second baby.  Late in her pregnancy the baby’s position was breech, and after a version attempt resulted in the baby’s heart rate dropping, it became clear that she would have to birth by cesarean.

Joanna is well versed in the power of early skin-to-skin contact, and was able to arrange a period of skin-to-skin contact in the operating room.

1)  Why was it important to you to hold your baby skin-to-skin after your cesarean section?

When I met with my midwife and learned that we would need a cesarean, my emotions overwhelmed me.  After I was able to briefly compose myself I spouted, “I just want him to be a good feeder.”

Breastfeeding is really important to me, I’m a lactation consultant by day and enjoyed breastfeeding my first for almost two years.  I was very afraid that the cesarean would rob me of that experience.  I was also very afraid that I wouldn’t experience that same intimate time with my second baby that I enjoyed with my first through immediate and ongoing skin-to-skin time and lots of breastfeeding.

The midwife was awesome and added “skin-to-skin” to the problem list in my chart so the whole team knew it was really important to me.  Then at my pre-op appointment with the obstetrician I again expressed my deep concern/yearning over being able to do skin-to-skin.  She said she couldn’t make any promises because she wouldn’t be attending the delivery but would pass along how passionate I was and encouraged me to remind the team on the day of surgery my wishes.

On the day of the surgery as each provider talked to me in advance, they all said they had read in my chart that I wanted to do skin-to-skin.  They were more supportive than I expected.  I imagined I would be received with rolling eyes and that I would have to fight to get what I wanted, and likely be disappointed.  They all treated me like I had a reasonable request and it was no big deal to accommodate that request.  These positive conversations went on with my labor and delivery nurse, my OB, and the anesthesia team.

After my son was delivered he went to the baby warmer in the OR which I could see out of the corner of my eye.  They had him there probably less than 5 minutes; drying him, checking weight, doing a brief newborn exam.  Vaccines, eye drops, bath were on hold.

The nurse attending the baby asked if I was ready and I practically wanted to jump off the table!  Working inpatient lactation I’ve seen moms in the first few hours after c-sections and was prepared to feel awful and experience nausea and vomiting, among other side effects.  The anesthesia team was still by my head checking my vitals, etc.  Leads were all over my chest, and I couldn’t really feel my hands too well from the spinal.

They placed my baby on my chest with his feet almost on my left shoulder and his check on my right breast.  I placed my arms around him.  My husband sat at my left shoulder and also had a hand on the baby’s back for extra support.  We were able to stay skin-to-skin like this for about 10 minutes all the while the OB and team were closing the incision.

Out of nowhere I start feeling really yucky and very panicked. I told them I felt awful and somebody needed to take the baby.  Not seconds after they took him off my chest and had him back on the baby warmer did I throw up.  After that subsided, the baby nurse asked my permission to take the baby to the nursery with my husband and finish the newborn exam, and do the vaccines and eyedrops, with the bath on hold until later.  I consented, as I was still feeling awful and there was no way I could have him on me that point.

Shortly thereafter I was in the recovery room.  I was still feeling terrible, was really pale, had low blood pressure, and was shaking.  I was still feeling the effects quite heavily from the spinal.  My husband came in with the baby.  He was eager to get the first feeding going, anxiously looking at this watch because we were 1-2 hours since delivery.  The nurse was hesitant because I was still feeling and looking so awful.  I stayed in a semi-reclined position and my husband helped the baby get his first latch and then helped place him back skin-to-skin.

I was fortunate to know a lactation consultant where I delivered, and I offered to share my personal photos of us doing skin-to-skin in the OR for the hospital’s professional use.  She reported that within a month of when I delivered another c-section mom was able to do skin-to-skin and had subsequent great breastfeeding experience, and the baby had minimal weight loss.  That mom had had a horrible experience breastfeeding her first baby, who never latched.   She did skin-to-skin with her second child, who had a beautiful feeding at 90 minutes of age and was discharged exclusively breastfeeding with 4 percent weight loss!

She reports that they are still having resistance among providers to consistently have c-section moms do skin-to-skin in the OR.  When I last talked to her she said that they will be publishing my photos to be used in a campaign for skin-to-skin in OR.

I wrote thank you notes and sent to the managers of the labor and mother/baby units, thanking them for our experience.  If I can remember some of the details from my thank you note it was that I was treated with respect, and that nobody made me feel like I was asking for something unreasonable.  At a recent multidisciplinary meeting one of the managers read my thank you note aloud.  And, I’m told, one of the quality assurance team members was almost moved to tears.

I cherished that intimate time of getting to know my newborn through skin-to-skin.

This post is the 25th in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.

A little while back I wrote about the power of skin-to-skin contact and its relationship to breastfeeding and many other healthy outcomes for babies.

But one thing that kept nagging at me as I wrote it:  If one of three births (and perhaps as many as one in two, if current trends continue) is a cesarean, and if early skin-to-skin seems to be so important, what can be done to improve the chances that a baby born by cesarean has a good shot at this important experience?  A while back, Best for Babes linked to a wonderful video from Norway (shown above) showing skin-to-skin and breastfeeding in the operating room.  But is there evidence that this could work on a large scale here?

I’m very pleased to share a study, just published this fall, on one hospital’s experiment with making skin-to-skin in the operating room the standard of care after a cesarean for healthy, term babies.

So, on to this very exciting study:  A Baby Friendly San Francisco hospital recently initiated a quality improvement project in which skin-to-skin contact in the operating room and during recovery was used as a means of increasing breastfeeding success.  This intervention was prompted by reviewing data for a two week sample of healthy, term infants, which found the following problems:

Over 90% of [healthy, full term] infants born vaginally were exclusively breastfed during their hospital stay (11 out of 12) compared to only 50% of infants born by cesarean (5 out of 10). Furthermore, only 20% of the cesarean infants were [skin-to-skin] STS with their mothers within 90 minutes of birth, and 40% were not STS at all during the first 4 hours after birth. Of these infants who were not STS at all in the first 4 hours, 100% received formula supplementation while in the hospital.

So, the hospital embarked on an intervention to make skin-to-skin the standard practice in the operating room and in recovery.  Here were their findings:

During the first 3 months of our intervention, the rate of early STS among healthy babies born by cesarean increased from 20% to 68%. The rate of infants who did not get STS contact within 4 hours of birth decreased from 40% to 9%.  Nine months after the initiation of the intervention, 60% of healthy cesarean births utilized STS in the [operating room] OR, and 70% involved STS within 90 minutes of birth.

Healthy infants born by cesarean who experienced STS in the OR had lower rates of formula supplementation in the hospital (33%), compared to infants who experienced STS within 90 minutes but not in the OR (42%), and those who did not experience STS in the first 90 minutes of life (74%).

And how did mothers react to having this early skin-to-skin contact?

We received positive feedback regarding mothers’ experience with STS in the OR. Mothers stated that they would like to have STS contact with their babies in the OR if they were to experience a cesarean again, and commonly concluded that STS in the OR made them feel happy.

One woman, when asked how she felt about having her baby STS with her in the OR, responded (translated from Spanish): I felt some pain at the end of the surgery because the effects of the anesthesia were wearing off, but when they put the baby in my arms I forgot about the pain because I was so happy to have him with me. She denied feeling worried about holding her baby STS in the OR and stated: With my last child they took her to the nursery right away [after the cesarean] and she never wanted to latch after that … but this baby latched right away and he nurses really well because I had him with me right away.

Another Spanish-speaking mother shared about her STS in the OR experience: It was nice, feeling her skin on me … She was looking at me with her eyes wide open … and I think we both could feel the attraction.

The authors write that some routines and staffing patterns had to be changed.  They also note that, while there was some initial resistance to change, “We received positive responses after staff received the in-service education on benefits of STS and understood the need for improvement.”

The authors conclude: “We concluded that STS contact was feasible after cesarean and could be provided for healthy mothers and infants immediately after cesarean birth. Perinatal and neonatal nurses should be leaders in changing practice to incorporate early STS contact into routine care after cesarean birth.”

It may be a while before skin-to-skin in the operating room is embraced as the standard of care, but this account of one hospital’s successful experience and the evidence it provides that the practice supports breastfeeding, gives me hope!

Next week I’ll share an interview with a friend and fellow lactation consultant who had skin-to-skin contact in the operating room after her second son was born by cesarean.

This post is the 23rd in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.

To borrow a phrase, if there were a drug that could do the following things for premature and/or term infants, would it be ethical not to use it?

• Better survival rates in preterm babies
• Better oxygenation
• Better heart rate*
• Better temperature
• Opportunity to self attach to the breast
• Lower stress hormones
• Less crying
• Better blood sugars
• Better immunity, even six months later
• Lowered risk of infection
• Lowered risk of necrotizing enterocolitis
• Increased maternal attachment
• Increased breast milk supply
• Increased maternal confidence in ability to care for babies
• Increased maternal confidence that their babies are well cared for
• Increased maternal sense of control
• Better rates of breastfeeding, even many months later**

The ‘drug’ is your skin, in contact with your baby’s skin.  All of these things occur when your baby is held in skin-to-skin contact with you. 

Research has even shown that our chest temperature automatically increases right after birth – a built in “warmer” for our babies.  And since I have your attention, I’m going to take this opportunity to share my favorite trivia about skin-to-skin:

1) If you graph a baby’s temperature in an incubator, which uses a sensor to gauge a baby’s temperature and raise or lower the warmth, the graph will show the baby’s temperature in a wave-like pattern because there is a delay as the incubator responds to the baby’s temperature.  Compare that to a baby on its mom’s chest.  What does the graph look like?  A straight line.  The mother’s chest raises and lowers the temperature instantaneously.  Beat that, machine.

2)  If you place twins on their mother’s chest, one on each breast, each breast will raise and lower its temperature independently to meet the warmth need of each baby.

Though it’s logical to assume that this has been practiced for ages by mothers, research demonstrating the benefits of keeping babies in their natural habitat (mothers’ bodies) dates to 1979, when two doctors in Bogota, Columbia stumbled upon a dramatic finding.

Drs. Rey and Martinez were trying to care for preterm infants in an extremely resource-poor environment.  There was a shortage of warmers.  The mortality rate of premature infants there was about 70%.  Then, they began recommending that mothers hold their babies, skin-to-skin between their breasts as much as possible, and breastfeed on cue.

A miraculous thing happened:  the mortality rate of their patients wasn’t 70%.  It was 30%.

This practice became known as Kangaroo Care, and subsequent research in many other developing countries confirmed their findings.

The next question that needed to be answered was whether there was any benefit to full term babies.  And the answer, established by this review of 18 studies, is a resounding yes.  The World Health Organization fully supports it for all babies, declaring: “Almost two decades of implementation and research have made it clear that KMC is more than an alternative to incubator care. It has been shown to be effective for thermal control, breastfeeding and bonding in all newborn infants, irrespective of setting, weight, gestational age, and clinical conditions.”

So, are hospitals fully supportive and encouraging of Kangaroo Care and skin-to-skin?  I think that it’s safe to say that things are moving in that direction, but there is a lot of work yet to be done.

The most obvious place to look for progress is in the nation’s NICUs, since evidence for Kangaroo Care has been around the longest for preterm babies.  A national survey in 2002 found that 82% of NICUs were practice kangaroo care, and I would imagine that that number has increased in the ten years since.  But barriers exist, even there, and one of the key reasons is staff education and motivation.

The survey found that the practice of Kangaroo Care was more strongly influenced by perceptions than evidence.  As summarized in this article, it found that “Staff reluctance seemed particularly focused on the misconception that kangaroo care would require extra work on their part.” Another study published in 2011 which looked into barriers to kangaroo care found, “Key institutional factors were education and motivation of staff.”

While I couldn’t find any national data on the use of skin-to-skin in full term babies, I can say that I’ve heard similar objections to routine skin-to-skin care.  There is a perception that encouraging moms to hold their babies skin-to-skin will create more work for hospital staff, when in fact the opposite appears to be true.  Babies held skin-to-skin cry less, feed better, and need less care generally because they are in a much more stable state.  Moms are happier, too, and isn’t it possible that this results in fewer call buttons being pushed?

Culture change is hard, and takes time, but the evidence in favor of Kangaroo Care and skin-to-skin makes encouragement of these practices an imperative.

Did your hospital encourage skin-to-skin (or kangaroo care, if you had a preemie)?

* As with breastfeeding, we could discuss these outcomes in terms of the risks of not holding a baby skin-to-skin, rather than “better” rates associated with holding a baby skin-to-skin.  For example, we could say “When a baby is separated from its mother, its heart rate slows to an abnormally low rate as part of a “protest- despair” response.   A return to skin-to-skin contact with the mother restores a normal heart rate.”  Another example:  “A baby removed from its mother is at higher risk for hypothermia than a baby in its normal state – held skin-to-skin with its mother.”

** Skin-to-skin is great for all babies, whether breastfeeding or not.

When I had my son eight years ago we were living in Davis, California, home of the University of California, Davis (UC Davis).  UC Davis is where the pioneering research on teaching babies to sign was done by Drs. Linda Acredolo and Susan Goodwyn.

There had been so much research in the community that baby sign, even in the early 2000′s, was deeply ingrained in the parenting culture of the town.  So we, along with most other families we knew, taught our son baby sign. We didn’t use any particular program; this was before the proliferation of programs and classes.  We read Baby Signs by our local authors, and read their series of board books to our son.  But mostly we just showed him the signs while saying the words, in context, over and over and over.

And did it work!  We participated in one UC Davis baby sign study which required us to check in with a graduate student every week to report on any new signs.  I remember the grad student asking, “Really?  He learned how many this week?” He learned over 100 signs, and my daughter, now 16 months, appears to be headed toward that milestone, too.

Baby sign taught us so much about how our son felt, what he wanted, how he learned, but most powerfully to me, how he saw the world.  I remember vividly taking him to the zoo and showing his the gorilla exhibit.  His face lit up, and I was heartened that he was happy to see a real gorilla.  Then he started excitedly signing “ball! ball!”  I looked around, and sure enough, there was a ball in the gorilla cage.  That was the source of his glee.  When we got to the peacock cage and the bird spread it’s plumage, he signed, “bird, umbrella!”

And most memorably:   At a summertime party he ambled over to a woman whose sandals had leather flowers.  He loved to smell flowers, so he got down low and smelled her shoes/feet.  Then, with a disturbed face, he signed “all done!”  That was one time we were glad that other people couldn’t understand his signs!

In case you’re wondering, our kids’ verbal development was consistent what the research has shown:  all that signing didn’t slow down their spoken language, and it may have actually speeded it up.

One of the best surprises about baby sign was how much it helped us communicate about breastfeeding with both our kids, in a number of ways.  One is being able to talk while nursing.  Here is a sampling of what my kids have signed while nursing.  We call it talking with your mouth full:

“outside” (looking out the window)
“flowers” (also looking out the window)
“light” (looking up at the chandelier)
“all done” (just before coming off the breast)
“more” (obvious, right?)
“up!” (pick me up now!)
“telephone” (as in “the telephone’s ringing!”)
“train!” and “airplane!” (when hearing the sounds)
“yeah!” (clapping over her head, while nursing at the county fair and hearing everyone clap at the end of a performance)

Being able to sign “nurse,” (a sign made up by my son – tapping her chest) has helped my daughter tell me a number of things about how she views breastfeeding:

- She asks to nurse when she gets hurt.  I’m not really in the habit of offering to nurse when she gets hurt (this almost always involves her bumping her head on a coffee table or falling over backwards), but since she’s been able to sign “nurse,” I’ve found that this is her favorite way of being consoled.

- At times she asks to nurse more often than I thought she would.  I guess that this shouldn’t be too surprising, but it resulted at times in more nursing than we otherwise would be doing.

- Daily cluster feeding period is even more noticeable.  Where before I might have assumed that she wanted to be carried around or something else, the sign makes it crystal clear that she wants to nurse over and over in the hours before bed.

And then, most recently, my daughter and I had this conversation, mostly in sign on her end, about how she felt about nursing while teething:

Baby:    [signed while nursing] “Scared.”

Me:      ”You’re scared?”

Baby:    [signed] “Yes.”

Me:      ”What are you scared of?”

Baby:    [signed] “Nursing.”

Me:      ”You’re scared of nursing?”

Baby:    [signed] “Yes,” [un-latches, spoken] “Mama.”

Me:      ”You’re scared of nursing mama.  Is that because you have a hurt in your mouth?”

Baby:    [goes back to nursing, signs] “Yes. Hurt.”

She’s told me this many times since, but it hasn’t slowed her nursing down at all.

If you’d like to learn more about how to teach your baby to sign, there are many programs and classes out there.  But when people ask me to recommend a program I usually tell them that I can sum it up in four steps:

1. Start as early as you want, just know that they won’t sign back for a while.  We started when our babies were about 3 months old, but knew that they wouldn’t sign back until they were around 9 or 10 months old.
2. Learn some signs.  Here’s a dictionary of common signs, and you can Google for more.  The earliest signs our babies learned were objects, especially animals, which babies find so captivating.  The most useful signs to us were “more” and “all done,” but they came later.
3. While with your baby, say the word and do the sign at the same time, at a height which makes it easy for the baby to see. Try to do it in context – in other words, you see a dog or a picture of one, and you sign/say it then.  Teaching signs while reading books is fun, and the first ones our babies learned were the ones in the My First Baby Signs board books, but you can use any book.  Older siblings can be great teachers.
4. Do this over, and over, and over, until you feel like a complete idiot and are sure that they’ll never learn a single sign.  At some point, they probably will.  Then keep going!  They’ll probably make up their own signs at some point, and that’s great.

It’s really that simple, and if you want you can do it without spending any money, using any DVDs or flash cards.  Obviously, we’ve loved it, and its enriched our breastfeeding relationship in many ways.

This is the 15th in a series of posts on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Happy World Breastfeeding Week!

I’ve been writing about the Booby Traps – the cultural and institutional barriers that stand in the way of moms reaching their personal breastfeeding goals – for a few months now.  But I think that this is a good time to pause for a moment to point out a number of barrier-busting developments in breastfeeding in the last year.

Though beating the Booby Traps often seems like an uphill battle, there have been some exciting and meaningful developments in the last year.  We have a lot to celebrate:

Surgeon General’s Call to Action to Support Breastfeeding.  This year began with a landmark policy statement by the Surgeon General, Dr. Regina Benjamin.  The Call to Action to Support Breastfeeding tackles the Booby Traps head on, identifying 20 key actions to improve support for breastfeeding.

Employers required to accommodate pumping moms.  The federal health care reform law requires many employers to provide reasonable break time and a private, non-bathroom place for some nursing mothers to express breast milk during the workday, for one year after the child’s birth.

First Lady promotes breastfeeding.  I remember joking with my colleagues at one hospital a few years ago about how great it would be if Michelle Obama were to stand up for breastfeeding.  We all laughed at how improbable that seemed.  Boy, were we wrong!

Infant Risk Center opens.  The treasure trove of information in Dr. Thomas Hale’s Medications and Mother’s Milk is now just a free phone call away.  Want to know if you can take a medication while breastfeeding?  Just call.  And now both LactMed and Medications and Mother’s Milk are available as apps for the iPhone and Android platforms.

CDC and AAP supports WHO growth charts.  The CDC and the American Academy of Pediatrics both endorsed the use of the World Health Organization’s growth charts, which establish growth of the breastfed infant as the norm for infant growth.  With these two endorsements, pediatric practices will move in larger numbers to begin using them.

Insurance coverage for breastfeeding support and pump rentals may be on the way.  The federal health care reform legislation contained a provision requiring that breastfeeding support be covered by insurance policies, but interpretation of it varied and it hasn’t made much difference.  But just last month the Institute of Medicine (IOM) released a report requested by the U.S. Department of Health and Human Services which recommends coverage for breastfeeding support (prenatal through postpartum) and breastpump rentals.  If adopted, this would make a big difference in our ability get help.

Evidence continues to support the use of anti-retroviral drugs to prevent most mother-to-child HIV infections through breastfeeding. Finally, for Babes in the developing world, research is continuing to support the effectiveness of using anti-retroviral drugs (ARVs) while breastfeeding at reducing HIV infection through breastmilk.  This is a huge development, as not breastfeeding can be deadly in developing countries, but mother-to child transmission through breastfeeding has been a major route of new infections.  Policies and practice are beginning to change.

Obviously, we have a ways to go to eliminate the Booby Traps, but it’s been a pretty good year, don’t you think?

Want to keep this momentum going?  Best for Babes works tirelessly to beat the Booby Traps, and you can help by donating to our Buck a Boob campaign this World Breastfeeding Week!

Donate a buck a boob today – just $2! – and take a stand against the Breastfeeding Booby Traps!

I’m sure I’ve missed some important things.  What do you have to add?

This is the 12th in a series of posts on Booby Traps,™ made possible by the generous support of Motherlove Herbal Company.

According to the CDC, the cesarean birth rate in the U.S. is at an all-time high.  It increased 71% between 1996 and 2007, rising from 21% to a record 32%.  During roughly the same period, the rate of vaginal birth after cesarean (VBAC) declined from 28% to 8.5%.  The World Health Organization recommends a cesarean rate no higher than 10-15%.

Back when the founders of La Leche League were having their babies mothers were sometimes told that breastfeeding after a cesarean was impossible.  Of course we now know that to be wrong, but the truth is that breastfeeding after a cesarean comes with particular challenges which can make it harder for mothers to meet their personal breastfeeding goals.

What are those challenges?  Linda Smith, in The Impact of Birthing Practices on Breastfeeding cites research showing that the following breastfeeding-related outcomes are associated with cesarean birth:

• Significant delays in initiating the first feeding
• Increased risk of separation from mother following birth, and increased risk of baby being admitted to the NICU
• Delayed onset of mature milk supplies (“milk coming in”)
• For babies:  altered sucking patterns, decreased neurological responses in the first two days, increased risk of respiratory problems in babies born by cesarean without labor, respiratory distress, low blood sugar, higher risk of infection in babies born by cesarean before 39 weeks gestation
• For mothers:  a longer and more painful recovery, lower oxytocin and prolactin levels in the early postpartum period, increased risk of rehospitalization and infection, higher rates of anxiety and stress, higher risk of exposure to medications of concern
• In elective cesarean without labor, reduced fetal endorphins and less endorphins (which act as pain killers) in breastmilk

And possibly as a consequence, research has found that mothers who have had cesarean births:

• Are more likely to have stopped breastfeeding within the first two weeks postpartum
• Are more likely to not be breastfeeding at 2 months

Cesarean section itself isn’t a Booby Trap,™ and there is no doubt that cesarean births are sometimes necessary to preserve the health of the mother and/or baby.

But birthing practices contributing to our record-high cesarean birth rate – practices like early elective birth and being denied the option of attempting a VBAC – are indeed institutional barriers to our breastfeeding success.

The good news is that with the right support, many mothers can overcome these challenges and meet their breastfeeding goals.  If you’re not sure how to get great support to both decrease your chances of a cesarean birth and to increase your chances of breastfeeding success if you do have one, please see our tips for assembling your A-Team.

I can speak from personal experience, having had one cesarean birth and one vaginal birth (VBAC).  Recovery from my cesarean birth was far more challenging both physically and emotionally, but both of my births were followed by wonderful breastfeeding experiences.

Did you have a cesarean birth?  Did it impact your breastfeeding experience?

“If a doula were a drug, it would be unethical not to use it.”  – John H. Kennell, MD

Doulas (trained support people for childbirth and postpartum) are associated with some great things:  shorter labors, less interventions, fewer c-sections, and a more positive birth experience overall.

But did you know that having a doula can help you meet your breastfeeding goals, too?  I’m happy to share just some of the evidence on how doulas can help you beat the Booby Traps.™

Can’t afford a doula?  Read on for some suggestions on finding a low cost or volunteer doula, and also for some evidence that having a trained close family member or friend can make a difference in your breastfeeding success.

Studies showing that doulas are your BFF:

A 2009 randomized controlled trial in a California hospital assigned mothers either standard care during labor or the addition of support from a doula.  Mothers with doula care also got two home visits from a doula.  Here’s what they found:

• Mothers who had doulas were less likely to experience a delay in their milk coming in.
• 68% of women receiving doula care and 54% of women receiving standard care were breastfeeding at 6 weeks.
• For women with a “prenatal stressor” (history of substance abuse, tobacco use during pregnancy, depression or anxiety disorder, chronic health condition, pregnancy-induced, hypertension, gestational diabetes, or other serious pregnancy complications) mothers who had doulas were more than twice as likely to be breastfeeding at 6 weeks.

A 2009 study on the effect of doulas (called “Birth Sisters” in this hospital) on exclusive breastfeeding at a Massachusetts Baby Friendly Hospital found that mothers who had a Birth Sister had higher rates of exclusive breastfeeding, delayed their first formula feedings, and fed less formula overall.

What if a close friend of family member is trained as your doula?  A 2007 randomized controlled-trial found that when a mom’s close female friend or relative was “minimally trained” as a doula and supported her, she was more likely to initiate breastfeeding.

What special magic do doulas have that results in better breastfeeding outcomes?

This is an interesting question.  Is it that doulas actually support mothers in breastfeeding (by providing encouragement and practical help), or is it that they help mothers have births that are more supportive of breastfeeding?

The authors of the California study I mentioned above looked at this question and point out that in one randomized controlled trial, “the doulas did not provide any direct assistance with breastfeeding, yet by 6 weeks postpartum the intervention group was signi¢cantly more likely to be exclusively breastfeeding: 51.4% versus 29.3%.”

Can’t afford to hire a doula?

I asked Ananda Lowe, co-author of The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know, to offer some suggestions for moms who can’t afford to hire a doula.  She writes:

Most doulas-in-training offer a reduced fee until they are certified.  A trainee has enough education in birth to be a valuable presence at a woman’s labor.  Contact the national doula organizations to find a trainee or an experienced doula, at www.cappa.net, www.dona.org, www.ictcmidwives.org, and www.tolabor.com.

Otherwise, ask a friend who had a positive birth experience or a natural childbirth to be at your birth.  Our culture thinks of birth as a private event between a woman and her mate, but hospitals are full of staff who are strangers.  In past eras, it was a woman’s experienced female friends who guided her through birth.  I strongly encourage women to bring a friend or two to their labor.  Birth is such an intense experience, and hospital procedures can seem so overwhelming, that it is probably asking too much of a pregnant woman and her mate to get through labor alone.

Did you have a doula for your birth?  Would you recommend it?

Brought to you by PumpEase & Posh Pads!

Here are three tools to break the ice AND show them just how valuable breastfeeding can be for business:

1.  Expecting mamas, are you worried about getting your maternity leave in order?  Make the case for longer leave by pointing out that recent research shows that longer maternity leave is key to breastfeeding success.

2.  Need some facts to back that up? Show them The Business Case for Breastfeeding. This downloadable kit has all the facts and figures you need to make a strong case: breastfeeding is good for business! Breastfeeding moms miss less work (which equals more productivity!), have lower healthcare costs, and are healthier themselves.

3.  And don’t forget The Surgeon General’s Call to Action to Support Breastfeeding. It’s loaded with facts and figures that can be the catalyst to starting a workplace lactation support program, altering your maternity leave, or making sure that the Babes who follow you have the support they need to breastfeed their babies, too.

Brought to you by Hadley Stilwell & A Mother’s Boutique!

As part of our series on Booby Traps™ in pregnancy, here’s a wonderful podcast interview with Danielle Rigg, co-founder of Best for Babes.

We talked about things you should and shouldn’t experience at your prenatal visits, how to find a breastfeeding-friendly provider, and the great resources Best for Babes has to help you beat the Booby Traps in pregnancy.  You’ll find lots of posts on this topic in the Booby Traps section of our blog.

You can listen to it with the podcast player below (look below “You Might Like”), listen to it with Quicktime, or download it for free at our Best for Babes iTunes store (coming soon)!

You’ll find our first podcast, an introduction to Best for Babes, here!