Tuesday 27 May 2014

Boob Sandwich ~ getting that perfect latch....

There is so much focus on the baby's position when coming in to the breast, her nose position, her open mouth, tongue down etc etc. We often forget about some of the other basics.

Nearly all nipple pain is a result of a shallow latch and one of the most common reasons for the shallow latch is so so easy to fix.

This is the most common and most simple correction i make when i assist mums and babies with latching.

The mother's hand position....

Not this - Fingers are too close to nipple. Baby will not be able to latch deeply. 
1- step 1 - take handful of breast deep into the breast with your free hand.
2 - step 2 - press thumb into breast, this leads to the tilting of the breast in photo 3. The boob sandwich.
3 - the tilt of the breast in this photo is a little exaggerated but the aim is to present a large amount of breast tissue. The tilt ensures an asymmetric latch. In this position the baby's nose is towards the thumb and chin towards the fingers.

... and again but this time the hand position is for football or underarm hold.
Not this - fingers too close. This is where baby's mouth needs to be.
1 - Deep handful of breast tissue. Nose towards thumb, chin towards fingers.
2 - Thumb into breast to tilt and present breast tissue to baby. Make a boob sandwich.
3 - Move those fingers right away. This is where the chin and bottom lips need to come in.

football hold - mums view

It's simple, how can baby get enough breast tissue in his or her mouth when mums fingers are where the mouth needs to be?

Move your fingers right back, and with a few other tweaks watch baby get that deep latch every time and say goodbye to sore nipples and a fussy baby because now she can get more milk!

Why baby needs a deep latch....
Pain and comfort levels aside, if the baby is not latched deeply into the breast she has to rely very much on the vacuum component of her suck to remove the milk. If she is positioned deeply then the milk is more easily removed. 

See here the deep latch, see how being latched well is important for transferring the milk from mum to baby.

This latch is too shallow. You can even see milk in the corner of his mouth, evidence of a poor latch. If the breast is to full and firm to "sandwich" well, hand expressing to soften around the areola is very helpful.
The "Boob Sandwich" can be a helpful when older babies are teething and doing a lot of busy on/off feeding, always ensuring a nice big mouthful of breast and protecting the nipples.

I hope this has helped, especially if you're in the early days where its so normal to be all fingers and thumbs and it just feels awkward. Keep at it, before you know it you'll be breastfeeding with your eyes closed, quite literally hopefully!

look at this gorgeous latch....

Sunday 11 May 2014

Breastfeeding ~ Choosing to Breastfeed through Depression.

Breastfeeding and Postnatal depression and anxiety -
a story of two mums and their personal struggles that is all too common with many many mothers today.

It goes without dispute that breastfeeding is the gold standard for infant feeding. We know the undeniable health risks of not breastfeeding for baby and mum. But what about the health risks of depression when the woman identifies breastfeeding as the sole or major contributing factor to her low mood. The health risks I speak of are serious indeed; harm to the baby or self harm to the mother, also psychosis and even suicide. It is dark and scary to think about, but this is real. Women need non biased, non judgmental support by family and health care providers to help them identify and address their mental health issues postnatally and to find the method of feeding that is right for them and their family.

Just as every baby is different, so to is every family. As much as I am and always will be the avid supporter of lactation, I am the first to acknowledge that breastfeeding is NOT for all families. Whilst the thought of continuing to breastfeed for one mum may seem depressing, difficult and impossible, for the next mum, the thought of quitting breastfeeding can be equally as impossible and heart wrenching.

Susan with Cooper and Miles.
This photo is forever imprinted in my mind. I first seen this photo when my twins were 8 months old and i related to my dear friend on such an intimate level, this photo was how i had been feeling the last so many months. To me this photo reflects completely the internal conflict of complete and utter love and adoration for your children and complete and utter fear that you might make a decision that impacts them negatively and the hopelessness over not really having control.
Let me introduce two mums, first time mums of twin boys born a day apart from each other. These mums were proud as ever about the dramatic entrances these four little men made into the world and how far they all had come, given their rocky starts to life.  For both mums parenting twins was hard from the get go. The shock of reality was such a blow; the hardest part of all was the reality of breastfeeding. The idealistic quiet nursing sessions, the fantasy of returning the sleeping babes their beds was so far removed from the ceaseless tandem feedings, the pumping, top ups of formula, low supply and the constant unsettledness of the two demanding creatures that they somewhere, deep down, adored. Breastfeeding was staring these mums in the face. Its like there was a forked road ahead and above the road was a massive neon sign flashing BREASTFEEDING. If life was going to look up a decision had to be made, the decision was to continue to breastfeed or, let it go. Both options difficult, both involved different struggles, but they eventually had same end result, the promise of a more settled, more manageable and eventually even, a happier day-to-day life.

One of these mums was me. I chose to continue with breastfeeding. I knew it was a going to be a struggle, I was fearful of how long the struggle could carry on for but what I was more fearful of, deeply, deeply, fearful of, was the depth my depression may go if I decided to no longer breastfeed. For my mental health I HAD to choose the road to continue breastfeeding.

The other mum, Susan, a friend of mine who was so pivotal in my early parenting journey, chose the other road. For her and her family not continuing to breastfeed wasn’t the end of the world, the difficulty of day to day life whilst struggling with breastfeeding and the impact it was having on her and her family was. This truly was the hardest decision of her life to date. For this family, to let breastfeeding go and take the road that meant leaving the feeding fight behind was the road to lifting her moods and finally after a long journey a happy family.

Everyone’s journey is unique and we all find healing in different ways. I finally mastered the art of breastfeeding somewhere around the 8 month mark after a slow and difficult up hill battle. My depression was continuing but manageable. Breastfeeding and the journey I went on was something I was proud of and i continued to breastfeed the twins until they were 28mths old. I am to this day certain I made the right choice. I still fear the place I could have gone, had I chose to stop breastfeeding.

After giving up breastfeeding her twins around 12 weeks of age Susan experienced much difficulty with her emotions. Life was settling in to some sore of more mother friendly routine but she was plagued with guilt for not being able to continue breastfeeding. Susan valued breastfeeding so strongly and wanted so badly to give to her babies this gift that only she could. Susan is a strong woman, she had a wonderfully supportive husband and family and grew a strong network of mother friends. This support got her through. She became proud of her breastfeeding relationship with her twins, she was proud of the fact she was able to identify the problem and the solution and she was gratified by the fact that she chose the best decision for her family. Susan never hid the fact that she was disappointed that breastfeeding didn’t work for her and her boys. Susan was always supportive of others breastfeeding, she supported many a new twin mum of the Multiple Birth Association and the Australian Breastfeeding Association. Choosing to give up breastfeeding the twins was potentially a crippling decision, but because of the support around her the difficulty the decision brought upon her was much shorter lived. The decision became critical in resolving the depression and anxiety she was experiencing.

Susan finally fulfilled her deep desire to breastfeed when her daughter was born, the couple went on to have a very special and healing breastfeeding relationship which continued into her third year of life.

Things are finally smooth sailing at 8mths of age.
We both made the right choice. We both made our decisions based on what we knew at the time and what we thought was right for us and our families. As good as breastfeeding is for baby, is it still as good for her if mum is unable to look at her baby and smile? Is ceasing breastfeeding because mum can get more sleep or have someone else help with feeds better for mum if her depression is only going to be worse off due to feelings of guilt and failure? Mums don’t need to be told what is best, they certainly don’t need to be judged. They need support.

Once the mother is feeling supported and her struggles are normalised by the network around her, they don’t seam as big and insurmountable anymore. If though, despite the help and care she is receiving, in spite of the mothers groups, breastfeeding groups, counseling etc, she continues to struggle and her depression continues or worsens this may signify a more chemical depression and therapy may need to continue with the introduction of antidepressant medication.

Breastfeeding became my safe place,
providing me so many quiet moments in the day.
With the right support and medication where appropriate breastfeeding is able to continue, breastfeeding actually plays an important role in the maintenance of keeping depressive symptoms at bay. One of the main hormones released when breastfeeding is Oxytocin, this chemical is known as the love hormone. Oxytocin is an endorphin, a natural opiate. The release of it in to the nursing mothers blood stream reduces and counteracts the effects of adrenalin and depressive symptoms are lessened. I am sure in my case, as a breastfeeding mother with depression, my symptoms were more stable due to the numerous sessions of breastfeeding day and night. For me, breastfeeding appeared to act as antidepressants had in the past.  

Most women concerned about their emotional wellbeing will make contact firstly with their GP, sometimes even before talking about how they’re feeling with their partner. An ill informed GP might hastily put the woman on medication and insist that therefore breastfeeding would need to be ceased.  It is true that medication may well be warranted, but it is often not the first line treatment unless the PND is particularly severe. A mother and baby friendly GP will start by ensuring the mother is aware of and has access or referral to community supports and psychological counseling. This GP will also know that very few antidepressant medications are contraindicated in breastfeeding.

Getting proper support from a counselor or psychologist is imperative to getting to the bottom of your grief. If antidepressant medication is indicated in your situation counseling is still important to gain a deeper 
understanding about your depression, its origins, its triggers and also to learn strategies to cope for long term maintenance of your depression.

Some women need to look outside the square of GP and regular counseling as breastfeeding your baby can resurface other difficult emotions related to their breasts and body image. For example, breastfeeding can be a massive stress to women who have a history of sexual abuse or eating/body image disorders and specific therapy related to these will be integral in reaching a level of acceptance and salvaging the breastfeeding relationship whilst also managing their depression and/or anxiety.

Some personality types and breastfeeding don’t blend well together, but what ever your personality one thing that’s for sure is breastfeeding is the biggest test of patience most mothers will even experience. Breastfeeding and rules do not mix. Timing feeds, schedules and routines can make for stressed and deflated mums. I believe this has to do with our expectations about motherhood and newborn babies behavior. What our generation knows culturally as normal infant behavior is based on formula fed babies. When our breastfed babies don’t sleep much, want to be held all the time and feed frequently we think something is wrong. We blame ourselves. We think we have failed.

In my practice the most common people who instill this self-doubt in new mothers are unfortunately the health professionals. Be them midwives, child health nurses, lactation nurses, pediatricians or other, we constantly hear “give them a dummy, don’t give them a dummy, don’t feed to sleep, don’t share your bed, baby should only feed this long and this amount of times”. Most often than not the moment of undoing is when mum begins to listen to this advice over the advice of her own gut. Ignoring our deepest instincts can become truly exhausting and disheartening, no wonder we become depressed.

I wish for all mums to be able to be supported in their family unit, however small or large that network is, to not have to fight for what she feel is right. If she is supported then she is able to safety to explore and dig deep, to know what really is the right decision for her at this particular point in time. For me, I owe the success of continuing to breastfeed through depression to a close network of mummy friends, my twin mum friends, breastfeeding or otherwise, who I could look at them and their babies a few months older than mine and think, “they got there, they’re still alive, maybe well be ok”, and stubbornness.

Be stubborn, if everyone around you thinks they know what is right for you and it is different to what you think is right for you, then stand firm. If you think giving up breastfeeding going you make your depression worse, fight for it. Its worth it!

Final Words...

For my third baby, Rhys, i never even once had to consider the option of not breastfeeding. My experience with the twins provided all evidence i needed.

It was again, albeit a different one, an experience of breastfeeding through depression.

I have chronic clinical depression, mothering with such a mental health disorder has been constantly challenging and i am to this day battling and learning as i go, for the first time ever i think I'm actually winning.

I will blog more on my mothering journey in the future, for now though, never give up hope that things will get better. With the right treatment and support you can find the light. I did and I'm finally smiling again.

Community Support and Counseling Services:

Do you know a mum who is expecting?
For a mum who may have a history of depression or PND, knowing they have support lined up for after baby is home can provide such piece of mind. Find out about my gift certificates here.

Until next time...

Louise xxx

Tuesday 6 May 2014

Louise David ~ Birth Photography

Wollongong Birth Photographer... 

Many people less appreciative of the birthing process than i ask, "why on eath would someone have a birth photrapgher present at their birth?". Our inability to comprehend each other is equal. Them, why you'd have one? and i, why you wouldn't? ...

To me, as a mother and a practicing midwife and Doula, birth is an unequivocal event in ones life. The anticipation of months of growing up and dreaming of this little life inside you is shared by your partner and loved ones by your side. To think you could fall so much in love with something you've not even laid eyes on yet.

Finally the physical and emotional preparation for the labour and the birth pay off as your innate birthing ability takes over. The lounge room, bedroom, bathroom, hospital room or operating theatre is overpoweringly taken over by emotion. Palpable raw energy of this powerful process that is going on. Finally, inevitably the baby arrives. The feelings that those witnessing would have thought couldn't get much more, explode exponentially! There are always tears... happy ones.

This is why one would want a birth photographer. 
To capture this magic. 
Im so excited to offer my service to women of the Illawarra. 
Whether your birthing at home, Wollongong hospital or out of the local area, consider inviting me to join you. For someone who respects birth and birthing women so much it would be an honour to capture you in your finest moment.

"I love to look back over my birth photos, i see a photo that captures the pain of a contraction and then a photo that captures the moment of his birth and i can relive that extraordinary explosion of feeling relief, pride and every other exquisite emotion all at the same time... I'm so happy i have my birth journey captured, it really is my finest moment"

Sarah on the photography of baby Taj's home birth

Click on the link below to see the photo montage of Hannah's labour and Eden's birth.

Edens Birth

I was so humbled to be present at and photograph the birth of my oldest friend as they welcomed their first baby to the world.  Hannah was such a goddess as she stayed strong through the relentless hours of contractions. The lack of fear and the control she possessed made me so so proud of her. She reminded me why i am a midwife, why i love birth and home birth and why i want to immortalise these moments in time by doing this.

 Wollongong Birth Photographer - 
Louise David Lactation Consultant

Take a look at my website for more of my work. You can see more photo montages and find out about birth photography prices and what i offer.

You can also find out about the other services i offer including home visit lactation consultation, breastfeeding education, Doula services and postnatal midwife services.

Don't hesitate to call or email me to find out more.

Until next time, 

Louise x