If being a good doula was based on what is in our doula bag, Mary Poppins would be the greatest doula.
Mary Poppins had quite the bag and all things considered it could make a fairly decent doula bag! There are a few items I would leave out of my doula bag, if I was Mary Poppins. The first one would be her coat rack. I am quite certain I can find a place for my coat at the hospital or a clients home. I can probably do without a plant, but hey, if you want a plant in your hospital room to make it a little more homelike, you can bring one…I won’t complain. Although, keep in mind, you might get some flowers gifted to you after you deliver your baby, so take up more than you need to.
Mary Poppins even brought her own lights. Lights are important, but again, I am not worried about the lighting at the hospital or your home. If you want dim lights, the doctors and midwives have flashlights - really, they do! Speaking of lights, some people like to have some flameless candles to create a nice ambience. I do have some in my doula bag, but as an FYI, they are a few dollars at the $1 Store.
Now, of course, I know some moms would want to but in my experience it is not super common. Again, if that is something you think you might want to try in your birth, lets chat about it and make a plan about who should bring the mirror, just like the plant.
That tape measure Mary Poppins has in her bag is amazing and I would love one! I mean imagine being able to measure people I am going to work intimately with and be told all about their personality. Wow, what a benefit that would be to me and to my clients. Wait, hold on! I do often have a tape measure in my doula bag…with my knitting. Yes, I pack knitting into my doula bag. What? Why on earth would I have knitting? We can talk about that later in another blog post.
Back to this tape measure idea. I don't have a tape measure that will tell me easily what your personality is, but I do however have a tool that will help me discover more about your personality and help me connect with you to make our work together easier and a little more flawless. The “Your Birth Experience” (YBE) program allows me to connect with you, identify your needs and then equip you with the resources necessary to achieve your goals. This leave mothers and their families empowered to envision their ideal birth, prepare for that birth and ultimately achieve the birth experience they desire. That’s pretty close to the magical tape measure, right? It is close enough for me.
So far you now know my doula bag has a few tea lights, running shoes, knitting and a tape measure. That tape measure isn't the good personality one - that comes from our prenatal meetings. That is all I have in my doula bag? Don't I have a rebozo, massage balls, TENS machines, birth balls? Nope. I do have some gum, some cash for parking, some hair ties and some snacks. Why so simple? Largely, infection control. For real, I don't want to disinfect birth balls and I surely don't want to clients sharing “dirty” ones. I don't want to have to wash beautiful fabrics from Mexico in harsh chemicals made for industrial disinfection standards. I can do some neat stuff with a hospital sheet instead. Bonus is that I can get that at the hospital and then leave it at the hospital to have it cleaned properly, just like the birth balls. Massage balls and TENS machines…what can be bad there? Nothing is really bad, but I prefer to not place an object between my clients and I. I find a better connection with direct contact and that increases endorphins which are great for labour. Again, if clients know they want to try a TENS machine or like the porcupine balls, I can help them use ones that they likely already own.
What I do have that cannot be packed into a bag is my years of experience and my confidence. Relief comes to my clients simply by my being present, much of the time. Clients know they can count on me to be present for them. I am a familiar face they know already and our relationship is solely focused on me helping them have a positive experience. They are presented with a bendy straw in a cup of water to juice, before they even knew they were thirsty. I am leading them to the washroom to pee and get that bladder out of the way of babies path because they didn’t realize they needed to pee. I am lightly touching and stroking their feet to remind them to relax their WHOLE body. I am that voice in their ear telling them that they can and are “doing it” when they feel like you are not being strong.
The thing is, people don't give birth every day, (truth be told, I don't attend birth everyday), but I do support women giving birth more often than the average person will give birth. I have been alongside many others before. Each experience is different and no path looks the same, but they are similar enough that I can follow the flow and go alongside and help women through it. They can say things like “Is this normal?” or “what else can I do?” or “what did that nurse/doctor/midwife mean?”. I will reassure them things are normal and they are doing great, I will make suggestions about what else they might want to do, or reassure them what they are doing is perfect & I will help them understand what the care providers are doing or saying. I can help the partner and encourage them just as much (maybe more, maybe less) as I do a labouring woman.
My doula bag started out full of items, and honestly, I could have taken a small suitcase on wheels to births when I first started because I felt like I needed to bring it all. I now know that to "bring it all", we need to do more work in the time before labour, and when I “bring it all” now, I am bringing our conversations, unique goals, unique desires, unique choices and my confidence, my experience and can be “tricky” just like Mary Poppins. I am confident I can pull stuff out of thin air that will help me meet your needs without carrying a lot of baggage.
~Written by Kim Smith, Doula, IBCLC
In short, no pun intended, “ties” are tight skin/tissue adhering the tongue to the floor of the mouth too tightly, which can make the tongue appear short (but not always...tongue ties are sneaky), or skin/tissue under the upper lip attaching to the gums...and even in the cheeks adhering to the gums. These ties can cause issues for breastfeeding, so as you can imagine, I have much experience as an International Board Certified Lactation Consultant (IBCLC). I might be the first person to start a conversation with a family about this concern or they might call me because someone else has questioned it.
Our hospital stays are too short to catch the tongue/lip tie concerns. Another variable is that common birth practices in our society right now can mask or mirror the same concerns that would signal a tongue/lip tie issue. It can take some investigation and skill to sleuth out what is what and know confidently the issues are related to ties.
Why does it seem like there are so many ties these days? I am not a researcher but rather a clinician so I am not involved in looking at what “might” be causing it (is it an external force or is it just always been this way) but rather dealing with the management of them. I will say, I have been in a breastfeeding helping role for 13 years and it is a subject that is brushed over in trainings of all sorts. I was an IBCLC for a couple years before I found myself in deep conversations about them - and if you know anything about becoming an IBCLC - there is a lot of training, education and exam taking...so a lot of opportunities to learn and to learn from different sources. I was NOT taught in any of my training how to do a proper infant exam. How crazy is that? That someone can become an IBCLC without learning how to do proper visual exam and functional exam. Once I learnt this skill I added it to my assessments, I began to observe and learn significantly more about infants oral structures. Do I see more tongue ties now than I did before then? Of course, I do. But I wasn’t looking for them before. We are taught that ONLY a heart shaped tongue, tissue right to the tip of the tongue and likely not latching, is a tongue tie. And that they are also not common at all. This is why I also say you cannot see just any IBCLC and if you see one IBCLC and you are not getting the results you want, get another one. IBCLCs are not all created the same. All while this is happening and professionals are learning more, families are learning more about breastfeeding but also COMMITTING to breastfeeding. This means that when they have trouble, they are reaching out and saying “help me”. That means our population of babes to check for ties has gone up so of course we are going to see more. In previous times, these families would have said “I tried breastfeeding but it didn’t work”. Researchers are working on the questions of why are human babies born this way. It sure would seem like the human race is setting itself up for failure as a species with how hard breastfeeding has become.
Who is the right person to see for tongue/lip ties and what are the steps after a diagnosis? Truthfully, I am biased in this. Maybe not biased but I am being aware of how my answer will be seen to others. I believe strongly the first stop needs to be a skilled IBCLC. There are so many reasons for this but with years of working with families with ties, I want to be able to set a plan for success up for families. This means all the steps and expectations are on the table, that before any treatment takes place, the parents know what it looks like, what to expect and how important a proper process is for success. Some plans are designed to fail and then it can leave the families more frustrated than they were with concerns.
Let us think for a few minutes about what complaints we hear about breastfeeding…I will make a really short list just as an example:
I mentioned mothers health playing a factor - maybe there are indicators that her own health is impairing milk supply. Babies respond to flow and without that flow, they also don’t want to try and improve anything. Add in a tongue tie and they just don’t care to breastfeed nicely. If supply is low, again even with a revision, they just are not happy breastfeeders. Then we have people saying “the tongue tie wasn’t the issue” and sometimes add in that “they did the procedure for nothing”. Or because intake is low they supplement, babies stops breastfeeding and everyone says “it is because you gave a bottle”. I make plans to not only increase supply, but supplement in a manner that breastfeeding still works.
We also need to know that the baby is healthy enough and strong enough for a revision. By that I don’t mean babies have to be 7 lbs or some random weight. I mean where are they in regards to their expected weight gain. Maybe they are not gaining weight, maybe they are gaining weight, but slowly - so maybe a baby that isn’t back to birth weight at 2 or 3 weeks yet or just slowly gaining over weeks and months, maybe they are gaining weight a little faster and maybe not getting much concern from anyone but still not growing on “their curve” or are they babies who are gaining weight exactly like we expect and on their appropriate growth chart. This matters! This is a very important factor. No one is checking this before performing a procedure. Babies with low weights, have low stamina and low appetite and don’t care to breastfeed better tongue tie or not, with or without a revision. If they go ahead and have a revision sometimes they start to refuse the breast when they have previously latched or just are still sloppy feeders, or tired feeders, frustrated feeders. I am really making sure this growth part gets figured out first. If we can get the weight up first and not just up but to their appropriate weight for age based on proper growth charts, then when they have a revision, they usually get it all sorted out much faster and kick compensations like nipple shields, supplements, nursing all the time, being at the breast to soothe or moms having to be particular about positions, etc. Each baby needs a unique plan to get to their weight up and that is a key piece of what I provide. A breastfeeding plan HAS to include something more than “just supplement after a feed”. It also has to have a plan to assess if function is regained after a revision or if there needs to be some work put into helping baby use the tongue and other facial muscles to feed. Again, an IBCLC who is skilled is vital to this. It is not just "suck training" like a finger or soother that is going to do this. There are so many actions and exercises to help.
Now, when I get called after a revision, I can still help and we can get past these remaining pieces, it just is in reverse but I find it is a bit more stressful for moms and families because they also have a cranky baby and after care exercises to get in, and often pumping & supplementing as all. It is better when I can set it up as steps and one focus at a time. Once supply and weight is up, it is one less stress, so then they can handle the stress of the aftercare and extra needs of the baby.
If you suspect your baby has any sort of tie - tongue/lip - and are needing some help navigating it all, I am happy to be a resource for you. You can see more of what I offer for consultations here.