3 Things We Wish Every Doula Did
Postpartum Doula Support Strategies
In our current society, families rarely have access to the "village" of practical help raising children that was the norm for thousands of years. In many non-westernized cultures, women spend 40 days "lying in" following delivery of their baby where they simply rest and recover in bed with baby while other family members and friends take care of older children, cook, clean, and bring the new mother everything she needs to be nourished and nurtured. In turn, this allows mothers to heal physically, emotionally and truly get to know their baby through uninterrupted contact. Not surprisingly, these cultures have some of the lowest rates of postpartum depression and highest rates of breastfeeding success compared to our "bounce back quickly" culture.
Doulas can be an incredible resource for new families to fill in the gaps surrounding perinatal care and allow mothers opportunity to rest and get to know their baby. Although doula care may look different from the traditional model of bedrest/multigenerational support, the goal is the same: nurture the mother so she can feel her best and nurture the baby. Below are tips we would love to pass along to doulas who are providing infant care. These are strategies we have found greatly aid families whose goals include breastfeeding.
#1 Help Baby Unwind
After 9 cramped months in the womb, babies often retain much of their tightly curled posture for several days postpartum. They may startle easily or have a hard time settling because they are used to being "held" tightly by the womb, which is why swaddling is such a common practice. Every doula knows that a swaddled baby is a calmer, more restful baby. Unfortunately, swaddling keeps infants from being able to "unwind" and limits baby's ability to move and stretch which can contribute to baby having limited range of movement in his/her shoulders and jaw. Tight muscles and fascia greatly affect baby's ability to breastfeed well and can make latching more difficult. We would love for doulas to help families snuggle babies in ways that promote baby's unrestricted ability to sprawl, stretch, and wiggle. In the daytime, the ideal spot for baby is skin to skin on mother's bare chest. This is baby's first exercise in "tummy time." (Plus, studies show it increases milk production, reduces postpartum depression, and supports infant brain development.) When baby is in doula's care it can be a great opportunity for the doula to gently and playfully move baby's arms up and down and out out to the side ("sooo big") to improve range of motion. We are all for contact naps, but if baby is not being held by a caregiver, then allowing baby to sleep unswaddled on a flat surface with chin off the chest allows baby's neck and jaw to extend and improve mobility. Avoid placing baby in swings/bouncers/seats/nests that put baby's chin on his/her chest as this promotes neck and jaw tightness that makes it hard for baby to open wide and get a deep latch. At night, use a light swaddle only as needed if baby is having a hard time settling and not sleeping 2 hours between feeds. If baby is already sleeping 2+ hour intervals, discontinue using the swaddle altogether.
#2 Help the Family Spot Feeding Cues
One of the most important learning curves for new families is to learn how to identify and respond to their baby's cues. Experienced doulas can be incredibly helpful acting as the "baby interpreter" for families, showing them how their baby's rooting, fidgeting, hands-to-mouth all mean baby is communicating a desire to breastfeed. Families should also be informed that some things can "mask" a baby's feeding cues. For example, if a pacifier is in baby's mouth this will hide baby's feeding cues. All infant experts agree, babies should be fed whenever they exhibit early feeding cues. Its important for families to understand by the time a baby spits out the pacifier and cries, he/she has likely been hungry for about an hour, and those early feeding cues were being masked by the pacifier. If a pacifier is used at all, we prefer it be limited to 2-3 minutes at a time for the purpose of helping baby settle (after a diaper change, for example). Parents should also be informed swaddling masks feeding cues, as it tends to put babies into a deep sleep state like they experienced in the womb, where they were cord-fed and did not have to wake up to be fed. In the outer world, its crucial for milk supply and growth that babies wake themselves up when they are hungry and express feeding cues. Babies are much better at doing this when they aren't swaddled. Doulas can help families keep track of baby's feeding patterns to ensure baby is getting a minimum of 8-12 feeds per 24 hours and that there are no artificial conditions masking baby's ability to quickly and easily communicate feeding cues. If swaddles are being used, we recommend once baby has been asleep for 2+ hours the swaddle be removed so baby is allowed to enter a light sleep stage and wake themselves when they are hungry. We can't tell you how many cases of failure to thrive we have seen that are related to masked feeding cues.
#3 Bottle Feed Like You're Breastfeeding
Many mothers whose goal is to primarily breastfeed still like to have the option for baby to intermittently take bottles, whether its due to breastfeeding difficulties or for flexibility. However, during the first month, babies are particularly sensitive to disruptions and need extra care taken to feed bottles in ways that closely mimic breastfeeding. One of the best ways for doulas to support mothers who are combining breastfeeding and bottlefeeding is to bottle feed newborns in the sidelying position, which is similar to the cross-cradle hold used for breastfeeding. Because feeding on their side is one of the most natural ways for a baby to feed at breast, it also works great for bottle feeding and helps baby alternate between breast and bottle more effortlessly. Sidelying feeding positions give newborns more control over the flow and movement of milk in their mouth, which reduces the stressful experience of having milk "pour" down their throats. It also allows them to build their oral-motor skills of actively drawing the milk out of the bottle with their suck, similar to how infants work for the flow of milk from the breast. Helping baby root and then get a deep latch on the bottle is also beneficial for reducing nipple confusion. Check out the video below on the sidelying hold for newborns or visit our bottle feeding article for additional tips on bottle feeding.
Attention Doulas! Did you know doulas can attend our Infant Feeding Classes free of charge?! We love supporting your work in the community and partnering together to care for new families in the Charlotte and Lake Norman region. Email info@LKNBreastfeedingSolutions.com with your doula certification or training program and we will send you free access to our Infant Feeding E-Classes.