Doula Support and Breastfeeding
This past week we celebrated World Doula Week 2018.The purpose of World Doula Week (WDW) is to empower doulas all over the world to improve the physiological, social, emotional, and psychological health of women, newborns and families in birth and in the postpartum period. In an effort to highlight the work of doulas right here in the Tampa Bay community we set out to interview some of the leaders in labor and postpartum support. We are honored to share the passion, experience and words of wisdom from Taylor Bland of Trinity Caim Birth Services, Yamel Belen of One Love Doula Services, Cheryl Waterbury of Calming Presence Birth Services, Christie Collbran of Buddha Belly Birth and Jessy French-King a labor doula.
As IBCLCs we are passionate about breastfeeding and we know doulas can make a huge difference when it comes to birth and breastfeeding outcomes. We have some great relationships with doulas serving mutual families already, but it's great to know who all is out there so we can better collaborate.
We hope you enjoy reading about the doula support options in our community and how with their support, knowledge and experience you can enjoy positive breastfeeding outcomes. Happy reading!
Welcome everyone! Thanks for taking the time to participate. We know you are all experienced and passionate birth workers. Our first question is about you! What kind of doula work do you specialize in and what brought you to this work?
Taylor: "I specialize in birth, bereavement and post-partum doula work, also offering placenta services! What brought me to be a doula was having a traumatic birth experience myself. I was luckily able to still deliver naturally, but to my disbelief, my midwife was not the person I thought she was, when it came to being there for me during my birth. Despite my poor experience, I am blessed to say that it encouraged me to educate myself more on the birth community, education and more, and I wanted to help as many women as possible have a POSITIVE experience, when they look back on their birth. All women deserve that! Bereavement called to me because I feel that there is a lack of education and support internationally for grieving parents, and something needs to be done about that lack thereof!
Yamel: "I am an RN and doula. I specialize in labor/birth support as well as postpartum doula support which includes loads of lactation support."
Cheryl: "The majority of my clients choose to birth in hospitals. It's not necessarily what I set out to do, but I have become very comfortable in the hospital setting and feel this is the environment where birthing people meed the most support. In second place is supporting births at birth centers. I rarely am invited to support home births. I have been to every hospital in Tampa Bay so far, except Florida Hospital Wesley Chapel. I became a doula as a second career, after retiring from being a teacher of the Deaf. The births of my own children were amazing and empowering and ever since those experiences I had a secret passion for birth (in the 1980s). But it wasn't until considering a career change that I considered birth work as a realistic way to earn a living. Over the years I heard so many births stories from friends and colleagues that were vastly different than my own positive stories. I wanted a way to educate expectant parents about their option and help them achieve the kind of births they wanted."
Christie: "Thank you for inviting me to participate. I am a birth & postpartum doula, but more so I am the co-owner of Buddha Belly Birth Services, a doula agency that provides many services including labor doula support, postpartum doula support, childbirth education, placenta encapsulation, lactation counseling, belly casting and more. Our team of doulas are passionate about helping families have a better birth and postpartum experience. My love for this field grew after I took a 12 week childbirth education class when I was pregnant with my first son. I realized there was so much information to know and that families needed this knowledge. I became a doula in 2009 and have been working in this field ever since."
Jessy: "I am a certified labor doula, CLC and photographer, all of which I am very passionate! In 2007 I gave birth to my first baby and a passion was lit inside of me. I want all women to have the support, education, and respect they deserve during their pregnancy, labors, postpartum and breastfeeding journeys."
As IBCLCs we know prenatal breastfeeding education is very important. Do you find many of your clients are interested in breastfeeding and if so, what kind of education are they receiving? Do you offer prenatal breastfeeding education? Do you recommend it?
Taylor: "I absolutely recommend breastfeeding and every one of my clients so far has been very adamant and successful with breastfeeding, (YAY!). I discuss it with my clients and encourage them to build relationships with IBCLCs and CLCs during their pregnancy so they have someone to go to if they have issues that come up after delivery with their breastfeeding journey. I offer as much evidence and experience based knowledge that I have but I am certainly not an expert and while I further my education to offer more breastfeeding knowledge and help to my clients, I connect with as many professionals in my community as possible to make sure they get the all-encompassing help that they need."
Yamel: "I would say 100% of my clientele is interested in breastfeeding. They are receiving education via literature either books they have heard of or items we recommend. Furthermore, we go over breastfeeding during our prenatal visits, as well as immediately post birth to get that successful first latch and then I make sure and revisit how they are doing in regards to BF during our postpartum visit (this is my favorite) this gives me the opportunity to identify my clients needs, struggles, and be able to provide further tools or if necessary reach out to my peers such as an IBCLC or pediatric dentist for further evaluation if I identify an issue. I find that prenatal education combined with immediate postpartum intervention helps for a long lasting breastfeeding relationship."
Cheryl: "Nearly 100% of my clients choose to breastfeed, at least initially. Prenatally, I encourage them to attend a prenatal breastfeeding class. I also offer to teach a stand-alone class. If they are also taking my CBE, it is included as a 90 minute segment. If they don't take official classes, I provide handouts and discuss the basics during a prenatal meeting. The majority of my clients attend a class, not taught by me, prenatally."
Christie: "We find that vast majority of our clients are interested and planning to breastfeeding. We highly recommend prenatal breastfeeding education and offer a private prenatal breastfeeding class, as well as cover the topic of breastfeeding in our comprehensive private childbirth classes."
Jessy: "I absolutely agree that breastfeeding support and education during pregnancy is a wonderful jumpstart to breastfeeding. I do not offer breastfeeding classes, but I do always recommend for my clients to take a breastfeeding class, read breastfeeding material that I recommend to them and attend a local breastfeeding support group led by IBCLC’s even while pregnant. It is a great way for them to connect with other moms, listen to their questions, and learn, all while still pregnant."
How might you explain your role in establishing breastfeeding in the first week of life? What services do you offer to help get breastfeeding off to a great start?
Taylor: "I consider my role in breastfeeding to continue being that support person and be as helpful as possible in getting the information they need for the problems they are having, if any, right away. If that is asking for the Lactation Consultant at the hospital to visit them each day, several times a day, until they are discharged, or helping them arrange to go to breastfeeding support group nearby right away, anything that I can do to facilitate an easier transition into learning how to breastfeed, I will do! I talk to them during pregnancy and post-partum about establishing supply, why supplementing should be avoided unless absolutely necessary, what cluster feeding is, what a good latch looks like, indicators of a lip or tongue tie and how that can be corrected, and more!"
Yamel: "We offer all support necessary during the postpartum visit, furthermore clients have full access to me electronically and telephonically and if they request or I note they require another home visit we schedule this as well. I make sure to keep the lines of communication open because at times women are experiencing difficulties but have trouble verbalizing since they are in fact nursing a newborn 24/7. So reaching out and asking some open ended questions really helps to identify how they are doing in those first weeks."
Cheryl: "Immediately postpartum, it is actually difficult to give much support, as the nurses pretty much take over and most clients do not resist their interventions. But once the client and baby are transferred to the postpartum unit, or go home, I become available and they will call, if needed. I also follow up closely during the first week to see if they need any help prior to our postpartum visit. I am also a CLC. Two weeks of breastfeeding support is included in my doula package. In-person assistance required beyond 2 weeks is an additional fee, or I refer to someone more experienced in their particular area of need."
Christie: "In additional to offering a prenatal breastfeeding class, many of our birth doulas and nearly all of our postpartum doulas are certified lactation counselors with lots of breastfeeding experience. They can answer questions and provide evidenced based information about breastfeeding before and after birth. Our birth doulas are present at the birth and immediately after the baby is born for a few hours postpartum. This is a crucial time in the breastfeeding relationship. During this time our doulas encourage skin to skin, letting the baby self attach to his mother and preserving and protecting this special bonding experience. They can help mother with her first latch, first feedings, good positioning, resolving any discomfort or other issues that arise. The birth doula stays in touch regularly and does a postpartum visit within the first few days to check up on the new family and again provide any breastfeeding support as needed. If they are having a hard time, the doula helps them to resolve issues and get back on track. If she finds they need even more assistance beyond her scope she recommends a CLC or IBCLC consultation and follows up to ensure her client gets the help she needs. Our postpartum doulas provide support in the immediate postpartum period with day time or overnight shifts for as long as the family wishes to have her present. And just like the birth doulas, postpartum doulas can help answer questions, provide support and troubleshoot any breastfeeding issues that come up.
The major thing that I believe a doula brings that makes a huge difference is encouragement and confidence boosting which is so needed by a new breastfeeding Mom. Mom and baby are learning something new and there can be ups and downs. Our doulas will always be on Mom’s side and will do everything they can to help her achieve her breastfeeding goals. We hear from our clients that the support and care they received from their doulas was critical in their breastfeeding journeys. "
Jessy: "As their labor doula, I stay for the first 1-2 hours postpartum. One of my main goals after delivery is to watch and if needed assist my client with the first latch. Talking my clients through and answering any initial questions they have. I feel more than qualified, as a CLC to help with this initial part of the breastfeeding relationship. Before leaving my client after the birth and assessing the first latch, I always encourage my client to reach out for support. If it is a hospital delivery, I remind them that their is lactation support in hospital for them to take advantage of during their stay and to not hesitate to reach out during that time. Once they go home, I remind them that I can refer them to a local IBCLC if they need anymore support. We schedule a one week postpartum visit where we go over their birth, recovery, breastfeeding and anymore questions or support that they have or need."
How do you find birth preparation is related to breastfeeding outcomes? What labor interventions seem to make a difference?
Taylor: "I do find that birth preparation and the type of birth that a mama ends up having does usually impact the start of the breastfeeding relationship. The use of an epidural, Pitocin, having a Cesarean Section, do all seem to make a difference because there is a risk that it can impact your bond, your hormones, your body and your baby’s body’s natural cues. When a mom is left to birth naturally, the way that she wants, in a calm setting without stressors being placed on her, it is easier for her body to recognize and process her delivery and allow those hormones to flow to facilitate the beginning of a healthy breastfeeding relationship."
Yamel: "We discuss how interventions can impact breastfeeding relationships, items such as suction or the lack of immediate skin to skin can hinder breastfeeding. Being that we discuss this and other items, families have he tools and they have it in their head what they do and don’t want in their labor in order to breastfeed as soon as possible after delivery."
Cheryl: "Clients who have long, stressful labors with lots of interventions seem to have the hardest time breastfeeding. I'm not really sure which interventions make a difference, as I've never really purposely considered this aspect. But if I had to consider a few clients who really struggled with breastfeeding, I'd say it was a combination of prodromal labor, AROM, pitocin augmentation, epidural, and assisted delivery. By the time all of that is done, client is exhausted and emotionally unable to focus on nurturing baby."
Christie: "There are so many factors that affect breastfeeding outcomes and so much that we don’t have control over as mothers. Birth is a dynamic event and it’s important to remain flexible. All the preparation in the world can often still result in a totally different outcome than hoped for due to medical reasons. But there is no doubt that being prepared, taking birth/breastfeeding classes and getting your questions answered in relation to your birth wishes or preference is always a good idea. Knowing whether your birth location, care provider and pediatrician are supportive and knowledgeable about breastfeeding is helpful as well. Interventions can have an affect on breastfeeding, but with good support and determination interventions do not have to be detrimental in the long term. For example IV fluids in labor can result in swelling in the body/breasts which can affect efforts to latch the baby on. Cesareans can sometimes result in a delay between the time baby is born and when skin to skin and bonding/breastfeeding can occur. Working with a doula that is also a trained lactation professional can be helpful when navigating these situations."
Jessy: "I find that when my clients are more prepared for their birth, as far as education, hiring a doula and choosing the birth that they feel is best for them, correlates to a more positive birth experience. Which I do believe flows over to the breastfeeding experience they are about to embark upon. That being said, as far as interventions. Factors such as induction, which may lead to being on IV fluids if pitocin is used and the possibility of unplanned c-section may affect the initial stages of breastfeeding for a few different reasons, one being the swelling from the fluids. Which in turn could cause more interventions while working to breastfeed the first few days, such as pumping, nipple shield, supplementing, bottle feeding etc. I believe that when women have taken classes, have a doula, hired an IBCLC or postpartum doula, the support and tools they will have help them succeed with or without any obstacles that may come their way."
What has been your experience with breastfeeding outcomes in the hospital setting vs. a birth center or home birth? What about with medicated births vs. drug-free births?
Taylor: "I notice that a birth center and home birth naturally have less interventions and medications involved, so of course, the breastfeeding success will typically follow that. A mom is able to relax and bond with her baby skin to skin and learn how to nurse together, without interruption, more often in a birth center or at home, than in a hospital."
Yamel: "My experience in regards to hospital vs. birth center or home birth has been success in breastfeeding. It seems I frequent a breastfeeding friendly hospital so they are practicing baby friendly techniques both during labor and after birth as well as staff that is well educated in breastfeeding and thankfully I haven’t had any negative encounters which have caused a negative breastfeeding experience. In regards to medication that can impact the alertness of Baby it does add an added item of concern but certainly not an area that can be overcome with good support."
Cheryl: "I have had many clients successfully breastfeed following births in hospitals, as well as birth centers. The opposite is also true. I haven't ever analyzed all those conditions, so it's hard to answer this question accurately. I do frequently see breastfeeding negatively impacted by circumcision. The first day or 2 went perfectly smoothly, then as soon as the baby is circumcised and sent home, serious problems arise."
Christie: "The local birth centers and home birth midwives in Tampa Bay are extremely supportive of breastfeeding and provide excellent support. They regularly refer their clients to CLC or IBCLCs when additional help is needed. One difference with these options is that once you are home you are not visited by nurses and lactation staff on a daily frequent basis like you are during your hospital stay. If you need additional assistance, this is a great time to hire a postpartum doula or a home-visiting lactation professional. Don’t go it alone and wait too long when things are difficult. Help is available! In regards to hospitals, it really depends on the hospital in question. There are some local Tampa Bay hospitals (Tampa General Hospital, Morton Plant & Mease Countryside) that have achieved Baby Friendly status and they strive to promote and foster healthy breastfeeding relationships. They have a team of resources to help breastfeeding women and get better outcomes as a result. Other local hospitals that do not have IBCLCs or CLCs available have lower breastfeeding outcomes. Pain medication in labor is not completely without risks and side affects but in our experience medicated and unmedicated mothers have pretty similar outcomes. The choice to have an unmedicated or medicated birth is very personal and we support woman no matter what they choose in this regard. For some women the stress of labor can be so traumatic, that they are more relaxed and able to bond, connect and breastfeed their baby after birth due to the medicine they received than they would have been without it."
Jessy: "In my experience, there is higher breastfeeding success with clients who deliver at a birth center or at home. Again, in part because these women have also taken the steps prenatally to prepare and educate themselves, as well as having a wonderful support system from their care providers, doula, IBCLC. That is not to say women who choose to have a hospital birth will not succeed in breastfeeding, just as those women can also have a natural birth in a hospital. The support they need just may not be optimal in all hospitals."
We have an amazing birth network in Tampa. We love working with doulas to provide the best clinical lactation care possible to shared clients. When breastfeeding complications arise, what’s the plan? Do you have your “team” to refer to? What’s been your experience collaborating with IBCLCs? How could we work together to better serve Tampa Bay families?
Taylor: "I don’t have one specific place that I always refer clients to, it usually depends on their location, the availability of the provider, costs, what specific services that provider offers, etc. There are a lot of factors that go in that I look at before I recommend them to someone specific. I have loved every IBCLC I have come across in the Tampa Bay area thus far. I think the support classes and workshops are an amazing resource for new parents, honestly, it lets them see that they are not alone in their struggles!"
Yamel: "As an RN I am very familiar that collaborative care and continuous care aids in better outcomes. With that being said, I have no issues with reaching out to someone I trust and have good rappor with in the community. If a Mom and baby are struggling and I have used all my personal resources it’s time to get a second opinion or additional assessment. I do have IBCLC’s that I refer to, as well as preferred dentists for tongue and lip tie identification and revision when needed. We could work together in a better way by caring for families with no judgement of how others work. The last thing a family needs to hear is a professional bad mouthing another (yes this happens) should someone reache out to me because they have a concern about another doula (for example) or they are unhappy with the service they received I don’t discourage them from venting but I don’t harp on what they share, nor do I share what this client shares with me with anyone else. After all we are all professionals and we are doing this work because we love and want to support growing families."
Cheryl: "I try my best to provide support myself, but when the problems persist or are beyond my scope of information, I ask an IBCLC for guidance, or refer the client to them for direct support. I also refer clients to peer support groups, online groups, or medical consultation, depending on the situation."
Christie: "Yes, we have a wonderful list of IBCLCs, including Sweet Songs Breastfeeding, that we refer to. When breastfeeding complications arise we first call on our all of our amazing CLCs at Buddha Belly to support our clients to the best of their abilities. If the situation requires advanced knowledge we refer out to the local IBCLCs in our community to ensure that our clients get the level of support they need. We also have dentists that we have established great relationships with who we refer to for helping families that may be struggling with possible lip or tongue tie issues affecting breastfeeding. Our experience collaborating with IBCLCs has been fantastic. We send our clients to the IBCLCs on our referral list closest to them since we serve the greater Tampa Bay Area including: Hillsborough, Pinellas and Pasco counties. Many of our clients have been referred to Sweet Songs Breastfeeding and we are so grateful for the excellent care they’ve been given."
Jessy: "As both a doula and CLC I have the knowledge to both recognize a breastfeeding hurdle as well as know when an IBCLC is needed. I prefer my clients to see an IBCLC when complications arise and I always refer them. I remind my clients that reaching out and seeing their IBCLC continually is a great way to succeed in their breastfeeding journey."
Lastly, what do you want to tell moms when it comes to breastfeeding? What advice, words of wisdom or otherwise do you want to share?
Taylor: "You are not, in any way shape or form, a failure as a woman or mother, if you have problems breastfeeding and you have to do things a little different than another mother. There is a solution for you and please continue to reach out for support, there are so many amazing resources to help you and you can do it. There is a giant community of milk donors if it is needed, instead of turning straight to formula when problems arise. I just want mothers to know that they are doing amazing, no matter what. There are so many factors that go into breastfeeding and learning to breastfeed is a challenge for every new mother but it is possible to overcome the hurdles and you are not alone!!"
Yamel: "I want to tell moms the one thing I repeat over and over to my loved ones and to my clients. Breastfeeding is 90% determination and 10% supply. There will be some difficult days, you may be stuck under a baby forever in the beginning but it will get easier, reach out when needed you aren’t alone and this community truly wants to help towards your breastfeeding success."
Cheryl: "Sometimes it's easy and sometimes it's not, but nearly every breastfeeding difficulty can be resolved with the right support. As long as it is your goal to breastfeed, don't give up, ask for help, and trust that you and your baby can do this."
Christie: "It will get easier and you can do it! Every drop of milk you provide to your baby is a success. Be easy on yourself and do what is right for you and your family. Don’t hesitate to reach out for help. There are professionals here that want to help! We are rooting for you every step of the way."
Jessy: "When you are on your breastfeeding journey, support is everything. Finding a tribe of like minded women for support is so important. Then also, Listen to your body and your baby. Follow your baby’s cues and you will find a rhythm."
A big thank you to our lovely Tampa Bay Birth and Postpartum Doulas featured in our interview. Your unwavering dedication and support to the families in our community does not go unrecognized and we are grateful for your breastfeeding knowledge and support!
Check out the links below for more information on these doulas.
Taylor Bland: https://www.facebook.com/trinitycaimbirthservices/
Yamel Belen: http://onelovedoula.com/
Cheryl Waterbury: https://calmingpresencebirth.com/
Christie Collbran: http://www.buddhabellybirth.com/
Jessy French-King: https://www.facebook.com/jessykingdoula/