Breathing is regulated by the autonomic nervous system and is subconscious.  Breathing and our breath are things that we mostly take for granted.  So, why am I writing a blog post about breath?  

Recently I was attending a birth (as a Birth Doula) and I realized how much I focus on helping mothers to breathe during labor.  The following day I was working with a mom as a Lactation Consultant and again I found myself focusing on her breath.  That led me to think about how much I use breath/breathing slowly as a parent and in my day-to-day life to keep myself calm and focused.  I felt the topic deserved to be explored.

During labor....

• Mothers who control their breathing tend to be calmer and able to keep their body more relaxed.  
  
• By breathing slowly and steadily the mother is helping to deliver a steady flow of oxygen to baby through the placenta.
• Deep breathing with vocalization can help to manage discomfort and pain during the final stages of labor.
• If baby's heart rate was to drop it can raise right back up if mama does some good steady breathing. 
  
• Breathing that resembles panting can help a mother who feels the urge to push but is not completely dilated and is asked to wait.
  
• Slow focused breathing during the pushing stage can ease a baby out and help to avoid tearing of the perineum.  
  
• Some mamas will almost "breathe the baby out" by barely pushing and just allowing baby to ease out with mama's breath.
  
• Mother and partner breathing in unison can create a calm atmosphere in the birth space and help both to focus.
  

Once baby is born.....

• Baby's first breaths are what parents are waiting to hear.  They let us know that our baby is ok.
  
• Once the umbilical cord is cut the baby is now required to breathe on its own for the first time.
  
• Slow steady breathing can help mama deal with the discomfort of the first postpartum contractions of the uterus.
  
• If any repairs to the perineum are necessary, your partner or Doula can help you control your discomfort by talking to you about breathing out and breathing slowly.
  
• Making sure we control our breath while breastfeeding can help us to relax while mama and baby learn to latch.
  

While breastfeeding....

• There may be times when breastfeeding is uncomfortable.  Breathing slowly can help us to deal with that discomfort.
  
• When I work with new mothers as an IBCLC I often talk to them about their breath as I gently press down on their shoulder to show them that they need to relax.
• As we go on to nurse our babies into toddlerhood, we often struggle with discomfort during ovulation and our menstrual cycle.  Taking the time to breathe calmly can help us to not snap at our innocently nursing toddler even when the feeling is grating on our last nerve.
  

As Parents....

• Over the years I have found myself in some pretty frustrating situations...understatement....and breathing has helped guide me through.  
  
• When a toddler throws a tantrum in a restaurant....just breathe, smile and then pick them up and remove them from the situation.
  
• When a school-aged child talks back....breathe then respond calmly.
  
• Oh and when a high school-aged child openly defies you....breathe and then let them know what the consequences to their actions are.  
  
• As you watch your first-born child depart for college....just breathe.  They will be fine.

Breathing and Breath are so incredibly important!!  Start paying attention and using it to help you deal with all that life throws at you. 

What is the role of your Doula in supporting your breastfeeding relationship?  

I was reading a Facebook post recently about a mother's first birth/breastfeeding experience.  She made a comment similar to, "I did everything right.  I hired a doula, had a natural unmedicated birth, etc. and still had breastfeeding issues."  I thought to myself...what do mothers expect from their doulas in regards to breastfeeding support? 

Doulas are Childbirth Professionals which doesn't actually mean that they are Breastfeeding Professionals.  In San Antonio I am currently the only Doula that is also an International Board Certified Lactation Consultant (IBCLC).  Many of my fellow Doulas have made the effort to obtain additional breastfeeding education which is something I applaud them for and support them in doing.  I love being a resource for my fellow Doulas who come to me asking which programs I recommend or ask for guidance on their road to becoming more breastfeeding proficient.  

Two weekends ago my business partner Ginger and I taught a class to a group of newly trained Doulas on Breastfeeding.  We loved working with these new Doulas and we loved putting together the class.  Here is some of what we shared with those Doulas regarding the Role of the Doula in regards to Breastfeeding:

At your prenatal visits your Doula should...

• Discuss breastfeeding basics, skin-to-skin and how your birth can affect your breastfeeding relationship.
  
• Provide you with resources for local breastfeeding classes and support groups.
  
• Suggest breastfeeding books, dvds, etc. that would be helpful to you.
  
• Discuss your plans to go back to work and how that will affect breastfeeding.
  

At your birth your Doula should....

• Assist you with latching your baby.
  
• Make you comfortable and take care of any needs that you have while you are nursing.
  
• Ask the medical staff for assistance if you need it and she is unable to provide it.
  

At your postpartum visits your Doula should....

• Make sure that breastfeeding is going well.
  
• Make sure that you are taking care of yourself so that you can take good care of your baby.  Hydration, nutrition and rest are important to successful breastfeeding.
  
• Provide resources for lactation professionals if you need additional support outside of her knowledge.
  

What your Doula should NOT do....

• Provide assistance out of their Scope of Practice.  For example,  a Doula should not be doing an oral assessment on a baby unless she is a trained lactation professional and is working under that scope.
  
• Your Doula should not be in the way during your initial breastfeeding and should make sure that your partner is able to see what baby is doing so that they can assist you when no one else is around.  
  
• Your Doula should not be holding your baby for long periods of time.  Your baby needs to bond with you and your Partner.  Your baby should be learning your scents and tastes not anyone else's.  The Doula should never be center stage at a birth especially during early bonding.
  

Make sure that your Doula is covering the topics that we suggested and that they are not working outside of their Scope of Practice.  Working with babies is a delicate thing.  A newborn baby can start to go downhill pretty quickly if they are having issues with milk transfer or if you are having issues with your milk supply.  You should always consult with your Health Care Provider as well as with an IBCLC when you are experiencing breastfeeding difficulties.

Most babies will lose weight after they are born.  We like to say that babies are born "juicy" and so weight loss is normal.  A study published in the December 2014 issue of Pediatrics (the Official Journal of the American Academy of Pediatrics) confirms this.  The study is authored by Dr. Flaherman of the University of California, San Francisco, and her colleagues.  

In this era of induction and cesarean births we are seeing babies with higher weight loss percentages than in years past.  Having worked in lactation for over 16 years I have seen these expected percentages change over the years.  In the 1990's a 7% weight loss was what was considered "normal."  Somewhere along the way it became 10%.  I now consistently see babies losing 10% and sometimes more.  My colleagues and I work with mothers who are on IV fluids, pitocin and epidural drips for 24 hours or more.  That is a lot of fluid being taken on by the mother and in turn the baby.  A few days after an induced or cesarean birth the mother usually finds her legs are swollen up like tree trunks and her feet won't fit into anything but flip flops.  Where do we think these fluids go for baby?  

According to the authors of the study of the 108,907 exclusively breastfed newborns, 83,433 were delivered vaginally and 25,474 were delivered by cesarean. "Differential weight loss by delivery mode was evident 6 hours after delivery and persisted over time. Almost 5% of vaginally delivered newborns and >10% of those delivered by cesarean had lost ≥10% of their birth weight 48 hours after delivery. By 72 hours, >25% of newborns delivered by cesarean had lost ≥10% of their birth weight."  

We regularly tell parents that their pediatrician will expect their baby to be back up to "birth weight" at the two week appointment.  We will see if this study will change these guidelines or if they will stay the same.  Either way we at The MILC Group will continue to support the families of our community in feeding their babies.