Breastfeeding—Starting Out Right

Breastfeeding is the natural, physiologic way of feeding infants and young children, and human milk is the milk made specifically for human infants. Formulas made from cow’s milk or soybeans (most formulas, even “designer formulas”) are only superficially similar, and advertising which states otherwise is misleading. Breastfeeding should be easy and trouble free for most mothers. A good start helps to assure breastfeeding is a happy experience for both mother and baby.

The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for about six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottle feeding sill predominate in too many health care institutions and make breastfeeding difficult, even impossible, for too many mothers and babies. For breastfeeding to be well and properly established, a good start in the early few days can be crucial. Admittedly, even with a terrible start, many mothers and babies manage.

The trick to breastfeeding is getting the baby to latch on well. A baby who latches on well, gets milk well. A baby who latches on poorly has more difficulty getting milk, especially if the supply is low. A poor latch is similar to giving a baby a bottle with a nipple hole that is too small—the bottle is full of milk, but the baby will not get much. When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain. Unfortunately anyone can say that the baby is latched on well, even if he isn’t.

Too many people who should know better just don’t know what a good latch is. Here are a few ways breastfeeding can be made easy:

1. A proper latch is crucial to success. This is the key to successful breastfeeding. Unfortunately, too many mothers are being “helped” by people who don’t know what a proper latch is. If you are being told your two day old’s latch is good despite your having very sore nipples, be sceptical, and ask for help from someone else who knows. Before you leave the hospital, you should be shown that your baby is latched on properly, and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast (open mouth wide—pause—close mouth type of suck). See also the websites www.breastfeedingonline.com/newman.shtml for videos on how to latch a baby on (as well as other videos). If you and the baby are leaving hospital not knowing this, get experienced help quickly (see handout When Latching). Some staff in hospital will tell mothers that if the breastfeeding is painful, the latch is not good (usually true), so that the mother should take the baby off and latch him on again. This is not a good idea. The pain usually settles, and the latch should be fixed on the other side or at the next feeding. Taking the baby off the breast and latching him on again and again only multiplies the pain and the damage.

2. The baby should be at the breast immediately after birth. The vast majority of newborns can be at the breast within minutes of birth. Indeed, research has shown that, given the chance, many babies only minutes old will crawl up to the breast from the mother’s abdomen, latch on and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who “self-attach” run into far fewer breastfeeding problems. This process does not take any effort on the mother’s part, and the excuse that it cannot be done because the mother is tired after labour is nonsense, pure and simple. Incidentally, studies have also shown that skin-to-skin contact between mothers and babies keeps the baby as warm as an incubator (see section on skin to skin contact).

3. The mother and baby should room in together. There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods.
• Health facilities that have routine separations of mothers and babies after birth are years behind the times, and the reasons for the separation often have to do with letting parents know who is in control (the hospital) and who is not (the parents). Often, bogus reasons are given for separations. One example is that the baby passed meconium before birth. A baby who passes meconium and is fine a few minutes after birth will be fine and does not need to be in an incubator for several hours’ “observation”.
• There is no evidence that mothers who are separated from their babies are better rested. On the contrary, they are more rested and less stressed when they are with their babies. Mothers and babies learn how to sleep in the same rhythm. Thus, when the baby starts waking for a feed, the mother is also starting to wake up naturally. This is not as tiring for the mother as being awakened from deep sleep, as she often is if the baby is elsewhere when he wakes up. If the mother is shown how to feed the baby while both are lying down side by side are better rested.
• The baby shows long before he starts crying that he is ready to feed. His breathing may change, for example. Or he may start to stretch. The mother, being in light sleep, will awaken, her milk will start to flow and the calm baby will be content to nurse. A baby who has been crying for some time before being tried on the breast may refuse to take the breast even if he is ravenous. Mothers and babies should be encouraged to sleep side by side in hospital. This is a great way for mothers to rest while the baby nurses. Breastfeeding should be relaxing, not tiring.

4. Artificial nipples should not be given to the baby. There seems to be some controversy about whether “nipple confusion” exists. Babies will take whatever gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is normally producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, the baby will tend to prefer the rapid flow method. You don’t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don’t seem to be able to manage it. Note, it is not the baby who is confused. Nipple confusion includes a range of problems, including the baby not taking the breast as well as he could and thus not getting milk well and/or the mother getting sore nipples. Just because a baby will “take both” does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented (see handout #5 Using a Lactation Aid, and handout #8 Finger Feeding) why use an artificial nipple?

5. No restriction on length or frequency of breastfeedings. A baby who drinks well will not be on the breast for hours at a time. Thus, if he is, it is usually because he is not latching on well and not getting the milk that is available. Get help to fix the baby’s latch, and use compression to get the baby more milk (handout #15 Breast Compression). Compression works very well in the first few days to get the colostrum flowing well. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.

6. Supplements of water, sugar water, or formula are rarely needed. Most supplements could be avoided by getting the baby to take the breast properly and thus get the milk that is available. If you are being told you need to supplement without someone having observed you breastfeeding, ask for someone to help who knows what they are doing. There are rare indications for supplementation, but often supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid at the breast (see handout #5), not cup, finger feeding, syringe or bottle. The best supplement is your own colostrum. It can be mixed with 5% sugar water if you are not able to express much at first. Formula is hardly ever necessary in the first few days.

7. Free formula samples and formula company literature are not gifts. There is only one purpose for these “gifts” and that is to get you to use formula. It is very effective, and it is unethical marketing. If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding. “But I need formula because the baby is not getting enough!”. Maybe, but, more likely, you weren’t given good help and the baby is simply not getting the milk that is available. Even if you need formula, nobody should be suggesting a particular brand and giving you free samples. Get good help. Formula samples are not help.
Under some circumstances, it may be impossible to start breastfeeding early. However, most “medical reasons” (maternal medication, for example) are not true reasons for stopping or delaying breastfeeding, and you are getting misinformation. Get good help. Premature babies can start breastfeeding much, much earlier than they do in many health facilities. In fact, studies are now quite definite that it is less stressful for a premature baby to breastfeed than to bottle feed. Unfortunately, too many health professionals dealing with premature babies do not seem to be aware of this.

Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA)
Handout #1. Breastfeeding—Starting Out Right. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code on the markeing of breastmilk substitutes is violated.

http://www.breastfeedingonline.com Cindy Curtis, RN, IBCLC

Exercise in Pregnancy

Preparing for birth should be much like preparing for an athletic event because labour and birth are indeed physical events we can prepare our bodies for. A healthy and fit mother will not only feel better during pregnancy, she will have the strength and flexibility to move during labour easily and comfortably.

After the first trimester, activities that involve lying flat on her back for long periods of time should be avoided. That’s because the weight of a developing baby may press down on and compress blood vessels that play an important role in blood circulation to the uterus, pelvis and legs.

As fatigue tends to be most common in the first and third trimesters, she may find herself less able to exercise during these periods.

Contact sports or extreme sports (for example, skiing, scuba diving, and sky diving) should be avoided because they have the potential to do harm to mother and baby.

Discuss with primary caregiver any unusual symptoms experienced during or after exercise, such as discomfort in her chest, neck, jaw, or arms; nausea, dizziness, fainting, or excessive shortness of breath; or short-term changes in vision.

Consider exercising in a medically supervised program, at least initially, if there are any peripheral vascular disease or kidney problems. Those with peripheral neuropathy should not run, jog, or walk long distances without the approval of their doctors, and those with retinopathy should check with their eye doctors before initiating an exercise program.

Preparation

A woman’s exercise level during pregnancy depends largely upon her level of fitness before she became pregnant. In other words, the more physically fit before, the more activity she can do safely during pregnancy. It is important to realize that during pregnancy is not the time to strive for exercise milestones or try to lose weight. It is a good idea to monitor heart rate, a good way to monitor optimal exercise intensity without overexertion.

Strengthening and toning torso, back, pelvis, thighs and stomach will help with the labour process. Exercise performed safely during pregnancy can lessen your fatigue, improve your self-confidence and mood, reduce backaches and bad posture, and strengthen your endurance during a prolonged labor.

Muscular Control of the Vagina and Perineum (“Kegel”)

This exercise is very important. Sitting, standing or lying down; contract and tighten the muscles of the pelvic floor (those used to stop the flow of urine flow). Think of pulling the opening of the vagina all the way up to the cervix. Hold for a count of five and slowly release. After releasing, relax and bulge your perineum down. Putting a hand over the perineum as it tightens and then bulge it out can identify this. Do four to six sets of twenty-five, spread over the course of the day. This is commonly known as the “Kegel” exercise, after Doctor Arnold Kegel, who identified the importance of this exercise.

Tailor Sitting

Sit on the floor with soles of feet together. Lean upper torso forward until a gentle pull is felt in inner thighs. Hold the stretch for twenty to thirty seconds, building the length of stretch time gradually. Repeat three to four times.  Sit in this way whenever possible; choose to sit on the floor at least three times daily.

Pelvic Rock

Kneeling on all fours (or leaning on chair seat if mother has carpal tunnel syndrome), tighten the abdominal muscles, especially the lower muscles, while tightening and tucking in bottom. This may be done frequently throughout the day to ease back discomfort and strengthen abdominal muscles. Repeat twenty to thirty times.

This is an excellent exercise to move a posterior (baby’s back is to mother’s back) baby into an anterior position (optimal position, baby’s back to mother’s front, usually with the back on mother’s left front). It is important that if baby is posterior, mothers should avoid reclining (on couch, in recliner, bucket seats in vehicles) and assume upright, forward leaning or side lying to help baby turn.

Squatting

Stand with feet and heels flat on floor, about a shoulder width apart. Face a chair or other stable object for support. Feet should point outward, not forward. Hold onto the support, and bend knees out while lowering bottom to no lower than knees, keeping feet flat on floor. Slowly build time until this position can be held comfortably for a minute or longer.

There is some concern about assuming this position during pregnancy as it is felt that it may commit a baby who is in a posterior position which is known to prolong pregnancy (non-progressing prodomal labour as baby attempts to turn prior to active labour), prolong labour and increase labour pain. However, most posterior babies do not engage (move into the pelvis) prior to labour. If baby is believed to be posterior, focus on pelvic rocking (above).

Beach Ball Hold

Sit on floor, knees bent, feet flat on floor. Holding lower abdominal muscles in tightly, tuck chin to chest, cross arms across chest, and lean back slowly while keeping feet flat on floor until upper torso leans back at approximately forty-five degree angle. Hold this position for a count of ten seconds. Return to original position by using hands on knees to support lower back. Repeat ten times and build slowly until you can repeat twenty to thirty times.

Practicing Good Posture

Stand against a door and try to touch it with the small of your back. Place hands under ribs on each side of the chest. Now pretend to lift the rib cage up. There will be an automatically straightening of the shoulders, tuck hips under, and raise chin. Hold head high and be proud to be pregnant!

Walking

Walk daily, starting slowly and building slowly until walking one to two miles in thirty to forty-five minutes is comfortable. Wear supportive and comfortable shoes, and stretch thighs and calves before and after walking to avoid muscle damage. Walk with abdominal muscles pulled in, bottom tucked tight, back straight, and head looking forward. Swing arms to increase aerobic exercise.

A “side-hitch” indicates inadequate oxygen intake; breathe slowly and deeply, slowing pace if necessary.

Important Points to Remember:

• Pay special attention to proper footwear.
• Drink lots of water and stay well hydrated before, during, and after activity.
• Warm up before a workout, and cool down afterwards.
• Skip exercising any time you have a fever.
• Exercise to the point of mild fatigue and never to the point of exhaustion.
• Mothers should avoid exercising in hot, humid climates and not get overheated (more than 100.4 deg F core body temperature).

Alert Caregiver when:

• Vaginal bleeding or spotting, abdominal cramping, absence of fetal movement, or prolonged contractions after stopping exercise.
• Light-headedness or dizziness, serious headache, shortness of breath, palpitations, fast resting heart rate (more than 100 beats per minute), and chest pain that continue past a short rest period.

This may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All Rights Reserved.

ICAN Website

Why are families having homebirths? Though each couple may have individual reasons, most plan homebirths because they believe that most of the time pregnancy and childbirth are normal functions of a healthy body — not a potential life-and-death crisis that requires the supervision of a surgeon.

Six Myths About Childbirth Exposed

Myth #1 — Hospital births are statistically safer than homebirths.

Myth #2 — You can get more professional attention in a hospital than you could get at home.

Myth #3 — The more modern technology you have on hand, the easier the birth will be.

Myth #4 — A hospital is a more sanitary place to have a baby than at home.

Myth #5 — A hospital is the most comfortable place to have a baby.

Myth #6 — It’s impossible to find any qualified person to assist you in having a baby at home.

Click here to read more about each of these myths about home birth.

Induction of Labor

The International Cesarean Awareness Network strongly advises women and health care practitioners to avoid induction of labor unless a true medical indication exists. Induction of labor frequently leads to further intervention in birth including the need for fetal monitoring, epidural anesthesia, instrumental delivery and cesarean section. Each of these interventions increases risks to babies and mothers.

First time mothers are especially vulnerable: Induction itself doubles a first-time mother’s risk of having a cesarean section.1,2

A cesarean puts a woman’s entire reproductive life, including subsequent pregnancies, at higher risk.

For all women, induction of labor increases the use of forceps and vacuum extraction as well as rates of shoulder dystocia.2,3

Women with a prior cesarean who are induced have a 33-75% risk of having another cesarean.4,5

Induction of labor has been shown to increase the risk of uterine rupture for women with a prior cesarean scar.6-9

Babies whose births are induced more often experience resuscitation, admission to the intensive care unit, and phototherapy to treat jaundice, which generally require separation from the mother. 10

References:
1. Maslow AS, Sweeny AL. Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstet Gynecol 2000 Jun;95(6 Pt 1):917-2.
2. Dublin S, Lydon-Rochelle M, Kaplan RC, Watts DH, Critchlow CW. Maternal and neonatal outcomes after induction of labor without an identified indication. Am J Obstet Gynecol 2000 Oct;183(4):986-94
3. Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 1998 Aug;179(2):476-80
4. Learman LA, Evertson LR, Shiboski S. Predictors of repeat cesarean delivery after trial of labor: do any exist? J Am Coll Surg. 1996 Mar;182(3):257-62.
5. Sims EJ, Newman RB, Hulsey TC. Vaginal birth after cesarean: to induce or not to induce. Am J Obstet Gynecol 2001 May;184(6):1122- 4.
6. Blanchette H, Blanchette M, McCabe J, Vincent S. Is vaginal birth after cesarean safe? Experience at a community hospital. Am J Obstet Gynecol 2001 Jun;184(7):1478-84; discussion 1484-7.
7. Baskett TF, Kieser KE. A 10-year population-based study of uterine rupture. Obstet Gynecol 2001 Apr;97(4 Suppl 1):S69.
8. Shimonovitz S, Botosneano A, Hochner-Celnikier D. Successful first vaginal birth after cesarean section: a predictor of reduced risk for uterine rupture in subsequent deliveries. Isr Med Assoc J 2000 Jul;2(7):526-8.
9. Ravasia DJ, Wood SL, Pollard JK. Uterine rupture during induced trial of labor among women with previous cesarean delivery. Am J Obstet Gynecol 2000 Nov;183(5):1176-9.
10. Boulvain M, Marcoux S, Bureau M, Fortier M, Fraser W. Risks of induction of labour in uncomplicated term pregnancies. Paediatr Perinat Epidemiol. 2001 Apr;15(2):131-8.

This material may be copied and distributed with retained copyright.

Click here to visit the ICAN Website.

I guess it all starts with Henry arriving at 39 weeks. Even though I KNEW that I could go past 40 weeks (Keith was born at 42 weeks), I didn’t really believe it. Boy, was I wrong. So 39 weeks came and went. So did 40 weeks. And 41. AND 42. It was a long month, to say the least. A couple of days after my car accident I saw the midwife to check in. I was 6-7cm dilated, so we tried some homeopathics to get labor going. No go. They gave me some contractions, but those contractions didn’t end up in a baby. So the weekend came… and went… Monday night I had contractions all night, but the didn’t get any stronger or closer together. Tuesday around 10am I called the midwife, and we decided she’d come down and we’d evict this baby. If you know me you know that I’m not a fan of inductions, but sometimes the risks of staying pregnant outweigh the risks of the induction. I was pretty much at that point. Postdates, baby wasn’t moving as much as I’d like, the car accident… time to have a baby. I’d probably still be pregnant if we just waited for Miss Caroline to get her act together. So I called Ed (who was working at the Jersey shore – way to stay in the area in case your wife has a baby Ed!) and my doula and told them that the midwife would be over in an hour or two and we’d be having a baby. I called my mom to get Henry, and the midwife showed up around noon. She broke my water and gave me a dose of cohosh tincture, then my mom came to get the kids. We convinced Keith to go with her to lunch and then come back, because babies take a little while to show up. He’d be fine – get some lunch, come back and see a baby be born! So the boys left around 12:30 or so, and the midwife gave me another dose of cohoshes. Two contractions later, I changed my mind about the whole having a baby thing. I called Ed and told him to hurry up and come home, and called my doula. Contractions were 2 minutes apart, lasting about a minute. The second midwife showed up around 1 and got me into the shower so I’d cope better. At 1:30 I started pushing. I only pushed a couple of times with Henry, and for 20 minutes with Keith, so after a few pushes I was done. Unfortunately baby had different ideas! I ended up pushing for about an hour. Ed and the doula showed up a little bit after I started pushing, and were HUGE helps! I hate pushing with a passion. Finally, she was born at 2:28pm – two and a half hours after the midwife showed up at my house, and less than two hours after I felt the first contraction. She was a bit slow to adjust to outside life (is THAT a surprise? Why do I think my Caroline is going to be consistently late in life?!?), but after a bit of oxygen she was fine. My doula told me it was a girl, and I didn’t believe it until I saw her. I still don’t really believe it! Ed called Keith to apologize for him missing the birth, but it was all made better when he was told that he had a baby sister. He dropped the phone and Ed heard him say “I finally got what I wanted!” Mom and dad brought the boys right over to meet their sister, and they’ve been over the moon with her since.

Click here to visit this family’s blog.

State of American Childbirth

Pregnancy and childbirth are normal, healthy processes for the majority of women and babies.

SCOPE AND SCALE OF MATERNITY CARE — EACH YEAR IN THE UNITED STATES:

1. Over 4 million Births
2. 99% in Hospitals
3. Over 90% Attended by Surgeons
4. Second Most Common Reason for Hospitalization
5. Most Common Reason for the Hospitalization of Women
6. Care for Mothers and Babies combined Rank 4th in Hospital Expenses
7. Over 6.8 million Obstetric Procedures Performed – 2nd Most Common Category of Surgical Procedures
8. Three of the Four Most Common Surgical Procedures Performed in the United States are Obstetric

Nearly all women giving birth in hospitals are subjected to some level of technological or medical intervention.
THE MOST COMMON INTERVENTIONS ARE:

1. Over 31% (1.3 million) Cesarean Surgeries – Has risen over 50% since 1996, HIGHEST EVER
2. Vaginal Birth after Cesarean (VBAC) rate has fallen over 50% since 1996, ACCESS DISAPPEARING
3. 34% (1.4 million) of Labors Medically Induced
4. 41% (1.66 million) Need Vaginal Stitching (episiotomy, tears, vacuum extraction, forceps)
5. 47% (1.88 million) of Labors Artificially Stimulated
6. 60% (2.4 million) of Women Denied Fluids
7. 76% (3.04 million) of Women Restrained In Bed
8. 85% (3.4 million) of Women Denied Food
9. 86% (3.44 million) Given Drugs For Pain Relief
10. Over 90% (3.68 million) of Women Attached To Electronic Fetal Monitors

What do we have to show for all this intervention?

OUTCOMES IN THE UNITED STATES:

1. High Infant Mortality Rate – Stayed Flat over the last 6 years, 29th in the world – Twice as High for African American Babies
2. Maternal Mortality Rate – Not Improved in 20 years, 25th in the world – Four times as High for African American Mothers
3. 12.8% (over 546,000) of Babies Born Preterm – has Risen 21% since 1990
4. Over 8.3% (over 354,000) of Babies Born Low Birth Weight – has Risen 19% since 1990
5. 44% (1.76 million) of Mothers have Emotional Or Physical Impairment after Birth Interfering with Ability to Care for their Babies
6. Over 25% (1 million) of Mothers have New Health Problems after Birth
7. 63% (2.52 million) of Mothers have some symptoms of Postpartum Depression
8. 18% (720,000) of Mothers show symptoms of Post Traumatic Stress with 9% showing all signs of PTSD.

With all the money we spend, why aren’t our outcomes better? Countries with lower costs and better outcomes for mothers and babies rely on midwives to attend most births – and many support out-of-hospital births.

The Midwives Model of Care & The Mother-Friendly Childbirth Initiative
www.cfmidwifery.org/mmoc www.motherfriendly.org
Promote Wellness, Education, and Individualized, Motherbaby-Centered Care.
Midwives are Key to Effective, Affordable Mother-Friendly Childbirth

Reprinted with Permission from Citizens for Midwifery

Click here for this article along with references.

Childbirth Connection is a vast resource for families interested in important information regarding all issues surrounding new motherhood. Here is a link to a short article about baby blues and postpartum depression, and how to know if you have crossed over the line and need to seek outside help. This excerpt is taken from the book “Journey to Parenthood.” The text of this book is freely available on the Childbirth Connection website.

Baby Blues article

Childbirth Connection home page

This video is amazing – and she has a beautiful voice!

My Commitments as Your Doula

· Two to three prenatal visits in your home or other location of your choice. These visits may include birth plan options and assistance, how I can help you as your doula, physiology of labor, breathing and relaxtion, breastfeeding preparation, etc. Each visit will be tailored to your specific needs and will include time to answer any questions you have.

 · I am the person that you first contact when you are in labor. If for any reason you are unable to contact me or due to an emergency, I will provide contact details for a backup doula. I will be on call for you 24 hours a day beginning two weeks before your estimated due date up until labor begins. This mean that I will carry my cell phone with me at all times, and will not leave town without advising you unless it is an emergency or an event not known about at the time of the contract signing.

· I will provide early labor support as requested, including in your home. I will remain with you once active labor has begun until one to two hours after your baby is born. I may take short breaks for meals and rest if time allows – this will be discussed with you at the time and I will not leave you if it is inappropriate.

· I will draw on my knowledge and experience to provide emotional support, physical comfort (relaxation, massage, positioning and other techniques for comfort), and communicate with the medical staff to make sure you have the information you need to make informed decisions during labor.

·  The presence of a doula lifts the sole responsibility of the labor off the shoulders of your partner, allowing him to enjoy the whole birth process. I can help your partner to feel calm and informed, giving him ideas to continue support from beginning to end. At no time will I “take over” or deliberately exclude your partner. I am there to provide support to both of you at all times. Sometimes a partner likes to stay by the mother’s side during the whole of labor, while others prefer to take a break. This is your birth experience and it is important that you feel free to decide on what you want at the time.

· As a doula, I can advocate for you at a time when it is sometimes difficult for you to advocate for yourself. However, I will not and can not make decisions for you. In a situation where medical decisions must be made, my role is to quietly remind you what your wishes are, assist you in asking questions and gaining information about other options, and then look to you and your partner for the final decision.

· I will assist in providing information and supplying emotional support by telephone on postpartum care, breastfeeding, and newborn care after the birth, as requested. Please contact me if you have any concerns. If I cannot help, I will be able to find the appropriate person who can. I will help to initiate the breastfeeding process, if that is what you choose to do. If you wish to bottle feed your baby, I will help you with the first feeding.

 · Within the first 5 days after the birth of your baby, I will visit you at home or in the hospital. I will answer any questions or give you a referral to the appropriate professional that can meet your needs. I will meet with you for at least two postpartum visits, and more depending on your needs.

Have questions? Please feel free to contact me at any time, I am happy to talk with you about my services and any questions you may have. Click here to send me an e-mail or call me at (210)635-8728 and leave a message.