In parenting as in life, everything is about perspective. It is our outlook combined with basic biological factors which make the soundtrack of our lives, helping us transition through the common adjustments the postpartum period requires.
Becoming a parent is perhaps one of the biggest shifts in life, one that requires major adaptation. Not only do we adjust physically as mothers to allow room for another human being to grow and develop inside us, but we prepare psychologically to become parents. We seek out education, and look to our families, friends and acquaintances for guidance and example.
But truly nothing can prepare us for the reality of early parenthood. Even the comprehensive and detailed courses that bring us information that is vital to new parenthood seem millennia away!
Awake late in the night, holding your fresh baby, much of what you learned seems out of reach.
Being at home with that new little being can be overwhelming for new parents. There is so much to know and we feel often inadequate and afraid that one simple decision is the only thing separating us from calamity. Our perspective is coloured by desperate love and inexperience.
The truth is that we have everything it takes. We always had it. We just have to trust it. But how?
There are four keys which MotherWit Postpartum Doulas use to help new parents develop strategies to balance life: NUTRITION, SUPPORT, LOVE and SLEEP.
- NUTRITION is paramount to keeping a sleep-deprived, adrenaline-pumping brain in check. Accepting healthy meals from family and friends is key. Postpartum Doulas also bring food according to your needs.
- SUPPORT refers to asking for help, calling on family and friends, asking questions, and seeking out respectful, non-judgemental resources.
- LOVE speaks to laughter, joy, allowing worry to melt away from time to time and relishing this new experience. It means loving yourself, your partner, and your new family member. And throw in a cart-load of forgiveness. You may as well start now!
- SLEEP… ah sleep. I leave sleep for last because the lack of it is the wrench that can throw all of the above into chaos. When we are sleep-deprived our perspective can be very warped. If you have never been woken up every hour for days on end, suddenly have a tiny and extremely demanding life depending on you absolutely and completely, then new parenthood will feel like some sort of insane Amazing Race you can’t get out of! Days and nights melt into each other and seem endless.
Often family and friends can be a great support here. Having a set of arms to hold Baby as you nap can be a life-saver. But sometimes what is needed is a (nearly) full night’s sleep.
This is where overnight Doula support comes in.
A Doula, experienced in pregnancy, birth and postpartum care, is a great choice of person to care for you and your baby during the night hours, when things can seem even more overwhelming. Doula arrives as you are ready for bed and often spends a few moments making tea and discussing your concerns before tucking you into bed.
The Doula will take care of Baby’s needs as they arise, tending to changing, burping, and soothing. If your baby needs your breast, they are brought to you for feeding, the Doula providing hand-on support and company in those challenging wee hours. Doulas will also feed Baby with a bottle to help you get more sleep if this is your need. A Doula will, however, know when Baby needs that comfort only mama’s arms can provide. You don’t need to worry that your baby will be missing you. We can find the balance between as much sleep for you as possible, and ensuring Baby’s needs for connection with you are met.
Burping, diapering and rocking are generally taken care of so the new parents can get as much sleep as possible.
What is the result? It seems it is almost a miracle! Parents rise in the morning and coffee is brewing and ready. They often have time to shower before meeting Doula with a smile.
Our goal is for you to need us less, not more. Even one or two nights of restful sleep is often a turning point for many new parents. The brain is boosted with sleep, the over active adrenal glands take a break, and sweet relaxation takes over.
The many nights I have spent caring for new families in their cozy home are some of my most memorable moments as a Doula. It is perhaps the epitome of what it is to care for and nurture a new family into being. It is a sweet and gentle time, a time to move slowly and carefully. The world slows down, and in this moment space is created for your family to take its rightful place.
We no longer live in a world where “elders” are part of our cultural structure, but we can be sought out and utilized. Nothing is more comforting that sleeping soundly as the world is cared for by someone else. That is why Doulas do this work and carry this cultural tradition forward. It is important, valuable and often miraculous!
MotherWit Doula Care
When we have our first babies, it doesn’t matter where we come from or how well we have mastered other areas of our lives. We all begin parenthood as newbies, and the learning curve is steep. We fumble and falter, gain confidence and wisdom, run into stumbling blocks, and hopefully learn to forgive ourselves those days it feels like we should start making large deposits into our child’s future therapy fund.
Despite what a balancing act having a child is, many of us venture to have more than one. I went on to have four. Parental concerns shift with subsequent babies from “How do I take care of a newborn?” to “How will my toddler and I cope with my attention being so focused on the new baby?”
With older children it is different, because they can communicate their feelings more clearly. Toddlers, who are often still in diapers and just learning how to string several words together, are the ones parents tend to worry about the most.
These are the most common concerns parents have about how their toddlers will cope with the new baby:
1) What is the best way to introduce my toddler to the new baby?
Every family has different wishes for the first meeting. Some parents experienced a rough birth and prefer their toddlers to visit when they’re feeling less sore and more present. Others want the toddler to be brought over right away. Some are even present for the birth. Whatever feels right for your family is likely the best plan.
What parents are often afraid of is their toddler reacting negatively to the new baby at that first precious meeting. It can happen, and it is best to not take it personally, or as a sign that things aren’t starting on the right foot. Toddlers are unpredictable, and don’t always show up emotionally in the way we hope.
Having the toddler be introduced to their sibling in the presence of someone else they are attached to is an appealing idea to many families. If the older child becomes upset, Grandma or Uncle can be there as the safe harbour. It is around this time many toddlers begin to see that it is not only Mom or Dad who can provide a loving haven. And it can be hard for some parents to see this happening, as they interpret it as a withdrawal from them. They feel guilty. But in fact it is okay to let “the village” help.
Many parents have a tradition of giving the toddler a gift from the new baby, as a way to honour them for being a wonderful big sibling. This can definitely smooth the rough edges for some kids.
Encouraging visitors who come to see the new baby to take time to connect with the toddler helps too. In all the new baby excitement, the older kids can definitely feel overlooked, which enforces their feelings of exclusion.
2) Will my toddler regress in behaviour?
Most likely? Yes, to a greater or lesser extent. Without being able to communicate skillfully with words, it makes sense they’ll articulate their feelings, intentionally or not, through their actions.
It is normal for kids who were perhaps using the toilet to begin having accidents, or even giving up the toilet all together for a while. Night waking can be more frequent, and bottles/breast may be requested again.
Many parents want to have their toddlers be a little more grown up before the baby arrives, and think about stopping some of their comfort seeking behaviours. But stripping away too many of the things that may provide their toddlers with comfort (binkies, blankies, and bears, for example) at a time they may most need to have some security, may not be most helpful.
Either way a parent decides, if a new habit has been formed, regression for a while is normal. This too shall pass.
3) Will my toddler be jealous with all the time I spend with the baby?
Yes, they will probably be jealous. It is absolutely normal for a little one who is used to their parents’ consistent attention to feel jealous when a new baby comes. We cannot reason that feeling out of a kid. The reason parents ask this is not because they can’t handle the behavioural acting out the kid will likely do as a result of their tender feelings, but because their hearts are broken at the thought of their beloved child being sad.
To minimize some of the jealous feelings, some parents play the “Being a Baby is SO Boring” game. It gently encourages the toddler to feel proud to be a bigger kid. It goes like this: “See Baby having her milk? Poor Baby, she doesn’t get to eat big kid food like you do. She only gets milk. And she can’t understand the books we read together. It’s not as fun for Baby, because she’s not big like you. How about you eat your snack and I read to you while Baby drinks her milk?”
The goal isn’t to push the toddler into any given behaviour, but to suggest that it’s kind of cool to not be a baby anymore. As cushy as baby life might look being in Mom’s or Dad’s arms a lot, baby life is comparatively limited.
4) How will I ever love my new baby as much as I love my toddler?
As a mother of four, I have learned that the heart is not like a loaf of bread. It is not a finite thing that is sliced up into pieces and given away in increments, leaving the possibility of nothing left. With the intense love we’ve shared with our older kid since their birth, we can worry we’re down to the heel of the loaf.
The good news is that the heart is infinite. It has an absolutely endless supply of love. It has the capacity to welcome and include our new arrivals with as much intensity as we share with our older kids.
5) I hate to say this, but I find my toddler annoying.
What often concerns the birth giver most is that there can be a period in which they feel like they actually love the new baby more. This can be unexpected and distressing, something they may not admit to people, even though it is quite normal. Hormonally, our bodies are geared towards bonding fiercely with and protecting our babies. Toddlers can appear suddenly huge, loud, and demanding.
Let’s repeat our parental mantra: This too shall pass. In a normal situation, hormones adjust, toddlers adjust, and everyone finds their place a little more comfortably in the family. The love will then generally not be seen as “more or less”, simply as different, because our children are different people.
Parent hearts are often so very tender over the fact their toddler is having to go through some tough emotional adjustments. As loving parents we want to spare our children from pain. It hurts us to see them sad. And the sadness that can be expressed in a myriad of toddler ways in response to Baby fills parents with guilt and worry.
If we think about it, almost all major life transitions contain elements of pain. Growth can hurt. It is a natural part of the process of being human. Even for toddlers. If we can connect with our toddlers time to time in the authenticity of their pain and simply love them without trying to fix the feelings we wish they wouldn’t have, we honour the human growth work they are doing.
The acknowledgement, “you are sad, this is hard, and I love you exactly as you are,” can be more effective in facilitating growth and healing than drowning out the reality of pain with gifts, distraction, or words like “but don’t you want to be a good big brother/sister?”
While it can be hard to come to terms with the role adjustment of going from being “the baby” to being a big sibling, we do get used to it. And we can even end up enjoying it.
Guest post by MotherWit Doula Megan Tolbert
in a group tend to get kind of chatty. And in my neck of the woods,
doula chatter swings from the ridiculous to the sublime in the blink
of an eye.
late afternoon, a smack* of doulas was sitting around my living room,
enjoying a glass of wine in preparation for our evening reservation
at a local spa. Naturally the conversation turned to how we would
survive stranded on a desert island.
tame a monkey, and teach it to breastfeed. I’d relactate, and survive
off my own breastmilk!” declared one enterprising doula.
heated discussion followed about how one would tame this alleged
monkey (it would have to be a baby monkey, it was decided), how long
the relactation process would take (given the fact that the doula in
question had not breastfed for eight years or more at that time), and
whether the caloric expenditure involved in producing the breastmilk
would be worthwhile in the first place.
deep into a second glass of wine, I had an epiphany.
GUYS. Why are you breastfeeding this monkey, when you could be EATING
all have a tendency to overcomplicate things sometimes. I see it done
during birth in hospital settings, where a C-section can be proposed
before even considering a simple solution, like changing positions to
help baby descend.
see it with new (and sometimes experienced) doulas in some of the
Facebook groups I belong to, frantically listing all the things
they’ve done so far to “fix” a clients long early labour—only
to be reminded that maybe the best thing they could do right now is
get their clients to sleep, and just leave them alone for a while.
see it with new parents when I visit them postpartum, frazzled and
exhausted, baby fussy and demanding—they’ve forgotten the first
thing they ever learned in hospital about newborn care: Skin to skin.
So back to bed we go, pillows placed just so, dress down mama and
baby, and just….breathe. And suddenly this breastfeeding thing
doesn’t seem so challenging.
back to basics oftentimes gets the job done. Occam’s Razor is a vital
principle in my work as a doula, one I have to remind myself of over
and over: The simplest explanation is usually the correct one.
birth, in parenthood, in life: Keep it simple. And for goodness sake,
stop breastfeeding that monkey and just eat the darned thing!
“Smack” is the unofficial collective noun for a group of doulas,
like a murder of crows, a pride of lions, or an exaltation of larks.
Many people use fighting words when it comes to cancer. “I battled cancer.” “My mother lost her fight with cancer.” For many, The Warrior Path is essential to their journey, and I honour that. When I had cancer, I felt a strong aversion to using the language of war. I chose a different path that I felt worked for me, and want to share another possible way of being fierce in the face of illness.
In 2012 a blood test to investigate pains in my lower back and unusual vaginal bleeding determined my kidneys were in distress and I was anemic to a level that required blood transfusion. I was hospitalized, and upon further investigation it was determined I had invasive cervical cancer. Flooded with shock, rage, and fear, I was tempted to fight it tooth and nail. But something in me said, “Breathe”.
I went through a procedure in which a tube was placed into each kidney for drainage, since my ureters were dangerously narrowed by the cancer which riddled my pelvis. After my kidneys were drained and stable, the tubes were replaced by stents in my ureters. Those stents were hell.
I began six weeks of chemo along with daily radiation. I received three treatments of Brachytherapy, a process involving radiation directly to the tumors. I didn’t see these fierce medicines as weapons against my cancer, rather I chose to embrace them as friends that would help me reboot my system to be open to healthier patterns. I blessed them with such gratitude for their availability at this point in time, as well as the magnificent doctors who had the skills to apply them.
Unmanageable pain was the worst part of the experience for me. There was no real life, as I was either out of my head on drugs or frightening my children with the sound of my moaning.
So did I want to fight cancer at times? You bet I did. I had moments of rage and panic, which breed the “fight or flight” impetus. With cancer that advanced I was terrified of dying and leaving my husband and four children. I believed I would never feel better, that my “good” days were entirely behind me, and that this existence was all that was left.
I was bitter that cancer was in my cervix. I was a doula, a veritable cervix fairy, and here was mine obliterated by disease. I would have taken cancer anywhere else in my body far less personally. But as a wise friend said, “Of COURSE it’s in your cervix! This is how you will make meaning of this journey.”
A few months after treatment, which had showed promising results, I was admitted to the hospital again in renal failure, vomiting my face off and feeling like there were bugs crawling all over my skin. Three doctors stood at my bedside telling me that an MRI showed a mass near my lower spine, and that if this wasn’t metastasized cancer, it would be a miracle.
I checked myself out of the hospital with re-inserted kidney tubes. I schlepped them around attached to some not-so-sexy looking urine collection bags I wore strapped to my legs. As awful as this sounds, I was grateful for the tubes, as life feels much better with functioning kidneys.
The doctors wanted me to stay in the hospital to get an immediate PET scan to determine the extent of the cancer. I told them I’d get the PET scan in six weeks as an out-patient, as I wanted to take some time to enjoy feeling stable. Nobody argued, as there were no medical heroics to be had.
Clear headed and with nothing to lose, I wanted to go deeply within and explore how I was going to live my precious available moments. I wanted to be with the friends who made me laugh. I wanted to do things I didn’t normally do for fear of being judged, like explore more esoteric healing practices. I wanted to express overflowing love and blessings to all those who sent me thoughts and prayers for healing, and who supported me in doing the things that nourished my wellness. I needed to come hurtling out my suffocating spiritual closet into a place of freedom for my soul’s expression without caring if people didn’t understand me.
I wanted to teach another doula training, but this time include the spiritual aspects of the work. I had always shied away from teaching from that place of spiritual authenticity because I thought people wouldn’t want to learn from me, judging me as being earthy/crunchy woo woo, which frankly is not great for a professional doula’s reputation. I scheduled a course and taught it in Toronto the way I wanted, including ceremony and deep soul nourishment for my beloved students. It remains one of the most powerful gatherings I’ve ever been part of.
I drank Cosmos with friends and walked around my beloved city, eating whatever I wanted. I enjoyed my family fully. I focused on life, not the lurking mass. I participated in a Sweat Lodge with a spiritual community in New York state without apologizing to the non-crunchy folks in my life, and revelled in the joy of feeling fully myself.
On that pivotal trip to Sweat Lodge, I learned from a friend about an amazing school in New York City called One Spirit Interfaith Seminary. Its program focused not upon promoting any religious dogma, but upon serving as a presence of peace and healing in the world on people’s own terms. Despite my diagnosis, I applied to this two year
seminary program in order to become an interspiritual minister, trusting the internal “YES” that guided me. I chose to love life again, no matter what.
I noticed that relinquishing my bitterness about cancer and choosing to live fearlessly made me feel better physically and emotionally. I did the things that were meaningful to me without caring what people thought. I kissed my fears of living my real dreams goodbye, realizing that the fears I carried were simply the awesome parts of me I had never claimed.
I discovered that a chapter in the story of my cancer was about a part of me that had grown wild. I had gotten so caught up in being the mother/wife/doula I thought I SHOULD be, I denied the woman I truly was, and she was demanding to be witnessed in all her passion and ferocity. Fighting cancer meant fighting myself, and that just didn’t make sense in my narrative.
I have never been religious, but I realized I was still struggling with my concept of “god”. Through insights that came from working diligently to heal what I felt was a toxic, disempowering relationship with a disassociated higher power “out there”, I learned to trust what emerged from the higher power within.
I finally went for that PET scan. When I saw my oncologist a week later he said, “It appears you have no evidence of disease.” Do I think my approach provided a magical cure? No. I think I had a lot of good luck on my side. But I do believe making peace with cancer left me feeling serene and with the ability to cope with
whatever life threw at me. Had I discovered cancer was still there and advancing, I would not have thought I “lost” any “fight”. I don’t see cancer as some foe trying to conquer people. Illness and death are not failures.
Three years later, I remain cancer-free, living a life dedicated to helping people have awesome birth experiences, training doulas to have
healthy, thriving practices, and providing spiritual support to folks as a minister.
Many people fight cancer and win. Fantastic! That is their story, and I deeply honour it. My intuition spoke to me of working differently with cancer, and learning the lessons it had to teach me. I like to think it worked for me. Everyone who sets their foot to the path of healing must decide their own approach, and
infuse it with their own belief.
May your motherwit, that innate intuitive knowing, be a strong partner in your healing.Lesley
I am so honoured to have received this recount of a precious new mother’s experience after the premature birth of her son. I will refer to her as Anne.
Anne’s quest for healing after her disempowering experience in the NICU led her to write out her story as an exercise in personal process. She has generously agreed to allow me to share it.
As a doula, I am rarely allowed in the NICUs in my town. The odd times I am, all I can do is offer support. Parents don’t have time to read books I might recommend on evidence based care, and they are not something people generally choose to read in pregnancy, as rarely do people expect, nor should go around fearing the possibility of having a premature or sick baby. I am not a medical expert. What I do with every contact I have is say, “You are doing amazingly. Be strong about saying you’ll be holding and breastfeeding your baby as much as possible. It will be better when you get home.”
I can only bolster parents’ trust in their own instincts. encourage a lot of question asking in the hopes they will receive correct information, provide information on the benefits of Kangaroo care, and listen heartbroken to the parental feelings of overwhelm and self-doubt.
Parents are so busy in the NICU and catching up on rest, that our communications are usually few and far between, their focus completely taken up by the care of their child and themselves. As a doula, I make sure my communications are calm and as encouraging as possible. The best healing I can bring is to love them up when they get home (where I am allowed to be with them as long as they wish, unlike in the NICU), and support them as they begin to reconnect to their fractured motherwit.
Even the fiercest and most knowledgeable of self-advocates may, at the mercy of postpartum hormones, exhaustion, fear for their baby’s health, and perhaps even a sense of guilt about not wanting to seem ungrateful for the fact their baby is in loving, capable hands, be at risk for being completely railroaded by the environment. It hurts when my role becomes more about emotional damage control than being able to do much practical support as I can in a birthing room. When I do have the opportunity to be in the NICU, I am treated as someone taking up too much space, and am often told impatiently that I can’t be there much longer.
It is my wish all parents, health care providers, and doulas take away from Anne’s and her partner’s story the inspiration to participate in the creation a more nourishing, correct information providing, and parent/baby-as-symbiotic-unit approach to caring for families spending time in the NICU.
Here is her story:
Trying to find your
voice as a new parent in the NICU
Advocates for less
medicalized births often talk about the dangers of the “cascade of
interventions” when laboring in hospitals and they encourage
pregnant women to be as informed as possible when deciding what they
do or don’t want or need while birthing. I am a researcher by
profession, and so when I was preparing to give birth to my first
child, who was born this past September, I really heeded this call. I
feel empowered when I am informed. My husband and I read books on
pregnancy, birth and breastfeeding, among other topics, we hired a
doula, we attended birth prep and baby care classes, I scoured
literature reviews on baby health and safety issues, and as a result,
we both felt relatively informed about the process that was about to
unfold in front of us. We knew that there was no such thing as being
“ready” to have a baby, but having spent so much time reading and
listening and talking gave us a sense of the kinds of possibilities
and issues that could arise during this huge life transition, and it
felt good to feel like we were not going in blindly and like we had
enough knowledge to be able to make decisions that were right for us
when the time came.
catch-22 of preparing to have a child is that you will most need to
feel educated and informed when things do not go as planned, and yet
it is both not realistic and not healthy to prepare yourself for
every little thing that can go wrong. Most writing that calls for
less medicalization of moms and babies assumes a context in which
everything goes relatively normally – it is often reiterated that
healthy births are not “medical events”. But how can we maintain
our agency and our dignity when they do become medical events? What I
want to reflect on here is the difficulty of trying to be informed,
advocate for yourself and make healthy choices for your newborn
outside that “normal” context. When my water suddenly ruptured
just a day shy of 35 weeks pregnant, I was prepared for the very easy
and uneventful birth that followed. What I was not prepared for were
the 2 weeks we spent in the NICU afterwards, and how we would
struggle to make the right choices for our son in such a constrained
and often enigmatic place. We had not done our research on caring for
a preterm infant – why would you? And while our son received loving
and attentive care during those two weeks and is now thriving, we
found ourselves stressed out, disempowered and really struggled while
he was there. It was an experience that really marked us and shaped
our early days as parents, and one that I am struggling to let go of.
We often found
ourselves invoking the “cascade of interventions” not when
discussing my birth, but while trying to make sense of what was
happening to us in the NICU. Our son was born at 35 weeks on the dot,
screaming, for which I will always be grateful. A neonatology team
was in the room and examined him within minutes of his birth. He was
just shy of 5 lbs and they quickly declared him healthy and said they
did not think he would need any time in the NICU. I had about four
glorious hours of skin to skin with him before that opinion changed
because he repeatedly flunked his blood sugar test. We consented to
have him taken to the NICU to help sort out his hypoglycemia, and we
were told that this was such a minor issue that we were looking at an
overnight stay, at most.
I was wheeled into
post-partum and a nurse gruffly gave me a breast pump and told me I
was going to need to start pumping. Assuming that everything would go
normally, I had never even looked at a breast pump before, nor did I
know how to use one, much less all those “tricks” I know now to
pump more effectively. I got very brief instructions and then
warnings about keeping up with it or else I would mess up my milk
supply. I visited our son in the NICU as soon as I had settled in,
and I was truly moved by the kindness of the nurse who was gentle and
reassuring as she completed his intake. But seeing him small,
vulnerable, in an incubator and hooked up to monitors was
heartbreaking. When the nurse wasn’t looking, I opened the
incubator door and put my hand in to hold his little hand and touch
his head. I felt like I was cheating. No one had thought to tell my
husband or I, that first day, that we were actually allowed to hold
our child and do skin to skin with him. It was only while texting
about it with Lesley that she mentioned that NICUs always let their
parents hold their babies except in the most dire circumstances, and
so I worked up the nerve to ask. Those first hours I just stared at
him in there and tried not to cry.
This was a running
theme of our NICU experience – the strange feeling of needing to
ask permission to care for your own child. It was two days before we
would even change one of his diapers. Our son’s hypoglycemia
cleared up within 24 hours and so we were excited to go home.
However, the IV he had in got messed up and needed to be removed, so
a nurse suggested putting in a gavage (feeding tube that goes through
the nose) instead, as it would be less invasive and less prone to
infection. We consented. They had made it seem like no big deal. What
we did not know at the time was that NICU protocol almost everywhere
is that once a baby has a gavage, they will not be released until
they eat without it for 24 hours. And so while the issue that brought
us to the NICU had disappeared, the gavage kept us there for two
weeks. We were now there for feeding issues. No one thought to
mention this change in medical concern. It would be days before we
really understood why we were there.
This was another
running theme of our time in the NICU; the lack of true informed
consent. No one explained to us what it meant to put that tube in,
and then we felt blindsided when we got stuck there like we did.
Gavaging preemies is a really standard, common practice in NICUs;
there was no reason not to explain to us the implications of going
down that path. The absence of clear information was not for lack of
trying on my part. For example, our son had a moderate/borderline
severe case of jaundice, and I asked our attending resident some
questions about how they were making the call whether or not to treat
it for three days in a row before I finally got a reply that
explained their decision and the risks and benefits that informed it,
rather than just reiterating it. (If I remember correctly, that
eventual reply actually came from the attending pediatrician.)
Our son’s new
diagnosis was “prematurity”. There was nothing wrong with him; he
was just young and struggled to stay awake long enough to eat. NICUs
have very particular ways of measuring what that means. They do 8
feedings a day, every three hours, and they use the baby’s weight
to determine a set amount of milk or formula the baby needs to be
able to ingest at each meal. “Feeding on demand” was out the
window. I had very little colostrum, which I now understand to be
normal, so he was immediately started on formula to meet the quantity
they had determined he needed. If we put him to the breast, which
many nurses encouraged, whatever he got at it did not “count” as
it could not be measured. Breastfeeding was therefore mostly for
“practice” and to help with my supply, but he still needed to get
a set quantity either by bottle or by gavage. If he fell asleep
finishing a bottle, the rest would be gavaged. The NICU was very
encouraging of breastfeeding, and yet the fact that you cannot
quantify it the way you can a bottle meant that for all the
breastfeeding tips I received, bottle-feeding had to be our focus. By
the end of our stay I would feel guilty if I put him to the breast
for a feed because I worried (incorrectly, it turns out, but this is
what I was told) that it would wear him out for his subsequent bottle
and we would get stuck there longer because of my stubborn insistence
I would pump at
least every three hours in order to try and give him as much
colostrum and then milk as possible. Those first few days, nurses
kept asking me if my milk had come in yet – at one point a hospital
lactation consultant told me that because it was day three after a
vaginal birth, I should expect to be engorged within the next twelve
hours. I watched the clock. It didn’t happen. I thought something
was wrong with me. The doctor would do his rounds every morning,
conferring with nurses and residents within earshot of me and my son
in the incubator, talking about us in the third person. “How’s
mother’s milk?” he would ask, and they would always answer that I
had a weak supply. The first few days, my son actually hated the
formula and refused to drink from it (we had much more success
getting him to drink pumped milk from a bottle); with my supposed
weak supply, I felt like I was failing him and keeping us in there.
What no one told me, until a kind doctor on one of our very last days
there, was that my supply was weak because we were there, and that
most women experience supply issues when they are in the NICU,
because they are stressed, and are only allowed to put their babies
to the breast a few times a day, and because the pump is not as
effective as a baby at dictating how much milk to produce.
I heard a million
comments over those two weeks, which were innocuous in their
intentions, along the lines of, “wow, you don’t have a lot of
milk, do you?” Never say something like that to a post-partum mom.
I held back tears every time. Those comments crushed me. I wish I had
known that it was just because I was there. I saw so many mothers
who, by the end of their stay in the NICU, had given up on
breastfeeding, quite understandably; pumping 8-10 times a day only to
produce inadequate milk is brutal. It felt like the hardest thing I
had ever done. I would set my alarm at night to pump and every time I
woke up I would feel disoriented, wondering where my baby was, and
sadly trudging to the pump instead. I had constant nightmares. It
felt profoundly wrong, in this really primal way, to sleep and wake
at night without my son there. When we came home it was such a
pleasure to wake to a crying baby instead of the breast pump.
I do not debate that
our son probably needed to be in the NICU. It would have been
incredibly stressful trying to feed this small and sleepy baby all by
ourselves at home. There is a decent chance we would have ended up
there anyway. NICUs are amazing places that work very hard to care
for often very vulnerable babies, and the nurses we encountered
there, with literally only two exceptions over a two week span, were
among the kindest, most caring people I have ever met. I cried while
saying goodbye to them. They taught us how to care for our son; how
to swaddle him, bathe him, burp him, and they were always encouraging
and gentle with us. They are the most talented nurses I have ever
encountered and they worked their asses off as NICUs in Montreal are
painfully understaffed, often pulling doubles or giving up days off,
coming back early from sick leave or taking on more babies at a time
than they were supposed to. My son was in very good and loving hands
and I think about them with enormous gratitude every day.
What made our time
in the NICU so difficult was mostly not the individual caregivers
(although I will mention a couple of exceptions below), but the
larger structure of this place and how it worked. The nurses were
kind, but the system itself was incredibly unkind. We ended up in two
different NICUs; first, a huge high-level NICU for 5 days, which then
(mercifully) transferred us to a lower-level one closer to home for
the next ten days. The higher level one had 75 beds for babies, and
only three courtesy rooms for the parents to sleep in, which we
therefore had to fight for every day. Doctors talked about us in the
third person, but spent little time talking to us. Our son was on
such a strict schedule that we generally had to ask for permission to
do things like take him out of his incubator. He was hooked up to
heart and respiration monitors despite there being no concerns about
his heart or lungs; it was just standard protocol to monitor him.
This might seem like a little thing, but he was talented at ripping
the monitors off (our little rebel!) and so they would constantly
malfunction and the beeping frayed our already damaged nerves. And on
a less avoidable note, it was brutal experiencing that post-partum
hormone crash in a place as frenzied as a high-level NICU. There were
sick babies, harried parents and alarms going off everywhere, and we
all felt very keenly how fragile all these little lives were. It is
just a really hard place to be. Between sick babies and crazy
hormones, I realize now that I was probably the most emotionally
vulnerable I have ever been in my life during those two weeks, and I
therefore had to navigate all of the issues I am describing here
feeling like a walking open wound.
Experiencing all of
this is especially brutal when it feels like a machine that is much
bigger than you, where there is more action than information. Like
the example of when they put in my son’s gavage or monitored my
son’s jaundice, informed consent was hard to come by. Despite this
standard 24-hour feeding rule, every day in our first NICU they made
it seem like we might be going home imminently. They told us they did
not want to make any “predictions” that would give us false hope,
and so all we ever heard was “at least until tomorrow.” We ran
ourselves ragged and therefore didn’t really sleep for 5 days
thinking that this was a very short-term stay. When we arrived in the
second, lower-level NICU, a kind pediatrician, in his initial
assessment, told us, “you will be here for a maximum of ten more
days.” I just about burst into tears, as that was so much longer
than we had expected, but we were so, so grateful to have someone
give us an idea of what was to come, rather than being evasive. His
assessment was prophetic as it was exactly ten days later that we
While most nurses
were truly gifted caregivers doing their best in impossible
circumstances, we nevertheless felt very vulnerable when it came to
the couple we encountered who were not. One nurse that we had over
two nights described herself as “old school” and told us she did
not believe in skin to skin or bonding, nor did she know anything
(nor really care) about breastfeeding. Our baby was a medical problem
to solve, not to snuggle. She made my husband feel particularly
unwelcome visiting our son at night, and so we eventually stayed away
as much as possible while she was around in order to avoid conflict.
We realized that there were two approaches to caring for babies in
the NICU; one that saw only the babies as the patients, and another
that saw the whole family as part of the caring process. I know now
that all medical evidence about newborns shows that they and their
parents are basically one entity in the early months, and that their
health is inseparable. Nurses like this one, who believed that their
only responsibility was to the baby, were going against pretty much
all current research.
It was during his
first night with this nurse that my son began to have bradycardias,
which is a brief deceleration of the heart caused by his
still-developing nervous system. We were repeatedly assured by all
medical staff that these were harmless unless they started occurring
extremely frequently, yet they somehow made a big deal of them every
time one happened anyway, such that they felt terrifying. It becomes
hard to assert yourself when you are terrified. What I did not know
until I did some reading once we got home was that the best cure for
bradycardias is “kangaroo care”, i.e. extended skin to skin
contact between mother and baby. After our terrible first night with
this nurse, which left me sobbing on the phone with my mother, I kept
saying that it could not be a coincidence that this problem had
cropped up with such an unkind caregiver. I now know just how right I
was. Her “old school” approach actively impeded his development.
And yet when the doctors did their rounds, all they noted was the
bradycardias, without reflecting on where they came from or the
context in which they occurred.
While that was the
most extreme example, we still found ourselves at the mercy of
nurses’ and doctors’ often subjective opinions. In our second
NICU, there were signs at every incubator encouraging skin-to-skin
contact. My husband and I would spend about 16 hours a day there,
holding our son as much as we could, trying to make a place as weird
as the NICU as normal as possible during those formative first days
of his life. During one exhausted night towards the end of our stay,
a nurse got fed up with how much we held him, and told us our son
would rest better in the incubator. Sheepish, we put him back in the
incubator and prepared to leave for the night, but I wanted him to
fall asleep first. He lay there, eyes open, hiccupping, unable to
fall asleep as well as he did in our arms, for about an hour, while I
held back tear. I put my hand into the incubator and lay it on his
head, afraid to touch him more because we had just been chastised. He
looked tiny and alone and I cried the whole way home.
The next day we
asked the attending pediatrician about this, who of course confirmed
that the nurse was wrong, and that in fact babies rest better through
skin to skin than through an incubator, which is a machine trying to
simulate that environment. She said that as he was a healthy baby who
just needed some time to grow, “TLC” was all we could really do
for him at this point. This helped us feel more brave about insisting
on holding him (and at least this NICU allowed us to hold him without
permission, although we still needed their OK to feed him), although
certain nurses then viewed us as “difficult”.
Similarly, when it
came to feeding, some nurses would come over beforehand and discuss
with us our options for the next feeding – should we try breast,
bottle, gavage, or what kind of combination of these methods? They
trusted that even though they were the medical professionals, we also
knew our baby as we spent all day with him, and could read his cues
regarding how awake and hungry he was at any given feeding. Others
would come over and tell us, without asking our input, that X method
was best for the next feeding, in particular treating me as difficult
if I insisted on trying even five minutes at the breast beforehand. I
was once chastised for taking my baby out of his incubator when he
woke up hungry a bit ahead of schedule and putting him to the breast,
figuring that it couldn’t hurt to do so while we waited for the
nurse to prepare his bottle anyway. Watching my baby root around
because he woke up 15 minutes ahead of schedule and not being allowed
to feed him seemed counter to any common sense about how to help a
baby whose principal health concern was his ability to eat.
The very same doctor
mentioned above eventually let us in on the secret of the NICU, at
least when it comes to things like helping preemies develop and learn
to eat independently, rather than treating specific illnesses that
one sees in more serious cases; as she put it, “it is not an exact
science”. Frustrated by the gavage, which I worried left my son so
full that he did not feel enough hunger to work on his feeding, and
by the different approaches of the nurses to feeding him such that
our experience seemed to depend so much on the individual opinions of
whatever nurse was assigned to us on a given day, she admitted that
the process is very much subjective. She also said that the obsession
with him ingesting particular quantities was not evidence-based nor
actually particularly essential – they could tell if he was eating
enough the same way all parents of full-term babies do, through
diapers and weight gain – but rather it was a liability issue, i.e.
to have numbers on record to prove that the hospital had fed a baby
enough in case anything happened. So my stress about not pumping
enough, the formula, the dictatorial schedule with bottles all the
same amount – that was less about what was necessary and more about
making sure we couldn’t sue them were anything to go wrong.
Our son got amazing,
attentive care in the NICU. But we were not prepared to navigate its
procedures, because who prepares to spend two weeks in the hospital
with a premature baby? After we were released, I read up about
care for premature infants, about
best practices suggesting that the parents care for the baby as much
as possible, about how to encourage breastfeeding, etc., and I
could see all the questions we could have asked and all the places
where we were not given the opportunity for informed consent (either
in terms of information or in terms of consenting). We got very, very
lucky when our son was discharged, because we happened to have a
nurse that day who really cared about breastfeeding, and faxed in a
referral for us for a breastfeeding clinic as well as asking the
doctor to give me a prescription for domperidone to help get my
supply up. I am not sure I would still be breastfeeding were it not
for her encouragement and those resources she pointed me to. People
like her helped us survive.
adjusting to home life after such a quantified experience of infant
care was rough. We were so happy to be home, away from the sound of
beeping monitors and able to feed and snuggle our baby whenever we
wanted. But as I texted to Lesley in the immediate days afterwards, I
felt like my “mother’s intuition” was broken. We were used to
looking at a monitor to make sure our son was breathing, rather than
looking at him (and trusting that he was probably breathing). We had
no idea how to wean him off the bottle to encourage him to take the
breast. It took me a couple of weeks to believe that he was getting
any milk at the breast at all. He did not know how to feed on demand.
All is well now, but it took a full five weeks to get back fully
breastfeeding, and to emerge from the path that the NICU had started
Advocates for less
medicalized birthing and more natural parenting spend a lot of time
talking about “evidence-based” practices and the tendency of
large institutions to move slowly when adapting to research and to be
very conservative for reasons often more related to liability and
convenience rather than actual need. The NICU is, of course, a very
“medicalized” space by necessity, as it should be when it comes
to healing sick babies. But I should point out that parents of sicker
babies than ours probably need the transparency and compassion we
ached for even more than we did. Having had the experience of trying
to care for a healthy, just undercooked, baby in the NICU, it is so
hard to find the balance between the medical and the, well, normal.
It is clear he needed help learning how to eat, for example. But the
way in which he was given a gavage was confounding; not only was
there no informed consent, as I explained above, but it also felt
like they had created the problem (baby is being fed by tube) that we
now had to fix, which due to their systems, required a bottle. In
short, it felt like they broke him in order to fix him. In reflecting
on our experience, I have spent a lot of time thinking about what
more humane care for premature babies would look like – it is
obvious, for example, that it would involve babies rooming in with
parents and more real breastfeeding support (rather than mere
encouragement that it is a good idea) and less obsession with the
quantitative. It would allow for feeding on demand and parents doing
most of the care of their babies themselves. All of these things,
however, could not work in hospitals concerned with liability issues
and would require infinitely more resources; how could feeding on
demand work with busy nurses’ schedules? And how could there
possibly be enough rooms to allow parents to room in with babies? And
so for all my hard feelings about my experience, I get why NICUs are
the way they are; we are kind of stuck in the system that we have.
And so I am left
with this question of how parents can apply the ethos of gentle,
informed and respectful birthing practices to medicalized
environments like the NICU. We were so ready for birth and yet so
blindsided by what came after. How can you maintain your agency as a
parent and your right to care for your child when you find yourselves
unexpectedly hospitalized? And why is this experience staying with me
like it is? Life is great now; our son is healthy and, if you ask me,
perfect. And yet I still find myself thinking back to those early
nights, full of hormones, waiting to be given permission to hold my
son, trying to remind myself to look at him to see how he was doing
rather than at the monitor. Why was this experience so destabilizing?
I am simultaneously
so grateful to the NICU for caring for him and getting us through his
prematurity and yet angry that we were often left out of the
decisions made about his care, and allowed so little room to maneuver
within that larger system. It is hard to balance that gratefulness
and that anger. I might feel differently had he been truly ill, but
we were in the strange position of having a totally healthy child and
yet having his care really quantified and medicalized nonetheless.
This was hard to negotiate and impossible to prepare for. What I am
left with is the same wish that many birthing advocates have for
laboring mothers; more transparency, more information, more concern
with giving parents agency and helping them make empowered decisions
about their babies. Even when things do not go as planned and we find
ourselves requiring medical intervention, it does not mean the
process needs to be so unkind and opaque. I wish I knew then what I
know now about caring for premature infants, but surely I shouldn’t
have needed to have prepared myself with mountains of research to
have had a more humane experience. Humanity in such stressful
situations should be the norm.