Breastfeeding

Preventing Breastfeeding Pain

For me the number one deterrent to breastfeeding is when it's PAINFUL – raw, sore, red nipples;  lumpy, achy breasts; dreading the next feed. So for every other nursing mama, I've compiled a list of tips for preventing breastfeeding pain. Hope it helps you milk mama's!

Tips for Preventing Breastfeeding Pain:
  • Consult a Lactation Consultant (LC) to learn how to position baby correctly for an efficient, pain-free latch.
  • Be weary of advice from anyone who is not an LC – doctors, your friends or family are NOT trained, certified breastfeeding consultants, and their advice is often more of a hindrance than help.
  • Have baby checked for physical abnormalities that may affect latching and feeding.
  • Keep breasts free from bacteria or yeast – wash bras, breast pads and pumping and feeding equipment in hot water regularly, wash or sanitize hands before touching breasts, nipples or baby's mouth.
  • Allow breasts freedom of movement – wear a supportive yet comfortable and unrestrictive bra, the same applies for clothing.
  • Feed on demand – allow baby to dictate feedings, do not time or schedule feedings.
  • Allow baby to fully drain the first breast before moving on to the second – don't leave any milk behind. If baby only feeds a little from the second, then start with the second breast at the next feed.
  • Don't let breasts become excessively engorged – if baby has a long gap between feeds and breasts are too painful with engorgement, gently massage breasts and express a little milk to a comfortable fullness.
  • Avoid feeding props – this includes nipple shields, top-up feeds and pacifiers.
  • If you decide to wean, do so gradually, not abruptly.
  • Diet – a tablespoon of lecithin a day is excellent for preventing and clearing plugged milk ducts. And it goes without saying you need to up your intake of fresh (preferably spring) water.

Sources:
Breastfeeding and Engorgement
Marsha Walker, RN, IBCLC
Dealing with a Plugged Duct or Mastitis
Sara Walters
Mastitis--Plugged Ducts and Breast Infections
Bonnie Tilson
Nipple Pain: Causes, Treatments, and Remedies
Jahaan Martin
Mastitis and Yeast Infection
Jack Newman MD, FRCPC
Sore Nipples
Jack Newman MD, FRCPC
Hand disinfection as the central factor in prevention of puerperal mastitis
Peters F, Flick-Filliés D, Ebel S.
Birth

Orgasmic Birth, Our Birthright

©2008 Jada Shapiro www.birthdaypresence.net
Who would think birth could be a sexual experience? The contractions, the hormones, the ecstatic orgasms. Yes, the fantastic, glorious orgasms that women, if relaxed enough, experience during birth.

Like almost every other human being, I never thought birth could be pleasurable, until I experienced a spontaneous orgasm while giving birth to my son three years ago. Little did I know at the time, that orgasm was 22 times more relaxing than the tranquillizer I was asking for earlier during labor. But it was a confusing and embarrassing experience, so I never mentioned it to a soul. About 2 years later I stumbled upon the phrase 'orgasmic birth' in an online discussion. Naturally I wanted to investigate it, and when I did it made a lot more sense. Here's what's interesting:

Women's sexuality involves making love, giving birth and nursing. In each case, nipples become sensitive, blood flow increases, vaginal lubrication increases, and production of the hormone Oxytocin soars. Also like sex, childbirth is horrendously painful and traumatic if it occurs forcibly or under conditions that undermine a woman's sense of dignity.

The key player in sexual pleasure – whether it be sex, birth or breastfeeding – is the hormone oxytocin. It diminishes pain, triggers ecstatic sensations and increases feelings of empathy. As the level of pain increases during these sexual activities, as does oxytocin, allowing the body to experience both intense pain and intense pleasure at the same time. However, oxytocin is only released when a woman feels relaxed and safe. It is secreted in spurts and not continuously, and levels decrease over time unless you retrigger its release with stimulation. Anything that causes tenseness, anxiety, stress or fear can easily inhibit its release – turning a potentially ecstatic experience, into a horrifically painful one.

This explains why currently it's estimated only 30% of women experience orgasmic birth, these are often women who birth unmedicated at home where surroundings are conducive to relaxation and sexual activity. A dimly lit room, dotted with candles, sensual music, luxurious fabrics, and a warm bath are a wonderful starting point for orgasmic birth.

I can tell you that when I did orgasm during birth, I felt like a goddess. I was so in control, powerful, relaxed, and focused with every cell in my body. I could feel everyone in the room stand back and look on me with awe. I am surprised my body managed such a feat despite birthing in a fluorescent lit, clinical hospital room. Powerful is how every woman should be given the chance to feel during birth. But most women don't feel that way during birth, they feel weak and vulnerable.

The concept of a sexual, pleasurable birth is new to most women. So why is orgasming during birth not widely known? Many women struggle through excruciating childbirth unaware that orgasmic birth is possible. The sexual element is all but removed from childbirth and viewed as taboo. Most women enter their births with the expectation of experiencing the worst pain known to human civilization. They fight with every muscle in their bodies against each contraction, oblivious to the fact that fighting the contractions is exacerbating the pain. Is it possible that if women were able to relax they may just experience earth shattering orgasms instead?

It seems the majority of women in our society have been given a false or incomplete concept of birth. By perpetuating the myth birth can only be painful, and by enforcing every conceivable medical intervention during birth, we are hindering the possibility of a natural, relaxed, pleasurable birth, possibly making women suffer unnecessarily through horrific childbirth pain. The way modern obstetrics has inhibited pleasurable birth almost feels misogynistic and oppressive.

Tinamarie Bernard, from her article 'Orgasmic Birth' describes a very different vision of the future of childbirth….
"Consider this legacy for the next generation of birthing mothers: Quiet room, dim lights, husband kissing his wife, massaging her perineum, whispering loving words to her, all while she's in a state of ecstasy. As the baby is crowning, she is given clitoral stimulation to bring much needed blood and reparative nutrients to the genital region, so that instead of tearing, her perineum is flushed with blood, preventing damage to her sensitive, sensual tissues."

And I'll leave you with a description of what an orgasmic birth feels like….
"All my erogenous zones were stimulated. I was making sounds very similar to a sexual climax. And it was a very definite climax. I was doing the most feminine thing a woman can do and it felt fantastic."
- Katrina Caslake, Midwife and mother of two


Sources:
Orgasmic Birth: Discovering Sexuality in Childbirth
By birthamiracle
Sensual and Orgasmic Childbirth
By Juniper Russo
Orgasmic Birth, the Eco-Sexy Way to Deliver?
By Tinamarie Bernard
How to have a sensual, drug-free birth
By Anastasia Stephens
Oxytocin Hormone and Birth Less-Painful, More Pleasurable Delivery
By Laura Shanley
Birth

International MotherBaby Childbirth Initiative

Below is a document outlining the care YOU should be receiving from your obstetrician, gynecologist, midwife or other health professional throughout your childbearing years. The full PDF of the document below is available here.

The International MotherBaby Childbirth Initiative (IMBCI) is an evidence‐based global effort developed in the early 2000s to:

  • Improve maternal care during birth in order to save lives and prevent harm from the overuse of obstetric technologies.
  • Promote care during labour and birth and breastfeeding that is centered on physiology and normalcy.
  • Emphasize a humanistic women‐ and family‐centered approach and all types of care most conducive to good outcomes, including collaboration among involved professionals, midwifery knowledge and skills, hands‐on support for the mother.

The 10 Steps of the MotherBaby Childbirth Initiative are based on the results of best available evidence about the safety and effectiveness of specific tests, treatments, and other interventions for mothers and babies. "Safe" means that care is provided through evidence-based practices that minimize the risk of error and harm and support the normal physiology of labour and birth. "Effective" means that the care provided achieves expected benefits and is appropriate to the needs of the pregnant woman and her baby based on sound evidence. Safe and effective care of the MotherBaby provides the best possible health outcomes and benefits with the most appropriate and conservative use of resources and technology. Optimal MotherBaby maternity services have written policies, implemented in education and practice, requiring that its health care providers:

Step 1 Treat every woman with respect and dignity, fully informing and involving her in decision making about care for herself and her baby in language that she understands, and providing her the right to informed consent and refusal.

Step 2 Possess and routinely apply midwifery knowledge and skills that enhance and optimize the normal physiology of pregnancy, labour, birth, breastfeeding, and the postpartum period.

Step 3 Inform the mother of the benefits of continuous support during labour and birth, and affirm her right to receive such support from companions of her choice, such as fathers, partners, family members, doulas4, or others. Continuous support has been shown to reduce the need for intrapartum analgesia, decrease the rate of operative births and increase mothers' satisfaction with their birthing experience.

Step 4 Provide drug-free comfort and pain-relief methods during labour, explaining their benefits for facilitating normal birth and avoiding unnecessary harm, and showing women (and their companions) how to use these methods, including touch, holding, massage, labouring in water, and coping/relaxation techniques. Respect women's preferences and choices.

Step 5 Provide specific evidence-based practices proven to be beneficial in supporting the normal physiology of labour, birth, and the postpartum period, including:
  • Allowing labour to unfold at its own pace, while refraining from interventions based on fixed time limits and utilizing the partogram to keep track of labour progress;
  • Offering the mother unrestricted access to food and drink as she wishes during labour;
  • Supporting her to walk and move about freely and assisting her to assume the positions of her choice, including squatting, sitting, and hands-and-knees, and providing tools supportive of upright positions6;
  • Techniques for turning the baby in utero and for vaginal breech delivery;
  • Facilitating immediate and sustained skin-to-skin MotherBaby contact for warmth, attachment, breastfeeding initiation, and developmental stimulation, and ensuring that MotherBaby stay together;
  • Allowing adequate time for the cord blood to transfer to the baby for the blood volume, oxygen, and nutrients it provides;
  • Ensuring the mother's full access to her ill or premature infant, including kangaroo care, and supporting the mother to provide her own milk (or other human milk) to her baby when breastfeeding is not possible.
Step 6 Avoid potentially harmful procedures and practices that have no scientific support for routine or frequent use in normal labour and birth. When considered for a specific situation, their use should be supported by best available evidence that the benefits are likely to outweigh the potential harms and should be fully discussed with the mother to ensure her informed consent. These include:
  • shaving
  • enema
  • sweeping of the membranes
  • artificial rupture of membranes
  • medical induction and/or augmentation of labour
  • repetitive vaginal exams
  • withholding food and water
  • keeping the mother in bed
  • intravenous fluids (IV)
  • continuous electronic fetal monitoring (cardiotocography)
  • pharmacological pain control
  • insertion of a bladder catheter
  • supine or lithotomy (legs-in-stirrups) position
  • caregiver-directed pushing
  • fundal pressure (Kristeller)
  • episiotomy
  • forceps and vacuum extraction
  • manual exploration of the uterus
  • primary and repeat caesarean section
  • suctioning of the newborn
  • immediate cord clamping
  • separation of mother and baby
Step 7 Implement measures that enhance wellness and prevent emergencies, illness, and death of MotherBaby:
  • Provide education about and foster access to good nutrition, clean water, and a clean and safe environment;
  • Provide education in and access to methods of disease prevention, including malaria and HIV/AIDS prevention and treatment, and tetanus toxoid immunization;
  • Provide education in responsible sexuality, family planning, and women's reproductive rights, and provide access to family planning options;
  • Provide supportive prenatal, intrapartum, postpartum, and newborn care that addresses the physical and emotional health of the MotherBaby within the context of family relationships and community environment.
Step 8 Provide access to evidence-based skilled emergency treatment for life-threatening complications. Ensure that all maternal and newborn healthcare providers have adequate and ongoing training in emergency skills for appropriate and timely treatment of mothers and their newborns.

Step 9 Provide a continuum of collaborative maternal and newborn care with all relevant health care providers, institutions and organizations. Include traditional birth attendants and others who attend births out of hospital in this continuum of care. Specifically, individuals within institutions, agencies and organizations offering maternity-related services should:
  • Collaborate across disciplinary, cultural, and institutional boundaries to provide the MotherBaby with the best possible care, recognizing each other's particular competencies and respecting each other's points of view;
  • Foster continuity of care during labour and birth for the MotherBaby from a small number of caregivers;
  • Provide consultations and transfers of care in a timely manner to appropriate institutions and specialists;
  • Ensure that the mother is aware of and can access available community services specific to her needs and those of her newborn.
Step 10 Strive to achieve the 10 Steps to Successful Breastfeeding as described in the WHO/UNICEF Baby-friendly Hospital Initiative:
  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement the policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within a half-hour of birth. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
  7. Practice "rooming in"-- allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
The International MotherBaby Childbirth Organization, in collaboration with other organizations, is developing a companion document detailing the extensive scientific evidence supporting the 10 Steps of the IMBCI, and will update both documents over time as needed to reflect the best available research.

Get more info about IMBCI here.