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Birth Doula FAQs

What’s a doula?
A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother and partner during pregnancy, birth & early postpartum. In much of the world today and throughout history, women support women through labour & birth.

What’s the difference between a midwife and a doula?
Doulas work as part of a team with doctors or midwives, but not instead of. They provide non-medical support and comfort measures (e.g. encouragement, massage, positioning suggestions). They do not perform clinical tasks such as heart rate, blood pressure, or internal exams.

Midwives are highly trained in the medical aspects of birth. The carry oxygen, medicines, resuscitation equipment and other gear, and are known as primary care-givers during birth. In North America primary/medical birth care is offered by either a midwife or a physician.

Why choose a doula over simply using a friend or family member as support?
Doulas are trained and experienced in childbirth support. They know the sounds and behaviors of laboring women, and what that may indicate about progress. Doulas are trained in pain-reducing comfort measures, natural methods to keep labor progressing, and to support both the laboring woman and her partner. Doulas are familiar with local hospital policies & practices and have often built a rapport with the doctors, nurses and midwives. See http://evidencebasedbirth.com/2012/06/26/why-wouldnt-you-hire-a-doula/

In most Canadian hospitals, women are allowed 2 support persons – usually that’s her partner and a support person. Some hospitals accommodate a 3rd support person. Homebirths and birth centers encourage women to have all the support they wish.

How does the doula fit in with nursing staff?
Doulas do not replace nurses or other medical staff, but rather work as part of the team. They are there to comfort and support the mother & her partner. Nurses change shifts; doulas stay.

How does a doula assist with communication in hospitals during labor & birth?
During prenatal meetings doulas learn what’s important to a couple and discuss how to make informed decisions. A doula may remind or encourage a client to ask the questions necessary to understand a procedure and make informed decisions. Doulas do not speak on a client’s behalf nor intervene in their clinical care. They do not make decisions for clients, nor judge the decisions clients’ make, but are there to support those decisions.

What difference does the presence of a trained doula have on birth outcomes?
The presence of a doula tends to result in shorter labours with fewer complications and less interventions. When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer caesareans and requests for medical intervention, and less postpartum depression. In case of unplanned circumstances, doula support helps reduce negative feelings about one’s childbirth experience. Studies [1],[2],[3],[4]   have shown that babies born with doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.

Analysis of six randomized trials1 demonstrates that lack of doula presence correlates with:

  • Double the overall caesarean rate
  • 33% increase in length of labour
  • 67% increase in oxytocin use
  • 2 ½ times more requests for epidurals

Will a doula make my partner feel unnecessary?
A responsible doula compliments and enhances the father/partner in their supportive role rather than acting as a replacement. (While I respect people’s individual circumstances, I will use “father” words for most of this paragraph.) The presence of a doula allows the father to support his partner emotionally during labor & birth without the pressure to remember everything he learned in childbirth class! The father typically has little-to-no actual experience with the birth process, yet is expected to act as a coach. Some partners feel (accurately) that this is a huge expectation. Many fathers experience the birth as an emotional journey of their own and find it hard to be objective. A doula is supportive to both the mother and her partner, and plays a crucial role in helping a partner become involved in the birth to the extent he/she feels comfortable. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.

When a couple works well together during the birth process they’re better able to handle the challenges of early parenthood. An incredible bond forms or is made stronger.

How often and when do we meet?
We’ll meet 2-3 times before the birth. The introductory meeting is any-time – it’s never too early. The prenatal meetings are best done between 24-36 weeks. After your baby is born there will be a minimum of one postpartum visit, more if needed or desired.

Are doulas only useful if planning an un-medicated birth?
The role of the doula is to help attain a safe and pleasant birth, not to choose the type of birth. The presence of a doula is beneficial no matter what type of birth you are planning. In fact, women who choose a medicated birth need as much support as those who choose a natural birth, but a different kind of support. For women who know they want a medicated birth, the doula still provides emotional support, informational support and comfort measures to help the women through labor and the administration of medications. Doulas can help a mom deal with possible side affects and by filling in the gap that medication may not cover; rarely does medication take all discomfort away.

For a mother who faces a cesarean, a doula provides comfort, support and encouragement. Often a cesarean is an unexpected situation and moms are left feeling unprepared, disappointed and lonely. In this case doula support is especially helpful during the early postpartum period.

What if I planned a drug-free birth then change my mind during labour?
Doulas don’t make decisions for clients or intervene in clinical care, nor do they judge women’s choices. They provide informational & emotional support while respecting a woman’s decisions.

What kind of comfort measures do you use during the labour & birth process?
While there are common comfort measures taught in doula training courses, each doula also brings her own tools and methods. Ours include the following:

  • Positioning suggestions
  • Massage & various touch methods
  • Homeopathy & Bach Flowers (optional; no extra charge)
  • Aromatherapy
  • Encouragement & reassurance
  • Heat or cold as desired
  • Hydrotherapy (water for comfort in labour, and/or water-birth)
  • Create space for partner, and recommendations to help partner to offer support
  • A calm, reassuring presence who trusts the birth process

When do we call you in labour?
Please call at the first signs of suspected labour. We’ll discuss what those are. From then on you’ll keep us posted on your progress and what’s happening.

When and where do you join us in labour?
When depends on the woman, her partner, and the labour. Early support often takes the form of checking in by phone and/or dropping by your place.  Your doula joins you either at your home or in hospital or birth center and remains with you until 1-2 hours after the birth.

How does shared-care work?
Doulas team up to provide enhanced service. Clients benefit from combined experience, education, and availability. Since doulas are on call for up to a month for each client, shared care allows them time for important life events and days off without having to turn clients away or rely on unfamiliar back-up. Clients meet both doulas prenatally so they’re familiar with whichever one attends birth.

What if you can’t be at the birth?
In the rare circumstance that one of your doulas can’t be there, you will be well supported. We work with reliable back-ups who offer excellent care. Fees remain the same. If the back-up is likely to be part of care, some clients wish to meet her prenatally, which can be arranged.

Do we pay more to work with 2 doulas?
No. Fees are outlined in the contract. The cost of working with both doulas is the same as hiring one of them individually.

What kind of postpartum support do you offer?
Your birth doula usually stays for 1-2 hours after the birth, until you’re ready to be on your own with your baby. We also visit in the first day or two postpartum, offering basic breastfeeding support, answering questions, and going over your birth. We are available for questions and can offer resources (educational and community). A second postpartum visit is offered.

What if I need extra help with breastfeeding or baby-care?
The information above describes our work as birth-doulas. Another kind of doula, a “postpartum doula”, specializes in extended care and breastfeeding support. There are also breastfeeding counselors and lactation consultants that can be arranged through public health or hired privately. We can provide resources and contact info. If you’re on the Mother-Baby Unit the nurses or unit Lactation Consultants can provide support.

Where’s that name from?
In ancient Greece “doula” meant the highest female servant who helped the lady of the house through child-bearing. Medical researchers Marshall Klaus and John Kennell, who conducted several randomized clinical trials on the medical outcomes of doula attended births, adopted the term to refer to labour support as well as prenatal and postpartum support.

 

[1] Klaus, M.H.; Kennel, J.H.; Berkowitz, G.; Klaus, P. “Maternal Assistance and Support in Labor: Father, Nurse, Midwife or Doula?” Clinical Consultations in Obstetrics and Gynecology 4 (December 1992).

[2] Sauls, DJ. Effects of labor support on mothers, babies, and birth outcomes. J Obstet Gynecol Neonatal Nurs. 2002 Nov-Dec; 31(6):733-41.

[3] O’Driscoll, K. and Meagher, D. Active Management of Labor. 2d ed. London: Bailliere Tindall, 1986.

[4] Klaus, M.H. and Kennel, J.H. Parent-Infant Bonding. St. Louis: C.V. Mosby, 1982.

Essential Herbal Tea for Pregnancy & Breastfeeding

Women have consumed infusions (tea) of Red Raspberry leaf and Nettle leaf through the ages for a healthy childbearing year, healthy reproductive organs at any stage of life, and to keep their skin soft and supple.  This blend is very high in easily absorbed minerals.  If no milk or sugar is added then this drink counts toward your daily water intake.

Drink 1-3 cups of Pregnancy Tea, hot or cold, daily through first 2 trimesters, and 3 cups during last trimester. 

Combine these teas in any ratio you wish, but the general recipe is:

  • 2 parts Red Raspberry Leaf
  • 2 parts Nettle Leaf
  • 1 part Horsetail Leaf (added for calcium & strong bones)
  • Optional: 1 bag or small scoop of lemon, berry/fruit teas (ensure no licorice), mint or lemongrass to change up the flavour.

A batch can be stored in the fridge for up to 3 days.

Red raspberry (Rubus idaeus)

  • Most commonly used and well-known pregnancy herb
  • Tones female reproductive system; also pelvic and uterine muscles
  • High amounts vitamin C, easily assimilated calcium and iron
  • Also vitamins E, A, B-complex, many minerals inc phosphorus and potassium
  • High mineral content helps tissues stretch, decreases stretch marks, helps prevent anemia
  • Lower rates of miscarriage and postpartum hemorrhage
  • Prepares body for labor. Therefore decreases pain and length of labor.  Doesn’t strengthen contractions but makes them more efficient.
  • Help expel placenta
  • Good for morning sickness

Nettle (Urtica dioica)

  • High amounts of virtually all mineral & vitamins needed for health
  • Especially high in A,C,E,D,K, calcium, potassium, phosphorus, iron, sulfur
  • High amounts of chlorophyll (for energy and nutrients, vitamin K)
  • Nourish and strengthen kidneys; gently dislodge and dissolve any mineral buildup
  • Relax leg cramps and muscle spasms
  • Prevent hemorrhage after birth due to high vitamin K
  • Strengthens blood vessels, therefore good for hemorrhoid prevention
  • Astringent for hemorrhoids
  • Increases quality of breast milk

Other herbs high in easily-assimilated vitamins and minerals (alone or added to the above teas) include Horsetail a.k.a. Shavegrass (very high in calcium), Alfalfa and Kelp.

Several other herbs are safe during pregnancy and are tasty e.g. mint.  Some aid pregnancy related issues such as nausea, heartburn, cramping, and constipation to name a few.  These include but are not limited to ginger, chamomile, slippery elm bark, and fennel.  Consult a qualified herbalist with knowledge of pregnancy herbs before taking any.

By the way, this tea is healthy for the males in your life too, and is safe for all ages from infancy on.  It’s a lovely, mildly flavoured drink for the whole family.

Prefer pre-packaged tea?  Health stores and quality Mama/Baby stores sell pregnancy tea, e.g. Earth Mama Angel Baby “Third Trimester Tea” (which you can take in any trimester).

Birth Support on a Budget

If rates for full doula care seem too high, please read on.  There are many ways I can contribute to you being prepared and supported through your birth. I offer prenatal classes, birth prep consultations, a lower-priced doula package, birth-plan prep sessions, and creative ideas for paying your doula.  Details for all of this are below.

My current fees of $1200-1600 are a fair reflection of my extensive experience, skills and knowledge.  Besides the often long and unpredictable hours, there are costs associated with being a professional doula. Some of these are monetary such as training, missing other work-shifts, association fees, parking and all the normal expenses related to self-employment.  Other costs are not measurable, such as missed family events, being on-call (700+ hours per client), and recovery time from long births.  Experienced doulas are worth the expense and in fact are the first to fill their client list.

If you wish to benefit from my expertise but the cost is out of your range, then you might be interested in attending prenatal classes or accessing other services such as Birth Plan Preparation, or working with me and one of the doulas I’m mentoring.

  • Easing Labour Pain – a 2hr class (mother and her partner and/or birth companion)
  • Prenatal Classes
  • Placenta Encapsulation
  • Contact me to set up private consultations for specific topics
  • Lower-cost doula package:  Work with me and one of the newer doulas I’m mentoring for $850.  Prenatal preparation is vital for having your ideal birth. Therefore you’ll have all prenatal consultations, including creating a birth-plan and any questions answered along the way, with me and the new doula, who is fully and professionally trained, and meets the requirements of mentorship with me. She’s a professional doula who is building her birth experience. The newer doula will be your primary doula for your labour and birth. We both attend the postpartum visit. (I train Birth and Postpartum Doulas of excellence through Birth Ways International.) Many happy clients have chosen this option.

To understand doula fees, please see http://www.cordmama.com/blog/2015/3/23/why-doulas-are-expensive-and-why-youre-glad-they-are

If you have a partner who doesn’t understand paying for extra support, please see http://goodmenproject.com/families/new-dads-advice-just-hire-a-damn-doula-jrmk/

Other Options:

  • We can set up a payment plan.
  • Gift certificates for my services.
  • Raise funds e.g. a collection-box at your baby-shower or Mother-Blessing, or ask people to contribute to your doula rather than buying other gifts.
  • Find a less experienced doula, as they usually have lower fees. See The Doulas of Regina for a listing of local doulas.
  • If there’s no way you can pay for birth support, check out the Doulas of Regina  Relief Fund.  They pay for doulas to attend the births of women who qualify based on financial need.

Breech Baby – What You Can Do Prenatally

“Breech” is a term describing your baby as head-up rather than the optimal head-down position.  Breech position is not uncommon in the middle of pregnancy and most babies turn head down toward the end.  Some turn during labour.  A baby coming bottom first can have more difficulty being born and while a caesarean birth may be suggested, there are many doctors willing to catch breech babies.  For now let’s focus on turning the baby.   The best time to turn the baby is around 35 weeks.

Baby Movements / Fetal Kick-Counts

Awareness of your baby’s movement is an important and non-invasive assessment of fetal well-being.  Basically, activity is reassuring and decrease or cessation is worrisome.  “Kick count” is the counting and tracking of fetal movement – kicks, flutters, swishes, jabs or rolls.  Mothers learn normal patterns for their baby such as sleep cycles, times of activity and triggers.  It’s also a way to bond and connect.

If you’ve been busy or are unsure about movement relax and have a meal, a small glass of juice or some fruit.  Palpate your baby to induce movement.  Pay attention to the movements.  Babies sleep.  If your blood sugar is low then so is your baby’s.  You should feel at least 10 movements over 2 hours (it usually takes much less time), and at least one movement in the first hour.

Keeping a journal of kick counts beginning at 28 weeks provides valuable information.

Instructions

  • Be properly hydrated and fed.
  • Ideally start the kick count at about the same time daily; think of it as a baby-date.
  • Rest when you do the kick counts, by sitting or lying on your left side.
  • Note the date, start time and the time at which the 10th movement takes place.
  • Calculate the total time for 10 movements.
  • Keep notes in the same place to see patterns emerge. Any method works.  Below is an example of a chart and one of a log.

Contact your midwife, doctor, or go to the birth unit at your local hospital immediately if:

  • You have followed the recommendations above and have not felt 10 kicks in 2 hours.
  • There’s a significant change in the pattern over the 3 to 4 days.
  • Your baby has a significant or sudden change in movements.
  • You have concerns.

Example of a Kick Counts Log
Note the date/week of gestation, and start time.  Count or jot down a √ or x for 10 movements.  Note the finish time, and total time.   Keep an eye on patters with the total time.

Week #32
Mon 9:00 XXXXXXXXXX    9:32         Total: 32 min
Tues 12:00 XXXXXXXXXX    12:45     Total: 45 min
Wed 9:00 XXXXXXXXXX    9:55      Total: 55 min
Thurs 9:00 XXXXXXXXXX    9:45      Total: 45 min
Fri 9:30 XXXXXXXXXX    10:05      Total: 35 min
Sat 9:15 XXXXXXXXXX    10:05      Total: 50 min
Sun 10:00 XXXXXXXXXX    14:15      Total: 4 hr, 15 min

Note the significant change in total time.  In this case you would seek medical attention on Sunday.

Kick Count- Blank Tracking Sheet (pdf)

Kick Count Chart – example (pdf)

 

Home Birth Supply List

Prepare Your Home Before 37 weeks:

  1. Midwife & doula contact info entered into cell-phones.
  2. A contact page on your fridge or pinned to a wall, easy to find, in case we have to call for fast help. (Trust me – brain-freeze is a thing!)  Please print, fill out and post this Homebirth Contact Form, or add the extra info to the page your midwives provide and ask you to post.
  3. Other “Important Phone Numbers” list on your fridge.
  4. Some cleared surfaces for equipment set-up.
  5. Plan for birth-attendant parking.
  6. Outside lights working, house # visible at night (may require a temporary # to be put up).
  7. Clear a path to door and through halls in case we have to quickly run in equipment for set up or quickly depart.
  8. Child-care plan (unless they’re attending birth; MW & doulas can offer tips).
  9. Pet-care plan – pets with teeth / claws absolutely need to be locked up or sent elsewhere as even the most gentle animal can become over-protective and stressed while mama’s in labour.
  10. If you’d like candles then please use only beeswax or battery-candles. The rest are toxic and can give your support people headaches.
  11. Get your bed “birth-ready” – make bed in this order (from bare mattress): extra mattress pad, sheets for after the birth, then a plastic liner/sheet or water-proof mattress pad, a regular mattress pad if you’re using a plastic sheet (optional but nice, because plastic gets hot and sticky; an extra flannel sheet works too), “birth” sheets, blankets & pillow cases that can be used for birth.  Have pillow cases and blankets for after the birth nearby.  Note: if you don’t wish to sleep with plastic in the days/weeks before birth, please have all this ready near bed so someone can quickly make the bed during labour.
    Note: Waterproof plastic liner/sheets can be a clear shower curtain liner or plastic drop-sheet (like a thin tarp). Mattress stores sell nice waterproof mattress pads that feel like normal bedding.
  12. If you’re planning a water birth then ensure hot water temperature is turned up
  13. Birth-Kit from MW (if she provides this; otherwise purchase and assemble yourself):
    – Package of 10 or more large absorbent under-pads / “blue pads”
    – Peri-bottle for postpartum perineal care (one per washroom)
    – 4 -6 pair disposable mesh underwear
  14. If you have a guest-room, it’s nice to have it ready for birth-attendants, just in case.
  15. Extra bits if you’re planning a water birth:
    Note: I am a water birth expert and can offer all kinds of guidance if there are issues with any of this, but we need to know ahead of time!
    – Purchase / rent birth pool (unless your bath-tub is appropriate) and all related supplies.
    – Determine where and when to set up the pool.
    – Tarp to protect the floor. Padding under the tarp is nice.
    – Hot water temperature is turned up.
    – Ensure the hose for filling the birth pool fits one of your taps and reaches your pool. Seriously, you can not imagine how often this isn’t done and foils waterbirth plans! Do not just assume it all fits. If the hose won’t connect then you’ll need an adapter or extra pump; ask me.

Birth Containers

Please prepare in plastic tubs or reserved laundry baskets; boxes work in a pinch.

 1) Dryer Items
These items will be warmed in the dryer prior to birth.  Place in a separate bag or container, stored near dryer or with Birth Container). Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.

  • 6 towels (make it 8-10 for waterbirth!)
  • 6 receiving blankets
  • 2 hats for baby
  • 3 flannel sheets/blankets for mother (4 for for waterbirth)

2) Other Linen
This is in addition to the Dryer Items above.  This linen is kept in a separate container please, near birth-spacee e.g. in bedroom, by birth-pool.  Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.

  • Newborn outfit incl. diaper, undershirt, sleeper, socks, hat and blankets
  • Nighty / PJs for mother
  • Set of sheets to fit bed
  • 1-2 flannel sheets/light blankets for waterbirth
  • 6 old washcloths, old diapers, etc. for hot compresses
  • 10 washcloths for mother comfort
  • 6 towels; make it 12 minimum for waterbirth!
  • 10 cloths/rags for clean-up after

3) Other Items
Keep this in a container close to or in birth-space.
Note: There may be some repeats from the Birth Bag Suggestions list, which you’re encouraged to check out for some great ideas of things you can use at home, hospital or birth centre.

  • Large plastic sheet to protect bedding – e.g. drop sheet or plastic shower curtain liner (see above for how to prepare your bed for birth)
  • 4 large, strong garbage bags (2 for garbage, plus replacements)
  • Large laundry bin or an additional large strong garbage bag to collect soiled linens
  • 1 large roll paper towel (please – no matter how much you love Mother Earth
  • Plastic ice cream pail or other suitable container with lid for placenta
  • Flashlight with new batteries
  • Large pkg. maxi pads, extra long (the bigger, thicker the pad the better). Avoid pads with a “dry-weave” topping as they can be irritating to your perineum
  • Small bottle of peroxide – best thing ever to clean blood from surfaces and fabrics
  • Flexible straws
  • Cookie sheet or other large firm portable surface
  • Bottle of hydrogen peroxide (cleans blood stains)
  • Digital thermometer
  • Q-tips, in case of care of umbilical cord
  • (optional) Small unopened bottle of food-grade oil e.g. coconut for crowning
  • (optional) Large saucepan or Crockpot for heating compresses and oils

4) Waterbirth
Your pool should have come with a supply list.  Please ask if you need more info.  If you’re lucky enough to have a big comfy built-in tub, the only extra thing you’ll need is a floating thermometer and a small fish-net or sieve.

Nourishment

Think about lots of healthy foods and drinks (Labour-Drinks) you and your family might enjoy during and after labour and birth, and stock up.  HINT– birth attendants LOVE tea and snacks too! 😉

Make a few trays of ice-cubes (can keep cubes in a zip-lock).

Lending Library for Doula Clients

Below is my list of resources – books, DVDs, CDs – available for clients to borrow, and descriptions.  If you have a question please ask, as I have many evidence-based research articles I can share with you.

Books

Ina May’s Guide to Childbirth by Ina May Gaskin
My fave childbirth book ever!  First half is filled with empowering birth stories and for many women has totally turned around fears and negated all that societal mis-information about birth.  Second half has research based info on what you really need to know about your body and labour – the forgotten, empowering info you don’t hear about in our society unless you really search it out.  Most interventions aren’t even discussed which is why I like my clients to pair this with the Dahl book for a balance of a deep knowing of our power and modern day procedures.  But if a woman tells me she’ll only read 1 book this is the one.

Birthing From Within by Pam England & Rob Horowitz
What I call the third trilogy in really preparing for birth.  Not too much about hospital procedures because it really focuses on the emotional / spiritual preparation for both parents-to-be.  This work literally changed the face of birthing in North America.  Great info about how our non-physical selves affect the process (>95% in my humble opinion), how to uncover some of our beliefs and work toward really feeling confident.  (Pam did The Elk & the Epidural DVD and we get the ice-cube exercise from her teachings.)

Pregnancy & Childbirth Secrets by Gail Dahl
A best-seller to help you prepare for a positive childbirth in any setting.  Kind of like a non-scary, empowering version of What to Expect.  (That book scared the crap out of me while pregnant!)  Laid out month-by-month.  Packed full of info and includes sections on preparing for birth, every pregnancy issue and intervention I can think of, extensive sections on breastfeeding and baby-care.  An example of some of the top secrets for childbirth:  Go in with a plan for pain. There is much more to know than breathing. Her book lists over thirty methods to help reduce pain during labor.

Smart Medicine for a Healthier Child by Zand & Rountree
It’s the best kid-health book I know of from infancy right to teen years, and the only one you’ll need unless you plan to specialize in some aspect of kid-health.  There are short sections on basic safety, nutrition, health etc.  The bulk of the book is an alphabetical listing of specific illnesses and conditions – what it is, signs & symptoms, many ways to treat allopathically (i.e. Western medical style) and holistically (i.e. outside the medical model).  Each illness has a “when to seek medical advice” paragraph, which I found quite reassuring as a new mom.

DVDs & CDs

Birth Day (DVD) by Naoli Vinaver Lopez (10min)
Natural home water birth, empowering, short, non-graphic; good one to show siblings-to-be. Naolí’s birth takes place at home with her husband and two children. It’s a touching and intimate account of natural birth, waterbirth and close family dynamics. The love and support Naolí receives gives her courage to labor uninhibited. Her children are present to receive their sister and be part of the process. She provides narration about what she was feeling and thinking during labor.

Birth with Gloria LeMay (DVD)
Includes:

  • 9 Homebirths without narration
  • Same 9 Homebirths with commentary
  • 30 min intact PSA featuring Dr. Dean Edell
  • 25 min The Prepuce presentation by Doctors Opposing Circumcision. This is a film for medical students on the importance and function of the male foreskin.

It’s My Body, My Baby, My Birth (DVD) (27min)
An educational DVD that tells the story of 7 mothers and their emotional journeys to natural childbirth. Partners express their fears and concerns, ultimately transforming as well.
The story is enhanced with footage of partners and the roles of various professional birth workers.

Pregnant in America¬ (DVD) by Steve Buonaugurio (106min) – (may be on Netflix)
A story about the institutionalization of birth in North America – kind of like Business of Being Born but more fun to watch; follows a couple from pregnancy to birth. Shocked by the greed of U.S. hospitals, insurance companies and medical organizations, Steve and his wife Mandy set out to create a natural home birth in a world where everything is anything but natural. The film is educational and entertaining and prepares excepting parent for their uncertain journey of being pregnant and having their baby.

The Birth of Sabine (DVD) by Andaluz Waterbirth Center (10min)
Sabine’s video shows the excitement and anticipation of a first pregnancy. Follow a couple from the positive pregnancy test, prenatal visits, to the unexpected surprise of her water breaking days before labor begins. They are shown making decisions and using natural methods of induction up until the day they are (gratefully!) in labor. Dad helps catch baby as she is born into the water and placed immediately on mamas chest.

What Babies Want (DVD) by Debby Takikawa and Noah Wyle (58min)
Mind blowing info about infant’s experience of pregnancy, birth and early childhood. This info changed my life. An award winning documentary that explores the profoundly important and sacred opportunity we have in bringing children into the world. Filled with captivating stories and infused with Noah Wyle’s warmth as narrator, the film demonstrates how life patterns are established at birth and before. It includes information on early development as well as appearances by experts: babies and families.

The Elk and the Epidural (DVD) by Pam England of Birthing From Within (15min)
Discusses pros and cons, when use is appropriate, and how to support a family if epidurals are used. Candid info not presented by mainstream medicine, research based. Illustrates the truthful and typical experience of labor with an epidural. Parents learn about the advantages, disadvantages, and the cascade of medical support that accompanies epidurals. The message to parents is to develop and maintain a solution-focused, non-judgmental mindset, so that if an epidural (or any medical support) becomes necessary, they can stay present emotionally and spiritually for the birth of their child.

Gentle Birth Choices (DVD) by Barbara Harper (55min)
Blends interviews of midwives and physicians with footage of six different birth experiences–including a home birth, waterbirths, vaginal birth after a prior Cesarean section, and birth with other children present. The DVD vividly demonstrates the strength of women during childbirth and the healthy and happy outcome of women exercising gentle birth choices. It is a moving and powerful instructional tool, not only for expectant parents, but also for midwives, hospitals, birth centers, and doctors. This remarkable production combines art, education, and politics.

Giving Birth (DVD) by Susanne Arms (35min)
Lots of info about how nature equips us to handle labour and have a safe birth. Lots of great info about how hormones work in labour – every woman should know this. NOTE: Research done on Giving Birth proved that this film is effective in lowering the level of fear of birth in men as well as women.

It shows the model for normal birth and why it is important for mothers and babies. It contrasts the two different models for birth ~ the medical model vs. the midwifery model and explains the risks of routine obstetric practices. You will learn what scientific evidence has discovered about birth and hear it from three obstetricians a labor and delivery nurse, and a doula. You will learn why doulas are important if you birth in a hospital. You will also hear from a mother post-Caesarean and watch two (non-graphic) births. You will experience a woman giving birth in her own home, attended by a midwife, and see images of a water birth. This video explores common misconceptions about pain in labor, epidural anesthesia, cesarean, and many routine hospital procedures. Giving Birth presents what midwifery care is all about.

Birth As We Know It (DVD) by Elena Tonetti-Vladimirova (75min)
Variety of births clips in a variety of settings; watch as many or as few as you wish. This movie features eleven natural births, including home birth, water birth, twins, breech delivery and self-birth. Also featured are informative interviews on topics rarely discussed, such as the Sexuality of Childbirth, Circumcision and Limbic Imprinting, and conveys its message in a non-intrusive way.

Giving Birth & Being Born (DVD) (20min)
Shows 4 natural births in a European birth centre, in variety of positions. The women use a variety of equipment, including birth ball, wall mounted ladder, rope, stool and mats to increase their comfort, with their partners offering support and encouragement. There is no commentary, just simple music to underpin the visuals and a very few sub titles to explain what is being said by the midwives and women. Bonus (36 minutes) offers an explanation of the basics of the birth process, using video animation and short clips from Part 1 to illustrate the various topics.

Business of Being Born (DVD) by Ricki Lake & Abby Epstein – (May be on NETFLIX)
A documentary story about the institutionalization and financial business of birth in North America. This film interlaces intimate birth stories with surprising historical, political and scientific insights and disturbing statistics about the U.S. maternity care system. When director Epstein discovers she is pregnant during the making of the film, the journey becomes even more personal. The filmmakers ask: Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?

Orgasmic Birth (DVD)
Yup – just like it sounds. A documentary about medicalization of births and how well women can cope in the right circumstances. Examines the intimate nature of birth and the powerful role it plays in women’s lives when they are permitted to experience it fully. This documentary asks viewers to re-examine everything they thought they knew about giving birth and the potential it holds. Undisturbed birth is revealed as an integral part of women’s sexuality and a widely neglected human right. Couples share their birth experiences, discussing their fears and how they found the support, nurturing, and ultimately the power and strength within themselves to labor and birth their babies in a beautiful, loving, and ecstatic way.

Relaxation, Rhythm, Ritual: The 3 Rs of Childbirth (DVD) by Penny Simkin (15min)
Penny shares 23 “scenes” from the labors and births of 10 women, illustrating with moving examples what she often refers to as “The 3 Rs of Childbirth: Relaxation, Rhythm, and Ritual.” Watching these different women and their unique responses to contractions as they progress from early labor to birth will inspire women looking forward to birth.

Reducing Infant Mortality and Improving the Health of Babies (DVD) (17min)
Free viewing at http://www.reducinginfantmortality.com/ Listen to Obstetricians, Doulas, Neonatologists, Midwives, Psychologists, Pediatricians, and other Physicians explain how our health care system is failing babies and mothers and what we can do about it. This film is a tool for everyone to use to draw attention to infant mortality and infant and maternal health issues as national health care policy is debated on Capitol Hill.

First Hour of Life (DVD) by Marshall Klaus (33min)
Dr. Marshall Klaus has studied infant bonding and newborns for over forty years. He, along with John Kennell, introduced the Doula concept into mainstream US medical practice. Now, filmmakers from Italy have combined an interview with Dr. Klaus and footage from four (Italian) home births in a profound and simple video which should be required viewing for all parents, obstetricians, nurses, and childbirth educators.

Kangaroo Mother Care I & II (DVD) by Nils Bergman, MD

KMC I – Rediscover the natural way to care for your newborn baby (26min)
This video summarizes the latest research to prove that the newborn thrives best on his mother’s chest, where the temperature is perfectly controlled all the time. How to wrap the baby to mother’s chest is also shown. Kangaroo Care is for all newborn babies, but especially premature ones. Dads can do it too!   This is the “How-To” video. Kangaroo Mother Care enables the baby to relax, and improve the heart rate and the body temperature. Breastfeeding is an essential and natural part of Kangaroo Care.

KMC II – Restoring the original paradigm for infant care and breastfeeding (52min)
This comprehensive, expanded video is instruction for health professionals who support the maternal/newborn dyad. Dr. Bergman clearly and simply presents what happens to a human newborn when separated from the mother. His own research plus >200 studies shows many benefits to the newborn in skin to skin care.

Dr. Jack Newman’s Visual Guide to Breastfeeding (DVD) (45min)
Simple reassuring info about breastfeeding. This is a no-nonsense approach to baby-led breastfeeding. It illustrates the numerous benefits of breastfeeding for both mother and baby, including detailed reviews on the importance of colostrum, proper latching techniques, latching the baby who does not yet latch, and how to treat the colicky baby by changing milk flow.

Topics covered:

  • How to know if baby is getting enough milk
  • Breast compressions
  • Avoiding sore nipples
  • How to get a baby to latch
  • Colicky babies
  • How to increase baby’s intake of breastmilk
  • Risks of formula
  • Using a lactation aid

Baby-Led Breastfeeding (DVD) by Christina Smillie (16min)
This film shows mothers learning to breastfeed naturally, by letting their babies show them how. Human babies are already hardwired to seek out and find the breast at birth and this film shows babies instinctively finding the nipple. The film includes babies of various ages with a variety of breastfeeding challenges. In this video we see just how babies can do it, when we get out of the babies’ way.

Prenatal Yoga (DVD) by Shiva Rea
Learn poses for each trimester. DVD includes:

  • Calming meditation and deep breathing
  • Gentle workout with seated poses, standing poses and floor work
  • Guided relaxation

Postnatal Yoga (DVD) by Shiva Rea Reconnect with your strength, your energy and your pre-pregnancy shape and lifestyle through warmth, guidance and inspiration of instructor Shiva Rea. Post-pregnancy is a most important time for a woman to regain her physical strength and stamina. This gentle program focuses on moves and exercises that help alleviate the stress incurred by giving birth.

Happiest Baby on the Block (DVD) by Dr. Harvey Karp (128min)
Note: I haven’t watched this yet so can’t share an opinion. It was donated by a client who highly recommends it. Aimed to help soothe most of baby’s cries in seconds…plus add 1-3 hours to tot’s sleep! Parents master these fun tips best by watching. Then, after they you get good at switching-on your baby’s amazing calming reflex, Dr. Harvey Karp, noted pediatrician and child development expert, reveals the amazing secret reflux that literally is ‘THE OFF SWITCH” for baby’s crying! Learn the 5 simple ways to turn on the calming reflex (the 5S’s).

Babies Know… Seven Principles of Prenatal and Perinatal Psychology (DVD) (20 min)
Seven Principles of Pre- and Perinatal Psychology is all about infant consciousness from the moment of conception through birth, and the significance of our first experiences after birth on development. Becoming aware of this level of consciousness can have a profound impact on our babies being born today, as well as people of any age investigating how experiences from within the womb and birth have impacted the overall experience of being human.

Trauma, Brain & Relationship – Helping Children Heal (DVD) (30min)
This documentary is an overview to help those who care about children recognize, prevent and heal psychological trauma. Internationally and nationally recognized authorities who work with children and teenagers in the field of emotional trauma offer insight and information about the origins of relationship/developmental problems, as well as problems associated with PTSD later in life. A central message of the documentary is that even though psychological trauma often goes unrecognized in children, emotional trauma is very responsive to relational repair. It clarifies such points as the difference between emotional trauma and emotional stress.

Your Body, Your Birth (CD) by Lynn Griesemer (78min)
Inspires, encourages and reveals secrets for a rewarding birth experience – one you can cherish for the rest of your life. This CD is about taking charge of your birth and your life. Topics include: exploitation in pregnancy and delivery; medical aspects of birth (drugs, safety, myths, technology); natural childbirth (definition, advantages, why we should avoid drugs at birth, why more people don’t aspire to natural childbirth); tips for a successful pregnancy and birth; how to make birth-related decisions that you feel comfortable with; goal setting; imagination; body image; human needs; what obstetricians will do for you; strategies for a satisfying birth.

Wondrous Beginnings (CD) by Wendy Anne McCarty (49min)
This audio CD is part of the What Babies Want Audio Lecture Series about the consciousness of infants. This CD offers insights into our spiritual nature, right from the beginning of life.

Dr. McCarty intertwines amazing new theories and findings with heart-warming healing stories of families who have come to her for guidance. This CD is especially encouraging and supportive of pregnant families and families with young children. Wendy leads us on an amazing journey through a new understanding of the consciousness of the infant. Her emphasis on scientific research does not contradict her deep spiritual understanding of what it is to be human. She presents ideas and stories pertaining to the process of coming into the world from preconception through early childhood.

Ancient Encoded Wisdom (CD) by Joseph Chilton Pearce (45min)
This audio CD is part of the What Babies Want Audio Lecture Series about the consciousness of infants. This CD offers insight into our birthing culture. Joseph Chilton Pearce offers us a clear, no-holds-barred look at the developmental needs of babies and children, and clearly spells out for us the roots of violence inherent in our birthing and parenting practices. He also offers simple and concise choices that we can make for positive change.

Golden Nuggets for Breastfeeding Early Days

Some little-known gold nuggets for breastfeeding in the first days (you may wish to print this and stick it on the fridge or by your feeding-nest):

  • Breastfeeding may take practise but is designed to work
  • Watch for feeding cues* and offer breast.  Crying is considered a late sign of a stressed babe.
  • Offer one cue, then pause to let babe work it out.  E.g. nipple to baby’s lips, then pause for 5 seconds to allow babe to sort out latch.  If she needs another cue, then give on, pause, and repeat if needed.  Baby is learning too.
  • Babies rest/pause with eyes closed.  If babe stops sucking but stays on breast, let him rest and resume feeding.  He’s likely not actually sleeping, so don’t take him off.  (Sleep test – lift and drop arm.  Sleeping baby’s arm will fall; wake baby’s arm will respond.)
  • You should feel a tug or pull, but no pinching.  Avoid the temptation to feed through a bad latch, no matter how demanding baby is.  Not even once!!  Break the seal (insert pinkie into babe’s mouth) and start again.  Even if it takes 10 tries.
  • Don’t hold baby’s head while feeding.  It may be sore from birth.  Sore or not, the stimulation causes baby to pull back from breast.  Hold head by putting hand on bones at top of neck if necessary.
  • Don’t “pet”, rub, stroke babe while feeding.  Holding and feeding baby is an act of big love in and of itself.  (Imagine if you were trying to enjoy a fine meal, and someone was petting and rubbing you all over.  Ok that might be fun, but not conducive to eating.)
  • After 3-6 weeks the effort of breastfeeding becomes way less than the effort of formula.  Keep going – it gets easier and is worth the early efforts.

Best Start has an excellent 1 page chart for the first days –  feeding guidelines, newborn stomach size, diapers and other info.  Print this!

* Here’s a great graphic to help you identify visual feeding cues.

 

 

Feeding Baby in the First Year

A baby’s nutrition in the first year has life-long effects.  Inadequate nutrition is responsible for more than 35% of child-deaths, and higher rates of illness and developmental delays (World Health Organization, 2009).  Even in affluent North America babies and children are malnourished, often due to misinformation and poor food choices.

Health Canada (2012):  Breastfeeding – exclusively for the first six months, and sustained for two years or longer with appropriate complementary feeding – is important for the nutrition, immunologic protection, growth, and development of infants and toddlers.  Several international health organizations such as UNICEF, WHO, and the American Academy of Pediatrics make the same recommendation. 

Birth to 6 months
Babies should be exclusively breastfed until at least 6 months of age. There are no nutritional benefits to early complimentary feeding, only risks.  Babies who are only partially breastfed (i.e. supplemented with formula or other liquids or solids) in the first 6 months are healthier than those who are not breastfed at all, but risks are significantly higher than in exclusively breastfed babies.

If you think your baby is ready for solids before 6 months then please see section below regarding signs.

Benefits of breastfeeding, i.e. why formula should be used only as medicine
Human breastmilk is uniquely designed for human babies and contains all the required nutrients.   It’s the only thing an infant’s gut is designed to digest and assimilate until at least 6 months of age.  Breastmilk contains substances that augment the immature immune system, and aid in digestion and absorption of nutrients.  Anything else is likely to ferment, lead to gas, colic, poor nutrient absorption (malnourishment), illness and food-allergies.

Babies who are breastfed:

  • Decreased risk of SIDS, less likely to die of other causes in first months
  • Lower rates and severity of diarrhea and pneumonia
  • Lower rates and severity of ear-aches, flu, meningitis, bladder infections, respiratory illness, and other acute infections
  • Decreased risk of childhood leukemia
  • Decreased risk of long term chronic illness such as asthma, diabetes, gastro-intestinal disease (celiac, ulcerative colitis, Crohn’s), cardiovascular disease, obesity
  • Higher cognitive function / greater intelligence

Benefits of breastfeeding to mother include decreased risk of post-partum hemorrhage, breast and ovarian cancers, late-onset diabetes, and heart disease; faster loss of weight gained in pregnancy, and delayed return of fertility (although this is not necessarily a birth-control method).

6 to 12 months
Baby’s weight / size has nothing to do with readiness for solids.  At 6 months a baby’s digestive & immune systems have developed enough to introduce solids.  Earlier is correlated with allergies, digestive problems, immune problems, and obesity.  After 6-8 months caloric and nutrient needs exceed those provided by exclusive breastfeeding.  Further delay of complementary foods may stunt growth.  Start with breastmilk then finish with solids from 6-12 months.  Do encourage – but do not force nor coerce – the baby to eat.

STEP-1:  6 months, or whenever baby shows interest in food (whichever is later)
Offer breast-milk first then finish the meal with solids.  Introduce 1 food at a time for a few days, in small amounts, and then try another.  This helps the caregiver be aware of allergies or intolerances.  Simple, natural, pureed, unprocessed, organic – whole foods, like they came from earth.  There’s no need to buy special baby food – healthy family food, properly prepared, is just fine.

  • 200 kcal/day (in addition to about 400 kcal breastmilk) of mushy or runny foods
  • Offer 30-45 ml (2-3 tbsp) food per feed, at 2-3 meals daily
  • Pureed, raw or lightly cooked, non-citrus fruits e.g. apples, pears, bananas, blueberries
  • Cooked & pureed veggies – start with avocados, roots (carrots, yams, beets) and squashes
  • Cooked whole gluten-free grains (rice, quinoa) or oatmeal
  • Egg -yolks (yolks are usually not an allergen; whites may be)

STEP-2:  7-8 months, or 1 month after beginning step-1 (which-ever is later)
Continue with step-1.  Increase portions gradually up to 125-250 ml (1/2-1 cup) per meal and the following:

  • As child grows used to solids can also offer 1-2 snacks daily
  • Organic meats, pureed
  • Other cooked, pureed veggies
  • Can start combining foods that are tolerated

STEP-3:  8-10 months, or 1 month after beginning step-2 (which-ever is later)
Continue with step-2 and add:

  • 300 kcal/day (in addition to about 400 kcal breastmilk) of mashed food or finely chopped that baby can pick up
  • Offer 125-250 ml (1/2-1 cup) per feed at 3-4 meals daily, and 1-2 snacks if needed
  • Whole eggs
  • More variety

12 months and beyond … or 2 months after beginning step-3 (whichever is later)

  • See general recommendations below
  • Baby can eat regular family foods but watch for allergy or sensitivity
  • 550 kcal daily (in addition to about 350 kcal breastmilk)
  • 175-250 ml (3/4-1 cup) per meal for 3-4 meals daily and 1-2 snacks
  • Continue to breastfeed until 2 years of age

Signs that baby’s ready to start complimentary feeding
Solids can be introduced when baby shows signs of being ready, but only after 6 months of age.  Some babies take longer than 6 months but most are ready for solids by 8 months.

  • 6 to 8 months of age
  • Can sit unsupported
  • Doesn’t automatically push solids out of mouth with tongue (a reflex present until at least 6m in most babies)
  • Willing and able to chew
  • Can pinch or pick up food or other objects between thumb and forefinger
  • Eager to participate in mealtime
  • Shows interest in food – e.g. reaches for food at mealtime, crawls to dog’s dish to steal food
  • Long-term increased need to nurse, unrelated to illness, teething pain, stress or growth spurt
    Note: this is only an indication if other signs are present; not a sign on its own

If baby shows signs before 6 months

Eagerness to engage in mealtimes doesn’t mean ready for solids.  It’s likely a social behaviour rather than a physiological one.  Baby can be included in family mealtimes without eating solid foods.

  • Join the family at mealtime in a lap, booster seat or high chair
  • Give a sippy-cup containing some expressed milk (if baby is more interested in playing with the cup than drinking the contents, you may wish to use water instead of valuable pumped milk)
  • Provide baby-safe cutlery and dishes to play with
  • Give baby an ice cube (baby-safe size & shape) or ice chips to play with
  • Offer a cube, popsicle or slushy frozen breastmilk to eat with a spoon

Food intolerance or sensitivity, allergy
Common allergens include soy, wheat, dairy, peanuts, egg-whites, food colouring, corn, citrus, strawberries, raspberries, kiwis, pork and shellfish.

The following correlate with food intolerance or allergy:  mucous conditions, ear infections, runny nose, rashes (including diaper rash), colic, green stools, digestive issues (diarrhea, constipation, gas, vomiting), undigested food in diaper, asthma, wheezing, and /or behavioural changes after eating given food.

Safety precautions

  • Proper food storage and handling
  • Foods that are choking hazards; can block or wedge into wind-pipe
    • Hard and small sized, smooth / sticky solids g. popcorn, meat chunks meat, hard pieces of fruit / veggies, candies, hot dogs (unless cut lengthwise and cubed), gum, whole nuts and seeds, fruit-pits or seeds, cough drops, raisins, fish-bones, food on toothpicks or skewers.
    • Thick creamy texture e.g. a blob of nut-butter
  • Always supervise infants when they eat or drink
  • Mealtime supervisor should be familiar with baby’s chewing and swallowing abilities
  • Upright and secured position
  • Do not allow baby to eat while laying, running, walking, distracted, nor eat in the car
  • Avoid sharp objects
  • Take an infant / child choking & CPR class to be prepared in case of choking

General Recommendations

  • Organic, whole foods i.e. how they come from nature e.g. baked potato rather than French-fries
  • Purified water, if water is used
  • If juice is used, then fresh & home-made
  • Baby stomach is about the size of her/his fist – portion accordingly, considering breastmilk
  • Take time for eating patiently – meal time should be enjoyable
  • Feed infants directly and assist older children when they feed themselves
  • Feed slowly and patiently, and encourage children to eat, but do not force them
  • Variety of foods
  • Iron fortified food or easily digestible supplement (e.g. Floradix) in case of immediate cord clamping or anemia
  • Whole spectrum salt – Himalayan, Celtic
  • The Kidco Food Mill is a brilliant device for creating baby food on the fly. It’s affordable, simple to use and easy to clean.
  • Ice-cube trays make perfect infant-sized meals – nice to have on hand for child-care or those busy days that run away from us. Puree a few foods and freeze for later use.  Best for 1-3 months in fridge-freezer, and 6 months in chest-freezer.

Avoid

  • Foods that are choking hazards; can block or wedge into wind-pipe (see “Safety”)
  • Common allergens (see intolerance section), foods with family history or allergies, or that baby reacted to in mother’s breastmilk
  • Processed foods – fried, unhealthy fats, high-sugar e.g. chips, crackers, French-fries
  • Chemical additives
    • Fluoridated water, artificial colours & flavours, MSG, aspartame & derivatives
  • Unpasteurized honey, as it may contain spores that can be life-threatening to baby (after 1 year these have no effect on a mature digestive system)
  • Sugary drinks – pop, store-bought fruit-juices
  • Caffeine – coffee, tea, chocolate
  • Under-feeding – babies let us know when they’re hungry (crying, fussing, listless); avoid portion-control as needs change e.g. growth-spurt, immune system fighting a bug
  • Rushing through eating
  • Avoid distractions
  • Strong tastes – spicy, salty, overly sweet
  • No store-bought goat/cow milk until 8-10m of age, and only if child has no sensitivities (but it’s best to avoid non-human milk at all stages of life)

Special Circumstances
In the rare case that a mother is not able to breastfeed her baby, the following options can be considered.  They’re listed in order of healthiest to least.

  1. Pumped mother’s milk, if inability to breastfeed is due to a “mechanical problem” e.g. cleft-palate
  2. Fresh donor milk e.g. close relative, friend in the community (not recommended by public health due to worries about disease transmission)
  3. Frozen human milk from milk-bank
  4. Home-made formula (this is not recommended by public health regions) with added high quality probiotics and fish-oil / ω-3 EFA
  5. Organic formula from a reputable company with added high quality probiotics and fish-oil / ω-3 EFA
  6. Regular store-bought formula with added high quality probiotics and fish-oil / ω-3 EFA

Note: if the inability to breastfeed happens after 6m (e.g. medical problem) then it’s preferable to start on real food and purified water rather than store bought formula (World Health Organization, 2009).

 

References

Gaskin, I. M. (2009). Ina May’s guide to breastfeeding. New York: Bantam Books.

Hass, E. M. (2006). Staying healthy with nutrition. Toronto: Celestial Arts.

Health Canada. (2012). Infant feeding. Retrieved from Health Canada (Government of Canada): http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php

KellyMom. (2011). Is my baby ready for solid foods? Retrieved from Kelly Mom Parenting & Breastfeeding: http://kellymom.com/nutrition/starting-solids/solids-when/

La Leche Leage International. (2010). The womanly art of breastfeeding. Ballantine Books: New York.

Ochoa, S., & Kline, A. (2011). BIOL404 Chemistry & nutrition student syllabus. SLC: Midwives College of Utah.

Stuebe, A. (2009). The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics & Gynecology , 2 (4), 222-231.

World Health Organization. (2009). Infant and young child feeding – Model Chapter for textbooks for medical students and allied health professionals. Geneva: WHO Press.