We all know by now that breastfeeding your baby provides the best nutrition for your baby and is the safest choice for most women. We also know that many women want to breastfeed their babies but find it difficult to impossible for a variety of reasons. While nursing issues are common, it is rare that they cannot be solved with the right support and the commitment of the mom to seeing it through.

So many moms today have the commitment part down, but underestimated the importance of the "right support." Breastfeeding is painless when done correctly. When it isn't, the pain is intolerable. Sometimes the situation resolves itself. If it doesn't, it can become too painful for the mom to nurse, and an unplanned and unwanted transition to formula can be the result. With the right support, even the most challenging and seemingly bleak breastfeeding situations can be remedied and the pair can nurse  successfully. 

While you are still pregnant, you can start discovering and creating who, what and where your support system is. 

So what is helpful for breastfeeding?

A good start. A low to no intervention birth, baby with mom immediately after birth skin to skin until the end of the first feed, about two hours. If this initial step doesn't happen, then restart again as soon as mom does get baby. ie, put naked baby on mom's bare chest and let them discover mom. This delayed start works better if the baby hasn't been bathed. You can opt out of the bath at the hospital, just let them know before the baby leaves the room. You can also put it in your birth plan. Having a doula at your birth has been proven to help breastfeeding outcomes (ahem!) and can help you get closer to this ideal first two hours or more.

Realistic vs unrealistic expectations. Sometimes nothing is wrong, nothing needs to be fixed, but because mom and/or her partner, nurse, doctor, mother, friend etc don't know what to expect with breastfeeding, interventions are applied that actually interfere with the process instead of helping. A newborn goes through a nine stage process at birth that can take up to two hours. If the two hours are interrupted and not skin to skin at the time of birth, they may need even more time skin to skin with their mother to go through their stages. For more on the nine stages see: http://www.magicalhour.com/aboutus.html. I have a video showing these stages that I share with my clients prenatally. 

Most women today tell me they want the "first hour" and to "nurse immediately", but don't know what that really looks like. They ask nervously as soon as baby is on their chest, 
"Is the baby nursing yet?! Are they getting anything?! Am I doing this right?!" 
When you understand the nine stages a newborn goes through, you will realize that its pretty hard to do it wrong. Just let the baby be. Your partner can keep the nine stages on a check list and make sure noone takes the baby before they are done. This will go a long way.  An once of prevention is worth a pound of cure!

OK, so these last three paragraphs say essentially the same thing. That is because I cannot stress enough how helpful the appropriate start of breastfeeding can be. When given the time and patience, many newborns latch on themselves. Baby-led latch takes time, but it is often the most effective way to do it.

And of course, that doesn't always happen and maybe you can use an experienced lactation counselor to help get things started. But even so, if you followed the above plan, they will most likely be able to correct the latch easier and faster than if  you and the baby didn't get two hours of uninterrupted skin to skin immediately after the birth, or shortly after, as soon as possible, without a bath.

As the baby gets the hang of it, the next thing that many women mistake as an issue is the frequency with which a baby will nurse. Your newborn should be nursing 10-12 times per day. There is nothing so demanding to compare it too and many women worry that their baby is overeating, too attached to them, just nursing for comfort, and/or other misconceptions. There are instances where the baby doesn't have a good enough latch, and then they aren't getting enough transfer of milk at each feeding so then they nurse more often. This would need to be identified by an experienced lactation counselor, IBCLC, postpartum doula, and/or nurse experienced with lactation. But usually, its just the normal frequency of nursing that surprises women. Let me clarify this now, they nurse a lot. A lot, a lot, a lot. 

Your supportive team:
You need people around you who 1) support your breastfeeding and 2) know how to spot issues and resolve them. Make sure your OB or midwife supports breastfeeding. I think it'd be rare to find a midwife who doesn't support breastfeeding. But still. And make sure your prediatrician supports breastfeeding. When interviewing pediatricians, you might want to ask them if they are using the breastfed baby growth chart or forumla-fed baby growth chart. Also consider asking them what % of their clients nurse exclusively the first 6 months and what % continue with solids and nursing through 12 months (the WHO recommendation). Consider having a doula who is experienced in breastfeeding. If the birth doula you love doesn't do postpartum/lactation, there are plenty of postpartum doulas and lactation consultants and counselors who focus just on this special time. I do both by the way, birth and postpartum/lactation support.

If your close family members do not support your breastfeeding, this can be very difficult. It may be more than you want to deal with right after you give birth, but breastfeeding is so important, you can't really afford to allow them to interfere. For some moms with really tough families, just not telling them about your breastfeeding, and/or not having them over too often is the best they can do. Hopefully your family will be supportive and they won't add any challenges. Of course grandmas want to help, and they still can. A nursing mom really needs someone to come bring a hot meal, clean the house and do some laundry. Tell them your doula Maiysha said so!

Find and go to your local breastfeeding support group! This is so priceless! And if it isn't, find a different group that is. While breastfeeding is natural and we've been doing it forever, we have traditionally always done it within a supportive community. These groups provide this last missing piece of the puzzle. Find them before you deliver because once you deliver you are too tired and busy to do anything extra. If your breastfeeding is going well and you don't need any help, still go because you can help moms who are struggling. Just seeing other women nurse can help women figure out how to correct their position and their latch.

Classes and books? Everyone learns differently and these can help too. What classes and books provide is educating you to have more realistic expectations for nursing, what the flags are for problems, and when to seek help. But if you already followed my above tips, you would already have that. There are many books out there, I recommend The Ultimate Breastfeeding Book of Answers, Jack Pitman and Teresa Pitman, anything from Ina May Gaskin, La Leche League, and/or Karin Caldwell, just not the What to Expect when your Expecting series.

Then last but not least, know that there is a time and place for formula, and that is OK. If your baby gets bathed, a pacifier, formula in a bottle and is away from your for hours after birth, you can still nurse. Make sure you get an experienced lactation support by your side asap. It may take a longer to get things started, and you may need more hours of professional help to mitigate the fact that the baby's natural rhythm is off the track, but it can be done most of the time.

Safer Use of Infant Formula: 
If you do need to and/or choose to use formula, please do safely. Properly sanitize all bottles and nipples, and be sure and prepare properly. From the WHO website:
Powdered infant formula (PIF) has been associated with serious illness and death in infants due to infections with Enterobacter sakazakii. During production, PIF can become contaminated with harmful bacteria, such as Enterobacter sakazakii and Salmonella enterica. This is because, using current manufacturing technology, it is not feasible to produce sterile PIF. During the preparation of PIF, inappropriate handling practices can exacerbate the problem. WHO recommends mixing powered formula with water at a temperature of at least 70 degrees C, 158 degrees F - to kill E. sakazkii. Formula made with hot water needs to be cooled quickly to body temperature if it is being fed to the baby immediately. If formula is not being fed immediately, refrigerate it right away and keep refrigerated until feeding. Please read the full recommendation through the following link:
http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

This may seem like overkill, especially when we see moms in the park pouring water from their bottle of Poland Spring into a bottle, scooping in the formula and then shaking, but this is very dangerous.  Please do take care when preparing bottles and formula.

Now that you know that formula isn't as easy as it seems, you may as well keep on breastfeeding. Breastmilk never gets a re-call!

What to ask a doula when interviewing should be whatever questions you like. After all, you're not interviewing contractors to re-tile your bathroom. This is a very personal choice. Of course find out the details of her fees and what exactly that entails (all on my homepage, btw). But then, find out who she is. No matter how many births she's been to or how many clients she takes a month, its the connection that counts.

An online search will give you some very standard questions that mostly ask about the structure of her practice, but they're not very helpful in helping you find out what you really want to know on a deeper level. Here is my guide and some of my own answers to these common questions, as well as my suggestions for interviewing doulas.

Are you certified? Yes, but I attended births before I was certified. I provided excellent service at those early births. I feel I got my stride by birth number 3. I wasn't certified until I had over 15 births. I felt my calling to this work long before I did my certification. Many doulas have varied backgrounds coming into this field and you could find an amazing doula who isn't certified. I know one particular doula with 20+ years experience who chooses to not certify because she was practicing before the certification existed.


Another common question is to ask the doula how many clients she takes a month. What you could ask in addition to that is; do you have back-up and how often do you need back-up? How do your clients respond to your back-up? 

Isn't that what you really want to know? Many people assume that the more births a doula takes, the more they worry she may miss their birth. Up to a point, it really doesn't matter. Granted, 10+ births a month would be more likely to have a conflict. But the average doula does 1-7 per month with no problem. And even if it's one birth per month, her client from next month could go early on your due date. In practice, its actually very rare for clients do double up. 2-5 per month is average. 

Whether or not she is a high volume doula, she could still miss your birth. Maybe she has a conflict like some emergency with a family member. We all make every effort to attend our births. A better question I would ask is, what would you miss a birth for, and/or what have you missed a birth for, and how often does that happen?

Are you available for my due date? OK, this question is actually really important, but you should clear it before you set up a time to meet in person.

Then the next one, how many births have you attended? Cost? and do you have children?  I get it, but what you mean is, "do you have enough experience to know what you are doing?" See if you can get the answer to the latter, because that is what you really want to know. While experience of course counts, there are jems at all levels of experience. A newer, less experienced doula will have an incredible excitement and enthusiasm about attending your birth. That energy can be more important to you than whether or not she knows how to gently work with a cranky L&D nurse, or if she knows that when the doctor asks for lidocaine during pushing, they're planning to do an episiotomy. A more experienced doula has been more thoroughly tested, knows her way around the L&D floor, the terminology, the techniques and has proven herself to be reliable and skilled in her field, and therefore much more expensive. A doula with children may also be more expensive to help her cover the cost of childcare--a fair trade-off considering most people want a doula with children. There are also many wonderful doulas without children. Consider the fact that just because she doesn't have children, doesn't mean she has never been pregnant or given birth. And a doula without children has often had to work harder to prove herself in this rare field that favors mothers. 

The right doula for you is priceless. But we of course have budget constraints. Only interview doulas you can afford so that you are comfortable with whomever you hire. Some people are surprised to learn how expensive some doulas are. But if you figure the hours involved; training, continuing education, interview, prenatals, postpartums, travel time, labor and delivery could be 10-60 hours, plus being on-call 24/7...even the most expensive doulas are a bargain. It would be better if insurance covered our fee. We are the least expensive professional attending your birth, and usually putting in the most hours. I encourage people to file a claim with your insurance company for your doula. They probably won't pay for it, but it will send the message to them that this is what consumers want. Then hopefully the next generation will have better access to this care.

Have you worked with my caregiver before? This may or may not be helpful. Whenever I am working with a new provider, I research them with other doulas so I have some understanding of what to expect. Next, if your doctor is part of a practice, they may not be at your birth, and even if they are, they are only in the room briefly. If your provider and doula meet for the first time at your birth, we can still be a great team.

So then what do you ask a doula at the interview??? Ask her what you really want to ask her. Only you can decipher what you need from a doula. There is no one best doula for everyone, but there is the best doula for you.  Make the interview social, because your relationship will potentially become extremely intimate. Set the meeting at a comfortable place, so its an enjoyable exercise in paying attention to your pregnancy. Before the interview think about what your philosophies on birth, women and medicine. Share those opinions with her and see what she says. Look inside and ask yourself what your real questions are. Listen to your own voice, maybe you want to ask her something personal. Maybe you just want to share your fears and concerns and she how she responds to that. Everyone woman has her unique journey with her birth and her unique needs. The interview lets you feel out if this is the woman you want to help guide you on that journey. ;)

I love talking about birth to expectant parents, I really do. Here is more info on what I can offer in a private class, continued from my home page:

About my private childbirth classes
The foundation for what I teach comes from Bradley, The Yoga Birth Method, Fear to Freedom, Hypnobirthing, and of course lots of practical birthing experience as a doula and mother. I am certified in all of these methods except for Bradley, which is self-taught.

Classes are customized to what you would like to learn together.  We can do a one day crash course or a few days series over a few weeks. My rate for private childbirth classes at your home is $65/hour.  A minimum of four hours is recommended. You can invite one other mom/couple  at the same rate. Three or more is $75/hr. With additional people you may want to allow for additional time for the additional questions. Of course when the class  happens, we can go off the planned topics, and/or deeper into any specific topic that interests you. 

Below is a menu of topics for you to choose from. You can select what interests you and make a checklist and design your own class. I can then give you an estimate of how long I think that will take. Three hours may sound like a long time, but it can feel rushed if we don’t allow for 4 or more so that you really get to ask all your questions and really get a better understanding of all the information. I also give you some book recommendations and leave you with a bunch of hand-outs depending on what we end up doing.

Bradley • Hypnobirthing • The Yoga Birth Method • Fear to Freedom

Bradley provides a great foundation for the nuts and bolts of what to expect when you’re delivering. A one time Bradley session would be about 3 hours. The outline of the Bradley topics is as follows:

•   Exercises / Positions, and Relaxation
•   Anatomy & Physiology of Birth
•   Father / Coaches Role: Obstacles, Challenges, & Techniques
•   Massage
•   First and Second Stage Labor Techniques: Labor Rehearsals / Coaching Keys & Tools
•   Planning Your Birth
•   Variations & Complications, including Cesarean Birth
•   Postpartum Preparation (for mom and family)
•   Immediate Post-Birth Discussion (includes newborn procedures, cord clamping, skin-to-skin, and breastfeeding)
•   Newborn Care, including holds, colic tips, and early sleep tips.

Hypnobirthing is a technique that helps moms relax in labor. It is often most effective for early labor, and/or a mother who is already experienced in and confident with hypnotherapy. It also works best with a committed partner. There are many do-it-yourself hypnobirthing packages out there that you can use. You can purchase the mp3s and play them before and during your labor. We can do a guided relaxation exercise together so you can get an idea of what that is like and if you would like to practice it. That would take about 30 minutes and can be added to our class. I don’t teach it alone. There are instructors who do teach it alone.

The Yoga Birth Method is one of my favorites. This is where we really see the mind and body connection. YBM takes positions to the next level. Bradley gives you positions for comfort in labor, prenatal yoga is for your fitness in pregnancy, and YBM is for all of the above plus it is used both prenatally and during labor to really position you in such a way that eases the necessary movements the baby makes inside you to come down and out. While you are doing the positions, I am helping you practice yoga breathing and showing your partner how to use their hands to massage and enhance the opening power of the positions. The mind connection part is a whole other integral part of YBM, but you can choose to just use the asanas, positions, and not the whole method. If you choose the whole method, we do mind/spirit work identifying behaviors and patterns in yourself that you want to avoid and behaviors and alternatively patterns you want to strive to strengthen. Just learning the positions is about an hour. To learn the entire method with the mind/spirit work in addition to the physical positions would take about 2, maybe up to 3 hours. Adding in anatomy and physiology of birth and hospital interventions makes it a really complete class. That in total would be about 4-5 hours.

Last but not least is Fear to Freedom. This method is all about mind and body connection. This is a good choice for the mom who wants to go medication free, but understands it will take more than white knuckle determination. She realizes she needs some deeper introspection to uncover what emotional barriers she may have inside that may hinder her. She wants exercises and a method that will help her find her voice. This class is a series of ten classes, but each class can stand alone. Each class may take about 1-2 hours. If you would like to add in anatomy and physiology of labor, and hospital procedures/interventions, we can add that with another 2-3 hours to the class.

I pass your train station everyday. I see your building in the skyline as I take a cab down the FDR to another birth. And there you are, down the street from my aunts house...near where I used to hang-out as a teenager when I had that first boyfriend in Brooklyn...and that other train station, two stops from the last. I remember you in Queens, I remember you in a snow storm. I remember you in my Bronx, that was a long one! New Jersey too, I remember. I remember you walking the streets of Manhattan...I was born here too...even in the same hospital. Three blocks from where my grandmother used to live. Bumping into you a year later at Wholefoods--so big now! It was that day, that night, that morning, when you decided come. You are all over my city, where my first child was born too. My city has become all the more mine. I feel all the more connected to the families & future families... streets, stops, shops, places, history where I was lucky enough to witness the miracle of your birth!