Monday, November 4, 2013

Going Home from the Hospital After a Caesarean Birth - How a Doula Can Help

After three to five days or more of watchful nurses and occasional doctor's visits, you are probably more than ready to be alone with your new family. Your partner, family or friend will excitedly arrive with the car seat and that special going home outfit that you selected so carefully. You both get dressed with a mixture of glee and a wee bit of fear. This new little person is all your responsibility now. That part is common to all matter the type of birth she had.

But as you get in the car or taxi you may discover the first difference: seat belts that buckle low can irritate your caesarean incision. Usually your doctor will have removed your staples just before you leave the hospital, so that area is probably tender anyway. One trick that might work for the next week or so while that area is still very sensitive is to fold one of the baby's extra blankets and cushion it between the area and the seat belt.

If you live upstairs, you will soon discover another small difference: negotiating stairs can be tiring. Don't do it more often than you have to: plan trips up and down carefully. Rest once you are downstairs before attempting your return journey. For the first few days have someone else carry the baby up and down the stairs for you. If you have hand rails, now is a good time to use them.

That first shower after your birth was probably heaven, but at home you may find getting into the tub more challenging. Most hospital rooms are equipped with walk-in shower stalls, while most homes have tub/shower combinations. Stepping up and over into the tub may require some help for the first few attempts. Of course, it may be a couple more weeks before you incision is healed enough for an actual bath.

Of course, common household chores such as laundry, sweeping, mopping, hoovering and even cooking present difficulties as well. The general advice given after a caesarean is not to lift anything heavier than your baby for six to eight weeks, which means carrying laundry baskets is a definite no-no. Sweeping, mopping and hoovering may likewise be impossible for several weeks as the bending required puts pressure on your incision. Cooking although easier may be difficult for the first couple of weeks if you must stand for extended periods of time.

If like me, you have a perfectionist streak, you may wonder how you can possibly survive. One thing to remember is that although your situation may be a bit different, all new mothers require six to eight weeks of recovery. Some cultures even prescribe that period in traditions that sequester women and their babies from public view. After a caesarean birth, your recovery might be a bit slower than some vaginal births but each person and each birth is different. I have gone home from surgery and cooked dinner. Some women with traumatic vaginal births may recover even more slowly than you will.

This is especially important time for the breastfeeding couple (a term that infers the close connection between mother and infant). Breastfeeding after a caesarean may be challenging. Sad to say, but the number of mums breastfeeding six weeks after birth is significantly lower following a caesarean delivery. Delays in first feedings, separations from the baby for special care and difficulty finding a comfortable position for feeding means that caesarean mums may have more problems such as sore nipples, delayed coming in of the milk and lower milk supply. The good news is that with help and persistence in these first few days at home those difficulties can be overcome. One key is taking that time to just sit or lie undisturbed and feed your baby...on demand...without clock watching.

So if you have high standards, how can you relax and just enjoy your baby? In addition to focusing on your baby instead of that dirty dish, one option is to get help. Of course, your partner is one source of that help. In the UK, men have the right to paternity leave. In the US, men too can take time off following a birth through the Family Leave Act. But it is important too that your partner have time to bond with the new baby instead of just cooking, cleaning and doing laundry.

One absolutely fabulous way of managing this transition time is to hire a postpartum doula. Doula may be a term you are unfamiliar with. The term taken from Greek means woman who serves. Today it is a term that refers to trained women, most of whom are mothers or grandmothers themselves, who can help you during this time. Not only are they capable of handling all those tasks such as cleaning, cooking, laundry and errands, but many also have special training in breastfeeding and birth trauma that you may find critical at this time.

Where do you find a doula? What kind of training do doulas have? How do you know if she is right for your family?

A good place to begin your search is the Internet. A keyword search for doula will probably bring up several options, which of course leads to finding the right person for your family. As with any domestic position that will bring a virtual stranger into your home, a thorough interview is essential. It is a good idea to ask for references as well as police checks.

Ask her too about her training. There are no laws in the US or UK that mandate specific training for doulas. Anyone can call themselves a doula. Some doulas are former midwives or nursery nurses. Others are experienced mothers who want to help others by sharing their experience. But doula training is valuable. There are many different training options available: two or three day intensive workshops, self-study courses as well as longer term trainings that may combine self-study and workshops. But training should cover a few basics such as communication, physiology and the role of a doula. The key is that the doula has the knowledge and skills to handle the special needs of caesarean mums and babies.

But equally or perhaps more importantly is your intuition. Unlike a housekeeper who is responsible for things, this person is responsible for the care of you and your baby. Ask about her experience with caesarean births, her training in breastfeeding and her philosophy of bonding. Listen carefully to her answers and choose someone that matches your beliefs as closely as possible. Ask too about her experience with caesareans. How many families has she helped after a caesarean birth? Has she herself ever had a caesarean birth? Although personal experience is not necessary, a doula should understand the special needs of new mums and babies after a caesarean.

Remember while a doula is a paid staff member the role is similar to that once filled by extended family such as grandmothers, aunts and sisters. For this reason, the most important thing is that you feel completely comfortable with this person. She will be someone that you will rely upon extensively for physical and emotional support during the first weeks of your baby's birth when you are still recovering. She should share the same philosophy of parenting that you wish to follow. If breastfeeding and snuggling are important to you then she should be someone that will facilitate that. Likewise if having a strict schedule is what you want to achieve then she should have experience with that.

While having a doula may seem like a luxury expense that your new family can ill afford, for a caesarean mum and baby their help can prove a vital tool for bonding and breastfeeding. If your caesarean is planned, one way of budgeting for this expense may be to ask friends and family to contribute to the cost in lieu of other baby gifts. Also some doulas, mindful of the need for their services by working class families, will offer reduced rates or barter. Another way to look at it is that with the help of a doula to establish breastfeeding you will likely more than cover the costs you by not buying formula.

If you want to find out more about the Special Start that a doula can provide your family after a caesarean birth, visit the link below.

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