A nursing passion for postpartum

A nursing passion for postpartum

While Andrea Ulmer, RN, IBCLC, didn’t always plan or dream of going into nursing, she found her calling once she made the decision to enter the college. She works in postpartum at Royal University Hospital in Saskatoon and the passion and love she puts into her work deserve to be highlighted. In addition to having a huge heart and a desire to help women as much as she can, she recently added to her skillset and became an International Board Certified Lactation Consultant. Here is her story.

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Q: Did you always want to work in postpartum? How did you come to work in that area?

You could say being a nursing student taught me a lot about what I did not want to do with this career. What areas I never saw myself working in. I really had no idea what areas did or did not interest me when I first started the program. I was not exposed to postpartum till 3rd year and I was nervous in the beginning. I specifically remember being absolutely terrified to bathe a newborn!

It was in 4th year that I fell in love. There is no question in my mind the RN I was placed with as my preceptor had a direct impact on my career; she was the nurse I wanted to be. My first shift with her I was extremely nervous. She appeared as though having me as her sidekick was likely as fun as having rocks in your shoes; annoying! But we grew to work well together and I am forever grateful for everything that woman taught me. I was fortunate enough to work alongside her as a colleague for several years until she retired, and it was an absolute honour. It is safe to say she had a major impact on my choice to stay on postpartum.

I also remember vividly having an interview with the manager at the time when I was considering working there as a Grad Nurse. Coming out of nursing, many expect new grads to take jobs on medical or surgical floors to gain experience and maintain skills. Now I knew I did not want to do that, but the pressure and comments made had me second guess my path. When I mentioned this in my interview, this manager simply asked me “is that the nurse you want to be? Do you want to be the nurse with those skills?” And I answered with confidence” no”. And her reply was then “why would you choose an area you do not enjoy to keep skills you do not want?” She was the first person that gave me the feeling that it was ok to choose postpartum as a new grad. It felt like permission to choose a path less traveled. Without her I would not be where I am today, so I owe a lot to her as well. Plus she gave me a job so she’s high on my list of wonderful women!

Q: What do you love most about working in postpartum?

Oh where to start?! I get the pleasure and sometimes challenge of working with people from all walks of life. I have the privilege of being a part of some of the most important moments in families lives. I have witnessed unimaginable joy, and also heartbreaking and devastating sorrow. While each shift has similar routines and expectations, there is not one day the same as the next.

Helping families get to know their newborns is truly a gift. I cannot describe what it feels like to witness the joy in a mom’s face when her baby latches well for the first time. Or when a dad tucks his baby in skin to skin and he/she stops crying. I have laughed with families, I have cried with families, and I have been honoured to participate in many monumental memories with each of the families I have encountered.

I am also exposed to so many different cultural and personal beliefs, I am learning something new every day.

Q: What do you find most challenging about working on postpartum?

The general complaint that I think most nurses across the board would say is staffing. I am forever saying that we could be providing so much more for our families with the proper resources and time. When we are short staffed, or left to run at a busy pace based on our current models, the care we provide and the families’ experience suffers. And I never feel ok with that. Nothing feels worse than walking out at the end of a shift knowing there was so much more that needed to be done in that 12 hours for those families. It’s hard knowing what kind of nurse you have the ability to be, but working in such limiting environments and not having the opportunity to give your full potential.

Another challenge is differing opinions, practices, and approaches amongst coworkers. Again, I think this is found in any area of work. There will always be people doing one thing two different ways. Postpartum is an area with great leeway in terms of practice. I can go to work and give 95% of my efforts, and have the following nurse come on providing very little but essentially getting the same things accomplished. Only the experience for the family can be drastically changed based on who they interact with. It’s proven to be extremely hard to uphold standards in terms of providing the absolute best for the patients. I would say that is my greatest battle there. But I just keep showing up and try to give my best effort every time. It’s all I can do.

Q: Has becoming a mom impacted how you view your work on postpartum? How?

Absolutely yes. Before having a child I could only imagine what it felt like, could only assume what the sleeplessness and sore nipples and torn vagina was really all about. And then I experienced it. All of it!

My personal breastfeeding journey was not a pretty one. I went into it with the idea of “if it works, great, and if not, I am not going to wear myself down working for it”. I had witnessed so many women put so much pressure on themselves, and I swore that would not be me. And then, it was me. It started off alright, though there was some discomfort. Now being a postpartum nurse who happens to be extremely stubborn and struggles greatly with asking for help, I battled through the beginning and probably could have benefited from some advice. But by about the 4th month, my supply started to dwindle and my son’s weight gain was slowing. And I tried really hard to keep it going, taking domperidone and pumping every chance I got. But it was not enough, and on Dec 28th, 2010 I was standing in line at Walmart buying formula and crying. The girl behind me asked how old my baby was and when I said almost 5 months, she made a comment about why I was not breastfeeding. So here I was, trying to explain to a complete stranger that I had trouble with supply, and her response was “I had so much milk I could have fed other kids as well as my own”..oh the defeat, and the utter disappointment I felt was enough to send me into a spiral of sadness. Clearly it is a moment that has stuck with me, I remember the damn date!

So coming back to work, I vowed that if I had a mom willing to break her back to try and breastfeed, I would break my back right alongside her. I would come to know the strong desire to make it work, and the willingness to do anything for it. My heart still bleeds for those that struggle, and I often share my own story when it seems appropriate to do so. Sometimes a woman just needs to hear she’s not alone.

It’s also helped to have the ability to relate to labour stories. Again, knowing there are no two labours the same in this world, but hearing similar stories or symptoms to my own has been a great way to connect with patients.

Q: Why did you decide to become a Lactation Consultant:

I had a moment with a patient just over a year ago now. It was a quiet shift and I had lots of time to dedicate to each family. There was one couple I was working with who had just had their first baby. She was having a very hard time latching the baby and it was an uphill effort the whole time. At one point she asked me “are all the nurses up here LC’s?” And when I replied “no” she said “well you are great at your job then, thank you so much for helping me”…and it was truly my light bulb moment. It’s the best part of my job, when I have the time to do it. So why am I not focusing on it. Two days later I was going to a breast pump presentation with one of our LC’s and I blurted it out in the elevator with her that I wanted to pursue it. That was January of 2016, and 11 months later I have successfully been certified as an LC! It was a real ride…

Ultimately, breastfeeding can account for the majority of the work we do on postpartum, and if the proper supports are in place, it can be a real game changer in terms of a mother’s successful journey. I came to find out I want to play an even bigger role in that area of practice. I want to be a part of their journeys, good or bad.

Q: How do you think now being an IBCLC will impact your work?

I think it will keep me accountable to do my single best every single time for each mom I come in contact with. Sure, that is something I have always strived for, but now it’s professionally necessary and expected. It’s also an area of practice I have seen myself enjoying more in the last few years. I am excited to see where it can take me, how it can improve my practice, push me to be better for all the mom’s that want the chance to breastfeed their babies. Plus I don’t know how I’m going to do it, but I want to impact the way we practice as staff on postpartum. One of our long time and well respected LC’s just retired. She was an absolute trailblazer in that field. She made change happen. I can only hope to be half of what she was to the profession. I want to improve the way things are for women entering our facility. No matter what you choose, or how you choose to do it, I want everyone to feel respected, accepted, and heard. I feel like earning this certification is only the beginning to the work that needs to happen. But I’m excited to do my part.

 

What is family-centered maternity care & why it matters

What is family-centered maternity care & why it matters

While I didn’t know the exact definition of family-centered maternity care (FCMC) when I was pregnant and planning my birth, the birth I envisioned and hoped for fit that model without my knowing it.

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I came to be more interested in the concept when I joined a patient and family advisory council for maternal services for our local health region. I joined not because I want all moms to have my exact experience, but so they may each have the experience they desire and their choices respected.

There are various definitions of FCMC but the main gist is that it respects and takes into consideration the patients’ preferences and empowers patients to be responsible for their self-care. It also reduces the use of interventions that are unwanted, inappropriate, or not needed (more on this definition can be found here, though there are many others as well). Reducing the use of unnecessary interventions matters because interventions can directly affect breastfeeding.

It was fitting then when last fall I was contacted by a postpartum nurse/instructor who is also a PhD student focusing on obstetrical research. She wanted to speak to a woman about her birth experience to see how it fit into the FCMC model. I’m always happy to share my birth story, and I was even more excited because she wanted to make a video project. My only regret, if you can call it that, from our birth is I forgot to call our birth photographer we’d booked – baby just came too fast and it slipped our minds! My doula took some pictures, which were amazing, but of course not quite the same.

This nurse and I discussed how my birth fit into the principles of FCMC. Here they are in more detail:

  • Childbirth is seen as a wellness, not illness, and a normal life event.
  • Care is personalized to the individual needs of the family.
  • The hospital team assists the family in making informed choices for their care during pregnancy, labour, birth, postpartum, and newborn care, and strives to provide them with the experience they desire.
  • The father and/or other supportive persons of the mother’s choice are actively involved in the care.
  • Whenever the mother wishes, family and friends are encouraged to be present during the entire hospital stay including labour and birth.
  • A woman’s labour and birth care are provided in the same location unless a cesarean birth is necessary. Whenever possible, postpartum and newborn care are also given in the same location and by the same caregivers.
  • Mothers are encouraged to keep their babies in their rooms at all times, and nursing care focuses on teaching and role modelling while providing safe, quality care for the mom and baby together.
  • Parents have access to their high-risk newborns at all times and are included in the care of their infants to the extent possible given the newborn’s condition.

These don’t sound like outrageous expectations, but they are not the norm for every family when they go to give birth in a hospital, and that’s a shame.

Why does this matter? Because a mother’s birth experience has a direct effect on her postpartum experience. We already know we need to do more to improve postpartum care for moms. A good first step would be improving her birth experience as much as possible so she gets off to a good start and doesn’t have to add dealing with a traumatic birth on top of healing her body and taking care of a newborn.

Watch the video below to see the beautiful representation Darcie did of our birth and how it fits into family-centered maternity care. I’d love to hear how your experience fits into this model of care or how it could have been improved to better reflect it.

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It’s hard for dads, too

It’s hard for dads, too

Just because the dad didn’t carry a baby for nine or 10 months and give birth to them doesn’t mean the postpartum period isn’t challenging for him as well.

And I should say, this isn’t just dads. This goes for any spouse who didn’t give birth. For ease of writing, though, I will refer to dad/him.

Not sure about going to work with Daddy.

Not giving birth is part of the reason the postpartum period is difficult for him. As the mom, you’ve had time to mentally but especially physically prepare for having a baby. Your body has gone through many changes as you’ve grown and nourished your soon-to-be-born baby. While it may not feel as real as it did once your babe was placed in your arms, there was a certain realness to it that dads just don’t get to feel until that baby is born. And then WHAM! Baby is here and everything changes.

Men can feel the pressure of “a new mouth to feed” in various ways: mom may seem vulnerable and in need of protection and care; dad comes home from work and sees housework piling up; if he and you are like my husband and me, he has received numerous texts on the bad days, saying things like, “I don’t know how I’m going to do this…” or “I’m tired” or “I’m over-whelmed” or “I don’t know what to do” or “The dogs are whining, the baby is crying…” My husband said he could tell what kind of day I was having by the number of text messages he received from me. The more he received, the more I was spiralling.

One of my favourite pictures of my boys. Our baby isn’t even a month old here.

Men feel a lot of pressure: if they are fortunate to have had time off, it likely wasn’t for very long, and then they are back to their full-time job, while also having to take on more responsibilities in the home, while on less sleep than usual. Combine that with getting to know their new baby and trying to support their partner emotionally, and it can be draining.

Because the mom spends the most time with the baby, it can be an added challenge for dad to learn how to soothe his infant. I remember in one of my less shining moments half-shrieking at my husband to just hand me the baby whenever he cried because he likely needed to nurse. While this was mostly true, it wasn’t very helpful or conducive to getting him to take an active role in nurturing his son. Fortunately, he likely chalked it up to my being tired and emotional, and he didn’t seem to take it personally. There were times it was only him who could settle him: we went through a phase where the only way our baby would go to sleep was if he was placed in his carseat and rocked faster and higher than I could physically handle, so it fell to daddy. One of the sweetest moments was when I needed a nap, and my husband needed to let a potential tenant into our condo down the street. Without any help or instruction from me, he managed to wrap our son in our mei tai and wore him to the meeting.

We were fortunate that my husband has always had some level of flexibility with his work. If I felt I desperately needed him, he could be there. Not every father is so fortunate, and that would create added stress and worry: how powerless would you feel if your partner was sobbing on the phone, but you felt you couldn’t go there to be with them?

We didn’t hire a postpartum doula after we had our son, but I see now the benefit this would have, even for dads (honestly, just like how a labour/birth doula can be a huge support for dads, not just moms). A postpartum doula is a safe person to question, to listen to, to seek advice on things like baby care if inexperienced. There is no prior history between a postpartum doula and a new father, and there is no agenda besides making the postpartum period as pleasant as possible for everyone. The doula might be able to see both points of view of the mother and father and help them understand each other. My husband once confided to me that he was stressed, too: he pointed out that I had fellow new mom friends and many other friends to confide in who could relate. He had almost no one. Sadly, that’s not an uncommon feeling among dads. There just aren’t the same type of supports out there for new dads, but they need support just like mom does – especially because he is expected to have the strength to support mom!

What was good is my husband felt safe telling me this. Having open communication so you can both talk about your fears and stress will keep the relationship healthy and moving forward. Let dad know you still love him even though things have changed! And let him know you appreciate how much he is taking on and how hard he is working. No, he may not understand exactly what you are going through each day with the baby, but you also don’t understand exactly what he is going through each day at work and then coming home to his family. Both roles are important. Both roles require love and support from the other partner.

Remember that it isn’t just the mom who may be struggling during the postpartum period. Dad may be, too, so it doesn’t hurt to ask how he’s doing, send over a meal so it’s one less he has to worry about, or offer to come by and do the dishes so he can instead spend time with his partner and baby.

Follow your heart: the importance of choosing the right caregiver, part 2

Follow your heart: the importance of choosing the right caregiver, part 2

I knew before I became pregnant that I wanted a doula. I knew the stats on how much a doula could help me achieve the birth I wanted (and conversely, navigate my birth if it didn’t go the way I wanted). With the help of a good friend, I selected four and met them for interviews.

I met two of them outside of my home: one in a coffee shop, one where she worked. The other two came to my home. All lovely women, they were a good mix: one taught yoga and was a registered massage therapist. Another also taught yoga and did placenta encapsulation. Two sort of fit the stereotype many think of with doulas: a bit on the hippie-ish side. The other two didn’t fit that stereotype at all. One taught pilates and was also an esthetician. The other has four of her own children, including a VBAC birth, so vast personal experience.

I was drawn to two of them: the pilates instructor who had years and years of experience and had attended nearly 100 births (she doesn’t have any of her own children, which didn’t cross my mind at the time, so I guess it didn’t matter to me, or I might have asked). The doula who had four children was my last interview and our chat lasted two hours. I felt like I was talking to a friend. I wanted to hire her immediately. 

Related: Why silence is golden: the importance of choosing the right caregiver, part 1

When I talked it over with my husband, he wondered if it was because she was the last one, and said people are often drawn to the last choice, in part because we remember it best. In the end, I hired the pilates instructor who had two doulas apprenticing under her. Our rationale was I liked her, we were getting 3 doulas for the price of 1 (one of whom was also a massage therapist, which seemed like a good idea when labour would become painful), and she had a ton of experience.

I continued my relationship with the other doula. She lent me two of her books and ended up being the teacher at the prenatal classes we decided to take. When I spoke up about the importance of hiring a doula at this class, I felt a twinge of guilt that I hadn’t chosen her, even though she didn’t seem bothered at all by it. We kept in touch, and I eventually asked the doula I hired if she could be the backup. All of this signalled to me I should have trusted my heart and my gut.

My son and I were always drawn to her warm heart. Here she had just snuggled him to sleep.

As I grew closer to this fourth doula, I had this nagging feeling in the back of my mind that she was the one I should have hired. When the doula we hired forgot our first meeting, that nagging grew stronger. I tried to ignore it, but eventually I said it out loud to my friend who had helped me choose the four to interview. I needed to say it to someone in a safe space and just get it off my chest. Admitting it was another sign I should have followed my heart. 

It’s as if the universe was listening. My water broke and contractions began nearly four weeks before my estimated due date. The doula I’d hired was on vacation, so it was my backup I texted, called, and who attended my birth. And when she texted my friend to say I’d had a beautiful birth and delivered my baby boy, our friend replied, “It was you she wanted there all along.”

I know I still would have had a beautiful birth if the doula I’d hired had been there. She is a lovely person, I loved my prenatal pilates class, and it was through that class I met one of my best mommy friends, so I can’t say I regret that decision. It worked out in the end anyway – funny how that happens.

Choose a caregiver with your heart, not with your head. After all, matters of childbirth and parenting are mostly matters of the heart. It didn’t matter who had more or what experience or how many doulas for whatever price; what mattered most was the connection I felt, and it was undeniable. Who has a two-hour visit with someone they just met? People who will become close friends who text each other regularly, try to have coffee together regularly, and tell the other they love them regularly.

Listen to your heart. The heart doesn’t lie. It will guide you to the right decision when choosing a caregiver who will be sharing in some of the most beautiful and intimate moments of your life.

Why (and how) we need to make the postpartum period better

Why (and how) we need to make the postpartum period better

How many times have we heard the saying, “At least your baby is healthy. That’s what matters”? I feel like it’s a no-brainer. We all want healthy babies after birth. But how the mom is feeling and how she is supported (before, during, and after birth) matter, too, and we just don’t do a good enough job of this.

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The very early days (minutes, hours…). We’re still in Labour & Delivery here.

I’ve been thinking about this more because I’ve started a course for postpartum professionals (which I’ve since completed!). My latest lesson included a reading that compares how other cultures treat new moms compared to American culture. I’d say Canadian culture is pretty similar to American, but hopefully we’re making strides to include ideas from other cultures.

Some examples of how newborn mothers are treated in other cultures:

  • the postpartum period is recognized as a time of sacredness and healing;
  • protective measures are put into place for a new mom’s vulnerability (ritual bathing, belly binding, massage are just a few);
  • seclusion and rest (visitors are those who don’t need to be entertained: they will do your dishes, hold the baby if you’d like to take a shower, and you don’t care if they see you naked or breastfeeding);
  • functional assistance (see above: help with the dishes, laundry, meals, older children);
  • social recognition of the new role and status as a mom.

In North America, most of the focus is on the baby. Mom is likely discharged from the hospital within a day or two and no hospital staff is likely to ask if she has help. Since families are spread out more, she may not have any help at home. Dad is likely going back to work right away, so she is alone to recuperate from birth, learn how to breastfeed and be a mom, on top of everything else that needs to be done around the home. People often want to come over and see the baby and shower the baby with gifts. There *are* resources for her, but she’s likely too overwhelmed to seek them out for herself and doesn’t know where to begin.

This is not to say every mom experiences all of this or that some moms don’t embrace lots of visitors right away (we’re proud of our new babies and want people to meet them!). I’m obviously generalizing to make a point.Not every mom wants a stream of visitors through her door to fawn over the baby, and we need to find a way to respect that.

Why does this matter, you may ask? Check this out:

“As citizens of an industrialized nation, we often act as if we have nothing to learn from the Third World. Yet many of these cultures are doing something extraordinarily right–especially in how they care for new mothers. In their classic paper, Stern and Kruckman (1983) present an anthropological critique of the literature. They found that in the cultures they studied, postpartum disorders, including the “baby blues,” were virtually non-existent. In contrast, 50% to 85% of new mothers in industrialized nations experience the “baby blues,” and 15% to 25% (or more) experience postpartum depression.

Stern and Kruckman noted that cultures who had low incidence of postpartum mood disorders all had rituals that provided support and care for new mothers. These cultures, although quite different from each other, all shared five protective social structures (which is what I listed above).” (You can read more on the study here – the above excerpt is actually from a piece by Kathleen Kendall-Tackett, Ph.D., La Leche League leader. Check out more from her here.)

Looking back, I had (and continue to have) a great support network. We were in the hospital a few days, and our doula brought us a hot meal one day. A friend dropped off soup and muffins at our house. When we were discharged, my doula and husband locked me and the baby in our bedroom while they cleaned the house. Other friends brought meals. I hired another doula to teach me how to wear my baby and she also cleaned our house. My mom was around a lot as well.

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First night home. Got my water bottle, diapers, wipes a book, and it looks like muffins! And of course my sucky dogs.

It is too much to ask a mom to do all this on her own, yet that’s what we ask of moms! And then, because we ask this of moms, they feel bad if they can’t do it and ask for help or they just won’t ask at all. My baby is no longer a baby by society’s standards. He’s 22-months-old. Guess what? I still need and ask for help. There is no way I could get the small amount of cooking and housework done that I do, along with my other job, and now a course, without help from my husband, my mom, and friends. We need to not be afraid to ask for help, because in doing so, we are helping other moms.

As I was searching for positive post partum stories, I found an article about unexpected ways you can help a mom:

  • send food, but not just meals, so that the mom has healthy snacks for herself and older children if she has any (think fruit, muffins, nuts, granola bars, trail mix, cut up veggies and hummus);
  • call when you’re at the grocery store and ask what they need you to pick them up;
  • consider the company you keep (some moms want adult conversation, some moms want someone to hold their baby, some moms don’t want that, some moms might want to buddy up to go to the grocery store: you get the point. We’re all different, so consider and ask what kind of company a mom wants);
  • let someone else capture the moment (this one is cool! Snap some candid shots when visiting a mom and her new baby. Print it, frame it. She’ll appreciate it. Every mom wants to fill in that baby book, but it’s not high on the list of things that *need* to get done);
  • the gift of light reading (maybe even trashy reading…magazines, gift cards if she reads e-books, romance novels or whatever suits her fancy, because she might have some long nursing stretches in her future and wants a break from Netflix).

Just some ideas. The point is we need to do these little things and more to help new moms. It’s one of the biggest, if not THE biggest, transition in our lives, and we need support. The stats show it. We need to support and empower moms to ask for help. I hope I can be a part of that movement. I hope you will, too.

 

 

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