Travel Tips for Breastfeeding Moms Traveling without Baby
I absolutely love that the look of motherhood today is so varied and quite the mosaic. Women today have decided that they not only want a family but they also want a career, a higher level degree, time away with friends, their own business, solo trips abroad, and so much more. And I say, “Right on!”
One of the most exhilarating yet also daunting things for a new mama to do is travel without her baby while trying to also maintain a healthy milk supply. For many of us traveling for work is the first time we must leave our little one for an extended period of time. Whether you’ll be traveling abroad for work or to the next town over for a weekend getaway with girlfriends, there are a few things that you can do to prepare for your trip and feel confident to stick to your breastfeeding goals.
Before you leave
#1 Leave feeding schedule for your partner or caregiver
Detail even the tiniest of concerns you may have, as well as tips and tricks to help them sooth your baby. If you know that your little one needs to be propped up for 30 minutes after feeding, then let them know. If you want your baby to be fed in 2 oz. increments to avoid any waste of your precious milk, write it down. Be clear about your expectations so that you don’t feel a constant sense of angst while away.
Providing these details will allow you to enjoy your time away more and give you a sense of ease with the fact that the necessities have been covered. You’ve also allowed yourself time to review and think over the things you’d like done in your absence.
#2 Begin to document your baby’s normal feeding schedule
Write down the times they normally feed, whether or not they feed on one or both breasts, and if they are currently taking a bottle, how much they’re drinking at each feeding. Your baby’s caregiver can then use this as a guide for when to feed your little one and you can use it as an outline for yourself as to when to pump while away.
#3 If you’re traveling out of the country, bring a plug adaptor
These can easily be purchased online. It’s also a great idea to have a few batteries packed with you as well. This will allow you to pump in the airport during a layover if the voltage is different than back home and not the one you’ll need for the country you’ll be visiting. It’s also a great backup in case you’re in a location with unpredictable electricity. Bringing along a car adaptor for your breastpump is a great idea as well!
# 4 Record a video of your baby nursing & bring a piece of your baby’s clothing
You can play the video during your pumping sessions and smell your baby’s clothing while trying to get your milk to let-down. These physical mementos can really spark an emotional and physiological response that may help you when trying to relax and “perform” without your baby being present.
During Your Trip
photo via @thehappypumper
#5 Stay hydrated
As you probably already know, flying can really dry you out. Carrying a foldable water bottle or grabbing a cup of water at the airport coffee shop once you’re through security is a great way to remind yourself to stay hydrated. Also, once you’re on location and having a good time, a simple rule you can follow is for every glass of wine or alcohol you drink, you have a glass of water to go with it. Remember it’s best to wait between 1-2 hours per drink before pumping breastmilk for your baby.
READ MORE ABOUT KEEPING UP MILK SUPPLY HERE
#6 Shipping Milk Home
For moms traveling across the U.S. If you’re trying to figure out how to bring your milk back home, there’s this amazing company that will allow you to simply pack and ship home up to 72oz. per box of your milk straight to your front door! Awesome right?! This is also a great option for a mama who’s going on a last minute trip and hasn’t had a chance to store up enough milk for the time she’ll be away. Simply pump, pack it up, and send it home to your babe! Be sure to check out the CDC’s guidelines for proper storage and handling of breast milk.
#7 Stick to baby’s feeding schedule
Follow your previously created feeding log to determine how often you should pump. Even if your baby only fed on one side during your feedings at home, it can be very helpful to your milk supply to pump on both sides while away. Be sure to use a double electric or hospital grade pump, which provides the proper suction strength and stimulation needed for milk expression while not also feeding at the breast.
GET A FREE BREASTPUMP THROUGH YOUR HEALTH INSURANCE
#8 Try and plan for moments of calm and still in your day
This may not be possible for all of your feedings, but allowing yourself to take time and just relax or meditate can help you mentally and physically while away from your baby. Many mamas have difficulty letting down and filling bottles when in the midst of stress and work. A way to combat this is by meditating or doing simple relaxation exercises that help you reconnect and feel grounded while away.
When you are back home
#9 Take a nursing vacation
Try and plan for a day or two of home time with your baby after your trip away. Use this as a nursing vacation where you do unlimited skin-to-skin and feeding on demand. Take long herb baths with your baby resting on you and carry your baby in a carrier, so that your hands can still be free. This will help to give your milk supply a little boost in case you’ve noticed a dip while away.
#10 Let go and practice self care
Fully embrace the time you spent away and carry no guilt for the choice you made. It’s not selfish to invest in yourself, your business, and your friendships. Every mother deserves time away and support to mother in her own unique way.
The tips I shared here are from lessons I learned personally while traveling away from my own little one while maintaining my breastfeeding goals, as well as my role as a Lactation Educator Counselor supporting other mamas who live global boundless lives. I hope they support you in your breastfeeding journey and encourage you to mother in the way that’s most natural to you.
This guest post was written by Anjelica Malone. Angelica is a Lactation Educator Counselor and Breastfeeding Coach. She’s passionate about helping women incorporate breastfeeding into their lives, instead of allowing it to take over their lives. Anjelica is the mother of two little island-born girls and now resides in Seattle, Washington. Anjelica grew up traveling the world with her family and now loves sharing the experience of travel with her husband and kiddos. You can follow her adventures via the hashtag #AGlobalTribeOfWomen and learn about how to live a more conscious and globally-minded life at AnjelicaMalone.com.
What is a Babymoon and Should I Take One?
Pregnancy is a super sweet time of excitement and happiness but can also start to feel a little hectic now and then. Doesn’t it feel like there are so many to-dos and checklists? In between doctor/midwife appointments, baby showers, nursery painting, maternity photos and classes you’re also supposed to relax and take good care of yourself. It’s all a little overwhelming!
What is a Babymoon?
For all you expecting mamas, it may come as no surprise then that babymoons have become so popular in recent years.Though the term ‘babymoon’ used to mean the days immediately after birth when a couple took time to rest, bond and generally bask in the glow of their new baby, it’s now applied to a couple taking a big (or not so big) trip away together before the birth of their baby. Consider it a last hurrah before life changes in a major way.
Celebrities have made these getaways all the more mainstream and can be a great source for inspiration on locations to check out. A consistently popular destination is Mexico (famous babymooners include Kate Hudson, Kourtney Kardashian and Kristin Cavallari) and the Caribbean (Uma Thurman) but with Zika Virus other spots like Hawaii (Hilary Duff, Marissa Miller), Italy (Camila McConaughey, Sienna Miller and Hayden Panettiere) and California (Natalie Portman, Mariah Carey) are getting more love from couples wanting a beautiful babymoon without the worry.
Why Take a Babymoon?
Babymoons aren’t just for the rich and famous—the reasons why a babymoon is beneficial for all couples are simple but so important: Whether this is your first baby or your fifth, your free time is about to get cut down. Way down. A babymoon is a great opportunity to slow down, reconnect and make new memories as a couple. Use your babymoon to sleep in, relax and indulge in self-care before your focus shifts to midnight feedings and diaper changes. After all, happy, loving parents often make for a more relaxed baby so think of your babymoon as a gift for your baby as well—once your little one is on the scene you’ll be glad you invested in your relationship as a couple.
Babymoon Options for Expecting Couples
And lest you think a babymoon has to be expensive and exotic (although who doesn’t love a good tropical beach?!) think again: consider a ‘staycation’ style babymoon by spending the night in a nice hotel near you or a long weekend away to someplace within driving distance.
It’s now even possible to knock out two birds with one stone: as babymoons have become more popular—and expecting parents busier than ever—you can find beautiful weekend getaways that include all of your classes to prepare for childbirth and beyond. Here are a few of our favorites:
Set in the rolling hills of Fredericksburg, Texas just 80 miles west of funky Austin, The Babymoon Retreat offers a 4-night stay for couples in a boutique bed and breakfast. Led by doulas, childbirth educators and lactation counselors couples get daily classes in birth, breastfeeding and baby care so they don’t need to take a single class at home. Activities include complimentary massage therapy, daily yoga, Ask the Doula Session and more.
When: Late March and Mid October
Cost: $2,495 – $3,000 per couple depending on early bird sign-up
If you’re looking for an east coast getaway, this one’s for you! Hidden away in beautiful Maine, this 3-day weekend at a luxury resort includes private daily childbirth preparation and coaching with Laura Thompson Brady, founder of The Nourished Home. Activities include massage therapy, yoga, hiking and more.
When: Dates are customized to you! Laura takes only one couple at a time and offers this Babymoon to only a handful of couples each year
Cost: Also customized based on your needs
Regardless of where you end up, you won’t regret this little pitstop for two before reaching your final destination of parenthood!
This guest post was written by Phyllis Braesnell.
Advancements in technology, industry, and business have brought about many changes within the last century. Society has likewise evolved both for better or for worse. Among these evolutions has been a big shift in the standard process of childbirth. Back in the day it was fairly normal to live near extended family and close friends, so it was very natural to have many of them support a woman during labor and delivery. As we have changed over time, it is now more common to live far away from family and delivering in the hospital has become the norm. A side effect from these changes is that mothers have lost the standard support team of women around them while they labor. A possible replacement for this lack of support is to hire a doula. Despite the myriad of positive benefits of a professional doula, only a small percentage of women utilize them. Many newly pregnant women often wonder if a doula is a worthy investment.
Benefits of having a doula
Many studies have been conducted that show the positive effects of doula support, although currently only about 6% of women use one. These benefits include, but are not limited to: decreased labor time; and a lower rate of epidurals, c-sections, pitocin administration, and instrumental assistance during delivery. A Mother who hires a doula also tends to have a much more positive view of her experience. When she feels safe and protected, she lets go of fear (which interferes with progression). Stress levels decrease, and natural oxytocin levels rise, thus encouraging labor advancement. After babies are born, they are more likely to have higher apgar scores (Hodnett, Gates, Hofmeyr, Sakala, & Weston, 2013), and there is an earlier initiation of breastfeeding as well.
Do I need a doula?
There are many known benefits of doula support during labor, but do you really need one?
The large majority of women deliver babies in a hospital and are left to the care and attention of a medical team. A staff may be concerned and aware of a mother’s physical and emotional needs, but they are often distracted by their duties as part of hospital procedure and policy. A nurse, midwife, and doctor all have their own specific tasks to complete—monitoring the baby’s vitals, reading charts and logs, making sure mom is hydrated, and has good stats, etc. They are preoccupied with the safety of mother and baby and are also overseeing a large number of other laboring women at the same time. They will be in and out of the room constantly, and even monitoring moms from machines in the hall. Think of all that is going through the minds of these healthcare workers during delivery.
Making sure baby’s position is optimal, providing perineal support, trying to prevent tearing, coaching mom how to push, monitoring baby and mother’s vitals, assisting the baby when it emerges, making sure the baby is breathing, checking apgar scores, cleaning things up, performing sutures, baby care, delivering the placenta, avoiding hemorrhaging, and keeping things sterile. They have so much going on mentally and physically that although they may be sympathetic to the mother’s needs, they cannot be too preoccupied with them. Plus they have other patients simultaneously.
A Doula’s Purpose
Conversely a doula’s primary purpose is to provide emotional, physical, and informational support for the mother for the entire duration of labor, and afterward. She will be solely focused on you and at your side continually. But what if you have a partner, sister, mother or friend with you? It is highly recommended to have support from people you love and trust. Yet keep in mind that your support group is not always specifically trained in how to care for a laboring woman, no matter how much they love you, whereas a doula is. In order to become a certified doula, a candidate must meet many qualifications. DONA International, “the international leader in evidence-based doula training, certification, and continuing education,” requires that a doula meet the following criteria:
- have a minimum of 28 hours of labor support time logged
- read several required textbooks on labor and birth
- attend at least 3 births and be evaluated by a doctor, nurse or midwife, and the mother.
This knowledge and skill set put into practice is truly invaluable in knowing intuitively how to support a laboring mother.
Doula Services Prior to Delivery
A doula will usually meet with a client about two times prior before the mother goes into labor. During these meetings, she will get to know you a bit, get a feel for what your birth vision and preferences are, and help with a birth plan. She can address any concerns and fears you have about birth, and offer educational materials to review. She can learn about your personality and what calms you, as well as what gives you a boost when you are tired, and how you best anticipate needing support.
A good doula will also be well connected to the birth community for additional support and education. This can be a great resource for women wanting to gain more childbirth education and to get involved with other moms and resources in the area.
Doulas Stay With You the Whole Time
The best thing about doulas is that they are usually available as early as you’d like them in the process, even from the first few contractions. They can come to your home and be with you while you labor there, then transfer with you to the hospital. One of the main advantages to hiring a doula is that you meet her and know her before you go into labor, whereas your nurse and perhaps the doctor on call at a hospital can be complete strangers. Having your doula with you can help you feel more at ease when you arrive. Another advantage is she will stay right with you whereas doctors and nurses, and sometimes even partners will be in and out throughout the process.
Doulas Support Your Partner Too
Doulas are also valuable resources for birth partners. A doula does not replace a partner’s support; rather she assists both parties. She can allow the partner the main role of offering words of encouragement and emotional support while she provides some physical support, and vice versa. She can offer suggestions of what a partner can do to help mom. She can also support the partner should he start to feel anxious or overtired. In one recent study, it was recorded that on average, doulas touched the laboring mother 95 percent of the time, as compared with less than 20 percent by male partners. This in no way discredits the helpfulness of a partner, but rather sheds light on the fact that a doula and a partner have different primary roles. In the end she will be able to read signals from mom and partner of what their needs are in the moment.
A doula’s job is to be there for the mom and to encourage a safe and satisfying birth experience. She provides three kinds of support—informational, physical, and emotional.
Physical Support from a Doula
A doula draws upon her knowledge of many different labor positions and offers suggestions to the laboring mother to help ease discomfort and keep labor progressing. She can offer massage or counter pressure, adjust mother’s temperature with blankets or cool washcloths and fans. She can help to implement breathing and relaxation techniques, and will offer verbal reassurances. She can offer ice chips, drinks, and food if the hospital allows it. She remembers things mom might not think of like to use the bathroom frequently. She knows mom’s preferences and will guard the atmosphere so it remains as calm and peaceful as possible. This is invaluable, especially when the mother is focused and does not want to be bothered with details.
Doulas Offer Informational Support
A well-trained doula will be aware of the hospital policies where the mother is delivering, and will know what kinds of things are allowed and/or prohibited. She can offer advice and information if the mother has concerns or questions. A doula can be a liaison between the staff’s medical jargon and the procedures that are happening. Should unexpected complications arise, a doula can offer extra information, advice and encouragement for big decisions.
Emotional Support from Your Doula
Should some unexpected things arise during the course of the labor, a doula can offer emotional support and encouragement, especially if a c-section or epidural is ordered. She can help to ease fears and guilt and allow a mother to process her potential anxiety or confusion.
Keep in mind that a doula is not only valuable for mothers planning a natural birth, but for all kinds of deliveries. Birth can be an unpredictable event. Even if you plan on getting an epidural or having a planned c-section, a doula can offer tremendous emotional guidance during the process. She can help to aid in your comfort level both physically and mentally. She can be aware of the details that are happening while you are “in the zone.” If a lot of information is being thrown at a mother all at once, and she is already overwhelmed, it can be hard to process and remember what is being said. A doula can be a valuable second set of eyes and ears to absorb information and help answer your questions.
Postpartum Doula Services
Many doulas will offer care for postpartum mothers and charge an hourly rate. Their tasks can range anywhere from breastfeeding support, emotional support, physical care and healing of mother, to cleaning, cooking meals, or taking care of the baby so mother can rest. They will usually offer services up to a certain amount of time (like 4 hours), and some will even offer to sleep over and help with night feedings for an extra fee. The postpartum period can be a difficult time, especially for brand new moms, and the aid of a doula can be very valuable, so it’s something to consider. Even knowing the option is available can put one’s mind at ease.
An Example of a Positive Doula Experience
Elaine Stillerman of Massage Today tells of her positive experience with a doula.
“I called Ilana when I became pregnant. She came to my home to interview me and my husband about our hopes for the big day. Ilana took copious notes in the attempt to get to learn my likes, dislikes and what would be most helpful during labor. She gave us a realistic list of items I would need to make my labor more comfortable. Since then, I have provided my clients with that invaluable list and offer it in my textbook.
When the day came, Ilana had just returned from another birth she had stayed at for 13 hours. She had been home for two hours when I called. “Don’t worry,” she said, “I’m on mommy time.” My water broke and I went into active labor within minutes. The contractions were coming one after the other. She asked to hear a contraction. Did this mean put the phone on my abdomen? Or did she want to hear the sounds I was making? By this time, all rational thought was out the window. “What?” I asked. “Let me hear a contraction,” she repeated. Mine were silent. “I’ll meet you at the hospital.”
Once there, she directed my husband to get a different nurse and a private room for me. She disappeared for a few minutes and came back with a pile of waterproof pads and clean gowns. She opened her bag of goodies and asked if I was hungry or thirsty. And she held me. She massaged me. She danced with me. When the pains got intense, she took my face in her hands and said, “Give me the pain. Give it to me.” And the pains lessened.
When I felt I was losing strength, she told me to relax my feet and let Mother Earth’s power help me. She stayed by my side for 19 hours, encouraging me, honoring my efforts and nurturing me. And when my son was born, she told me how magnificent I had been. A week later, Ilana came to my home for a visit, bringing lunch, gifts, pictures and my birth story. We shared a life-affirming experience and I wasn’t going to let her out of my life since she had been such an important part of it.”
If this sounds like an experience you’d like to have, it is worth looking into hiring a doula.
How to find a doula
There are a few resources to help with finding the right doula for your specific needs. You’ll want to read reviews, choose several options, and then interview them to get a feel for the right fit for your personality. Here are some places to look.
- Dona.org – Doulas of North America
- Cappa.net– Childbirth and Postpartum Professional Association
- Alace.org– Association of Labor Assistants and Childbirth Educators
- Birthcenters.org– National Association of Childbearing Centers
- Doulamatch.com– online database of certified doulas, where you can search by state, years of experience, and price.
Doctor or Midwife Office- many offices have a list of doulas in the area or that they have personally worked with before. This is a great sign that the office is mother-centered and practices evidence based birth!
Hospital—Similarly, some hospitals have doulas on staff full time that they offer to laboring mothers.
What does a doula cost?
A doula’s services can range anywhere from about $300-$1800. They will usually charge a down payment upfront and then collect the rest after delivery. Many doulas are willing to work with you on price if you are not able to afford their fee. Some believe that every woman has a right to have the support they need. Don’t rule someone out just because their fee is high. Check with them first and see if it is flexible, or if they would accept a payment plan. Many insurance companies are now helping to cover the cost of doulas as well, so check there to see if you qualify.
Having a baby is in itself a monumental accomplishment. A doula can provide the additional physical, emotional, and informational support a mother needs to navigate labor and delivery more easily. A mother’s birth experiences are some of the most significant she will have in life. Consider enlisting the aid of a doula to make it the most positive experience you can.
- Bolbol-Haghighi N, Masoumi S, Kazemi, F. “Effect of Continued Support of Midwifery Students in Labour on the Childbirth and Labour Consequences: A Randomized Controlled Clinical Trial.” Journal of Clinical and Diagnostic Research. 10. 9 (2016):QC14-QC17. Effect of Continued Support of Midwifery Students in Labour on the Childbirth and Labour Consequences: A Randomized Controlled Clinical Trial-PubMed-NCBI. Feb. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27790526
- Stillerman, Elaine. “In Honor of a Doula.” Massage Today. Dec. 2008. Massage Today Digital Issue. Web. Feb. 2017. http://www.massagetoday.com/mpacms/mt/article.php?t=38&id=13902
This guest post was written by Austyn Smith.
My Personal Experience with Low Milk Supply
My postpartum journey was very difficult. It was an extremely emotional time for me. My feelings of pure bliss were exaggerated by intense fatigue and all the guilt and grief from not being able to exclusively breastfeed my baby. Now having an eight month old and being able to use my experience and perspective I am happy and proud of our breastfeeding journey and all the hard work and time I put into maintaining breastfeeding. I have learned a great deal about breast milk supply.
What Causes Low Breast Milk Supply?
There are many factors that can contribute to low milk supply; a premature baby, an ineffective latch, lip or tongue tie in the baby, prior nipple piercings or trauma, and breast augmentation can all impact supply. Additionally, medical conditions like Hormonal Disorders (PCOS, Thyroid Issues, Diabetes, Hypertension, Luteal Phase Defect), Hypoplasia/Insufficient Glandular Tissue, and flat or inverted nipples can all be contributing factors to breast milk supply.
I felt so upset about not having enough breast milk and in those first days really desired an understanding of why my body wasn’t able to make enough nourishment for my baby. It felt like the lactation consultants and doctors I saw truly didn’t care about explaining or figuring out why my breasts weren’t producing enough milk. I was able to do research to develop a better understanding of possible causes for low supply but was never diagnosed with a particular condition.
Tips for Increasing Low Milk Supply
There are many lactogenic foods that can help boost supply. Fortunately, most of the foods are easily accessible and relatively easy to add to your meals. I found many helpful recipes for lactation cookies and smoothies online that included multiple ingredients known to increase supply. At the local farmer’s market I found sprouted fenugreek and alfalfa. The sprouts were easy to add in a salad or snack on by the handful and helped maintain my supply.
Many herbs are known to help increase supply. Fenugreek is a popular supplement and is readily available in capsules. Dosage recommendations vary for fenugreek and I was instructed by a lactation consultant to take four capsules three times a day (beware! This herb upset my stomach). You should also note that consuming large quantities of Fenugreek creates a maple syrup like smell on your skin.
Other galactogogues include Blessed Thistle, Goats Rue, and Moringa. These herbs are a bit harder to find but are all are available on Amazon. I followed recommended dosages included on the products. Several brands of herbs like More Milk Plus and Mommy Knows Best are widely renowned for their effectiveness. I was able to see some results using the Mommy Knows Best supplements. I found several excellent tinctures and herb blends at Local herb shops. Mrs. Patels sells fenugreek bars, teas, and other treats to support milk supply. I splurged and tried the chocolate fenugreek bars and they made a slight difference in my extremely low supply. Many of the herbs and tinctures I have taken have a pretty harsh taste and a little chocolate helped get the medicine down.
What to Avoid
There are also things that I had to be intentional to avoid while breastfeeding with a low supply. Foods that negatively affect supply include peppermint, spearmint, parsley, sage, and oregano. Other things I was mindful of included getting as much rest as possible, keeping a close eye on my health, avoiding excessive amounts of caffeine, and being under too much stress all impacted my supply. I don’t smoke cigarettes or regularly drink alcohol but both are known to interfere with the let-down reflex. I also did not start taking my regular birth control pills because they contain estrogen, which is known to decline milk production. Medications like Antihistamines, decongestants, and diuretics all decrease breast milk supply as well.
There are prescription drugs that can induce lactation. Reglan and Domperidone are known to increase supply. Reglan is documented to have adverse side effects of depression and involuntary body movements. The use of Domperidone is very controversial in the United States and is not currently approved by the FDA. The use is widespread and well documented in other areas. A great resource is the podcast Breastfeeding Outside of the Box and one of their episodes covers Domperidone.
Pumping Like a Pro
I hate pumping, and I don’t know anyone who enjoys it. In the early months I was pumping around the clock every two hours after putting baby to breast. Pumping was very grueling and uncomfortable. It was upsetting for me to pump because my baby was very fussy in those days and I often had to hold her while I pumped. A hands-free pumping bra was essential. I used the Simple Wishes Pumping Bra but wish I knew about the Dairy Fairy Pumping Bra. The Dairy Fairy bra can be used as a hands-free pumping bra and a regular bra so no need to change in and out throughout the day.
Slanted Flanges were a gift I received from a friend and did make a slight difference with my pumping output and comfort. I found out about nipple cushions a bit too late, but have heard rave reviews about how they do wonders for making pumping more tolerable and increase milk pumped. I rented a Medela Symphony hospital grade pump but would love to have tried Spectra Pumps because they are the most affordable hospital grade pumps around.
Before I pumped I always started with a warm compress. A creative Lactation Consultant recommended I use a disposable diaper and fill it with hot water to warm my breasts before I pump, this worked wonders and held more warmth than a washcloth. While pumping I always did breast compressions and saw a difference in my output. For one dreaded week I did power pumping which increased my supply significantly. I always did power pumping first thing in the morning (around 5am) when milk supply is at its height and would pump for 20 minutes, rest for 10 minutes, pump for 10 minutes, rest for 10 minutes, and finish with pumping for 10 minutes. I was instructed to do power pumping for no longer than a week; many moms are able to see a big difference in supply in a few days.
Tips for Supplementing and Maintaining Breastfeeding Relationship
After all my work, the doctors still pressured us to supplement with formula. The baby had lost 11% of her birth weight by the first week and they stressed us out until we gave in and supplemented with formula. There were techniques that helped us with this transition including using the Paced bottle-feeding method. In combination with the Como Tomo slow flow bottles our baby was able to take her time eating so when she returned to the breast she wasn’t too upset/fatigued by the slow flow at the breast.
Similarly, using the finish at the breast method helped to maintain our breastfeeding time. The method focuses on feeding the baby a supplement similar to an appetizer so that the baby isn’t overly hungry or upset when it’s time to breastfeed and there may be a slow let down or flow of milk.
I tried using the Supplemental Nursing System (SNS) to work on maintaining our latch and stimulate a let down. I was never able to master using the SNS, but know that it is a miracle worker for many moms. The Lact-Aid is a similar device that I was never able to try.
I hope this information is helpful to others as they use their resiliency and perseverance to create a breastfeeding relationship with their baby. I found that surrounding myself with supportive people, allowing myself space and time to grieve, and creating realistic short-term goals all helped me get through the process. I spent as much time as I could enjoying my baby. In retrospect I wish I would of spent less energy on feeling sad and angry about my supply and more time cuddling my tiny miracle. My thoughts and heart are with everyone dealing with this challenge.
This guest post was written by Emma Gomez, listen to her birth and breastfeeding stories.
Whether you have a planned or unexpected cesarean section birth, the recovery can present challenges for any woman and being prepared for certain possibilities can help relieve you of added stress. After all, this is major abdominal surgery affecting nearly one-third of women in the United States and even higher numbers in some other countries; c-section prep and recovery are definitely worth thinking about and planning for, no matter what kind of birth you have in mind.
In Hospital Cesarean Recovery
If you know ahead of time that you will have a c-section, here are some things to bring and what to expect of your stay after delivery.
What to bring to the hospital
Aside from your normal hospital bag, these few extra items might be helpful.
- Nice shampoo and lotion. Your favorite shower items can be a nice way to treat yourself.
- Clothing. Definitely do not pack anything restrictive that could cut into your incision area. Maternity pants, sweats, and robes are all good options. These high-waisted panties have great reviews for c-section comfort and a bit of support.
- High fiber snacks. Many women report some degree of GI pain and discomfort following surgery, and constipation is not uncommon. Having some fibrous foods on hand to eat during your stay can aid in normalizing your bowels. Pack some easy snack items to munch on between meals. Apples, oranges, pears, berries, nuts, and dried fruit are all good options. Remember to drink as much water as you can!
- Slip-free shoes. Slippers with rubber soles or flip flops will be handy when you go for laps around the floor and to the bathroom. It may be difficult to regain your balance post-surgery because you use all those core muscles that are currently on the mend. So make sure your shoes have good grip.
- Fabric wrap for your waist. Purchasing a belly band or bringing some stretchy fabric to wrap snugly around your waist can really help with added support when you are moving around post-surgery. Even coughs and sneezes can be quite jarring to your incision area, so having that core stabilization is nice. It also helps to encourage your abs to come back together after separation during pregnancy (diastasis recti). Holding a pillow tight around your stomach when coughing or sneezing can also help ease the pain, but having a wrap or belly binder allows you to have support and free up your hands for holding your new baby.
What to expect post surgery
Hospital policies vary but a three or four day stay is most common. Recommendations for getting up and walking will vary based on the type of anesthesia you were given as well as how your body responded to it, but it’s not uncommon for the staff to have you up and walking around after approximately 12 hours. If 12 hours post-op falls in the middle of the night they will probably keep the catheter that was placed for surgery inserted and wait until the next morning. Some hospitals don’t suggest getting up to walk until 24 hours following surgery. This is something to discuss with your doctor to decide what is the best course of action for you personally.
Mobility After Cesarean Birth
The reasoning behind getting you up and moving as soon as is safe is to encourage good blood flow to your extremities and prevent clots. Walking will also help with digestion, but will likely wear you out, so don’t overdo it. Taking a lap around the floor every couple of hours is probably sufficient.
While you’re still in the bed you’ll likely wear cuffs around your lower legs that occasionally pump up with air and squeeze tight. These compressions lower the risk of blood clots when you are less mobile.
Some women may feel very gassy and bloated. This can make it uncomfortable to try to pass gas as well as cause discomfort to your incision area where the muscles used for bowel movements are still healing from surgery. Answering questions about whether you’ve passed gas or had a bowel movement yet can be embarrassing but the staff needs to know your GI tract is back up and working to ensure you don’t have any complications there.
Your first bowel movement can be a nerve wracking event. The act of pushing can be painful to your healing muscles so you’ll be given stool softeners beginning right after surgery to help minimize the amount of pushing required. Many women report the anticipation of pain during a bowel movement was much worse than the actual pain experienced while some women do experience severe discomfort.
Anesthesia, surgery, narcotic pain relievers, and decreased mobility can all contribute to constipation so it’s important to take the stool softeners regularly, drink plenty of water, eat wholesome fiber rich foods, and be as mobile as your energy and pain level permits to help alleviate possible GI issues.
Following all types of birth the uterus needs to contract in order to expel any remaining blood or tissue inside of it. Some women report no noticeable afterbirth pains (the uterine contractions that occur after baby is born), while others experience such strong ones that they equate them to labor pains.
Whether yours are mild or strong, they serve a purpose. It’s important for your uterus to begin the process of shrinking back down to its pre-pregnancy size. The nurses will need to assess the size and firmness of your uterus but palpating your abdomen. This is typically a fairly uncomfortable assessment whether you’ve had a cesarean or vaginal delivery. They have to press down hard to accurately assess the size of your uterus as well as how firm it is.
A shrinking, firm uterus is what they are looking for, whereas a ‘boggy’ uterus could indicate a problem requiring medication to help it contract more. The act of pressing down on it through your abdomen can help it along as well, and while they don’t usually have to press down very long it can be painful. The nurses will use this time to assess your level of bleeding as well. We recommend this afterbirth tincture.
Many women are surprised to learn that following a c-section you will still have very heavy vaginal bleeding, just like vaginal deliveries. This lasts for about 4-6 weeks and the protocol is the same—no tampons allowed, only big absorbent pads. Your caregiver will likely provide some large mesh disposable underwear to use after delivery. These are a great option for the first few days following birth as they typically don’t irritate your incision site or put any pressure on that area the way some underwear elastic can—basically they are glorious! Stocking up on these as well as large overnight pads (these are our favorites) is a good idea since you’ll be changing them frequently the first couple of weeks.
Passing some heavy clots is fairly normal. The rule of thumb is generally if you pass a clot smaller than your fist, it’s okay. Anything larger—call your doctor.
Cesarean Incision care
Following surgery, your incision will be covered with a bandage that usually isn’t removed until the next day. Your incision will either be closed with sutures (dissolvable or non-dissolvable), staples, steri strips, or surgical glue on your abdomen. Staples and some types of sutures will need to be removed by your doctor a few days after you’re discharged. Before being discharged you will be given incision care instructions specific to your type of closure.
Keep in mind that your incision will look very different immediately after surgery than it will eventually. Most incisions will shrink down considerably and flatten to a thin line. Itching and tenderness around your incision is normal but annoying, anything more severe than that would warrant a call to your doctor. Try this spray or salve for expedited healing and scar reducing.
Advocate for Yourself at the Hospital and Home
Recovering from surgery, adjusting to new motherhood, getting the hang of breastfeeding—the first few days after a cesarean can be stressful and overwhelming. It’s important to make your needs known to the staff. If they don’t know your wishes, they can’t follow them. It’s your job to advocate for yourself and your new baby. Be open and clear with the hospital staff and expect the same from them—you’ll both benefit from respectful and clear communication. Never be afraid to request a new nurse if you aren’t receiving the care you feel you need or even if your personalities are not meshing well.
You never get the first few days with your new baby back again and they’re too precious to have marred by having someone around who puts you on edge, this goes for visitors and family as well. While well meaning and excited for you, visitors and family often end up putting more strain on mom than support. If friends want to come see the new baby make them earn the visit! Have them hold the baby while you take a shower or nap. Fold a basket of laundry while you chat. Fix some lunch or start a freezer meal in the oven for you. Have older kids? Ask friends to take them to the park for a hour and let them peek at baby when the come to pick them up.
You might be surprised at how eager people are to help when given specific tasks! But if the thought of a house full of people fills you with dread then don’t put yourself through it. Ask your partner or a supportive family member or friend to spread the word that you aren’t ready for visitors yet but appreciate everyone’s well wishes and put a sign on the door with the same sentiments.
Breastfeeding after a Cesarean Section
The first few days, your breasts produce a nutrient-dense, antibody-rich yellow liquid called colostrum. Colostrum is nature’s first perfect food for baby and provides all the nutrition, immunity, and vitamins your baby needs. Colostrum usually transitions to mature breast milk within 2-6 days of delivery. It’s not unusual for milk production, or ‘coming in’, to be delayed following a cesarean due to the use of IV fluids and other medications such as Pitocin. Once this occurs your breasts will be much larger and you may experience some engorgement. The best remedy for the discomfort of engorgement is removal of milk from the breast by the baby. Your baby will signal the amount of milk she needs your breasts to make and your supply will normalize. There are wonderful breastfeeding resources to be found here.
Some women have no additional difficulties breastfeeding following a cesarean than after a vaginal delivery but some find positioning difficult while their incision area is still tender (we love this breastfeeding pillow for keeping off your incision). Utilize the lactation consultants at the hospital as much as you need them while there. It’s a great idea to have an outpatient lactation consultant’s contact info saved already prior to delivery in the event you need more assistance following discharge. Ask friends who have had fulfilling breastfeeding relationships with their children for references to check out before you’re home with a new baby, sleep deprived, and probably pretty emotional.
The International Cesarean Awareness Network has some great info available regarding breastfeeding after a cesarean that can be found here. Kellymom.com is a great breastfeeding resource website in general and wonderful article about breastfeeding after cesarean can be found here.
Recovery at home after Cesarean Birth
photo via @littlewhale3
Bringing a new baby home is an exciting time for everyone, but don’t forget to take care of yourself as well. Your baby needs a cared for mother as much as she needs to be cared for herself. Accept offers of help! People love to feel useful but may not know how best to help or are hesitant to step on toes. Give them direction and don’t be afraid to set boundaries when it comes to having people over. Physically, you’ll need to take it easy for a while. It’s often recommended that you not to lift anything heavier than the baby or drive for 2 weeks. After that, follow your body’s cues and rest as much as possible.
The best way to encourage a speedy recovery is to allow your body the time it needs to heal. Rushing the process can result in setbacks that will only prolong it. Once you feel up to it, which will vary for every woman, light exercises like walking can be beneficial.
Medication After C Section Birth
The types of medications prescribed for pain will vary from doctor to doctor and patient to patient. Ask someone (like your partner) to keep track of what time you take your medications as trying to remember on a sleep deprived brain is probably not the best plan. Many people recommend taking the meds on a strict schedule the first few days regardless of whether you’re in enough pain to feel you need it yet. This is suggested to prevent the pain getting ahead of you and then having to wait for the meds to kick in. Some people prefer to begin a slow weaning process off of the meds sooner if they don’t like the way they feel on them.
Pay attention to your reaction to the meds and to your pain level and make the best decision for your body. Don’t hesitate to call a nurse or doctor if you are concerned about any symptoms. There are many post-surgery symptoms that while totally benign, can alarm you if you haven’t experienced them before. Reach out for information when you need to.
Some women report referred pain in their shoulder during recovery. Not all women experience it, and it seems to be worse for patients who had general anesthesia vs. spinal anesthesia. The pain is due to irritation of the diaphragm, and trapped gas. Anti-gas medication and walking will help. The more regular you can get with your bowels, the sooner the pain will subside.
Bed comfort for Cesarean Mamas
Keep that wrap handy for when you get in and out of bed, to help with support. Wrapping before you get up and lay down provides stability and a little bit of comfort. Feel free to even keep it on for a while so you don’t have to constantly adjust it. Some women find it difficult to get up from a flat lying position in bed. Roll on your side first and push up with your hands to prevent straining your abdominal muscles. If this is still too uncomfortable try putting several pillows behind your back and rest or sleep in a reclined position. Your pelvis will be working to get back in its pre-pregnancy position and can ache after delivery. Try sleeping with a special pillow between your knees and ankles to help alleviate some pressure.
There are lots of hormonal changes that take place right after delivery, and your body is also getting rid of a lot of excess fluid it carried while pregnant as well as any intravenous fluids given before, during, and after surgery. All of these factors combined might have you waking up at night to find the bedding and your clothes completely soaked. For the first couple of weeks, some women sleep on an extra sheet folded in half, or a towel so they can remove it midway through the night to have clean linens beneath them. Others suggest having clean pajamas handy for a quick middle of the night change. Remember to keep drinking a lot of water. It sounds counter-intuitive to replace excess fluid you are losing through sweat, but remember how much water is going toward milk production, so it’s necessary to keep things functioning well, and restore balance.
Mobility After A Cesarean Birth
For some women, stairs prove to be tiring and awkward to navigate the first couple of weeks. If possible, you might consider setting things up at home so that all the supplies for baby and for yourself will be mostly on one floor. Then stay in that area most of the day minimizing the need to navigate the stairs repeatedly. For other women the lure of being in their own bed on the second floor is enough to make it worth it. Just don’t hesitate to ask for help going up and down, even just having someone walk along beside you can be reassuring.
Keep in mind that your center of gravity has drastically changed and your body is still adjusting to that as well as healing from surgery. It’s not uncommon to feel off balance and it’s better to have help nearby just in case. Consider having pillows handy on both floors should you need to squeeze one against your abdomen while coughing or sneezing. Plan to give yourself plenty of time to recover, should it happen sooner than you planned—it will be a pleasant surprise! Be gentle with yourself. All women are different. There is no ‘right’ amount of time for recovery. There are no hard and fast rules for a healing timeline. Listen to your body, introduce things slowly back into your routine, and ease into motherhood.
photo via @chan_askins
Emotional Recovery after Cesarean Birth
Take time to evaluate your feelings about your cesarean experience. Mothers with planned cesareans have the opportunity to consider this beforehand but may still find themselves overwhelmed with conflicting emotions after the fact. Mothers who had an unexpected cesarean may feel blindsided and it’s important to take stock of all of these emotions and know that they are all valid.
It’s ok to feel disappointed in the way your baby was born. If you had planned for or envisioned things going differently, it’s completely normal to be sad it didn’t work out that way. This does not take away from the love and joy you have for your child. You can be deliriously happy that they are here and still be upset about how they came. Birth trauma may sound like a dramatic way to describe it but it’s not uncommon for women to experience varying degrees of trauma after a cesarean birth whether it was planned or unexpected, or especially if it was an emergency situation.
Your Feelings Are Your Own
Birth is a highly emotional experience and any emotions you have towards your child’s birth are valid and you are not alone in feeling them. Perhaps your cesarean was calm, you felt respected, and things went smoothly—this is the hope for all women experiencing a cesarean. Many women feel at peace with their sections and might not understand why others are seemingly devastated by theirs. Other women are deeply saddened by having had a section and cannot fathom why someone would choose to have one unless necessary.
When speaking with other mothers or mothers-to-be, be respectful of others’ experiences and perceptions of their experiences. Just because you loved your c section doesn’t mean another woman is wrong for disliking hers. Just because you hated your experience doesn’t mean another woman is wrong for liking hers. Evaluate and process your own feelings towards your cesarean and reach out for help.
Find others who can be supportive of your journey of processing your cesarean. The International Cesarean Awareness Network provides support, education, and advocacy for women experiencing cesareans and interested in VBAC (vaginal birth after cesarean.) ICAN can be found online here as well as on Facebook and Instagram. They have local chapters across the world which can be located on their website. Many of their chapters have individual Facebook groups and hold in person meetings for support. Talking to other women who have experienced a cesarean is an invaluable resource for processing your experience as well as planning for a cesarean section or a VBAC.
Birth is hard. Birth is beautiful. Birth is transformative. Take the time to take care of yourself and be proud of what you’ve accomplished and experienced for your new baby.
This guest post was written by Austyn Smith and a very special thanks Laura Shawver and Elizabeth Quinn who provided lots of great information while writing this post.
- Hamilton BE, Martin JA, Osterman MJK, et al. Births: Final data for 2014. National vital statistics reports; vol 64 no 12. Hyattsville, MD: National Center for Health Statistics. 2015. https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12.pdf
- Althabe,Fernando; Belizán, José M.; Betrán, Ana P.; Gibbons, Luz; Lauer, Jeremy A.; Merialdi Mario. The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. World Health Report. 2010; Background paper, 30. Health Systems Financing. World Health Organization. 2010. [January 22, 2017]. http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf
- Basar, Birsen; Cift, Tayfur; Olmez, Fatma; Ustunyurt, Emin; Yilmaz, Canan. Shoulder Tip Pain After Cesarean Section. Journal of Clinical and Diagnostic Research. Ausust, 1, 2015 [January 22, 2017]. Bethesda MD: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576593/
Your Intuition, Your Gut, Mama Instincts — Whatever You Call It, Listen to It
Pregnancy, labor, and birth are monumental, life changing events. Doing research, educating yourself, being fully prepared, taking proper precautions, and trusting your OB and/or midwife are all important. However, keep in mind that women have been going through this since the beginning of time. Our bodies are engineered to create, sustain, and bring life into this world. Birth does not always go as planned, or as “textbook” as we’d like. There are times when preparation, education, and practitioner’s advice take a back seat and a powerful voice comes into play. Your intuition. A mother’s intuition is an important voice to pay attention to, and the more prepared and educated you are up front, the more you will be able to trust that your gut feelings are coming from a vital place, rather than from fear and panic. Below are some powerful accounts from women who paid attention to what their body was telling them, and the positive outcomes that followed.
Mamas Who Are Glad They Followed Their Intuition
“With my second baby’s birth, I had been 3 cm dilated for over two weeks and having contractions on and off, too. The night before my son was born (1.5 weeks after my due date and the day before my induction), I told my husband, that we needed to call my dad if I had three strong contractions and/or my water broke, because I just felt it would be a quick labor. At 2:30am I had those strong contractions, 3:00am my water broke and at 4:27am my baby was born! If I hadn’t had that feeling of things going quickly after a slow buildup, Sullivan may have been born in the car or even at home!” – Jesica Boro
“…My son was turned. I was feeling nauseous from not eating for so long. The midwife was trying to turn him and couldn’t so they wanted to get a doctor to help. I could feel it was coming time for me to have an emergency c-section. Before the doctor came into the room, I got on my hands and knees which [made me] throw up and that caused my son to turn so I delivered him naturally like I wanted. – @Celeste2401
“A week after i had my daughter in June, I was terribly ill. At a time when I was supposed to be mending and enjoying my new baby, I was so sick that all I could do was cry. My friends and family told me it was just after birth cramping and that I was still healing, but I finally decided to call in to the midwife and let her know what was going on. She advised me to go to the ER right away, and hours later I was having an emergency d&c for a retained placenta that was hemorrhaging. I am so glad I listened to my body. If I had waited any longer it could have been a much different outcome.” — Jamie Van Nuys
“I was laboring in the labor tub. I had only been in for 15 minutes and was just checked 30 minutes prior and only 5 cm. My intuition told me to get out and go lay in the bed (they don’t let you deliver in the tubs). I was standing up and felt the urge to push. Two pushes later and about two minutes later my son was born.” — Brittani Fink
“When I was in labor about a month ago, we were waiting for my mother-in-law to come watch our two older children. When she was about 40 minutes away, I got the feeling that we had to leave for the hospital NOW. My husband was a bit skeptical because I had only been in labor for about two hours. But, he went and woke up the neighbors in the middle of the night and we left. Our baby was born about one hour later. If we had waited, I would have had him in the car!” — Nicole Kavanaugh
“After three cesareans and no natural births I was told by my doctors that my body “wouldn’t know how to labor” so I decided to get a private midwife, not step foot in a hospital again for the rest of my pregnancy, and set my mind on a homebirth. Everyone gave me their unwanted opinions about it all and only my husband stood by me. After about 100 hours of labor, I gave birth at 42 weeks + 1 day to my biggest baby ever (all 9 lbs 10 oz. of him) in a pool in my living room! THE best feeling ever! I’m now 39 weeks with baby number 5, I have the same midwife as last time, and I cannot wait to give birth to this baby. I never believed for a second my body was broken, and I proved all the doctors and midwives at the hospital wrong. I did it.” — Rose McMurrie, Liverpool UK
“After the birth of my son last Thursday I was over the moon…but something kept telling me something was wrong and after the experience I went through I will never doubt my intuition! Three days after birth I knew something was wrong when I had been experiencing severe edema, painful headaches that wouldn’t go away, and sky high blood pressure. I decided to go to the emergency room and the doctors then told me I had developed postpartum preeclampsia. I was immediately admitted, I was at high risk for seizures, a stroke and even the possibility of going into a coma. After four very long, emotional, rough days I am finally responding to medication that is maintaining and stabilizing my blood pressure. I am back home with my baby and my fiance and most importantly I am alive and well…If I didn’t rush to the emergency room when I did, the signs I was showing could have been fatal for me. I appreciate my life so much more.” — @Ox.vs
“My first birth, I was in labor barely an hour when I told my husband to call the midwife. I had to push before she even got there. She didn’t even check me, but when I said I had to push she called the backup and got set up and my daughter was born 20 minutes later. So glad I didn’t fall into the thought that first births take a long time, or else I would have been birthing unassisted. Very glad to have planned a homebirth from the get go! Though my midwife training would have come in handy!” — Meganne Odile Coyle
“My baby’s bilirubin levels were high. Day three of life, the pediatrician made the assumption I wasn’t producing enough milk. “The baby will eat it if it’s there,” he said, and told us we needed to supplement with formula. I asked for a pump and made them weigh him before and after a feeding as well as pumped after. I was producing more than enough and wouldn’t you know it, his chart was being read wrong and he had been back to normal levels on day 2. Still breastfeeding like a champ nine months later.” — Marji Taylor
“At 38 weeks 5 days pregnant with my first son, I woke up in the middle of the night and found myself bleeding. I called my midwife who immediately recommended that I go into L&D and she would meet us there. Upon arrival at L&D the attending doctor recommended an induction and suspected that I was likely experiencing placenta abruption (i also had a low lying placenta). My partner and I decided to wait on the induction and the hospital admitted me for observation and told us to let them know when we were ready to be induced. But somehow, I felt that my son wasn’t ready to come. The bleeding eventually subsided, and after 17 hours of being observed, after one doctor after another came in telling us we needed to be induced, and braving through judgemental looks and fending off their repeated push to have an induction; against doctor’s orders, we decided to check ourselves out and go home. A day later, I went into active labor. After 9 hours, in the safety and comfort of our small apartment, with my partner and midwife by my side, my son was born at home. It was the home birth that we had wanted. I listened to my body and my son. My partner stood by my side and although it was very scary to leave the hospital, it was the best decision we made that day.” – @Bbmee
“The nurses wanted to check my dilation when I arrived at the hospital. I told them not to bother—I wasn’t fully dilated yet but was in transition and it would be soon. I told them my second stage is always under 5 minutes. They didn’t believe me. When I felt a shift I told the doctor I was ready to push and baby was coming. She checked and said, “No, you’re only at an 8.” She stood up and walked to the sink, and I called to my husband (who always catches our babies and who was ready), “She’s coming, catch her! “I heard his calm voice reply “I’m here, I’ve got her.” And she was born into her father’s hands at that moment, with no assistance from others. Which was exactly as I had wished.” — Elisabeth
“After 26 hours of non-medicated labor with a baby who had his head turned sideways and was in no hurry to come out, I decided to transfer from the birth center to the hospital to get an epidural. I knew that even if I did dilate all the way, I wouldn’t have enough energy to push my baby out on my own. After the epidural, I was able to get a few hours of sleep and when I woke up I was fully dilated and ready to push! I truly believe I was able to have a vaginal birth because of the sleep I got after the epidural! I am happy that I listened to my body and I have no regrets! My birth was hard, but that is what it was. My birth.” — Kristi Merideth
“I was on hour 6 or 7 of my twelve hour homebirth when I began to hyperventilate. I was in the birth tub facing away from everyone, so I don’t think they knew I was starting to lose it. I hadn’t dilated much at that point; how little, I don’t know. But I sensed the air of concern. I didn’t want to go to the hospital. That was my greatest fear. I began going down the “what if” spiral of doom and lost control of my breathing. Just then my intuition kicked in and told me to look up and open my eyes. A birth affirmation my friend made me came into view. It said: Think strong. Feel strong. Be strong. I began saying that over and over in my mind, pushing away the fear. My breath calmed, my outlook improved. I could do this. I would do this. At the next check, I was fully dilated!” — Katie Bunten
“When you reach the end of what you should know, you will be at the beginning of what you should sense.” ― Kahlil Gibran, Sand and Foam