odd directions

I have a lot of weird stuff going on. It feels like ever since I fell off the beaten path, when my skin mutinied and declined to acquiesce to my request of behaving like normal dermal tissue, I fell down my own personal rabbit hole of weirdness and have just been grabbing hold of oddities on my way down.

If someone were to sit me down and be like, so what are you up to these days (and have time for a long-winded answer) this is probably what I would say:

Well -insert name of person inquiring here- , I spend a lot of time overthinking everything. But primarily I spend the majority of my time hanging with my delightful Figlet, witnessing her grow and become her own person, and trying to make sure I don’t fuck that up too much.

I spend a lot of time trying to learn things, lots of things, that I think add to my life in fun and important ways (more on that in a moment), and as a result I spend a lot of time trying to figure out when to read. I wile away the hours trying to figure out when and how to take care of my ever changing body, when to workout, when to drink water, what and when to eat, when to have other self-care items thrown in there. I’m not really good at that yet, but I’m working on it.

Now back to those things I am trying to learn. Well I am trying to learn about death, how it looks in our society, in the world, why we find it so scary, how it is monetized, how it is supported, how it is prevented, how it is avoided. I try to understand my own experiences with death and work to find my own way with it hopefully before it is my time.

In a related subset, trying to learn about being a mom and my own body/mortality has me studying postpartum care, breastfeeding, etc to understand what is happening to me, what dictates the decisions mothers make around their postpartum period. Does it give me all the answers? No, but I don’t think anything ever will. So basically it helps me learn to live with indecision.

I am trying to learn about herbs, partially for self-care, partially because we treat most herbs like weeds when they are abundantly available, healthy, and easy to eat. Like dandelion and plantains. Also one of my friends from childhood is jumping into the learning process with me so we will have a lot of external motivation getting one another to keep learning.

I am trying to learn about sustainability, and what that looks like as an individual, a culture, a society, and a species. I am trying to learn how to grow all my own common veggies, fruits, and herbs in limited space with less-than-ideal conditions, without pesticides or really anything that doesn’t come from the ground or a more traceable circle of life. I am learning how different houses can be made more efficient, through better insulation, maintenance, windows on certain sides of the house, water filtration and storage, available solar enhancements, how to decrease electric and gas usage, etc.

I’m learning about bodies broadly- different schools of thought on how to maintain them, but also keeping in mind goals for what one wants their body to do. What postures are natural for longevity versus important for crazy loads? What diets help what conditions or demands? What home adjustments create healthier lifestyles? You name it. One change we have done is that we now sleep on a bed that is 5 inches of the ground, on top of a fairly hard futon mattress. We decided to try this because we wanted to:

• have more of a movement challenge waking up
• have a mattress that didn’t sag and conform to our bodies but instead provided some resistance
• see if it would help decrease our night sweating (it did!)
• see if it would improve our sleep (maybe it did? or maybe Figlet sleeping through the night more consistently is the culprit)
• see if it would decrease various joint pains we were having (it did!)

I’m one step closer to volunteering with hospice! I had my training this past weekend; next step is the mentoring. I’m excited but also have my reservations of working (for free) under healthcare (as all hospice volunteers are technically unpaid employees under Medicare. For a hospice organization to receive funding, they must employ volunteers). I’m hoping the people I visit are hyperlocal so I am able to walk to their residences, and thus visit for more time.

I am trying to write more (note the increased frequency of posts?!) for my own clarity of mind, and am still occasionally creating poems to capture the more intense feelings I have here and there. I am also reading more for pleasure and curiosity than pure intentional intellectual gain, which feels much more natural and enjoyable to me.

I think I keep circling back to this idea of my life going ferally because it feels like, though no parts of what I am doing are unique alone, the culmination of them is odd and uncommon. I find myself constantly trying to label myself (usually on instagram) to have some way of summing up all I am working on in my life in a concrete way. I usually fail miserably, and end up ranting like a loon, but the show must go on.

old plans meet new horizons (aka what I do when the little one sleeps)

In the past, I may have mentioned how I am obsessed with the fourth trimester and all things postpartum, or how when I was in my physical therapy doctorate program, I was interested in going into a women’s health specialty.

After I left the program, I searched for ways to slowly transition into the women’s health field from a different angle. And so from April through October 2018, I worked as a women’s health information specialist for Dr. Brianne Grogan, a women’s health PT and health and wellness coach and the creator of FemFusion Fitness. It was one of those random connections that seems fortuitous- in fact I had contacted her years ago after reading her book (way before I even had applied to PT schools) because I was interested in learning more about women’s health.

My job for her entailed handling email inquiries from women trying to understand

• what was going on with their bodies
• what content Bri had out, and
• who they should see (doctors, PTs, etc).

I also worked on various projects like helping make distributable content for bone building exercises, and I collected research for her new topics. On occasion I did some help with audience outreach to get her free content out into the world.

In time though we amicably went our separate ways. She moved on to focus more on holistic health practices and less on women’s health physical therapy and rehabilitation specifically, and so I continued on in my own direction, which at the time mostly included prepping for my baby’s arrival into the world. Working for Bri was an awesome opportunity because not only is she the nicest, but I got to brush the cobwebs out of my brain about women’s health rehabilitation and really delve into the subject (if you haven’t checked it out already, her youtube is full of free videos of explanations and exercises that cover a gambit of topics like prolapse, diastasis recti, pelvic pain, etc. Check it out here).

Afterward having my baby, I had not lost the love for the fascinating field of women’s health, I merely needed time to rethink how I could enter the world as a professional, no longer coming from the physical therapy realm.

I had been contemplating the idea of becoming a postpartum doula for a long time, and I finally realized what I was missing in that thought process. My objective couldn’t be simply to become a traditional postpartum doula because I would always have to explain about my skin condition, that I’m not contagious, what that means for my services, and work around my own flares and down time. But in reality when I was thinking about my own limitations, I should have been thinking about who could relate to having them. This led me to thinking about those expecting, new, or seasoned moms that have to live with eczema or other chronic conditions (shoutout to all the spoonies out there!) while growing/raising a babe or two (or three or more), and what their needs might be.

It’s not uncommon for people with chronic illnesses to have higher rates of depression, and it’s not uncommon for moms to suffer from postpartum depression, so what about those unlucky ladies that get hit with both? How do they find a support system that bridges both gaps, knowing that some of their depression comes from living with an incurable condition, and the other from being steamrolled with new hormones and emotions as a new life blends into theirs? That is a demographic I feel has not been studied or served enough. And so, I have begun to slowly pull my own experiences (both personal and professional) to better understand and then serve this group. I have been working on merging three of my interests to accomplish this:

1. postpartum education (e.g my postpartum doula course and my position researching and writing postpartum mental health pieces),
2. community engagement projects (two in the works: one to help educate mamas of color who may face discrimination from the medical/healthcare world or not have access to it at all, and one about how to train churches to better serve new moms in their area), and
3. volunteering more with the National Eczema Association. This helps me to be in the know about what policies are being created (or challenged), as well as what new treatments or practices are out.

I use these three directions to help understand my own struggles, as well as figure out how I might work to help mothers out there like me (or other parents/caregivers!). It also gives me more reasons to continually I brush up on healthcare policies, systemic support options, familial/community building techniques, measurable outcome scales, all manner of recent research and studies, etc, which I tend to like to peruse anyway.

I have also been exploring the other side of my interests- traditions and cultures around death. Soon I will be taking Alua Arthur’s End of Life training and learn how to best serve individuals and their families around their time of dying. I think it’s such a taboo thing that we really need to talk about more. The amount of people with traumatizing stories and feelings of regret around their loved ones times of dying is astounding, and historically many cultures prevented this by being present and accepting death as nature, not some scary thing never to be spoken about. As Alua says “talking about sex won’t make you pregnant. Talking about death won’t make you dead.”

I think talking about mortality brings up some important conversations (even just with oneself) about the relative value of our day to day decisions. Interestingly enough, many of my postpartum books now overlap with my study of death. I recently read Overwhelmed: Work, Love, and Play When No One Has the Time by Briget Schulte and it had multiple mentions of how mortality was regarded over the years, and how that was reflected in how we approach our day to day lives, including our aggressive work-above-all work culture today. The logic is, if you think about your mortality to a normal moderate amount, you make choices that are more centered around your mortality. We aren’t talking about the “YOLO” ideology, but rather decisions such as ‘maybe you don’t need to take that extra late business call that’s not really mission critical in lieu of spending time with your loved ones’, and that kind of logic.

Oh that reminds me- I did recently finish a class through Mothering Arts about how to create a community supported postpartum space that I really enjoyed. It offered lots of insight in how to welcome in new mamas as well as community “grannies” and draw-in local professional women to offer their expertise to the moms. My only rub is that I want to create a larger scale space than that demographic (though not necessarily a large number of people at one time). I want to create a space (maybe a physical community shop) that welcomes everyone is to have discussions, seek community, find aid… almost something that mixes time banks, death cafes, postpartum meet-ups, with a part-time bartering system, all wrapped into a welcoming looking shop. I get inspired by places like HausWitch though my target audience is slightly different.

Obviously my long term goals are still being constructed, but I think one day I would like to own this type of shop with my sister (who is paving her career in graphic design/UX and my best friend (who is a social worker), offering classes and discussions, innovative tech, and community services centered around the biggest times of change (birth/postpartum, and death). We also want to raise families together so working together would give us the time and space to figure out how to make it all work. ❤

On the book front, I’m currently reading Witches of America by Alex Mar which I’m finding so inspiring. It’s not that I want to be a witch per se, but I love learning about different routes of beliefs and what draws people to them, and Mar explores this topic so well.

Anyway, as the colder months approach, I’m in the hibernation phase of life again. Lots of reading, snuggles with the little one, obsessions with soups, teas, and decaf lattes. My family and I are moving soon, which is a new adventure on its own because we are finally leaving Massachusetts, but is a lot of mental overload on how to move across multiple states (any advice is welcome). The move might be hugely impactful on my skin too because I think my condition gets worse in the fall due to a mold allergy (and fall here is pretty moldy!). I’m actually friggin’ psyched to be moving- but more on that another day.

 

on breastfeeding, breastmilk, and NPR

A while back I took a class on breastfeeding at the hospital where I planned to deliver (North Shore Medical Center Salem Hospital). Below I’ve outlined some of the notes I took as they pertain to women’s health, as well as my own thoughts.

As many people are saying, “breast is best”, it’s interesting to look into why. Studies have shown breast feeding can help women lose some of the pregnancy weight faster as you are expelling energy to produce milk. It can also help reduce your risks of ovarian cancer, breast cancer, heart disease, and type 2 diabetes, as well as it releases hormones to calm you down.

But what’s actually going on in the body when it produces milk? The glands that produce milk (alveoli) send the milk to ducts which lead to the nipple opening. The baby draws the milk out when sucking, and the more the baby drinks, the more our breasts produce. At first we only produce colostrum, which is this fatty liquid that has all kinds of goodies like antibodies and beta carotene for our babies newly-developing immune system and gut. Then the real milk comes in after about 3-5 days. When a baby started nursing each time, first (s)he will get the foremilk which is mostly composed of water, and after feeding for a few minutes (up to 10 minutes) the hindmilk (which is a lot fattier) follows. The Letdown Reflex happens each time the baby feeds and it is when the baby has latched and the breasts transition from letting out foremilk to hindmilk. Some women can feel the letdown reflex happening (described as pins and needles or some localized tightness) but many women feel nothing.

But how does breastfeeding feel? Well, apparently it is a very novel sensation to most when the baby first latches (it definitely was in my experience) and for many it is difficult to get a good latch and takes some practice! The biggest worry is that a baby who has latched poorly and is just hooked onto your nipple and so (s)he will cause the mom pain. The way to avoid this is to make sure the baby gets more of the areola in its mouth rather than just the nipple. To detach a baby from your nipple if they are incorrectly latched, you definitely don’t want to just pull them off (ouch), but instead you should insert a clean finger into their mouth to break the suction, by running your finger along their gum line.

Also leaking is normal, especially at the beginning of breastfeeding, but it usually does slow down and stop as you continue breastfeeding and your baby gets used to it. You can use nursing pads and also press your nipple/cross your arms when you feel like you are leaking to help to try and stop it.

What about your diet; how does it affect the breastmilk? What can you eat? From this class I was told you can eat and drink anything, it’s just a matter of seeing what your baby’s reaction is (if they get gassy, fussy, hiccup-y, etc after a meal, check back to see what you last eat). Obviously some things to consider are making sure things like alcohol and caffeine are out of your system before you breastfeed (I think the advice was if you have an alcoholic drink, you don’t want to feel tipsy, and you want to wait about 2 hours before you breastfeed… but don’t quote me on those hours). Also for babies that have occult blood (invisible blood in the baby’s stool), the first things a doctor may advise you to avoid are probably dairy and soy, because they are the most common culprits that irritate the babies developing gastro-intestinal system (this is what occurred in my experience). The Kelly Mom blog has a post that goes into food sensitivities in more detail.

For pumping, the advice was not to start until 3-4 weeks unless needed and to make sure you get a pump with a suction cup that is sized correctly to your breast; you don’t want your nipple squished on the sides. The other advice was to pump in the morning, or after a baby’s feeding (I believe about 30 minutes after is the recommendation).

For general nipple care, the advice was to try using your own breast milk around the inflamed area first. Then you can try lansinoh or coconut oil on tender area, and then if it’s really bad, use manuka honey (here’s a cream made with it), but wash it off before feeding the baby.

Other painful aspects about breastfeeding include:

• Engorgement: this occurs when you don’t breastfeed enough so your breasts become swollen and hard. Regularly nursing helps prevent this, but if you need to you can also remove milk by hand (or what’s called expressing milk) you can use a pump. Just express until your breasts are no longer hard. Cold compresses can also be used after feeding to help bring down the swelling. To express, massage the breast tissue and then grab above and below the breast with your thumb and forefinger and press back towards your chest wall, then gently squeeze, moving your hand all around to help drain multiple areas.
• Mastitis: this is the most common problem, and it is when your breast gets infected with bacteria, causing pain. You will probably have a fever or other flu-like symptoms as well. This can occur from blocked ducts, nipple injuries, or problems with breastfeeding. You want to call the doctor if you feel this has occurred. Also also make sure to wash your hands frequently to reduce infection risk.
• Blocked ducts: this is caused by not relieving the breasts. A blocked duct will feel sore and tender. Try taking a warm shower and apply moist heat, and/or gently massage before breast feeding. Also try expressing after feedings if you still feel engorged.
• Yeast infection: this will cause your nipples to be shiny, red, and painful. Yeast (also called thrush) can also grow in your baby’s mouth so look for cottage cheese looking stuff in their cheeks.

Who can you call for help? Nowadays you can call your doctor, your baby’s pediatrician, and/or some hospitals also have lactation support groups (sometimes free), or lactation consultants (usually not free) that you can call to get one-on-one help.

A little more about breastmilk. In lieu of my own little own having some kind of sickness, I’ve been looking more into breastmilk’s functions. This searching led me to this internet viral photo showing how a mom’s breastmilk changed when her infant got sick. The 2013 study mentioned in that post talks about breastmilk’s immunological function and explains how when the mom or baby get sick, the number of leukocytes (aka white blood cells) in the breastmilk drastically increases to help protect them, because leukocytes help fight disease. I find that to be such a cool example of symbiosis. I personally have also noticed that breastfeeding seems to keep both me and the baby from getting some of the sicknesses that were going around (my mom, mother-in-law, and husband each got sick after the baby was born while the two moms were visiting!).

Lastly, I also read an article by NPR addressing the breastfeeding versus formula debate for poor countries.  The major points that this article made were that formula is not a godsend for impoverished countries for the following reasons:

• formula requires water to make it, of which clean sources are not always available
• formula causes increased risks of diarrhea and respiratory infections, and
• formula can cost up to 30% of a families income, and subsequently families made dilute the formula to make it last longer, which reduces the amount of nutrients the baby gets per serving.

The article also talked about how it’s weird that we are constantly trying to research the benefits of breastfeeding when it’s as natural as “breathing, chewing, hearing, passing stool”. It also went on to explain that even an underfed mom can make excellent quality milk, and as for quantity, it is also enough except in the case of severe malnutrition. The latter point is interesting to me because I hear a lot of moms, including myself with babies labeled as “failure to thrive”, which essentially means our babies aren’t gaining weight at a rate that the medical professional expects. In my case, the doctor assumed I wasn’t producing enough milk and told me to supplement with formula. It turned out that my baby drank the same amount of formula as I was producing of milk, so I wasn’t the common denominator and rather my baby just drank only tiny amounts per feed. I’m curious as to why there are many medical professionals that believe many moms can’t produce enough milk when studies may be showing the contrary.

Anyway, the article ended by saying that it is up to the mom on how they want to provide for their child, however, it is important that they have accurate information to make informed decisions. This means that we would need to reform the system so doctors are never paid to handout formula samples, and on in which moms are not incentivized by free samples to use formula.

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Hey, if what you read seemed dated or familiar, I’ve been combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

why doesn’t the postpartum period include eczema care?

As you may or may not know about me, my goal in life (career-wise at least) is to create a company that cultivates support for women with chronic illnesses as they embark on becoming mothers. One of my dreams is that services provided will help to make up for the loss of midwifery-type support that towns and cities used to have, and combat the decrease of share “wise woman” spaces, but specifically in the context of helping women who have varying autoimmune or other chronic disorders.

In my dream scenario, this company I create is inspired by community and healthy social growth, devoted to bringing together all people, not just those who can pay, or who are healthy.

If I ever delved into having a physical space for the company (as opposed to being a traveling owner), the space would be free to visit (when not going to a scheduled appointment), and would have lots of nooks and tables and chairs for people to enjoy the space, and some days would have events that would have an entrance fee but it would be reasonable, and would include a free meal that my husband would make along with other perks like meet-the-community-support-team, free lectures/discussions, etc. We’d work with local hotels, bed and breakfasts, and other places that rent out rooms to make sure there were plenty of accommodations ready too, which would help bring money back into the town.

Anyway, I could go on for days, but as a result of my lofty goal, I constantly have my eyes peeled for events or opportunities that bring about that community feel, especially in women’s health. 4th Trimester Arizona is one of those awesome events I learned of after it occurred. It seemed like the perfect fusion of mixing the community members (moms, dads, grandparents, etc) with local businesses, and with health/health care professionals, allowing for support and engagement for new moms and their families. The event included workshops, panels, free wellness services, a dad track, bonding activities, and more, all with the intent of strengthening community.

Going through a few of the speakers of 4th Trimester Arizona led me to Matrescence 4th Trimester Planning and Support, an organization started by Caitlin Green Cheney and Elizabeth Wood. They hold workshops that include how to prepare for the 4th trimester, including how to make a support system. Here is a Q&A session they did that tells a little more about their company and their backgrounds/how they got to where there are. They also encouraged me, because although they are more of a service you pay for, their intent is still to help provide education in tandem with support. I am finding that one thing most humans seem to crave in this day is more support in their endeavors; the world has gotten so big and diverse that finding a space where you feel a part of is so important. Hence my whole reason for wanting to become a postpartum advisor for women that are usually the most isolated, those who are chronically ill.

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Hey, if what you read seemed dated or familiar, I’ve been combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

on new adventures (sleep training and postpartum doula training)

Hello again. It’s been a while since I’ve posted any content, in fact I think I haven’t posted since I was in my second trimester!

Well, I have since given birth to my beautiful little one, Figlet, and am now working through a new stage of life with her: sleep training.

It may seem a bit late as she is almost 7 months now but in reality sleep training can be initiated at any age. In my case, in her earlier months I was so worried about her weight gain (as she is small and has been consistently in the 5% quartile) and her potential food sensitivities that I was eating (she’s exclusively breastfed and she occasionally had blood in her stool), that I focused on nothing else.

As a result, Fi now appears to be in a bad holding pattern where she fluctuates between waking up twice a night to waking up every hour or so from 12pm-5am and fighting going back down to sleep unless I feed her. Her daytime naps are a total crapshoot (sometimes she sleeps like a goddess, other times she will fight it for hours but is too tired to do anything else).

So, I am working on reading through the research about various techniques to go about breaking the latter habit, looking at everything from the Ferber Method to the Sears Method. I’ll be headed to the library later today to get the official books on various methods, but in the meantime, from scouring the internet at 2am, here are a few of the suggestions (from secondary sources):

The gradual retreat/disappearing chair method

1. place chair by crib
2. put baby down when drowsy then sit on chair
3. when baby cries, go to her and pat/stroke her but avoid eye contact
4. when baby stops crying, move chair slightly further away and sit
5. if baby cries again repeat pat/stroke and no eye contact
6. when baby stops crying move chair further back again
7. repeat until baby is asleep. might take 10 minutes for them to fall into deep sleep

The kissing game method

1. put baby down when drowsy and promise to return in a minute to give a kiss
2. return almost immediate to give another kiss
3. take a few steps towards door then return and give another kiss
4. promise to return in a minute to give another kiss
5. put something away/do something in room, then give another kiss. 6. promise to return in a minute for another kiss
6. pop outside room for a few seconds then return for a kiss
7. as long as child is lying down she gets more kisses (no chat, cuddles, stories, drinks)
8. repeat until child is asleep

The Ferber Method

1. put baby in crib awake, turn off lights, say goodnight and leave room
2. if baby cries, come back after predetermined time (a minute or two). Pat baby in reassuring way but don’t pick up. Leave room promptly
3. this time stay out of the room slightly longer before returning to reassure baby
4. continue with longer and longer periods of time
5. if baby wakes in the middle of the night, start back over with lowest wait time at beginning of night
6. on second night, wait a little longer than previous night (so first night try for example 3 min, 5 min, 10 min. second night try 5 min, 10 min, 12 min)

The night weaning method

1. start gradually by nursing baby shorter periods of time or giving smaller amounts of milk in bottle, prolong time between feedings by patting baby to sleep
2. make sure baby get plenty to eat during day (decrease distractions)
3. offer extra feeding in evening
4. avoid weaning during transitions (vacations, traveling, teething)
5. have non-boob feeder comfort during night
6. eliminate feedings one at a time. tell her she can nurse in teh morning. pat her belly/back

The pick up, put down method

1. if baby cries when first put down, put hand on her chest with “shhh” or key phrase
2. if that doesn’t work, pick up and repeat phase
3. when she stops crying but is still awake, but her back down even if she starts to cry on way down
4. if still crying, pick her up again. do until you can see signs that baby is settling (cries getting weaker)
5. when behavior settling, don’t pick up anymore. place hand on chest and say phrase
6. leave room
7. if baby starts to cry, repeat process again as many times as needed until she’s asleep

The nighttime crier method

1. put baby down when drowsy
2. Visit baby briefly ever 5-15 min if she’s crying
3. make visits boring, brief, but supportive
4. do not remove child from crib (no rocking if you do). Most babies cry 30-90 min then fall asleep
5. middle of night crying: temporary hold baby until asleep (helpful for transitions) if she cries for more than 10 min. little talking, no lights. dad is often more effective 6. give baby security object 7. phase out nighttime holding

The overall commonalities between all these methods is that you first have to have a good bedtime routine established, and that you should feel free to adjust the timings as you feel best fits your baby.

So far we’ve attempted sleep training once with Figlet (last night in fact), and it took hours to get her down. Jake had to do it because she got ragingly upset if I tried to and me attending to her didn’t result in her getting fed. I am handling the nap version of this today (so far unsuccessfully) and then we’ll see how tonight fares.

Speaking of how things fare, that brings me to my other adventure. I have finally gone and signed up for a postpartum doula course and will be working my way through that in the coming months. I might just skip ahead to do the reading that pertains to sleep habits and use the material to help inform my ongoing real life experience. I’ll be taking the little one to the library next to where we live to stock up on the necessary books and then I’ll come home and work through them with her.

More to come about my course and in depth sleep training experimenting with Figlet soon!

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Hey, if what you read seemed dated or familiar, I’ve been combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

the 4th trimester, books, and blogs

The “4th trimester” is a term that has growing in popularity recently (and with it better policies!). It refers to the first 3 months after a baby is born, when there is still substantial growing happening (the baby develops the ability to sweat, to produce tears, to hold his/her head up, etc).

The exciting part is just how much more this period of time is being acknowledged by the women’s health community, including by healthcare providers. People are realizing that this is a period that can be quite difficult for women to adjust to, as well as babies. More discussions about postpartum depression, as well as physiological changes that can happen to the women are being had  (like how many women find that their stomach muscles do not “bounce back” after birth whether its due to diastasis recti aka abdominal muscle separation, or from having issues with pelvic organ prolapse).

The American College of Obstetricians and Gynecologists came out with a statement called “Optimizing Postpartum Care” this past May that talks about changes they believe should be included in the healthcare protocols/coverage, including an initial contact with the Ob/Gyn within 3 weeks of the baby being born, and then a comprehensive examination by 12 weeks to include “a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance”.

There are also doctors out there like Eva Zasloff (the founder of Tova Health), who are trying to reform postpartum care even more by offering comprehensive combined mom and baby postpartum care via home visits. So instead of having to rush out to the doctors’ offices for all these check-ups, she (or someone from her team) comes to you to allow you and your baby to get checked from the comfort of your own home, which can also reduce the likelihood of getting infections/sicknesses from others coming in to see the doctor. Honest Mamas, a group of three moms who are also psychotherapists who make podcasts recently did an interview with Dr. Zasloff that can be found here.

My obsession about learning more about the 4th trimester (in tandem with my love of understanding how pregnancy, motherhood, and parenting are done in other countries) led me to this article called “How the World Nourishes Mothers” the other day on goop.com. They did a Q&A with Heng Ou, a mother and the creator of MotherBees, a company that does meal deliveries to new moms. The meals are based on zuo yuezi, a Chinese ideology of nourishing a new mom with specific warming foods to welcome her and help her transition into motherhood. Ou also wrote a book called The First Forty Days, which I plan to read (and use!) and will write up about afterwards in my books of the season post.

It’s interesting to think about how different cultures respond to new moms. For women that are blessed with communities and support systems, a wide array of behaviors can be seen, from how much rest time moms are expected to have, to what foods people bring them.

And lastly, since I first wrote this when I was getting quite close to my own due date, I’ve been looking to hear more about the 4th trimesters experience of new moms’. One morning, amidst a bout of insomnia, I came across this post by Jen Eddins on her blog Peanut Butter Runner. She talks about her life as a mom of a now 3-week old, her emotions, how her body is doing, etc.

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Hey, if what you read seemed dated or familiar, I’ve been combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

on racial differences in maternal care

Way back a few months, Fi and I visited my parents, and as a result she got her fill of dog exposure. Studies are still looking into the impact of early dog exposure (e.g. the first year of a baby’s life) on the child’s risk of asthma, allergies, and eczema later in life, and preliminary data seems to suggest that dogs have a positive effect in decreasing the risk of all three.

One study even found a higher correlation of eczema reduction for black children as opposed to white children from dog exposure, which could be useful as black people statistically have a higher risk for eczema (especially women).

These kinds of studies highlight the need for analysis of subgroups (e.g. race, gender, type of birth) to really understand who is being affected specifically. However, subgrouping is only useful so long as the studies are done through non-biased non-reductionist lenses. If accomplished, such specificity would allow for more applicable research to come out that could help promote better health, wellness, and medical decisions.

Which reminds me, I also listened to a webinar from the Black Mamas Matter Alliance. It covered a lot of material, but there was one particular point that stuck out to me (besides the need for a lot of policy reform across the country). It was the need for doulas, particularly those who live in the communities they serve (called community-based doulas).

Doulas act as support people for mothers, providing nonjudgmental (and non-medical) advice to moms from pregnancy to postpartum, making sure moms understand their rights and options. A doula from one’s own community would invaluable as they would understand the dynamics behind the community, as well as having firsthand experience with how the medical/clinical facilities are.

The webinar also talked about the need for insurance coverage for doulas (especially under Medicare), so that more mothers can afford them. I couldn’t agree more, especially as doulas correlate with better outcomes and statistics for the mothers overall.

The webinar is up on the BMMA site if you want to listen to it.

And lastly, I also read a book by a black midwife called Listen to Me Good, which was a book about a less well known figure in women’s history named Margaret Charles Smith. She was a midwife in Alabama who worked from the 40s to the 80s.

She never thought she’d become a lay midwife, as the hours were terrible and the pay even worse, especially for a black woman in the south. She learned traditions of birth and postpartum care through her grandmother and other “wise women”, and then later got standardized training through the nearest hospital, which allowed her to assist more women in a systemically recognized and medically approved fashion. She still continued to serve women as best she could without putting her neck on the line (she also helped deliver white women’s babies, which was a contentious point at the time).

The book also reflects on the various struggles black women faced in trying to work as midwives in Alabama, first due to explicit racism, but in later years, also due to systemic racism and prejudice through the worlds of healthcare and medicine, as doctors sought to get rid of lay midwifery (and devalued nurse-midwifery too in some areas). Many women, like Miss Smith, continued to try to care for women regardless, as they were the only option for hundreds of miles, and because white doctors were generally not interested in making the trip to aid poor black women give birth.

It really puts into perspective that even today, black women in America are still three to four times more likely to die during childbirth (or the first week immediately after) than white women. Food for thought.

One thing that could help bridge this increasing gap is better sensitivity training and education for medical practitioners. I was curious about different traditional practices and beliefs around postpartum care which led me to some interesting studies. One such study covered a few Central American countries and their beliefs around both the perinatal and postpartum periods.

I do think it’s important to know of the different roots behind postpartum treatments to help understand why a family may act/react the way they do to particular medical practices in western birth facilities (like hospitals). This is the way, in my opinion, to create a culture of care that uses a mom’s background/culture along with the medical evidence based practice to put the best interests of moms first, rather than of healthcare premiums.

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Hey, if what you read seemed dated or familiar, I’ve been combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

healing skin, hormones, and hot nights

It’s currently 3am and I’m awake despite the little one actually having been asleep since 830ish.

“Why on earth are you awake?”, you may be asking yourself, and rightly so.

Well let me tell you, internet reader. I am hot.

Now though the ambient temperature in the room feels cool, I know I set my thermostat a bit high (in my defense, with the skin disorder I’m usually always freezing, and the baby likes it warm too). However, I am not sweating. I’m just really warm. Warm enough to sleep in just a t-shirt and underwear, which I haven’t done since before my skin declared mutiny on my body (circa 20013?).

So as I’m over here pondering my existence in a semi-lucid state at 3 in the morning, the question that keeps popping up on the forefront of my mind is: this heat, what does this mean?

What does this mean? I’ve got a few theories.

1. My skin has shown an unprecedented amount of healing lately. I have soft skin on my face, stomach, back, and thighs. Perhaps I have done the majority of my topical steroid withdrawal pemance and am finally seeing the results, aka having skin of normal thickness and elasticity and with the ability to retain heat and moisture.  Maybe. Or, maybe,
2. I have finally hit the point where, despite still breastfeeding (which can delay this), my hormones are kicking back in, and I am soon to rejoin the ranks of menstruating-aged women. In which case, hormones could be the culprit for my heated sleep body. Or, perhaps,
3. My circadian rhythm is so butchered from having to wake up at all manner of times during the night shift for the last 7 months (more if you count pregnancy months too) that my body doesn’t know what to do with un-externally regulated sleep interruptions, and so in a desperate attempt to keep its new status quo, it’s driving me awake via continued thermoregulation fluctuations. Maybe that’s it.

Or maybe it’s some culmination of the three of those things because as is often the case with complex systems like humans, we don’t always have a simple solution.

At any rate, I’m enjoying the fact that my little one is getting so much sleep, and that I’m getting some silky smooth patches of skin. I’m not stressed and as I am awake I am making sure to hydrate, so I’m sure in time I’ll learn to sleep again. So c’est la vie et bonne nuit (that’s life and good night).

using boob milk for more than the baby

As some of you may know I am currently nursing my 3 month old baby girl, and in doing so as she is my first, I’ve learned that leaking is a thing (sometimes it occurs when she’s nursing on one side- the other side will start to drip milk, and other times they seem to leak for no apparently reason at all). As I wear nursing pads in my shirts during the day, the problem begins at night when I’m in bed trying to sleep. The leakage then can be really annoying. So my most recent solution has been spreading the milk on my skin, because why not- it’s already leaking all over it anyway.

My less impulsive logic for trying this experiment came from some research I had been doing a few weeks ago about breastmilk and its health benefits for the baby. Fi got sick and I wanted to know how her immature immune system could handle sickness when she only intakes breastmilk as her food source. This search led me to an internet viral photo showing how a mom’s breast milk changed when her infant got sick. The 2013 study mentioned in that post talks about breast milk’s immunological function and explains how when the mom or baby get sick, the number of leukocytes (aka white blood cells) in the breast milk drastically increases to help protect them, because leukocytes help fight disease (which I found to be such a cool example of symbiosis. I personally have also noticed that breastfeeding seems to keep both me and the baby from getting too severe of sicknesses. In fact, my mom, mother-in-law, and husband each got sick after the baby was born yet Fi and I were fine!).

I also read an article by NPR addressing the breastfeeding versus formula debate for poor countries.  A point it stated made me more curious about breast milk; it said formula can cause increased risks of diarrhea and respiratory infections. I assumed this is so because it requires using water to make (and clean sources are not always available in impoverished countries) but maybe it’s also because formula doesn’t have the same chemical and bacterial composition to allow it to be readily accepted by the baby’s developing digestive and immune systems? By extension I supposed that breast milk had to have some component in it that generally allows it to not irritate the digestive and immune systems*… which is my big sign to think “MICROBIOME” (* this of course is excluding when the baby has allergies or sensitivities to something the mom is eating that is going into her breast milk). The article also talked about how it’s weird that we are constantly trying to research the benefits of breastfeeding when it’s as natural as “breathing, chewing, hearing, passing stool”. But we live in a society where we need evidence and so I decided to play the game of informal (and badly controlled) science to see if I could test my own theory, that breast milk may help with (eczema) healing.

I did not participate in the rigors of the scientific process because I am lazy and I doubt Fi would be content amusing herself long enough for me to do it, but instead I just dabbed some breast milk on my shallow cuts every now and then instead of using neosporin or leaving the cut alone. My observations: it would seem as though breast milk can help with reducing the pain of shallow cuts (I tried it on the cracks on my knuckles and outer ears, cuts on my ankles and hands), and helps to speed up the healing of said cuts. It does not moisturize (the spots I put it on tended to be drier the next day… though that could be because when cuts heal on me, they start skin flaking…) but overall, the spots I put it on did seem to heal up and achieve a cleaner scab and softer skin around it.

Apparent cons of this experiment? The milk can sometimes burn (but again, everything burns when it touches my inflamed skin spots… even water) and it’s also a little sticky but it dries sticky-free. Fun fact, I have a pet peeve about being sticky. I hate it. So much.

After this self experiment, I was more curious to support why I might be seeing the results I saw so I did some low level cursory research. Also speaking of research, I received my diploma the other day. I officially have a Master of Science in Health Sciences from MGH Institute of Health Professions. I am now a MASTER of science. The academic title of master seems somewhat archaic; I envision myself similar in status to an entry-level alchemist or and mage, as I have established myself in a trade, but it will still take years to perfect my craft. Anyway…

There’s not a lot of recent research being done (or at least it’s not readily available yet) but I did come across two recent ones. This first paper, of which I could only access the abstract, tested wound healing of the cornea (yes, of the eye) in mice using human breast milk, milk from mice, artificial tears, and the control group. The results were that the human breast milk caused the fastest healing, followed by the mouse milk. The other two groups (artifucial tears and the control) were still not healed by the end of day two. The other study I found was published in 2015 in Nature, and it was titled, “Human milk proresolving mediators stimulate resolution of accuse inflammation”. It came to the conclusion that the lipid mediator-specializing proresolving mediator profile (a ratio of sorts between lipid mediators and specialized proresolving mediators) in human milk helped the macrophages (or cells that engulf bad bacteria) to contain pathogens and remove dead cells (in a process called efferocytosis- my word of the day). It is important to note that this was seen in vivo (in mice), and that breast milk was not applied topically to the skin. If the results are applicable to humans, I see this study as being useful because people with eczema suffer high levels of inflammation internally not just on their skin, and because turning off the inflammatory phase is also important in wound healing (more on this in a later post).

After that article I backtracked and wanted to know more about what breast milk is, which led me to this document that included the various components of breast milk (though I can not find the professor or the molecular virology lab anywhere else on the web…). Also note that the tables say the various factors are tested “in vitro” meaning not in the organism (for example, secretory IgA from breast milk was probably removed from breast milk and tested in a petri dish against E. coli). Even so, the breadth of potential abilities of breast milk, due to its staggering list of factors alone was interesting in its own right.

In conclusion, though I don’t think breast milk applied externally heals the mother’s eczema or TSW, I do think it can help me with superficial wounds, especially when it’s the middle of the night and I am otherwise unmotivated to leave the bed even if I’ve been scratching.

 

REFERENCES

Arnardottir H, Orr SK, Dalli J, Serhan CN. Human milk proresolving mediators stimulate resolution of acute inflammation. Mucosal Immunology. 2016, May 9;9(3):757-766.

Asena L, Suveren EH, Karabay G, Durson Altinors D. Human Breast Milk Drops Promote Coreanl Epithelial Wound Healing. Curr Eye Res. 2017 Apr;43(4):506-512.

Brink, Susan. “Why The Breastfeeding Vs. Formula Debate Is Especially Critical In Poor Countries.” Goats and Soda, https://www.npr.org/sections/goatsandsoda/2018/07/13/628105632/is-infant-formula-ever-a-good-option-in-poor-countries?utm_source=npr_newsletter&utm_medium=email&utm_content=20180719&utm_campaign=goatsandsoda&utm_term=nprnews. Accessed 1 Oct 2018.

how to handle a baby when you have eczema

For the first few days after having my little one, I was on such a high of nerves and adrenaline that I felt great!  I had been on antibiotics while in the hospital, and after getting home my skin started to feel really dry. I started taking some probiotics and focusing on drinking lots of water (I knew getting enough sleep was a lost cause), and keeping my stress down.

Initially, my skin was calm enough that I had no problem doing skin-to-skin contact with baby Fi, but around week 4 or so I started to experience more flare symptoms- sweating, itching, redness- whenever I had the baby lay on me for too long. I started to have to wear long sleeves when holding her to not get overheated. I’m not exactly sure when this happened, but it may have also correlated when the humidity increased, and the temperature with it.

I’m not sure if it was due to the antibiotics, the temperature, the lack of sleep, the terrible diet I had in the hospital (think chicken fingers and ice cream for multiple meals in a day), or the hormone fluctuations but my skin definitely became more sensitive post-pregnancy. Though estrogen has been considered one of the reasons women can flare-up worse during pregnancy (see my post about pregnancy and eczema), after pregnancy the estrogen drops so it’s unclear what would be provoking my symptoms (besides the above mentioned items).

Either way I’ve had to be more creative about adjusting to life with a newborn. The biggest aspect I’ve had to cultivate is endless patience mixed with quick stress-reduction habits. My lackadaisical approach to getting house and life stuff done has been somewhat of a saving grace because my little one has wreaked havoc on my schedule. I’m exhausted in the afternoons, I have no idea what it feels like to sleep more than 3 hours at a time anymore, I tend to eat a bit worse now (mostly eating too many carbs and too much) because I lack the self control to stay as dietarily balanced when I’m sleep deprived. It’s something I’ll have to work on in the coming months.

I find ways to not focus on my skin when it’s getting all sweaty from holding her and I have learned to wear light layers or wrap a small blanket between her and myself when breastfeeding to avoid irritating the more sensitive skin areas like my stomach.

There are some inherently awesome aspects to having a newborn when you have eczema (at least in my experience). For one, I tend not to think about myself as much so I am not as aware when I am itchy. She keeps me busy to such an extent that even when I’m immersing my hands in water (which is traditionally a huge irritant) to give her a bath, I barely notice. Also, lately my core temperature seems to be evening out even as my skin fluctuates (which means that the hot, sweaty skin nights and cold shivers have been decreasing). I actually enjoy the cold temperature more than I used to, and I don’t enjoy basking in the sun for quite as long.

And overall I do think that my skin has been able to consistently heal slowly but surely. I feel as though I look more or less human again, what with the redness decreasing.  I think the hormones from breastfeeding are helping my skin heal to some extent; I know my hair has gotten shinier, which is an awesome boon.