A Handful is a Mouthful… Hand Express Breastfeeding

A Handful is a Mouthful… Hand Express Breastfeeding

Denise Bolds, MSW CD(DONA)

January 13, 2016

Without any support, I breastfed my newborn son Jordan twenty-five years ago. I was a divorced (single) black mother and the recipient of medical disparity. My breastfeeding journey was arduous: I sustained a traumatic birth followed by post-partum depression. I was determined to breastfeed. The last thing I owned as a new mother; a breast pump.

That’s right, you heard me. I did not own a breast pump, not even a manual one. In all of my lack of experience and support, I breastfed my baby; when he wasn’t feeding, I was squeezing my milk from my breasts with my bare hands into a cup. At the time, I thought I was the only nut doing this. I kept it to myself for years.

Two Breasts, Two Hands…

You can do this.  Hand expressing has been around for years. I’ve heard stories of great-grandmas expressing their milk into Mason jars!  Twenty-five years later I am validated when I attended a workshop in NYC facilitated by Francie Webb: a schoolteacher, wife, mother and the CEO of TheMilkinMama. Francie hand expresses her milk for her babies while holding down a successful career.

As a certified birth doula and lactation counselor, I feel (pun intended) hand expressing is not encouraged or taught as a preliminary resource to mothers whom breastfeed. In fact, the same day I was in NYC attending Francie’s workshop, I saw a very pregnant woman waddling down the street with a Medela Pump kit in her hand. I always overhear conversations of mothers-to-be about their registries – the breast pump is at the top of the list. In fact, the more expensive, the better! Many mothers coordinate with their health insurance to secure a breast pump before the baby is born.  The breast pump is often misused and abused as a tool to stimulate milk production. What many do not realize: breast pumps can cause trauma to the breast. Hand expressing is natural, gentle and calming.  What in the heck is hand expressing?

A Gland In The Hand…

Anatomically, women have breasts to feed their offspring.  The breasts are made up of glandular tissue; these glands produce milk and travel through the breast by ducts. When stimulated the milk is ejected from the breast. Sounds familiar? The breast sounds just like a penis. A penis is also a gland that when stimulated ejects a product.  It is imperative to become comfortable in hand massaging the breasts prior to hand expressing, pumping or breastfeeding.  As with anything, practice and patience are necessary.  Breast milk is food, so please wash your hands before expressing or pumping.

Expressing is a form of massage that relaxes as well as stimulates. It involves the total breast: from the tail to the nipple.  Many images of pumping are portrayed with the nipple being sucked into a cup and suction pressure draws out milk. This is often cold and does not involve the total breast, just the anterior portion.  Noted lactation consultant Andrea Syms-Brown describes pumps as applying negative pressure, taking milk only from around the nipple and not the total breast where hand expressing involves positive and negative pressure engaging the total breast and stimulating mammary glands.

Technique: Your Hands… Clutch!

Relax all the way to your fingertips and correct your posture: hunched, drawn up shoulders promotes stress. Keep shoulders back and down. The breast is like a small purse or clutch with smaller side pockets, compartments inside.  Do you remember looking in your purse for something only to have to search in all the little side pockets too?  Your breasts are the same when it comes to breast milk.

Clutch the breast from your ribs and massage out to your nipple pushing the breast back against the chest so that milk is ejected forward through the nipple.  Use the base of your palms to massage from the top of your clavicle down to the nipple and repeat this on inner cleavage of the breast. Repeat on other side.

Speeding Doesn’t Equal Quality or Quantity…

Just as in breastfeeding with the baby to the breast, pumping hurriedly is a no-no. Just because you have an electric pump doesn’t mean you will release milk faster.  Relaxation and moving the milk to the nipple is key. Massaging the breast prior to pumping helps move the milk forward out of  the side pockets, reducing engorgement. Avoid lanolin as it may promote allergies for you and your baby.  Organic coconut oil is very helpful in nipple care.  If  your baby’s latching is making you sore or tender, using a pump can increase discomfort.

Getting to Second Base…

Practice hand-expressing in-between feeding your baby and watch how good you get at it. Get comfortable touching your breasts, massaging them. Decrease your stress and anxiety about forgetting pump attachments at home, keeping spares in your car of at grandma’s house.  Hand expressing is great for moms with preemies to get colostrum collection. Becoming proficient in hand expressing is natural and builds self-esteem. You can also be away from your baby and still express safely; with the baby using your stash at home.  Imagine how approachable hand expressing is for transgender parents!

Get Pumped With An Expert!

Francie Webb, TheMilkinMama offers workshops both on-line and in person to breastfeeding mothers, doulas, lactation counselors and more. You can contact her: ‪#‎gomilkyourself Follow: @themilkinmama

www.themilkinmama.com/onlinelearning

www.facebook.com/TheMilkinMama

Selah

Selah

Denise Bolds MSW, CD(DONA)

January 1, 2016

I am often asked: “What is
Selah?” I smile to myself; Selah is my favorite word. I was
introduced to Selah in my twenties, I kept it close to me, I found myself
evolving within Selah.

Selah is a word found in the
bible. In the book of Psalms, Selah is used 71 times; it is a word
that is clearly not defined. One interpretation: Selah is a pause, a break
given by God, a spiritual interlude that is granted by God. For me, Selah is
where God is waiting for me, it is where all the mysteries of the universe are
clear, tangible and mine to explore. A sacred space within sacrednesss.

At 51 years old, my life so far is an amazing journey. Born in Harlem NY, raised in Hell’s Kitchen, NY by two
hard working parents from the south. I went to private schools and I lived in a
home where I wanted for nothing. I married, got divorced and while pregnant
with my only child, my son Jordan, I started my journey at age 26 as a
single black mother. My second marriage was to a physically abusive person whom
I also divorced. I moved to upstate New York with my son where I earned three college
degrees, owned my first home – a stunning Victorian and got nine tattoos. I
also became empowered both spiritually and intellectually; I became an author
and advocate, I came into my maternal inheritance of a healer. Selah humbled me
from my affluence upbringing; waited patiently when I jumped into the
cesspool of man for years, only to pull myself out, clean myself up and never
take myself or anything for granted.

My father passed away at age
52; my world forever changed by his sudden exit, the result of a brain
tumor. Selah was still there waiting on me. I finally acknowledged its
presence: I met a Yoruba Babalaow who taught me by introducing me to my
ancestors; my Selah stood up and applauded in happiness.

Selah was present as three of
my babies slipped from my body before they were fully formed and able to live
on their own. Selah became my sledgehammer, allowing me to break through being partially
and permanently handicapped.

The longest time I roamed in
Selah was after my son graduated from college with his master’s degree. I had
to figure out who I was, what I wanted to do and where I wanted to be. My
pilgrimage to India amplified my Selah, I was spiritually stable, however I
still possessed a blockage.

Selah helped me face the
nine-year-old Denise who was molested by an adolescent during an over night
hospitalization stay. It was Selah who kept me safe and sane until I was ready
to listen to what the nine-year-old me had to say to myself. The little girl,
the nine-year-old Denise held onto this secret for over 40 years, revealing in
Selah when I turned 51. I am certain of my strength. Selah
commands certainty of me.

Selah teaches me, heals me,
evolves me. Selah is my passport to being a citizen of the universe.  My work, my calling as a labor doula, mentor,
and teacher is Selah working through me.

Every woman I encounter in a birth I support, I witness Selah. The moment God grants that break, that space
where time is not relevant, where I am just a grain of sand on a beach, yet I
have never been more powerful in supporting a woman in labor; being a light in
a intimate but universal moment.

Selah is the break, the pause, the respite, the separation of human from spirit. Selah demands trust, accountability, transparency
and courage.  Many may refer to Selah as
‘transitioning’ I know better.  It is so
much deeper and infinitely unforgettable.

It was easy to name my business Bold Sealh, LLC:
my last name is ‘Bolds’. My purpose: to experience Selah as much as possible in my life. It is
my wish that every woman experience and remember Selah in her birth and in her journey of life. The mysterious break, the spiritual rest God gives is more than a gift. It is a
word without definition – Selah. 

Bold Selah, LLC.

Midwife, Doula, Childbirth Educator & the Obstetrician: Working Collaboratively, Not Substitution.

Denise Bolds MSW, CD(DONA)

December 10, 2015

As a certified birth doula, I get this a lot: “Denise do I
get a midwife or a doula? Should I take childbirth education classes? I have a
doula, I don’t need childbirth education!”

So many women don’t understand the roles and functions of
the midwife, labor doula, childbirth educator and obstetrician.  These four services are not interchangeable; in fact they are a collaborative.

A midwife provides clinical support to the woman during her
pregnancy and childbirth. A midwife can provide this service in a hospital, birthing
center or home. Health insurances coverage require authorization.  Many midwives note that there  are huge obstacles in obtaining reimbursement
from health insurance plans. A midwife fees are several thousand dollars. At a
birth, a midwife is present as the birth is immanent.  Midwives possess licensure/certification, has
liability insurance according to the laws of the state she is allowed to
practice in. There are some states in the United States that do not allow
midwives to practice. Midwives work with doulas and obstetricians, supporting
the teaching of the childbirth educator. A midwife is on call, depending on the
size of her practice.

A childbirth educator (CBE) is also a certified professional
providing education in reproductive health and the stages of pregnancy and childbirth.
 A CBE provides fortification of confidence
of childbirth knowledge to the prospective parents through education. Being
exposed to terms, definitions and scenarios opens the mind to familiarity,
reducing uncertainty. The CBE aligns with the actions and knowledge of the
midwife, doula and obstetrician. A CBE is not present at the labor or birth.
The cost of a CBE ranges from free to several hundred dollars. They can provide
education in a community, hospital or private setting. The CBE supports the
midwife, doula and obstetrician educating in the scope of reproductive health
and childbirth and is an enhancement to empowerment. A CBE is not on call.

A labor doula, also a certified professional, is insured
against liability and certified in CPR. A labor doula provides emotional,
physical and spiritual support along with education and advocacy to the mother,
her partner and family. A doula is present throughout the pregnancy (depending
on when contracted by client) offering support from the onset of labor, through
the birth and post partum. A labor doula practices the education of a CBE in
the paradigm of midwifery and obstetrics. The cost of a labor doula ranges from
volunteer to several thousand dollars and is not covered by health insurance.
The labor doula contributes as part of a team with the midwife and obstetrician
on education that is introduced by the childbirth educator. A labor doula is on
call for her clients.

An obstetrician is a medical school trained professional in
medical and surgical treatment of pregnancy, labor, childbirth and
complications therein. An obstetrician treats in paradigm of diagnosis. There
is clinical support that is structured in education that often the mother and
her partner are not aware of; or can go beyond the education provided in
childbirth education. An obstetrician treats within a time constraint that is
allowable by health insurance coverage and malpractice insurance guidelines.
Obstetricians provide services at birthing centers and hospitals, not home
births. The fees of an obstetrician are much higher than a midwife and birth doula
combined. If a cesarean section occurs, costs increases up to four times as
well as the risks associated with this intervention. Services are covered by
health insurance coverage.  The obstetrician
contributes in the team of doula, childbirth educator. An OB is on scheduled
call rotation.

When a client asks if it is possible to substitute a midwife,
doula, childbirth educator or obstetrician, inform her that collaboration is
key to teamwork.  A mother can obtain the
birth she wants if her pregnancy is healthy, her providers and support are all
on board with her wishes and the facility she chooses to give birth at is as
well.