Expert Q+A: Rachel West with Rooted Birth Doula Collective

This is a transcript version of a live Q&A we did during our Bloom 2020 event. Stay tuned for more news about our upcoming Bloom 2021 event. The interview has been edited for clarity.

ACM Owner, Amanda:

Hello, ACM friends. I’m Amanda, thank you for joining us for this next segment of our Bloom 2020 Expert Q and A. We are with Rachel West and she is with Rooted Birth Doula Collective. And I’m so excited to talk to her today about the questions that you all submitted and asked over and over again in Community and Conversations because she’s got some great information to share with us. Tell us a little bit about you and about Rooted.

Rachel:

Well, I am a certified labor and postpartum doula, also a certified childbirth educator, hypnobirthing, and stress and hypnobirthing instructor. So, that is my role within Rooted, but Rooted Birth Doula Collective offers a number of different services for expecting families, new families—so of course labor and doula care. We also have educational services like breastfeeding, newborn care, and childbirth preparation. Of course, we offer hypnobirthing and infant massage, which is a really amazing class. And, after the baby comes, we offer in-home postnatal care, which is just so nice for new families to be able to get some good rest at night or even just some hands-on support during the day offering tips and tricks, and then of course consultation services. We specialize in no-cry sleep solutions. So it’s a really gentle way to encourage better sleep and wake cycles for both families and babies.

Amanda:

Because no matter what sleep is like number one. And I love hearing that. You know, one of the concerns we get all the time is I don’t want to do something harsh. I don’t want to do whatever. So I love that you offer no-cry solutions, too. I think one of the things that is frequently associated with having a doula and doula support during birth, no matter what kind of birth you’re choosing, is how to structure a birthing plan and communicate that, with wherever you’re birthing—whether it be a birthing center, or home or hospital—knowing that our bodies do what they need to do, and our babies are going to do what they need to do. Although you might not get to follow your plan, what’s the best way to go into thinking about a birthing plan and then making as much of that happen as possible?

How should a birth plan be structured and what goes into a birth plan?

Rachel:

That’s a really good question. It’s important to be thinking about your intentions going into your labor and delivery experience. And I would say one of the most important things when crafting a birth plan and when moving into your labor and delivery experiences is to be a strong advocate for yourself, regardless of where you’re delivering. It’s your body, your baby, your choice, and that’s very important. So both you and your support people should be strong advocates.

I also love when structuring a birth plan for individuals to help them think about their childbearing rights. There’s an amazing website called childbirthconnection.org. And you can find the list of 20 childbearing rights for laboring individuals, which I just really like. I would say when crafting the plan, keep it to the point, right? Make it something that’s easy for care providers to look over, to remember, to put into your chart. There are lots of nice templates online, too. So if you don’t feel like you want to start from scratch, although you can, you use some templates. I really like the visual birth plans, which have little images that you can flag. Mama Natural has one, Earth Mama also has one, and then the March of Dimes has a really nice, simple birth plan as well.

If you’re looking for something that’s just pretty to the point, some considerations you might keep in mind are organizing it by the flow of your labor and delivery experience. So starting with admitting, what are some of your hopes and dreams for the admittance process? Do you want your partner to be back with you and triaged? Do you want to have an IV or hep-block placed then move into labor and delivery?

I think one of the most important things you can keep on your plan is you want to be able to labor in any position comfortable to you free of limitation. This is one of your childbearing rights and it’s so, so very important. You might put on there how you prefer to be monitored, whether you want intermittent or constant monitoring, what your pain management intentions are. Are they medical or non-medical? The same consideration when birthing—is any position comfortable to you? If you have an epidural, there are certainly some limitations to freedom of movement. Also think about cord-cutting and clamping. Thinking about your intentions for moving into the postnatal period. What are your hopes for placental delivery? Do you want assistance with the delivery or do you want to kind of take a relaxed approach with that? Do you want Pitocin in the postnatal period? These are just all really important considerations.

And then lastly, there’s newborn care. What are your hopes and dreams for how your newborn is cared for in the birth setting? In the immediate postnatal setting, I always encourage individuals who are planning on breast or chest feeding to put that on your birth plan (including directions for no artificial nipples). This will all really help to set you up for breastfeeding success.

Amanda:

I think that that’s such a good point. And, y’all, if that sounds overwhelming, that’s what people like Rachel are here for. So start the templates that she mentioned, and if you don’t even know where to start, I like thinking about it in the segments of birth, so that you can kind of walk through it and keep it simple. Like not inundating yourself with unrealistic expectations, and walking through it with somebody who can give you the advice, like no artificial nipples, because I guess that totally makes, I mean, that kind of is a hard line, right? Like that’s a, don’t cross this line with me, but it’s something that everybody can remember, especially if it’s that important to you.

Rachel:

Absolutely. Yeah.

What advice would you give a first-time mom about breastfeeding?

Amanda:

Let’s talk about breastfeeding in the hospital and artificial nipples. We had one of our readers submit a question and she said, when she had her first son, she felt like she didn’t have any success at all with breastfeeding. The hospital sent a nurse once and then just suggested formula and then gave her formula. So what advice would you give to someone, especially a first time mom, who’s not had to deal with that before, and maybe doesn’t feel comfortable advocating for more help, so that she, or anybody, can start that journey without feeling so discouraged in less than 24 hours.

Rachel:

It’s so vulnerable in that time immediately postpartum. It’s like you should feel that encouragement and support. I would say to really set yourself up for breastfeeding success, it starts with immediate skin-to-skin postpartum. I mean, as long as the birthing person and the baby are thriving, try and get that baby skin-to-skin. What this does is brings baby to the breast or chest area, and they start to smell the areola, which smells exactly like amniotic fluid, which is very cool. So they’re attracted to it, right? The nipples look like a target. And that immediate skin-to-skin latching within the first hour or so of life really does help to set you up for breastfeeding success. I also think that one of the most important takeaways when it comes to breastfeeding is knowing that it is simple supply and demand, right?

The more time your baby spends at the breast, the more milk your body is going to make. And so any time baby spends away from the breast, whether that be with a pacifier or with a bottle you’re interrupting that relationship, that supply and demand relationship, and can really start to confuse your body. So even something as simple as offering a pacifier or a bottle in those first couple of days of life can really interfere with establishing milk supply. It takes about three to four weeks for you to establish your milk supply. So I would recommend trying to just bring baby to your breast all the time in those first three to four weeks. Even if people say, don’t let that baby use you as a pacifier in the first three to four weeks, it’s okay. Because it’s only helping to promote and regulate your milk supply.

And some other tips, I would say, try to see a lactation consultant. If you’re giving birth in the hospital, they have lactation consultants. Sometimes it does mean that you have to request their support, but request that support before leaving the hospital and then know that you have options outside of the hospital for support, whether it’s virtual care, in home care, whether you go back to the hospital to see outpatient lactation consultants, there are so many resources. And I will say that the families who I’ve supported, who have stopped breastfeeding are sometimes also the ones who aren’t really utilizing their resources. And that means sometimes seeing more than one lactation consultant, right? ‘Cause everybody comes at this from a different education and experience.

Amanda:

Right? You have to find those like everything else in life, you have to find the one that works for you and your family.

Rachel:

Precisely. Partner support is really important, too. Right? So getting those partners on board with the breastfeeding experience, encouraging them to promote this, right, this helps to contribute to a better, healthier family, healthier community. So partners can support the breast or chest feeding person by ensuring a comfortable environment, right? Dimming the lights. When the mom sits down to breastfeed, make sure her feet are propped up, she’s got a snack, she’s got some water. We created this loving atmosphere because the hormone responsible for the letdown of milk is oxytocin. And it flows most readily when we’re relaxed, we feel blissful.

And then last but not least, I would say, just keep in mind how tiny your baby’s tummy’s are. I think that the most common reason individuals stop breast or chest feeding is because of the notion of perceived inadequacy. I’m not making enough, right? There’s no true proof of that, but they feel like they’re not giving their babies enough. Your baby’s belly is like the size of a grape. I mean, that’s super tiny. So that colostrum is enough for your baby. Day three or four, like a ping pong ball. And, by the first week of life, maybe the size of an egg. So as your milk grows, your baby’s belly grows and they’re the perfect match for each other. And it’s important to keep that in mind.

Amanda:

I forget that, I forget that the bellies aren’t as big as you think they’re going to be, no matter how hungry they act.

Rachel:

Right. Imagining the size can give you confidence. Well, they’re so hungry because their belly is so tiny. By the time they’re done feeding, they’re having a BM!

Amanda:

I’m laughing so hard. Okay. So making the environment, welcoming in, and having your feet propped out, that was something that I didn’t realize. And when someone finally told me that I was like, Oh, look, the world has aligned. I had lots of friends whose husbands participate by bringing the baby to them at night so that they can stay where they are and stay cozy and it helps them feel involved. So I think that those are all great.

What are some great breast/chest feeding aides? How can larger breasted people have breastfeeding success?

Let’s talk about some like extra help if you need it. What are some great breast or chest feeding aids that maybe are different or new or something that is not mass marketed? What can we do to help the person feeding when maybe they just need a little extra help? And then the question that comes up often is especially for those with larger breasts because I think sometimes that feels like a huge challenge and obstacle. That’s the word I was looking for.

Rachel:

Absolutely. And positioning is really important when it comes to breastfeeding. It’s assuring that both the breast or chest feeding person and baby are feeling comfortable and aligned in a position. So that’s why I’m thinking of like tips or tools. Breastfeeding pillows are really nice and help so you’re not having to hold the baby up while you’re feeding or feeling like you’re not leaning forward. I mean, there are so many times I’ll see an individual who’s breast or chest feeding and they’re leaning over. Their back is hunched. They’re bringing the breasts to the baby. It’s hard enough being postpartum and a new parent, you don’t want to deal with neck and back misalignment on top of that. So really any sort of pillows that help to bring the baby to the breast are really essential.

And then specifically thinking about larger breasts, it’s important to note, and this is a common misconception just because your breasts are larger, it doesn’t necessarily mean that you have more milk or that your supply of milk is greater. The amount of breast tissue doesn’t necessarily equate to the number of milk ducts. So I think that’s an important note and then especially considering positioning and when breastfeeding with larger breasts, I’ve seen a lot of good feedback about the side-lying position, or even an inverted sideline.

Amanda:

I want to clarify that you’re not holding baby upside down for this.

Rachel:

Laying down. Yeah. Be sure that you’re not doing this position when sleepy, because you know, it’s easy to fall asleep in this condition. So safety first, but this is a nice position. You can really see babies latch, same with the football hold or the clutch hold where you kind of have baby to your side. This is a great position for larger breasts. You’re really able to see what’s going on and then position and shape your breast. So make a C shape while you’re feeding to really create an easier base for baby to latch onto. Some last tips for a breastfeeding person who has larger breasts—think about having the chin really pressed into the breast and the nose open so that they’re breathing really well.

And that’s pretty helpful positioning. And then you can breathe and babies breathe through their nose because they’re feeding all of the time. Then lastly, using a mirror can be helpful if you’re not so comfortable with the positioning. You can see what’s going on and then use a towel or a rolled up cloth or something underneath the breast to help elevate it so you’re not feeling like you have to hold it up, and so the baby is not pulling on the nipple. And there’s not gravity working against you in that way.

Amanda:

That is a good one. As a larger chested mom myself, that was definitely something. It was like, how do I hold the baby and prop myself up and ensure she’s in the right in position? So I love that idea. I would’ve never thought of that. And that’s so easy to try. I mean, you could totally do that at home!

Rachel:

I go to the store for that. What works for you? You know, you take all of these considerations and you find what works for you and your baby.

Amanda:

And you reach out for help if you need it. Nobody asks anybody to be able to do this on their own. They say that it’s natural and yes, it’s natural because that’s what your body’s doing, but it’s not necessarily intuitive, so pay to get help. And there are lots of resources. I feel like we’re really lucky as a city to have so many different resources—in-person and in-home and virtual. So y’all reach out if you need help finding a good fit for you because it exists.

Is there anything else that you can share with us that people may have a misconception about what doulas do, or making the decision about whether you need one and finding someone that’s a good fit for you just to wrap us up?

What do Doulas provide to expecting families?

Rachel:

So for those of you who aren’t familiar with what doulas do, we provide physical, emotional, and informational support to prenatal, laboring, and postnatal individuals. So one thing I really always like to drive home is that doulas are there to support the entire family unit. So it’s not just support for the pregnant or birthing person, we’re there to support partners, too. And we’re there to support older kiddos, as well. Rooted Birth does offer sibling doula services. So maybe you’re just trying to align childcare during the labor and delivery experience. We’re there to, again, support the entire family unit. How do we make this as much of a peaceful, blissful, and supportive experience and environment for people as they navigate the childbearing process? And without replacing the partner in any way. This is a question that I’ve been getting a lot. Oftentimes I’m just there to encourage the partner. Hey, why don’t you try this position or try pressing on her here, or let’s alternate, or I’ll put some music on you all slow dance. So sometimes we can just help to encourage partners to support as well, which is very important

Amanda:

Because we don’t know exactly what’s going to happen. We can’t possibly expect our partner to know exactly what’s going to happen.

Rachel:

I was just going to say, it’s just nice to have somebody in your corner, right?

Amanda:

Like an advocate. I mean, that’s what I keep thinking. It’s an advocate for the family and for the birthing person. And I think that is invaluable, especially right now when everything feels so crazy. It’s just a good person to have.

Thank you so much for talking with us and giving us that amazing information. If you want to contact Rooted Birth Doula Collective or Rachel with any of their questions, we’ll leave their website link here.

Rachel:

You can email, or visit our website and fill out a form there. We’re also on Instagram and Facebook.

Amanda:

Thank you so much. Seriously. We appreciate your time and giving this information to our our mamas and readers.

Rachel:

Thank you. My pleasure. It was great to connect.

Amanda
A fifth-generation San Antonionian - who happened to spend her formative years in Austin - Amanda loves the SAT from the confetti in her hair to the bluebonnets under her feet. Never one to miss a reason to host a party or decorate for a theme, Amanda revels in the 'mas Fiesta' attitude of the city. She's mom to Vivi (2012) aka #HurricaneVivi, Mac (2020) and wife to Francois, whom she met at Texas A&M (FTAC '05). She has a Masters in Early Childhood Education and a Doctorate in Making it Up As She Goes - which means she's a sometimes-fun-mom. You can find her on Instagram . She loves confetti, croissants, and a cold Ranch Water. Favorite Restaurant: Piatti's Favorite Landmark: Johnson Street footbridge in King William Favorite San Antonio Tradition: Fiesta Medals