Combi feeding is usually a term used for combining some breastfeeding with some formula feeds in between. It can also be used to mean some expressed breast milk and direct breastfeeding or formula feeding.
Risks of combi feeding (mixing breastfeeding and bottle feeding) :
- your baby can develop a preference for the bottle teat due to it being easier for them to remove milk from a bottle than a breast
- your baby's stomach can be stretched by a larger volume of milk from a bottle, thus making them more likely to be dissatisfied at the breast
- the introduction of formula milk can result in lower milk production from your breast. If baby develops a preference for the bottle they may not breastfeed as much and your supply may begin to reduce
Benefits of combi feeding :
- your partner/friend/family member can share the load of feeds
- it can be a good opportunity for the baby's non-birthing parent to bond with them
*Trigger warning*
This post contains discussion and information about birth trauma, this may be distressing for some people so please read on only if you feel comfortable to do so.
Birth trauma is PTSD (post-traumatic stress disorder) and can manifest in different ways for different people. Birth trauma can form alongside postnatal depression which can be extremely difficult for birthing people and their families. Sometimes it can also lead into hypervigilance, this is where you feel the need to be constantly watching your baby. Birth trauma can affect anyone. Birthing people as well as their partners can experience it. It can affect those who have emergencies during birth as well as those who have a “textbook” birth. Signs and symptoms of birth trauma can appear immediately after birth or several weeks later, in some cases it can even emerge when you start to plan for your next baby. They include flashbacks, panic attacks, being unable to sleep and feeling triggered when you look at your baby, think about the birth or hospital, or when you return to where you gave birth. Birth trauma can be caused by many things, it isn’t always the emergency itself which causes trauma, it can be the way those caring for you made you feel, for example if you didn’t feel listened to or if those caring for you didn’t explain what was happening and why those decisions were made. For some people birth trauma is experienced due to the care they received following birth.
Birth trauma may be reduced when birthing people and their birth partners engage with antenatal education and have talked through how they will navigate decisions within the birth space, including how the birth partner will advocate for them when they are in the throes of labour or postnatally when they are at their most vulnerable. However, in most cases, birth trauma happens as a result of a combination of factors out of the birthing person or their birth partner’s control. It is important to be aware of the signs and symptoms of birth trauma and reach out for support if you feel like this is something you are experiencing. Your midwife normally takes care of you for between 10 and 28 days after birth, after this your health visitor takes over, you can speak to your midwife, health visitor or GP if you think you are experiencing birth trauma.
It is important to be aware that some health care professionals do not have vast experience with birth trauma and it can be misdiagnosed as postnatal depression. If you feel that the person you have reached out to about your experiences has not given you enough support, it is really important to ask someone else, this is something your birth partner can support you with.
People who see the same midwife throughout their pregnancy, birth and postnatally may be less likely to experience birth trauma. An emergency situation can incredibly frightening for the birthing person and their partner, there may be times you fear for your own, your baby’s or your partner’s life. This typically isn’t what people expect for their child’s birth, it can be shocking and confusing, especially if things happen quickly. When you know and trust the midwife who is caring for you, you may feel less frightened as you know you will be supported and even if things happen quickly you can talk to them afterwards and know that you will be supported. When seeing lots of unfamiliar faces, it can make a situation feel more intimidating and it is not uncommon for this to be a factor in birth trauma.
Birth trauma isn’t always linked to emergencies in birth, it can also affect people when the treatment they received has left them feeling confused, not listened to or has not been the experience they had hoped for. It is not uncommon for people to feel birth disappointment if their birth did not go to plan, and due to the unpredictable nature of birth it is not uncommon for this to happen either.
While you are pregnant it is important to think through your birth plan, consider how labour may feel and know what the signs are that your labour is progressing well. Birth and labour pain is different to any other sensation you have experienced before and it is important to have confidence that some pain is normal and a sign that labour is progressing well.
The Birth Trauma Association supports people who are experiencing birth trauma, and there is ongoing support for professionals about how to support birthing people during emergencies so that they trust those caring for them and the situation is explained. Birth workers play an enormous role in preventing birth trauma, and while it is true that we cannot eliminate emergencies and completely take away peoples suffering, we can make people heard, ensure that birthing people and their partners are at the forefront of decision making and shown respect within the birth space at all times.
If you have had a baby and think you may be suffering from birth trauma you may benefit from speaking to the hospital where you gave birth about having a debrief, however if this does not feel like the right option for you can contact the Birth Trauma Association for more information and support, PANDAS foundation who support people suffering with postnatal depression, you can also speak to your GP about a referral to Mind charity, perinatal mental health (who support pregnant people during pregnancy and for a year following birth) or talking therapies. You can also make a self-referral for mental health support if you feel that you need it. Remember you are never alone, there are always people who have experienced what you are going through and who have come out the other side.
For some people the thought of pooing in front of other people is mortifying, which is understandable, however, childbirth is a really unique situation. The people who care for you during the birth of your child, whether it is midwives or doctors, are very comfortable and used to seeing people poo during childbirth.
Why do people poo during pushing?
When a baby's head is passing through the vagina it squashes everything flat to make room for rather a large cargo! People often urinate at this time as well as poo for this reason. If there is any faeces in the rectum this is likely to be squeezed out as the sensation of pushing the baby's head out is similar to that of going to the toilet. For birth workers, seeing poo is actually a positive sign that you are pushing in the right place and that your baby's head is advancing.
What makes the risk of pooing higher?
- Being constipated
- Having an induction of labour
- If you haven't been for a day or two
- If baby is back to back
- If you are unwell
Will I lose my dignity?
NO. There is no reason to lose your dignity in labour, it is your birth worker's job to support you and make sure you feel respected and protected. If you do poo during the pushing stage of labour, your birth worker will discreetly dispose of it. We will make sure you stay clean and comfortable so you don't have to worry about anything other than staying in the "zone".
How can I prevent it?
If you naturally labour, often you will need to poo several times during your labour, so your body naturally clears everything out. If you are induced and haven't been to the toilet for a couple of days you can ask your midwife for an enema, there are different types of enema so be sure to ask whether they're going to use a cream, gel, tablet or watery solution so you know what to expect. Sometimes, even if you have been regular during the final days of your pregnancy, or if you have an enema or naturally have a really good clear out, you still poo a little bit while pooing, but this can actually be a good thing!
Why is pooing in labour beneficial?
Pooing in labour benefits you by increasing the diameter of the birth canal so that baby can pass through more easily. It also benefits baby, if they come into contact with a small amount of faecal particles during childbirth they will start to colonise their microbiome (the good bacteria that helps them to build immunity and fight infection as they grow).
So don't worry too much about pooing in labour, it happens, it's not a big deal to those caring for you and we will try to keep you feeling powerful and amazing throughout your labour and birth!
TRIGGER WARNING - this post talks in detail about perineal and other types of vulval damage, please protect yourself and avoid reading this if you feel it will be traumatic or unhelpful
Lots of people are worried about whether they will tear when they give birth. It is an understandable fear, so let's talk about it!
What is it?
There are a few types of damage we can sustain when we push a head out of our vagina.
Have you heard of labial grazes? These don't get mentioned a lot but they're a small split in your labia and while they don't tend to cause too many problems, and often don't require repair, they can make that first wee blooming stingy!
A "first degree" tear is very superficial, it is just a split in the skin and unless it is bleeding, the midwife may leave this to heal on its own.
A "second degree" tear is the most common, this involves some skin and a little bit of the muscle. This will need to be repaired and is usually done by a midwife or doctor in the room where you gave birth
There are also third and fourth degree tears are rare but serious, they involve your anal sphincter. There are other rare types of tear which involve the urethra or clitoris which are extremely rare. These will all need to be repaired by a doctor in theatre, you will be given a spinal anaesthetic so you don't feel it.
An episiotomy is a cut to the right hand side of your perineum and is there to either avoid the types of tear in the paragraph above, to help you deliver your baby very quickly if their heart rate is becoming a concern for your midwife or doctor, or if you have an assisted delivery with ventouse or forceps.
Episiotomies are rare in normal deliveries and should not be done without very good reason. You can have an elective episiotomy if you have had a 3rd or 4th degree tear, this will be discussed with you in your pregnancy.
If you require an episiotomy for an emergency reason during your labour this should be discussed with you. It doesn't take long to explain the reasons and what will happen, even when time is critical, it is always your decision whether you have an episiotomy or not.
Why does it happen?
The most common reason is baby's position, if baby's head is either facing upwards (back to back) or is a little off centre, this can cause more damage than if their head is facing backwards.
Another reason this may happen is if baby's head is born quickly, breathing your baby's head out will minimise damage (although I am well aware this isn't always possible!)
Genetics! Some people are just more likely to tear.
Your position, some positions tend to have more perineal damage than others, if you are squatting when you give birth, you can put your hand on baby's head as they are born and ensure they come out slowly.
What can I do to minimise the risk?
Get informed! The best way to do this is (obviously) reading my posts... But taking antenatal classes will give you time to talk, ask questions and really get prepared for your labour.
Perineal massage - I will be putting out a post about this in the near future but there is lots of information on google about how to perform perineal massage, you can do it yourself or get your partner to help. The point it is to gently stretch the skin of your perineum, to stretch it further each time you do it and hold it there for several seconds. The best time to do it is straight after a bath, somewhere warm and when you are comfortable and relaxed.
Encourage your baby to be in the right position for labour. You don't have complete control over this but you can spend lots of time on your birth ball in the last 3 weeks of your pregnancy and hopefully baby will take the hint and move to the right position!
BREATHE! There is nothing more beneficial for minimising tearing than breathing your baby's head out. You have to allow your perineum time to stretch, your hormones and blood supply have increased to this area over your pregnancy and it's ability to stretch has increased 100 fold. Allow it time and breathe while you feel the burn, the burn is good, it means you are stretching! You can do this!
How do you repair it?
Perineal damage is repaired with sutures, this is normally a continuous thread of stitches and has a little knot at either end. Sometimes interrupted (individual) sutures are used, but this is based on who is doing the repair and what they feel is best for you and your healing.
1st and 2nd degree tears are normally repaired in the room you give birth in with local anaesthetic, we put lots of local anaesthetic into the area we will be suturing and ensure you are not in too much pain, if you are you can ask for further pain relief! You can also have gas and air.
3rd, 4th and other rare types of vulval damage will be repaired by a doctor in theatre, you will be given a spinal anaesthetic so you won't feel anything during this procedure.
It is actually your decision whether you choose to have your perineum sutured, you can ask for it to be left to heal on its own if this is what you would prefer. Discuss this with your midwife or doctor at the time.
How long does it take to heal?
Smaller tears can take just a couple of weeks to fully heal.
2nd degree tears may take up to 6 weeks and even then you may feel some discomfort, it is important to speak to your GP and ask for a physio referral if you are still in discomfort after 6 weeks.
3rd, 4th and other types of tear can take longer to heal, they can take a few months and you will need to undergo physio therapy to ensure you get back to your normal.
What can I do to help it heal?
Be kind to yourself, try to minimise over stretching, don't engage in sexual activities until you feel completely ready and when you do, take it slowly.
Keep your vulva really clean, don't use soap for the first 6 weeks but make sure your pad is changed regularly and you are showering daily. Also wash your hands BEFORE and after going to the toilet. This will minimise the risk of infection.
Pelvic floor exercises! These are so important for EVERYONE postnatally but especially those who have had a tear. Take it slow, be gentle and if it is causing pain, stop. Try to do some daily and slowly increase the amount you are doing. This will increase blood flow to your perineum and help it heal.
Eat well. Eating foods high in vitamins, minerals and protein will support your body to heal. You should also keep your diet high in fibre as straining to poo may cause extra damage, so drink plenty too!
You may see a stitch on the toilet paper on in your pants after a few days or weeks, this is totally normal and a sign that your perineum is healing well!
Make sure you speak to your midwife or GP if you think you are getting an infection or your wound is breaking down and coming open, this is rare but something you should know to look out for.
Joelle xx
Do you ever just sit and watch them while they sleep? If they’re not twitching or making noises, do you worry they’re not breathing? Do you wake up in the night and lay your hand on their tummy to feel their breathing?
It could be completely normal worries that every new parent goes through, or it could be the beginnings of postnatal anxiety.
Postnatal anxiety is really common, it is normal to have some anxiety about the precious little human you’ve just brought into the world, but it can make you feel exhausted and if it leads to obsessive behaviours you may need support from a mental health professional to help you manage these.
Postnatal anxiety can manifest as hypervigilance, where you feel it is necessary to watch baby closely when they are sleeping, even to the detriment of yourself.
Sometimes there are really logical explanations for hypervigilance. If your baby was born prematurely, small, was ill after delivery, if they spent time on neonatal unit or if they were ill after they were born, there is a very logical explanation for it, but it is important to recognise that this behaviour can become damaging to you and your family if left unchecked.
For me, my hypervigilance came from three places, the first was my experiences as a midwife, the second was my previous pregnancy loss, and the third was when Charlie’s heart condition was diagnosed. These were all massively life changing experiences in my life and led me to routinely lie awake watching Charlie, wake up several times a night to feel that he was breathing and to worry that I’d go to wake him up from a nap and he wouldn’t wake up.
It may be that your hypervigilance doesn’t come from any specific experience, just that you can’t stop checking them. This is associated with our primitive instinct to ensure their safety gone into overdrive. You are not alone if you are feeling like this, we are all navigating this crazy world of becoming a new parent, it is tough but you are doing an amazing job!
Here’s some things to remember;
- If your baby is at home with you, it is because they are healthy and well enough to be there, unwell babies aren’t routinely discharged
- There will always be horror stories, exceptions to the rule and someone who had an awful experience, but these cases are very, very rare, that is why they are so shocking and heart breaking
- If you are following the guidance for safe sleep and making your baby’s sleep space as safe as you can, you really cannot do any more
- Formulate strategies that help you cope. I have to give Charlie medication at 10pm for his heart, I go in and I know he is fine at that point, his door and ours is open overnight so I can hear him, I have the monitor on but facing the floor so it isn’t shining brightly in my eyes but I can check it if I want to. Maybe add a goodnight kiss into your routine when baby is sleeping in a different room to you, this way you go to bed knowing they are safe and well
- Don’t punish or berate yourself for being vigilant, it is not a bad thing to check on your baby but try to find a balance. Telling yourself off will not help you to feel calmer
- You are tired, staying awake watching your baby instead of sleeping will make you more tired. Sometimes it is just impossible to sleep and repeatedly telling yourself you should be sleeping only makes it worse. Make yourself a cup of decaf tea or coffee, have half an hour to yourself (not watching the baby but somewhere you can hear them) and reset before trying to sleep again.
- Know when to get help. PANDAS has great support, you can also speak to your midwife, health visitor or GP about getting support.
- It may be hard for your family to understand why you feel this way but it is important to get help if you need it, this is not something that will harm your baby and it is not something that would make social services get involved so you don't need to worry about stigma, it will stay private between you and your health care professionals unless you decide to tell someone
- Looking after you is just as important as looking after your baby, you cannot pour from an empty cup and if you are run down and struggling to function everything will seem harder and more of a challenge
Finally, always remember that everything is a phase, this will pass, so will the times where they wake up every hour through the night. They grow and change and so do we. You are amazing, you CAN do this!
If you're wondering how to check your baby is well, head to the downloadables page and download my Baby Care guide for free! This will really help you when deciding if your baby is ill or just doing normal newborn things.