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
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!
It all started with me cleaning the house, it took me 3+ hours to do the bathroom alone (it is a very small bathroom!) because I was getting irregular surges and kept having to stop, I got on my hands and knees and wiped the floor... twice and by the end of it I was having surges every 15-20 mins. I didn't tell my husband as we'd had so many false alarms during the previous 3 weeks that I didn't want him to get his hopes up and be disappointed if it wasn't the real deal. I'd had a clear mucousy show on Wednesday (27th) though so I thought maybe this was going to be more significant.
I started timing surges about 6pm, they were sporadic so I carried on as I was, we had dinner, I used the breast pump (I've been antenatal expressing as I have inverted nipples and wanted to make sure I had a small stash if baby struggled to latch) and the surges increased to 1 every 6-8mins over the next couple of hours, I was having to breathe through them but I still hadn't told my husband as I wasn't sure this was labour, so I was sneakily breathing them through while sat rolling my hips on my ball.
We put Rocketman on and turned the lights down, I tried to snuggle up with my husband for some oxytocin but I was too uncomfortable lying so I just sat next to him curled up. After half an hour or so I had to hold his hand for support while I breathed through the surges, about 9pm, so I finally told him I was tightening. I messaged my mum to make sure she was home and didn't have plans to go out overnight (I don't know where I imagined she'd be going tbh!) and to make sure she knew her phone needed to be on loud if I needed her. I messaged Janie around 10:30pm a picture of my surge timings to let her know we might need her overnight so she was prepared but that we were coping well at the moment.
My husband set up my birth space with fairy lights and put battery powered candles up the stairs, around the bedroom, bathroom and living room so we didn't need to turn on any bright lights. I tried to sleep but struggled to get settled, I kept opening my bowels which I knew was a good sign and wanted to make sure I got everything out before going in the pool! I put the TENS on around midnight and downloaded the Freya app which was SO lovely, the music and the counting really soothed me.
My husband really wanted to blow up the pool but I still wasn't sure this was the real thing (lol!) so I didn't want to scare off the surges by getting too excited, at half 1 I yielded and let him set it up if it would put his mind at ease. I told Janie things felt like they were ramping up but that I was coping, the pool was up with the liner in and hose ready but not filled, I really didn't want to get in too early if this wasn't the real thing (anyone seeing a pattern here 🤣🤦🏼♀️).
I tried to get some rest and slept between surges until about 3am, everytime I started to surge I clicked my app, clicked boost on the TENS and breeeeathed. I felt like I was coping really well but if my routine was interrupted by needing to go to the loo or my phone being locked instead of open on the app I lost it a bit and felt more uncomfortable. My husband came to tell me he had filled the pool if I wanted to get in, my surges were lasting 60s and I was having 3-4 in 10 minutes now so I thought it was a good idea. I had a bit of pinkish loss and knew that was a good sign, I kept feeling sick so I was making my husband carry around a bucket after me 🤣 and knew this was a good sign too, although I did ask him if he thought getting in the pool was a bit dramatic in case this wasn't the real thing.... I was so comfortable every time I went to the loo that I ended up staying there for a 5 mins every time I went, it felt so good to sit in that position, better than standing, squatting or all 4s.
I made my way down to the pool, taking the TENS off was a worry as I'd been relying on it so much but omggggg the pool I felt lovely as soon as I got in at about 330am, I loved the smell of it as well, as weird as that sounds, I love swimming and have really missed not being able to go during lockdown, the smell was so nice and comforting. The first few surges in the pool were a little more difficult as my little routine had gone with my TENS, I stopped timing them but carried on listening to the app as it was so soothing. At some point my husband switched it to the music I'd used for my hypnobirthing which was even better. I got the hang of the surges in the pool and just rolled to my left for one then right for one, between them I felt so good, the relief made me feel high and I LOVED those in between moments, I felt like I was really enjoying myself.
My husband was keen to call my mum, I didn't want to wake her up too early so he called her at 4 and she got there at 420am, I told her to just have a cuppa in the living room, I didn't want to feel observed but I was so glad she was there, she had 3 homebirths and had complete faith in me which felt great! My husband never left my side and as the surges got more intense I relied on him to get me through them, he was so fab reciting my affirmations, telling me I was doing amazingly and that I could do anything for 60 seconds.
My husband had been messaging Janie and keeping her posted but at 5am I decided I was probably in labour (yes, it genuinely took me that long to believe it!) and really wanted Janie there to support me too. She arrived at 525am just as I was getting guttural and feeling that if there had been anything left in my bowels it would've come out at that point, luckily I'd cleared it all out!
I had a couple more surges while Janie set up her bits and by my own sounds I knew I was getting into the 2nd stage, I said to Janie "I sound a bit second stagey don't I?" and she agreed I definitely did. She offered a VE and palpation but I declined, did my BP and temp which were normal and listened in to baby who sounded great, he'd been moving well all through my labour so I hadn't been worried, but it was nice to have the reassurance.
At around 540am I felt his head start to descend and felt my body take over, I never actively pushed I just let my body do its thing. I asked my mum to come and hold my right hand while my husband continued to hold my left, it was amazing to have their support either side of me, I drew so much strength from them.
As his head came down I felt much better, the last few surges before my body started pushing were tough but keeping my mind focused was absolutely key. I have been fortunate enough to see many women do this, I let their power be my strength and imagined them birthing with me, Janie told me I was safe when I started to whimper and I really needed to hear that, I asked my mum and husband to keep telling me I was safe and I trusted my birth team so much I knew they were right. Between surges Janie was doing some notes and as they came I called (screamed?) her back, my eyes were tight shut but I could feel her presence when she was there and felt much better knowing she was right with me.
I felt like I was quite loud as his head came down, I felt like it was a looong way for him to come, it burnt the whole way down but not unbearable, I knew about the ring of fire but I didn't think it would burn before that as well. The pushing stage was a lot more enjoyable than the end of the first stage. I felt his head going forwards and backwards, I loved the relief between them it felt amazing when his head drew back and I got a little breather, I kept saying "ok, ok, ok, I just need a little break now" and one came when I needed it, it was great! Janie said baby was moving down really well and I should feel it, I asked "is the head was nearly out or is it just PP visible", she reminded me that "JUST" PP visible was fantastic and nearly at the end! I thought I'd want to guide his head out myself but I just needed my hands held by my mum and husband, they were fantastic anchors. I did reach down to feel him at one point which I'm glad I did, I felt his little head rolls and knew he must've looked like a walnut .
I knew the head was starting to stretch me and made a decision to stop making noise and to focus, I knew I was safe, I knew to expect the ring of fire and I've heard women say they thought they were tearing but in reality they weren't so I went over this in my head (randomly, I also thought about that bit in Twilight where Bella turns into a vampire but she knows screaming won't lessen the pain so she just deals with it in silence 🤷🏼♀️ don't ask me where that one came from!). I recited to myself I am safe and I am stretching, my mouth was open and relaxed, breathing deeply, and with each surge I allowed him to come further, and thanked him for going back a little to let me have a break. I couldn't believe how much I was able to stretch but I wasn't scared at all, I knew I could do it because billions of women have done it before me, I was never scared at that point, I completely trusted my body.
His head came out slowly and calmly, I felt his face wiggling as he came out lol! People say there's relief after the head but I didn't really feel that, everything continued to sting and I shushed everyone when they started to get excited about his head being out because I still needed them, I knew my job wasn't done and wanted them to wait before they got emotional. I heard my husband starting to get teary and said "don't lose it now, I still need you, hold it together." It was a minute or so before my next surge, I just breathed deeply feeling his head out and waited for another surge, as it came I felt his shoulders come, I knew I wanted to birth his body as slowly as his head so I took my time gently birthing him which took a couple of pushes, Janie told me to pick him up and I lent forward and grabbed him, the first thing I did was check if he was a boy or a girl, I felt so many emotions, my vulva was stinging, my son was born, my husband was over the moon, my mum was ecstatic, I was a mum, my baby was here, I DID IT! I. DID. IT! I couldn't stop saying "I did it!" Everything I had dreamed of had actually happened!
I wanted to feed Charlie in the pool and felt like he probably would've had a suckle but the water had been topped before he came so it was a bit too full for me to feed him. We stayed in for about 20mins, I had a couple of surges and my body had a little push for the placenta but just a couple of blood clots came so I held Charlie and we made our way to the sofa, Janie laid out puppy pads in a row and gave me one to hold between my legs, my mum wrapped a towel around my shoulders and my husband supported me to climb out of the pool, they really were the best team ever! We lay on the sofa in our towels and I tried to get him to suckle but he wasn't really having any of it. I just looked at him and felt so full of love, I felt a big surge come after about 10 mins and my body pushed out the placenta about 35mins after delivery, we had a shower curtain and a couple of big inco pads on the sofa. Janie tied the cord and my husband cut it, Janie checked my perineum and told me I hadn't torn, I was over the moon! I knew I had labial grazes because that's what stung the most as his head was crowning, they didn't need any sutures though.
I can't remember what order everything came in next, I sat up on the sofa and tried to feed, he was rooting beautifully but didn't latch, Janie weighed him and we found out he was 8lb 15oz and we were all amazed! My husband had skin to skin while I was checked and then my mum had skin to skin while my husband helped me have a wee and get some clothes on. I couldn't believe how amazingly everything had gone, I took some paracetamol and just sat and soaked up all the joy and love around me.
I couldn't have hoped, wished or prayed for a more incredible birth experience, I still feel like I'm on cloud 9! I've never been a super positive person but I feel so proud of myself that I was able to completely trust my body and my baby. My birth team were just incredible, I'm so over the moon we had Janie, we knew each other so well that there was a lot of trust between us, I know that made a big difference to my confidence.
Over the last couple of days Charlie has picked up feeding like an absolute trooper! We are just over 48h and his poos are already turning seedy yellow! I'm so proud of him, and my boobs! Hypnobirthing really helped get my head in the game in the build up for labour, I'd highly recommend it!
I can't imagine having birthed without the pool, it was so hard to move at the end of pregnancy and that weightless feeling was absolute bliss!
I still just can't believe I did it!!
39+5 (by scan)
FTM and midwife
Surprise baby boy
8lb 15oz
No examinations
Bilateral labial grazes - intact perineum
TENS, hypnobirthing and water for pain relief
12h from first tightening
Approx 5h active labour from regular, intense surges
20min second stage, no directed pushing
Physiological 3rd stage
Independent Midwife Janie Al Alawi
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.