​“Birth is natural...”
“Thousands of women have done it before you…”
“That happened to me, and I got over it...”
“Everyone’s got a story...”

Perhaps it’s that last comment, meant in a throwaway “your story is nothing special” kind of way that really makes me feel sad. Yes, everyone does have a story. And every story is important.

​Unfortunately, whether your birth experience was good, bad or downright harrowing, sometimes you’re made to feel like you should just ‘move on’; as if the only outcomes that matter are that mum and baby are alive. Let me tell you, as a postpartum doula, I’ve heard many a birth story from a mother who is ‘alive’ in the sense that she’s breathing, but her heart and soul have been crushed by an experience she never could have imagined.

Sometimes it’s the result of a genuine and rare medical situation and it’s only by the grace of God and modern medicine that she’s alive to tell that story. Other times, tragically, it’s the result of a jaded midwife or overworked obstetrician who’s said or done something, no doubt inadvertently, but it’s scarred mum in a way that can’t be seen but is immeasurably felt.

Sometimes, it’s been a situation where mum was left feeling like she had no voice, therefore no choice. Things may not have been explained clearly enough for her to interpret between contractions. It’s not always possible to make informed decisions in a state of utter exhaustion.  Sometimes I feel that the ‘everyday-ness’ of the job for the medical professionals means that the miracle unfolding before them gets forgotten. It might be the fourth baby they’ve seen into the world that shift ... but it’s the first for the couple in the birthing suite. That is a sacred time that should not be rushed, interrupted or taken for granted.

​Then there’s the other side…

If you had a wonderful birth experience, I am genuinely excited and thrilled for you. And you definitely have the right to share that positive experience (quite frankly, not enough positive birth stories get told). BUT (there’s always a 'but'), be mindful of how you share it. If you have a friend who had a tough, or even traumatic birth experience, there’s no reason why you can’t refer to your own positive experience so long as you listen to her first, then empathise with her ... and finally, with kindness and compassion, ask if there’s anything you can do to help her change that next time around. Can you recommend a particular mode of pregnancy care? A wonderful practitioner? A beautiful doula? A talented birth photographer? A great hospital or birthing centre? An experienced chiropractor, massage therapist or acupuncturist?

Either way, whether your experience was really positive or quite the opposite, if you don’t debrief about it at some point, it will resurface and need to be worked through (often more so if it was a negative birth experience). Many mums find that they can stuff those feelings away and just ‘get on’ with the full-time role of being mother to a newborn … until they fall pregnant again. Suddenly, the thought of giving birth again can paralyse them. With the right help, this can actually be a catalyst for making different decisions and setting up a great support network for birth preparation, the birth itself and the postpartum period.

​Some mums find that their birth experience was so traumatic that they actually can’t be the mum they wanted to be. They can’t bond with their newborn, often experience feeding problems and sometimes, are in such anguish mentally and emotionally that they actually can’t look after themselves, let alone their baby. So whilst it’s often enough to just debrief with a friend, there are definitely situations where professional help is needed.

Here at The Nurtury, we offer birth debriefs as part of our Baby Care classes as well as in a more intimate home-visit setting. Sometimes, gaining insight from a midwife or doula (people who know birth), can help explain why things happened the way they did. This can offer some closure for mums who perhaps feel disappointed that their birth didn’t go according to plan. Sometimes they’ve come to terms with how things went, but would like some tools to empower them for next time.

We see the benefits of a good and safe debrief so often. We have quite a number of mums who say “I wasn’t going to come today; I haven’t been able to talk about my birth because I cry every time I think about it”. And yet, it’s these mums who, after talking, walk away from that session visibly lighter. It’s truly amazing. But what makes me sad is thinking about all the mums who don’t get to safely debrief about their birth. Who don’t get to have their questions answered. Who think they just need to move on … until they find themselves faced with birth again and they realise they haven’t. Or who spiral into postnatal depression, because the pressure just builds and builds.

​As parents we put a lot of trust in our health professionals, as we should, but it is also important to be well-educated ourselves in what is happening with our baby and the very best ways to help them. This blog will give you the tools and confidence to manage reflux to the best of your ability, alongside your health professional. Here are the facts...
 
SIMPLE REFLUX
Simple reflux is when the contents of the stomach are brought back up/regurgitated either into the oesophagus or mouth.

• It is very common in infants, and usually resolves itself over time.
• Some vomit more than others, and it doesn’t necessarily mean anything is wrong, or that they’ll have problems later in life.
• Switching from breast to bottle is unlikely to have any effect. It’s simply a matter of waiting for your baby to outgrow it. BUT, we can help you manage that road as smoothly as possible.

Colic is often incorrectly diagnosed as reflux and many babies unfortunately end up on medication when it is not the best solution, nor is it in the best interests of their baby. See our blog on Colic when beginning your reflux journey. This may be all you need to make a significant difference for you and your baby.

​STOMACH ACID ISN'T ALWAYS THE ENEMY!

• Stomach acid is often the assumed cause of a baby's reflux pain, but very rarely is the issue an overproduction of acid.  Homer, A. (2018).
• According to a study of 1,300 babies, 60% of babies continued to have reflux issues despite taking medication. Only 22% noted a dramatic change once on medication. Homer, A. (2018).
• We need our gastric acid to build our immune system, trigger the digestion process of proteins and absorb nutrients. Journal of Paediatrics UK (2012). It is not in our baby’s best interest to suppress that acid if that is not the cause of the reflux.
• Many reflux medications are designed to decrease stomach acid in the hope of reducing pain. This means those babies that are medicated have a decreased ability to digest food in the stomach. Protein is mainly digested in the stomach through a process requiring stomach acid. Partially digested protein in the intestines can trigger allergic reactions that may not have occurred if the protein had been allowed to be properly digested in the stomach. How? The immune system in the intestines mistakes undigested protein as harmful and launch an attack. The body then learns to have an allergic response. Homer, A. (2018)
• A study in 2013 of children on gastric acid suppressing medication showed a 367% increase in allergies, compared to those not on the medication. All studies come with an assumption of appropriate controls and research, but this definitely provides food for thought. (Researchgate.net - Development of food allergies in patients with Gastroesophageal reflux disease treated with gastric acid suppressive medications).

​FOODS FOR REFLUX BABIES AFTER 6 MONTHS OF AGE

• Aine Homer helps us to understand the production of acid in the stomach. The types of foods we eat controls the amount of hormones we produce, which in turn affects the amount of acid we produce. So, a baby’s stomach produces acid in response to the hormones released, which was in response to the food ingested. We need to be mindful of what foods we are giving to our little one as they may be either easing or increasing reflux symptoms. This is good to keep in mind when a baby starts solids. Parents often notice an increase in reflux symptoms when solids start.
• Remember that our food is for energy, nutrients and enjoyment. It is not just to fill their little tummies up. Foods such as rice, pasta, bread and cereals can flare up reflux symptoms as little ones don’t have the appropriate enzymes to digest these heavy foods. Homer, A. (2018).
• Instead, focus on nutritionally dense foods, e.g. an egg compared to a piece of white bread. Fats are also essential for brain development (e.g. avocado, fish and nuts) and they wont ferment in the gut like simple carbs like white bread can. Homer, A. (2018).
• 0-2 year olds digest simple proteins well. Cows' milk is a complex protein. Simple proteins include chicken, eggs (unless allergic), lamb, nuts, oily fish, pork and cheese (if no cow’s milk protein allergy).

​FURTHER NOTES REGARDING REFLUX MEDICATION
The concern is that medication may be treating the symptoms, not the cause. If you can eliminate the cause, then you eliminate the need for medication. My heart breaks when a child is put onto reflux medication when they are actually just an overtired baby.

It is essential to explore other options before resorting to medication, as:

1. The medication may not help the cause of your baby’s reflux, but rather just mask the underlying issue.
2. The medication can sometimes be a harm not a help.

We are so very careful with how we care for our babies - our alcohol intake, the creams we put on their skin, the first foods we give them. We then trust a chemical medication to solve their pain without first trying to solve the problem in a simpler and possibly safer way. Reflux medication has a place, but perhaps not to the extent it’s being prescribed.

Gastric acid suppression medications have been blamed for stopping the effective absorption of magnesium which is essential for:

• the absorption of other minerals
• the body’s use of some vitamins
• many essential metabolic processes
• the absorption of vitamin D and calcium

Is it wise to have medication as a first line of treatment? In her book, as referenced above, Aine Homer covers some useful information on different reflux medications. Here is a brief summary, but her book provides a more comprehensive helpful guide.

• Alginate medications (e.g. Gaviscon) are very mild and are not necessarily very effective. They draw  water out of the body to form a gel. This can dehydrate and constipate your baby and cause bloating.
• Antacids neutralise the stomach acid. They do not help with wind or bloating and may cause stomach cramps, diarrhoea and wind.
• H-2 Blockers (e.g. Zantac) reduce the amount of acid produced (which is not always a good thing). They can cause bloating and wind due to the sugars in the medications not being able to be digested. They can cause diarrhoea and headaches.
• Proton Pump Inhibitors (PPIs) - The US Food and Drug Administration have issued safety warnings for these medications due to increased risk of fractures, cause of vitamin and mineral deficiencies, constipation, wind and gastrointestinal disturbances.
• Be aware that when weaning from medication there can be rebound acid production from some medications. This means symptoms may be worse for a few days before they improve. 

The world of reflux disease is very complex, and you can see that it is very wise to have reliable health professionals by your side guiding you as you navigate this very tiring disease. Ingrid and I at The Nurtury are here to support you either over the phone or in person as you navigate this journey. We would also be more than happy to connect you with like-minded health professionals.

​Mums often come to see us at The Nurtury saying that they have been to other health professionals who have said “It’s just colic; they’ll grow out of it”. The poor mum is then left to manage a very sad, tired and hurting baby whilst trying to manage her own sleep deprivation. There are many things you can do about colic. It is real; there is a cause, so let’s find the solution.

Colic is defined as:

• Uncontrollable, extended crying in a baby who is otherwise well. They scream for at least 3 hours per day, at least 3 times per week, for at least 3 weeks.
• It’s often described as a ‘mystery’ and many doctors are unable to find the cause.

Baby appears to be in pain, have a tight tummy, pull their knees up, pass a lot of wind, often have green, frothy poos and scream, writhe and grunt.

​SO WHAT DO WE DO?
Ingrid and I follow a simple checklist before we jump to anything more serious. This simple checklist has made a significant difference to so many mums and babies. See our blog on Reflux for further help beyond this list, or give us a call.

Colic is almost certainly a feeding issue…that causes a sleeping issue…that affects the feeding issue (in cases of reflux, it could be a food intolerance or may be a more serious illness).

• Knowing your baby’s cues and responding appropriately is KEY.
• If your baby is tired then he needs help getting to sleep. What he doesn’t need is more food, as this will compound the problem.
• If your baby is hungry, he needs to have an effective feed.
• This is where demand feeding may be problematic.

We want to ensure that your baby is getting a full feed from one breast before you move them onto the other breast. If they are just getting a short feed from each breast or you have an oversupply of milk, their little belly may have an issue with lactose overload.

LACTOSE OVERLOAD
Lactose overload does NOT mean your baby is lactose intolerant (that’s a cow’s milk issue); it just means an excess of foremilk in their little tummy.
If your baby has lactose overload, they:

• Will be unsettled
• May often scream
• May pull knees up
• “Appear” hungry
• Want to suck
• Have good to large weight gain
• Have heavy, wet nappies
• Will often have explosive, green, frothy poo

The excess lactose from your oversupply, or excessive feeding from just the front milk (or ‘foremilk’ – the sugary milk), does not get digested and so it ferments in the bowel whilst drawing in water. This fermenting causes gas and fluid in the bowel, showing as tummy pain, screaming, pulling legs up and wanting to suck for comfort not food.

Remember - not all sucking means hunger; it can be a way of your baby saying “I need comfort”. 

OUR CHECKLIST

1. Try changing from “on demand” feeding to 1 breast per feed or block feeding. Allow the other breast to drip whilst feeding. Try and allow 2 ½ - 3 hours between feeds to allow the gut to settle. If this is not effective, there may be another issue requiring extra help.
   
   Pay attention to your baby’s nappies. Green, frothy poos can indicate that your baby is receiving too much foremilk and it can cause quite nasty tummy upsets. A good solution here is to express off some of the foremilk prior to a feed. Foremilk is not bad, but too much of it can cause issues.
   
   Having looked at lactose overload and changing to full feeds from one breast 3 hourly, try these other tips:
   
   
2. Have your baby in a more upright position to feed. This allows burps to come up more easily.
3. If you have an oversupply, you can try expressing off the first 30mL before the feed begins. It is wise to chat this through with us first.
4. When you feel a “letdown” or you notice your baby suddenly gulping, take them off the breast (much to their distress) and allow that milk to spray into a cloth nappy or bottle. This will help your little one to avoid swallowing too much air, which is a huge issue with colic and reflux.
5. Diet can also play a part. Many will tell you “Your food makes no difference!”. From years and years of experience, it can! If it gives YOU wind, it may well give your little one wind. It’s different for everyone and you will need to experiment. It may be broccoli, cauliflower, cabbage, onions, sultanas, grapes, fizzy drink, etc.
6. If these tips have not helped over a period of several days, it’s time to consider mum going off dairy. This includes all cheese, yoghurt, milk, chocolate, ice cream, etc. This can make a huge difference to babies and has prevented many babies from being unnecessarily put on reflux medication.
7. A tongue tie is also a significant consideration. When a baby cannot latch properly due to a tongue tie, they take in a significant amount of air. Unfortunately, very few health professionals are trained to correctly diagnose a tongue tie. Dr Steven Lin at Luminous Dentistry in Long Jetty, NSW, has a wonderful clinic for babies with tongue ties.
8. Is your baby actually hungry or are they overtired and just need help getting to sleep? Ingrid and I are just a home visit or phone consult away to help your baby (and you!) get some more sleep. It is very sad to hear that babies are on reflux medication when they are simply overtired and need help to get some sleep.

Ingrid and I have some beautiful sleep “training” techniques that will help you all to have a good night’s sleep, whilst never leaving your baby to cry for more than 2 minutes without comfort. See our packages page for further information on how to make a booking.
​
Jen Milligan is a midwife and co-founder of The Nurtury with Ingrid Clark.

My beautiful eldest daughter has just turned 15. Being a November baby, I was in a postpartum haze until just before Christmas, when it suddenly dawned on me that I had nothing to put under the tree for her first Christmas!

In a state of panic, and feeling like a very neglectful parent (what sort of mother forgets to buy their child a Christmas present?!), I rushed to the nearest department store in a late night shopping frenzy.  Being my first child, I wanted to buy something gender-neutral in case my next one was a boy. That way, it would be suitable for years to come. Having just received lots of items at my baby shower, she wasn’t really in need of any clothes or bedding. I’m not much of a keepsake person, so I wanted the gift to be practical. After roaming the aisles searching for ‘the perfect gift’, I lost any perspective I might have had, and unfortunately made a very poor choice.

That Christmas back in 2003, my daughter ‘opened’ her first present: an awful electronic play gym. Not only was there a selection of dreadful electronic tunes that blared out at one of two volume settings: ‘loud’ or ‘louder’, but when my daughter kicked her cute little feet they would activate a virtual discotheque of flashing lights, guaranteed to overstimulate any baby!

I think it lasted 1 day. She hated it…and so did I! I’m not sure what made me more sad; the fact that my sweet, content baby girl was totally traumatised by my choice of gift, or the fact that I wasted $80 on it. Either way, it was a stark lesson. My baby didn’t need an $80 toy. My baby didn’t even need a ‘gift’ in the material sense. All she needed was to be surrounded by love, to be fed, cuddled and settled to sleep without being overstimulated by flashing lights & gaudy music. To quote my wonderful business partner Jen, “the very best toy is YOU”. Your baby will be more emotionally full after seeing your smiling face, hearing your sing-song voice and looking into your eyes. No toy on this planet can come close to matching that!

So with Christmas just around the corner, I want to encourage you that the best thing you can do for your little ones is to keep the stress low, and stay emotionally connected with them. They couldn’t care less if there’s a present under the tree with their name on it or not. Don’t let yourself be guided by all the pre-Christmas advertising. I wish I had paused for a moment to think clearly before racing to the shops 15 years ago. Hindsight is a wonderful thing, but if I had my time over I would have bought just something small for her and put the rest of that money into her first bank account.
​
May you all have a blessed Christmas, surrounded by family, love & laughter (with no electronic play gyms in sight!).