 Hi everybody, I'm Tracy Donoghan. Thank you so much for joining me today. It's I know we're kind of getting to the end of this amazing 24 hours. I'm Very excited to kind of get logged back in and look at everyone else's presentations because I have to say this Organization does an incredible job year over year and the quality of the presentations gets better and better And it's amazing to see what's really happening out in the birth world around the world with that with other midwives and birth professionals, so I thought I would I guess Throw throw a little spanner in the works out there because I really think it's time that we rethink Reservating preparation and I came across a study there a couple of days ago and it Mentioned that 85% of postpartum women are going to experience some kind of mood disorder during postpartum like 85% of mothers just keep that number kind of in the back of your mind and and I'm sure you are probably as frustrated as I am and And if there's any duelism the group and and just how women are being I guess how breastfeeding is being presented to women in classes and What we can do to make sure that women are getting really good information And are getting good evidence-based information when it comes to breastfeeding So I do think it's time to rethink breastfeeding preparation But I'll I'll present my argument to you today and you can decide if fair if you're in agreement or not Or if there's ways that we can connect together and figure out what is going on um This is it's a very famous quote insanity is repeating the same mistakes and expecting different results so scientific knowledge on of ways to make breastfeeding More comfortable To encourage women to breastfeed for longer and to make it more fulfilling. It has the science has evolved But yet we're still teaching complicated holds We are so far from physiologic breastfeeding. It's it's beyond a joke So we need to look at what is the evidence for what I consider to be a mindful breastfeeding program as in bringing um more skills to parents so that it's not just about the mechanics of breastfeeding But the actual impact of the mental impact of postpartum and that absolutely huge Transition But I want to know why hasn't the as hasn't practice evolved with the science and I think you know We all know the answer to that It's the same when it comes to You know pregnancy and birth that we're still looking at outdated non-evidence based Care for an unfortunately a huge amount of women in the world today So just a disclosure that I do have a mindful breastfeeding program and I do receive income from the sale of my books and programs So again, nothing new here. We've like ridiculously low levels of rates in breastfeeding rates over six months when it comes to the us the uk rates are It's and tragic really one percent of uk infants exclusively breastfed to six months So it is definitely time when we look at it. We know the Lancet series a couple of weeks ago and the you know Women are challenged not just with their own thoughts and feelings about breastfeeding their own challenges But society as a whole and marketing uh to to these women So, you know as midwives and birth professionals, we talk about the naturalness of breastfeeding And yet if you looked at a breastfeeding book lately And when you pick up any of the traditionally Recommended books like we're sending women off with a stack of books this height And in the same sentence we're telling women that breastfeeding is natural So we can't have a boat wage. So women are getting mixed messages right from the beginning that yes, it's natural Yes, it's the best for your baby and for you Is it instinctive? Is it spontaneous? Is it easy because that's what the words we would associate when it comes to natural What depends on whose opinion you get if you get the baby's opinion and they've had a healthy straight forward physiological birth Is it instinctive spontaneous easy pretty much if we can set the table really for baby? For mom. Is it instinctive? Spontaneous easy it can be easier if we can look at how we are again teaching women about breastfeeding What we're doing in those initial moments after birth and what parents can do moving forward into that postpartum period So this idea that breastfeeding is natural We we just can't do that and give them books that are 500 pages long, you know, I think um, some of the breastfeeding books are A little bit thicker than some of my midwifery texts where when I was uh back in the day But I wanted to I guess explore more about everyone. I'm sure That is joining me today. I'm going to watch this presentation at a future time understands under undisturbed birth We know that there is a specific set of circumstances that we can facilitate as midwives to facilitate an undisturbed birth But what is happening then we have an undisturbed birth where we can we are stepping back. We are You know drinking tea intelligently Observing and if mom is coping great, we're just there to to smile and reassure her And it should be the same when it comes to breastfeeding after birth So especially again, we're coming to mom having a physiologic straightforward non eventful birth That why is it that breastfeeding that we just can't follow the same kind of rules when it comes to Undisturbed birth We're very quick to get our hands in there and get that baby and breast together Um, so I'm encouraging midwives, especially if you're used to being more hands on That you take a look at, you know, what are the elements of undisturbed breastfeeding? How can we create that for women in our care? So postpartum is considered a predictable crisis So as midwives and birth professionals, we have a professional and a moral responsibility To provide effective safe options to help parents meet those challenges of postpartum with self compassion and acceptance Relaxation techniques just are not enough if we go back to that first Number that I mentioned 85 percent of women experiencing some kind of mood disturbance and postpartum And and if we consider this predictable crisis, we know this crisis is coming in this this mother's life and this and their partner's life but specifically for the mother and we look at The leading direct cause of maternal death in some countries is suicide so How do we help women and their partners prepare For the emotional turmoil that comes with postpartum and that often comes with breastfeeding Are we telling them to relax? Are we telling them, you know, take a breath or think positive? There is no other circumstance where we know a crisis is coming where we would be we would think it was any way appropriate to Not give these parents these life skills We're sending in the way with relaxation techniques for one of the biggest crises really of their adult lives So when we look at what's going on in the brain when it comes to you know Why why would mindfulness of breastfeeding even like go together because most people think it's a it's a relaxation It's a relaxation technique. So In pregnancy, we have a time of these accelerated neuroplasticity There is lots happening with the brain as it changes to get ready for that role of motherhood to bond with this baby Um and to love on your baby So we have our brain is being influenced by external sources and internal sources But for a lot of women, especially in those initial few days of postpartum You've just come out of labor or you've just you know had a cesarean You're exhausted your body doesn't feel like it's working Your brain isn't working. You're in this exhausted fog and So all of this is changing the brain internal environment external environment, but mindfulness has also been shown to create structural changes in the brain And particularly in areas that are associated with positive mood And we can reduce activity. We are all familiar with that fight or flight response We can reduce activity in that stress response just by naming what's happening by interrupting the pattern of thought We also know that the baby's brain is influenced by the environment and that initial environment for those nine months is mom's body So we want baby marinating in those lovely oxytocin hormones and not in a chronically stressed environment Because what that's teaching the brain is are we preparing the brain? For life outside of the womb to be one of thriving Or is the brain being prepared for survival? And that will impact the structural the structure of our our baby's brains as well So then this is it's not about beating ourselves up because you know, we had a stressful day in work when we're pregnant It's about starting to notice our stress responses and react in a different way really to change our relationship with stressful thoughts So mindfulness is the awareness that arises through paying attention on purpose In the present moment non-judgmentally. So And it's really we start off with the awareness. So awareness is we start to notice those dodgy patterns of thought that we might have and I'm going to give you a prime example in a minute that will That will just I guess show this really really clearly So it's first of all it's noticing that I'm aware that I'm having the thought that My baby is really hungry all the time And of paying attention on purpose to the present moment So the the mind is such a great time traveler Spent a huge amount of time that we consider to be at 50% of the time Time traveling. So it's either in the past replaying an event or it's gone time traveling into the future to Create an anxiety around something that has not happened yet But when we look at the components of mindful meditation again, you can see where This idea that it's a relaxation technique completely diverges A relaxation technique is really about reducing physiological stress in that moment and getting the body back to a state of homeostasis Mindfulness meditation. There's specific components and mechanisms that impact what's going on in the mind Impact what's going on in the body. So attention regulation is a big part of that So it's intentionally directing our attention to the present moment. So when you find yourself Going off to Tesco's to do the Going through your shopping list when you're supposed to be doing something else or it's starting to be aware Yeah, the mind is a constant time traveler. That's what it does But oftentimes our mind, you know gets on a train of thought to stress town But when we have the awareness of oh, you know what there goes my mind off to you know stress town again I have an opportunity to shorten that stress response Because I have an awareness of it's the thought that's creating the stress in me and not an external event And then we have body awareness. So you're starting to tune into your body and And as again, most of us live from the neck up. So body awareness becomes a big part of a mindful meditation and Noticing your how your body is connecting with the chair or the ground Noticing what's happening within the body because oftentimes we can We can I guess recognize an emotion in our body before even reaches the brain and the brain decides Oh, that's anxiety or no, that's excitement because the both of them are quite similar physiologically And then there's emotional regulation And this is really I think where where the the meat is when it comes to a mindfulness practice starting in pregnancy You start to learn just to notice your thoughts without judging them We already have enough sticks to beat ourselves up with and not attaching to them So oftentimes what we do is we we want all the good things We don't want bad things to happen and either we push them away or we ignore them Or we find a way to distract ourselves and also changes in the perspective of the self so I often think of When we look at what's happening in those initial moments when this baby has been born And the physiological process of I mean It's just incredible when you when you're learning about how you know the areola changes temperature You know for for the baby coming to find the breast and find the nipple and the the smell of the amniotic fluid and all of this that's that's you know Teaching baby where to find their food source And it's so we there's so much we don't even know about this process and to be able to I think of it as Like the Sistine Chapel if you were to and if you've ever had the opportunity to see it in person um, it's when you look at this incredible Piece of art and ties in nicely with you know the art and signs of midwifery. We look at this art this piece of art Is around around physiological breastfeeding? But I feel like what we're currently doing It's it's not the Sistine Chapel It's like toddler finger painting when we get our hands in there and start trying to manipulate the baby and manipulate Mom especially as you know, we're seeing in more research that moms do not want to have their breasts manipulated or their breasts what they're called manhandled Um, so why does this matter? Why does it matter that we start helping women just notice their thoughts and those thought patterns that can create so much misery? And it matters because you never hear new mothers saying I can't stop thinking all these happy thoughts I just feel blissful all the time Postpartum is a breeze. We never hear that we rarely hear that Um, we usually hear the opposite So there's these default settings of the brain that that makes pregnancy more difficult makes Breastfeeding more difficult. One of them is the negativity bias So it's like the factory settings of the brain or the factory settings on your phone So it is the brain is always biased towards looking for Safety and avoiding danger. So it's always on the lookout for threats So it's much easier for the brain to focus on the bad stuff than it is on the good stuff So, you know 100 000 years ago, we were living in caves and you went out hunting for your your dinner And you heard a rustling in the bushes The mind will almost automatically think it's a tiger It's not going to think hamster because we'd better off thinking it's something bad And then we live to you know to survive another day because the brain did not evolve for Being old zen and and it's the brain evolved ultimately for survival to get our genes into the next generation Um, and then mind wandering forward to talked about that It's the mind wanders about 50 of the time even as you're sitting here listening to me today. You've got there's other Um distractions that are competing for your attention So just being aware of these two kind of factory settings that we all have And how they can impact our pregnancy birth and breastfeeding Negativity bias we're always on the lookout for trouble. So it's much easier for the brain to remember problematic events Um difficult events and then it does to remember something positive So I encourage women in pregnancy to do what I call birth basking as in sitting Uh imagining You you're you've just had your baby and all of those feelings that go around and you're actually rehearsing positive feelings you're rehearsing that feeling of accomplishment and achievement and an absolute Wonder because your baby is now in your arms because if we don't train the brain in that way The brain is automatically going to go to worst-case scenario and unfortunately In the medicalized world that we live in now and the high levels of intervention. This is Women are expecting for things not to go really well So it is a state of heart and mind again, not a relaxation technique It's a benefit It is kind of like a side effect that we experience when we understand the mind and how it works against us Um, especially when we're on autopilot. That's what we consider like a mind mindlessness So we do really say don't believe everything you think especially as a new mom um We And and not just as a new mom. I think it's it's a it's a good life lesson for for all of us because we tend to identify with our thoughts So much it kind of causes More issues and you know people have said to me, you know, mindfulness. It's kind of like a yeah meditation. It's this You know navel gazing, you know chanting and it's like a bubble bath for your brain It's so much more than this and if you're even just getting moms Just just looking at this of not believing everything you think that thoughts are not facts We would be off to a really good start with breastfeeding. So if we look at This scenario here is happening every single day in I'm pretty sure in most countries. It's the same mom same baby, but a different response So if the mom on the left has the thought my baby always seems hungry And we know this is one of the top reasons why women will stop breastfeeding It is that perception that they don't have enough milk and the baby is crying and seems to be hungry So if the initial thought is my baby always seems to be hungry And then it has a You know each negative thought kind of tax on underneath that and it becomes this downward spiral So is he getting enough milk? Maybe my milk isn't giving him what he needs. What if I am starving him? So you can see how it just gets more and more negative To the very end of i'm not enough and i'm a terrible mom From that and that came just she is now this mother has completely questioned her identity Her her worth as a woman as a mother Based on one thought my baby's out my baby always seems hungry So you can see on the left hand side that is kind of the it's a very common scenario for women today If we go to the right hand side and this is a mom who has some experience in mindfulness and has Is now starting to you know practice some of some of these approaches during pregnancy and now into post-cardom My baby always seems hungry. So it's the very same thought But instead of allowing that spiral downward what we have is mom Noticing oh i'm noticing i'm having the thought that my baby is always hungry So by doing that we are creating a little bit of distance between ourselves and the thought Because when we identify with the thought it feels like that that is also that's me. I'm my baby's always hungry I'm not doing something for my baby and it's interesting in when it comes to the language in Like in like in english english-speaking countries. We would say I am sad Or I am anxious or whatever that that feeling is in irish We would say tobronorum, which means literally translated means there is sadness on me But we don't identify with it. I'm not it's when we say in english. I'm sad or i'm depressed It becomes part of our personality Whereas when we can create a little bit of distance between the thought and the emotions that are coming after it It can change that woman's whole experience So then she will ask is this thought helpful? And this is this is a nice little kind of you know hack To use during pregnancy as well. Is this thought helpful? Well, we don't know maybe it is But that gives us again It lets us interrupt the pattern is a thought helpful and it gives us a chance to bring on that Executive functioning part of the brain. Oh, yeah. Well, well, I did learn that if they're having lots of wet and dirty diapers and the gaining weight and and you know No relaxing between feeds then it sounds like things are actually okay But I don't have any proof but that there is a problem, but I'm going to get some more support So we have two very different women's experiences based on whether they knew to oh, yeah Like that that is what I I call it dead not taking the base So that's a thought that's how is the thought making me feel in my body So it's making me feel anxious Then maybe that's not a train of thought we want to stay on But if you're thinking all these lovely things about your baby How great breastfeeding is going and how much you're enjoying it. That's a thought we want to keep trending But again positivity is not big on the brain's priorities So it will always try to go to yeah, but what if and what if this happens and yeah Let's just focus on present moment. So I hope that this Slide I think will be helpful to help understand how mindfulness can really shortcut a stressful interaction between mom and her own mind Because we know that psychological distress will impact mother's feeding decisions. So it's uh, but we're not doing that right now We're not helping them. So yeah, is this thought helpful? So we want to start small. We don't want to be practicing on you know, big stressful events starting in pregnancy gets his practice with the little small stuff irritations um Because experiential learning is just as important as knowledge transfer. So what we're getting in the books is one thing But being able to Actually um regulate your own emotions. I mean, this is something we should be teaching Yeah, school age kids. We yes, we want them learning math We want them learning English and being able to be you know productive citizens But if we're not teaching, you know, young adults and children how to regulate their emotional state They're going to be faced with you know, all kinds of challenges in their lives and we've left them again with no tools So never mind postpartum. We don't you haven't even given our you know, our kids The tools to uh to actually, you know, manage life as it is So a mindful approach is not telling mothers to go sit on a cushion and meditate when they're experiencing a mental or emotional crisis what we see When uh or women are practicing mindfulness is they have a clarity of thought Because when we turn off that that limbic brain that stressed response We can that executive functioning of the brain comes back online So we can actually recall what we learned in the class assume when it was an evidence-based class um And we can use that information ourselves then for Making informed decisions and making decisions from a place of calm and not a place of chaos Which is unfortunately where so many mothers find themselves We have so many women that are stopping breastfeeding before they were ready to and are left with feelings of guilt and Anxiety and grief for some of these women as well and We've we have these different cohorts We have the women who are struggling with breastfeeding and with you know, their own thoughts that they're having about breastfeeding that can derail their journey and then we have another group of women then who again are um Doing better during during breastfeeding But they can all still use these tools and whether things are going really well or not really well and there is some really interesting research on using mindfulness skills for Parents of babies who are in nicu because again, they are experiencing, you know in a extreme level of stress and for themselves to be able to emotionally regulate their own mental states and that protect their own Mental health I think this was actually a double one so it's more than mechanics and what I Know what what I've developed is it's a mind body approach to breastfeeding preparation and what I've done is combining mindfulness with uh, Nancy Morbacher's amazing Mindful or natural breastfeeding program So what we're trying to do is we start with the mind and we're focusing on mindfulness and compassion practices Compassion practices are again. These are things that the mom can do Standing in a supermarket when her baby is having a good moment That you don't have to find a cushion and sit and meditate simple and body focused practices that will Will turn on the oxytocin Activity in the brain and that that network and start to calm down the the anxiety level So then we have a body approach. So we're talking about the physiologic approach Nancy talks about These starter positions. So we are having women lay back and I call it the netflix position because it's like that Totally relaxed tv position We have babies that are placed on the breast We don't have to make them crawl 20 miles to get to the breast this I know we've Almost become obsessed with the doing the breast crawl But we can the baby has just come through a marathon as well It's like you run a marathon and then you get to the finish line and someone says Yeah, you just had to go another mile down the street to pick up your medal So let's not make babies work any harder than they need to so having baby on the breast But ventral position as in focus forward leaning forward full body contact on mom Some of the most common reasons for early cessation of breastfeeding pain anxiety and stress that emotional Turmoil perceived low supply family work life low breastfeeding self-efficacy and birth interventions And understanding and working with the mind can impact all of these areas in a positive way So mindfulness is not just for someone that you think might need some extra help to cut it a little bit anxious It is for everybody. Um, there was a study a couple of years ago looking at Hospitalized high risk women who were show and when they were they were high risk women They were in hospitals for significant periods of time during their pregnancy And they were they looked at, you know, their anxiety rates and depression rates And they found that just by giving them a digital mindfulness program for one week Was enough to significantly reduce their stress levels and reduce their anxiety levels So this is not we they don't have to go live on a mountaintop or do, you know, a silent retreat for 10 days These are really simple practices that we can help implement And even if it's just that one thing of starting to have women more aware of those patterns of thoughts that they have um, these are just a couple of um From some qualitative studies. I've cited them at the very end about women's experiences of using meditation So this first one. This is a mom with that baby in nikku Which is I would say for me meditating really helps me when I'm in a place where I'm extremely anxious Over something I can't control so meditation has been hugely helpful here because I think the nature of this place is that There's often nothing the parents can do other than what the nurses say Hold them when you when you can't talk to them softly that kind of thing. So yeah, I think meditation is hugely helpful so there's also some really interesting research around mindfulness and postpartum body image and making friends with our body and being compassionate towards our body after birth and our our new body that we uh That we experience um changes our relationship with our partner We know the first year with the new baby is tough going. I can be tough going on relationships and instead of, you know, you know Counting the number of times that you've gotten up at night and scores and We can start to relate to our partners in a little different way And that they're not there to irritate us because we are We can be quite irritable in those first couple of you know Once when nobody's really getting much sleep and then reducing birth trauma it's there's been some studies on looking at Ways to I guess inoculate against trauma as such a PTSD. So um, unfortunately or fortunately, um, a lot of this research has been done on the u.s. Army So they were finding that by teaching again simple mindfulness skills that They found that meditation could be a buffer against trauma So again, it's about not believing everything we think and being able to to have resource to settle ourselves in our body um during postpartum And reducing overwhelm if you think of how exhausted we are in postpartum And I really feel like when we look at postpartum depletion Part of the issue is the fact that we are have so much conflicting Pots that are going through our our head in those first couple of months Debating breastfeeding not breastfeeding Uh pair other moms judging us, you know, what our body looks like, you know our new identity There is just so much happening So to be able to kind of create a space and it's not a space where we're not thinking We're not it's not about stopping thought It's about noticing the thoughts that make me feel good And it's noticing the thoughts that make me feel really bad and the ones that Really are affecting me in a negative way that I spend less time on that train of thought So there's nothing mystical about what we're teaching. We're just it's really about awareness of that of thoughts So prepare some of the mindful the benefits reducing anxiety that self judgment our self talk I think, you know, everyone on the planet could do with a dose of mindfulness. I think especially in today's World with so much, you know mental health stress after covet Um, but what we do see, you know in the research is a change of pain perception Again, we know nipple pain is a big part of why women stop breastfeeding But what are we going to do for those women who we have this cohort of women who are breastfeeding And what about the women who stop breastfeeding? Who stop before they really wanted to there is nothing for those women? We have left a whole group of women with no support What are they supposed to do with these feelings of grief or inadequacy or failure? Um, and I think that for me is there is a huge part of of the benefits of this mindful awareness Um, because we know again in the research is really clear around body shame as well And and for women for whatever reason that they stopped There's usually something around the body that I couldn't do it or pain Um that we can help women start to notice is this, you know, is this thought helpful? Is this thought true and not to buy into or not to take the base of our own internal drama So Nancy Morbach who talks about these starter positions for at least the 10 days So we're looking at, you know, again, we've got the mindful preparation So mom is in a better headspace and then we have her starting with the these starter positions for the first 10 days Traditional breastfeeding is Disimpering women and it's confusing women. I mean when you look at any website look for how to latch a baby on it is mind-numbing It is complicated. It is confusing lead with the chin thick. No, you know, k. You know the k lips Um, don't hold baby's neck. There are so many rules And then we know that memory can be compromised on day two So that's making the recall more difficult Also, mom is panicking because she's trying to get baby latched on and there's all of this other stuff happening with her body And she is not in a positive mental state and then information overload. So all that teaching is not an oxytocin Facilitating experience. So we've made it overly complicated and we have and in the same breath told women that it's really natural So we've got babies born with these primitive neonatal reflexes and again, here we are with, you know Suzanne Colson's research is probably at least 20 years old. Maybe a little bit older Still hasn't really been implemented. We've started to see some new rcts on biological nurturing and laid back But it's again, why didn't it take 20 years for us to realize we can literally stand back Again, if mom and baby are doing okay And let the let baby express these neonatal reflexes to assist with feeding So these pressure points on baby are triggered when baby is in full body contact So when we are are forcing women into these complicated upright positions And we have these now these pressure points that are now being and reflexes are being Disregulated because of gravity. So if we lie back to a comfortable recline with baby on our chest Below the chin so we can see baby and make eye contact with baby But upright positions. It's more painful for mom. She is I mean, I think of that this this laid back Netflix position as being the default position for the first two weeks at home She doesn't have to mom doesn't have to worry about figuring out what baby's cues are Um, baby is right next door to the buffet. So baby will feed frequently So it's going to be less panic about getting baby's weight up, you know, because In at least in the u.s. You know, babies have to go for their, uh, their baby weight watchers to a pediatricians office, which is That's a whole other discussion So this is what what we're suggesting that this netflix position So mom is literally being taken care of hopefully with a midwife at home or a post part of doula and a great partner Um, but that full body contact support of baby's feet But what we've seen in Very recent rcts is that women who are doing this position who are shown this in hospital And these studies were all done in hospital Were significantly less likely to have nipple trauma nipple pain. They were more likely to Uh breastfeed past three months and in one of the studies it was to breastfeed past six months So we're building that confidence in the mind and the body But we can do it with hands off, um as much as possible But I think this is imagine this is the postpartum position or sideline But we've now, you know, we have mom who is feeding her baby in this position And yes, we're not saying she's going to go to starbucks and feed in this position But what she can do is once she has like her brain has come like back online really give it 10 days or so Where baby is feeding frequently right next to that to that buffet. There's no issues with weight gain And we know then that okay now we're 10 days in or just one moment, you know And then we have a mom that now can do all the complicated positions and and be out and about so But this is uh So that's my quick argument. Time to rethink breastfeeding preparation. I think so