Welcome. I'm glad you're here.
I hope that you find the support and information that you are seeking within these pages. If you have additional questions, please do not hesitate to contact me. I am happy to assist you in your journey.

Best Wishes,

Karissa






Karissa is a proud member of the following organizations











What Makes a "Good" Birth?

As a Childbirth Educator, I strive to employ what I call the Three Es. If I’m doing my job correctly, my students leave class feeling educated, empowered, and entertained. At the closing of every course, I ask my students to share what they have found to be most and least helpful. I also have an open dialogue with many of our local Midwifes and OBs and ask them how my clients respond to labor and birth. Often times, I hear that the Moms are unafraid, bold, and ask lots of questions. This makes me happy, and here’s why.
Anne Lyerly wrote a book titled "A Good Birth", and I was fortunate enough to attend her lecture a few years ago. She interviewed hundreds of Mothers and asked them to share their birth stories and how they felt about the experience. Dr. Lyerly identified five themes – agency, personal security, connectedness, respect, and knowledge— common across women's stories. What may surprise many is that a woman's perception and overall satisfaction of her birth, had less to do with how she brought her child into the world, and more to do with if she felt heard.
I approach birth as a “Choose Your Own Adventure” experience. Remember those books as a kid where you chose to flip to various chapters to shape your story? It starts with who you choose as your Health Care Provider. Whether it is a General Practitioner, Obstetrician or Midwife, it is essential that Mothers feel listened to, safe, and on the same page with their provider. Before interviewing a potential provider, a Mother should think about what is most important to her. Knowing that flexibility is essential, what would be the ideal birth experience? Thinking about what is desired and then finding that fit in a provider is more empowering than hiring and fitting into an HPC’s philosophy. Baby Center has a list of thought provoking questions to ask, which can be found here: http://assets.babycenter.com/ims/Content/ob_gyn_interview_May_2010.pdf
Choosing where you give birth goes hand in hand with whom you choose as a provider. Most providers have privileges at only one location. Check both provider and hospital VBAC and Cesarean rates. Hospital rates can be found here: http://www.vbacfinder.com/2015/01/north-carolina-hospital-vbac-rates.html. Visiting the hospitals and taking a tour can also be insightful. If you are choosing a birth center, or are having a homebirth, being familiar with back up care is important.
Choosing the right childbirth class is critical to advocating effectively. Parents are paying a lot of money for the experience of giving birth- good service should be expected. Parents have chosen the care team because they respect how they practice, but Mom and Partner should always feel free to ask questions, and in fact, be encouraged to do so. A good childbirth class will help you understand what questions to ask.
Whether you are considered high risk, planning to use pain medications, or choosing to birth naturally, it is important that you understand interventions. Remember, this is an adventure, and birth is fluid. When plans change, it’s important to have familiarity with procedures. Using your “BRAIN” is helpful.
Benefits- What is the benefit of the proposed intervention?
Risks- What are the potential risks to proceeding?
Alternatives- What are our other options?
Intuition- What do our guts tell us?
Necessary- Is it necessary at this moment, or can we have some time?
For brevity’s sake, as I could spend pages discussing what is important to include in class content, I encourage Moms and Partners to ask the following questions to potential instructors
  • What are the instructor’s goals for the class?
  • What is the instructor’s philosophy on pregnancy, birth and breastfeeding?
  • What is their curriculum based on? What evidence-based information do they use?
  • How long is the class? What does it cover?
  • Will the class include hands on practice?
  • What interventions are covered?
Bottom line, birth is sacred. A laboring Mother deserves respect, support and has the right to expect collaboration with her providers. Setting one's self up for success is a personal responsibility and can easily be achieved with a little due diligence.

FAQs


Below are a few questions about breastfeeding that I frequently field during my Breastfeeding Basics Class. Teaching this course affords me the unique opportunity to work with Pregnant Women and their Partners so that they can prepare for breastfeeding well before birth.

I have small breasts, can I still breastfeed? Yes! Your cup size has nothing to do with the amount of milk you will produce. In fact fat cells, not milk making cells, are what determine your size. Women produce about the same amount of milk per 24 hour period; however, storage capacity can vary from person to person. A baby whose mother has a large storage capacity, and who can therefore eat more in one session, may nurse less frequently than a babe whose mother has a smaller capacity.

What do I do when the baby wants to be on me ALL THE TIME?  I wish I could prepare pregnant woman for the amount of time they will spend nursing their babies. It's always a surprise. In a society where we revere multitasking, it can be a hard notion to accept when I suggest mom simply nurse, eat and rest. A baby is transitioning from womb to the world, and her Mother is her constant. She seeks comfort in mom, and breasts not only nourish, but they regulate breathing, heart rate, temperature, assist in the myelination of nerves and literally protect with the antibodies that are produced in breastmilk. You cannot spoil a baby. A local Doula, Kim, recently shared a wonderful story of a Russian neighbor who said she was puzzled by the statement "spoiling a baby". Spoiling is ugly and rancid. It is what happens when something is neglected and allowed to deteriorate . Holding ones baby is anything but spoiling.

Why does breastfeeding hurt so bad? Breastfeeding should NOT hurt. It's hard to believe when all we hear are horror stories about cracked bleeding nipples, but it's true, nursing should be a comfortable venture. If you are experiencing pain, break the latch by inserting a clean finger in the corner of baby's mouth. Be sure that she latches widely with a generous portion of your breast tissue in his/her mouth. If pain persists, please seek counsel from a successful breastfeeder, community organizations such as La Leche League or Nursing Mother of Raleigh, or a Lactation Professional.

How do I know my baby is eating enough? We live in a bottle feeding society, and since we dont have milliliter ticks on the sides of our breasts, many of us often wonder if we are producing enough for baby. When baby is first born, you will have colostrum, a thick sticky substance to nourish her. What colostrum lacks in quantity, it more than makes up for in antibodies and nutrients. In fact, on the first day of life, your baby eat less than a teaspoon of colostrum per feed! Babies are not born hungry. Their bellies are tiny and they have the stores to sustain themselves for the first days.  As your baby learns coordinate sucking and swallowing, your breasts will produce transitional and then mature milk. Look for the following signs of a well fed breastfed baby:
  • What goes in comes out. Is baby urinating frequently? Is it light in color?
  • Poop tells a story. At first it is dark meconium and then transitions  to green and eventually to yellow stool after a few days.
  • Does baby look satiated? Does baby come off the breast themselves and does he or she look relaxed after the feed? Is baby nursing 8 or more times per day?
  • Hydration is Key. Is Baby's mouth moist? And if you gently pinch the skin, does it bounce back? If so, these are good signs of hydration.

What kinds of foods should I avoid? What about java and vino?  You do not need to avoid any foods. In fact, some babies prefer the taste of their mother's breastmillk after she has consumed garlic and certain spices! Breastfed babies typically have a more adventurous palate and tend to be less picky eaters than their formula fed counterparts. Drinking caffeinated beverages in moderation is also okay.  Alcohol leaves your breastmilk much like it does your bloodstream, so a glass of wine is perfectly acceptable. The best advice is to watch your baby. If there seems to be a correlation between a certain meal and fussiness, you can always consider decreasing the amount of said food. Though some babies may have allergies to food that mom has consumed, it is atypical. If you find that your baby arches her back in pain or stools are discolored, blood or mucous tinged, discuss with your trusted LC or Health Care provider. Certain herbs are said to lower milk supply in some Mothers- these include parsley, mint, sage, oregano and thyme.

Seasonal Allergies and The Nursing Mother

The Triangle is unsurpassed in it's Spring beauty, and formidable during allergy season. According to Allergy Capitals, a part of the Asthma and Allergy Foundation of America (AAFA), Raleigh–Durham–Chapel Hill ranks at No. 31 amongst US cities with the most severe allergies. What does this mean for Breastfeeding Mamas and Babes?
 

Breastfeeding Helps Your Child with Long Term Allergy Issues. A Swedish study conducted by the Department of Environmental Health in Stockholm, concluded that there is a correlation between breastfeeding and the prevention of early development of allergic diseases up to two years of age.

Medications Mitigating Your Milk There are plenty of medications that will keep you feeling healthy during the allergy season, but beware of others that can tank your supply. A great website to learn more about your options is www.infantrisk.com. Here's a breakdown from Texas Tech University:

Antihistamines It is advised for a breastfeeding mom to use the newer non-sedating antihistamines instead of the older antihistamines. These include Cetirizine (Zyrtec), Loratidine (Claritin), and Fexofenadine (Allegra). The older sedating antihistamines include Diphenhydramine (Benadryl), Chlorpheneramine (Aller Chlor), and Brompheneramine (Dimetapp). Sedation in a newborn or young infant can lead to apnea or temporary breathing cessation and therefore is something to be concerned about.

Decongestants  Pseudoephedrine (Sudafed) and Phenylephrine (Vicks Sinex Nasal) are two of the most commonly used decongestants on the market. Pseudoephedrine is secreted into milk in low levels, however, it has been shown to decrease milk production and should be used with extreme caution in late-stage lactation (>8 months). Although levels of phenylephrine in milk have not been documented, they are thought to be low and theoretically can decrease milk supply. Antihistamines such as Zyrtec-D or Claritin-D contain these decongestants and should be used with caution by a breastfeeding mother. Oxymetazoline (Afrin) is a nasal spray decongestant that can be used to treat acute congestion. It should not be used for more than three days as it can cause rebound congestion.

Mast-Cell Stabilizers Mast Cell Stabilizers such as Cromolyn Sodium (Nasalcrom) suppress mast cell degranulation thereby reducing allergy symptoms. There is no data on its transfer into milk, but because it has a low pKa minimal levels would be expected in milk. This drug is used frequently in pediatric patients and poses little risk to an infant.

Corticosteroids Corticosteroids can be administered orally, inhaled, or intranasally. Inhaled corticosteroids include Beclomethasone (Beclovent) while intranasal ones include Fluticasone (Flonase, Flovent), Budesonide (Rhinocort), and Mometasone (Nasonex). Intranasal and inhaled corticosteroids may be safely used by a breastfeeding mother as the maternal plasma levels are low and therefore milk levels are low to undetectable. If oral steroids are used (i.e Prednisone), it is preferred for the dose to be kept low
Immunotherapy Allergy Immunotherapy or allergy injections are composed of protein substances that are unlikely to enter into milk. Allergy injections are safe to use in breastfeeding. Although adverse effects are unlikely, the infant should be observed for allergic reaction.

 
Staving Off the Sneezes, Naturally. There are many ways to stay comfortable during the allergy season while continuing to nurse.
  • Keep your windows closed in the home and car during allergy season to avoid over exposure to pollen.
  • Change your clothes when coming indoors to keep pollen outside.
  • Dust and vacuum often to remove remaining pollen, if possible, with a hepa filter/
  • Avoid outdoor activity during high pollen days, you can read the forecast by visiting www.pollen.com
  • Rinse that Allergy Away-The Neti pot is a non evasive way to rinse the nostrils and sinuses of pollen. It seems odd and looks a little weird, but it feels wonderful and can work wonders on stuffy noses and postnasal drip.

A Partners Role in Breastfeeding


My Husband, by Stephanie Goulet Photography


When we think of the postpartum period, we often think about Mom and Baby and less about the Partner. What role does he or she play as a Parent when the focus is on breastfeeding, maternal recovery and acclimating the baby to life outside of the womb? "The Fourth Trimester" can be a wonderful adventure for Parents as they navigate these new waters, and for many Partners, it's also a time where they may flounder. Here are some tips on how to support the breastfeeding relationship while also integrating your important role into the Family. (To avoid confusion, I will refer to the Partner as Dad from here on out, fully recognizing that there exist female Partners of Mothers who are just as vital)

The Dads role in the breastfeeding relationship should not be underestimated. Support throughout the relationship, but particularly in the first weeks, when Mom has hormonal shifts, may have a steep learning curve in breastfeeding, and is more venerable to other's suggestions, is critical. Dads in this postpartum phase can do the following for Mom that makes all the difference:
  • Acting as Gatekeeper and Allowing Only Positive People Around Mom, or Limiting Access from Grumps
  • Providing Perspective During Challenging Moments and Reminding Mom that This Challenge Will Not Last Forever
  • Making Sure that Mom is Well Fed and Hydrated
  • Telling Mom that She is Doing a Great Job
  • Being Patient About Resuming Sex. It Will Happen, but Perhaps Not Immediately.

Dads are also an essential member of the family. Babies often respond immediately after birth to Dad's voice, having become familiar with it in the womb. Dads  not only calm Mom, but also the baby with their presence, and he can bond in the early weeks and months by
  • Holding Baby Skin to Skin
  • Wearing Baby in a Carrier such as a Moby Wrap
  • Making a Ritual of Changing Diapers (sing a song, provide massage afterwards)
  • Creating a Bathtime or Bedtime Routine

As Mothers, we become all consumed with our babies and often forget that our first loves were our Partners. It is essential to the relationship to recognize this and acknowledge this to your Partner, and to assure them that you know they may feel like the third wheel. Here are some ideas that you may want to try that could make your Partner feel more included, and fit into your new busy schedule.
  • Appreciation Goes a Long Way, thank Dad for all that he is doing for the Family
  • Point Out the Wins. Men are afraid to fail. If he is doing something for you that is particularly awesome, tell him!
  • Tell Him His Baby Loves Him. If you see that your baby is responding well to his touch or voice, let Dad know he's needed and recognized.
  • Carve Out 5 Minutes to Ask About His Day. Give your man a few moments of your undivided attention and ask him how he is feeling and what's going on in his day.
Resources for Partners

Supporting the Nursing Mother



While our babies are made to breastfeed, and their instincts lead them to nurse, for many Mothers, it's doesn't initially feel natural. Breastfeeding is a learned behavior, and in our society, a woman's initial exposure to lactation could very well be when she's nursing her own baby! So, how do you set yourself up for success?

Are your Providers on Board?

Who is Catching Your Baby?
Choosing a prenatal healthcare provider who understands and respects the importance of breastfeeding can impact initial breastfeeding positively. Click here to learn about how you can choose prenatal providers who are breastfeeding friendly. To see a newborn nursing, visit this breastcrawl video.

Where You are Birthing?
You can learn more about Baby-Friendly birth sites that have incorporated the 10 Steps to Successful Breastfeeding to support New Mothers in their breastfeeding endeavors.





What Do You  Know about Your Baby's Care Provider?
If you have questions or concerns about your baby, you're most likely to call your Pediatrician or General Practitioner. Its important to find someone who encourages breastfeeding and understands that breastfed and formula fed babies can grow differently. The following websites can help you craft your questions when interviewing your baby's potential doctors.
 
What's in a Name?
As a pregnant woman, you are well aware that there are many professionals in the birthing world. The flurry of credentials can make your head spin- especially when it comes to those who provide breastfeeding guidance. Here are some of the groups and monikers you may become familiar with.

La Leche League Leaders
Peer to Peer support is a proven facilitator to successful breastfeeding. La Leche League Leaders have had personal experiences in breastfeeding their own children, and have the knowledge and resources to assist Mothers. Fellow Mothers at meetings are also instrumental in empowering one another and sharing their experiences from which others can learn. To learn more about our local LLL community, please visit www.lllofnc.org

International Board Certified Lactation Consultant (IBCLC) –These credentialed professionals have the most comprehensive knowledge and skills in breastfeeding support. IBCLCs are recognized around the world and work in a variety of settings including hospitals, doctors offices, birth centers and in private practice. To find an IBCLC, please click here.

Breastfeeding Peer Counselor Specialist or Educator (CLC, CLE, CBS, CBE)- A breastfeeding counselor can teach about the benefits of breastfeeding and can assist with basic challenges. Education can range from a one day to 90 hour+ curriculum. To learn more about my Certified Breastfeeding Specialist information, please click here.

WIC Peer Counselor-Peer counselors receive a 20-hour training and provides information on basic breastfeeding and can refer clients out to specialists.Click here to learn more.

Setting Up Realistic Expectations

A Family that understands breastfeeding together, keeps on going! Partners should attend a prenatal breastfeeding class with Mom. Expectations about support should be made clear to family and friends visiting prior to the baby's arrival. Here are some helpful sites and organizations:
Books
  •  The Womanly Art of Breastfeeding, LLL
  • Breastfeeding Mother's Guide to Making More Milk, West & Marasco
  • Mother Multiples, Gromada
  • Adventures in Tandem Nursing, Flower
  • Mothering Your Nursing Toddler, Bumgarner
  • Breastfeeding Your Premature Baby,Gotsch



Holidays Strike, Make Them Suck!

When you read my post title, you may envision a mob of retail workers refusing to work post turkey dinner. I don't blame anyone for protesting against having to peel out of sweatpants and brave the butt end of holiday consumerism at it's finest. As Thanksgiving weekend draws to a close, it reminds me of another type of striking that sits closer to the chest... literally.

A Nursing Strike is a refusal to breastfeed by a baby who is not otherwise ready to wean. There are a number of reasons a baby may begin to decline nursing including, but not limited to: mouth pain from teething; ear infection; stuffiness from illness or allergies; changes in milk due to medication, foods or pregnancy; change in daily routine.

For this post, I will focus on how a change in routine may disrupt your breastfeeding relationship. This is post could be many pages long on the subject but for brevity sake, and yours, I'll offer some helpful hints for avoiding the boob ban.

Holidays are a busy time of year- especially for new Parents. Everyone wants to visit with the new babe, and we as proud Mamas and Papas are keen to show off our sweet bundle. As we bustle about from party to party, travel home for the holidays, or host our own festivities routines become secondary to pleasing those around us. Perhaps baby's nighttime ritual is rushed, we decide to nurse baby in a different position for modesty or bottlefeed in an attempt to ease stress and let Great Aunt Hettie feed the baby.

Babies, though we may not always recognize it, enjoy consistency. They are constantly learning through understanding patterns of behavior. They are not exempt from becoming distracted by the holidays which may result in overstimulation and fussiness. Babies are also intuitive and can pick up on anxiety from parents. To avoid additional stress around the holidays for both you and baby, here are some helpful hints.

Remember that you have a new normal. Perhaps party crawling now interferes with baby's routine, and that's just fine. Find other ways to enjoy the holidays other than rushing from place to place.

Protect the nap schedule, for the both of you. If baby sleeps at certain times, schedule outings around that time. Sleeping when baby sleeps can help you feel more relaxed and prepared to take on the holidays.

Find a relaxing place to nurse, and use it as homebase. Many of us need a protected sanctuary to get away from it all. Finding a quiet spot to nurse, or even to regroup away from eyes and noise can help baby and mom stay connected. It also is a wonderful way to dodge unwanted advice.


Babywearing keeps baby close and out of other's hands. It's also a great way to nurse.

Your Partner is an Ally and Advocate Share your needs and expectations with your Partner explicitly and ask that he or she help you to establish boundaries with friends and family. For instance, if the baby is giving feeding cues, Partner brings the baby to Mama no matter who is holding her. Remember, by the time the baby is crying, she has already exhausted her cues and is frustrated. Getting a calm baby on the breast is much easier for all than latching on a ravenous anxious babe.

Learn to Say No This is a great word to learn early in Parenthood. If you feel that a task is too daunting or you simply prefer not to do something, offer an alternative or share that you're in a new phase in life and prefer not to do whatever is requested.

Keep your friends close, and your PITAs far Enjoy the holidays with those whom you love most and you can be yourself around. You have ten other months to deal with pains in the ass, and if you must in this holiday season, perhaps request a trust friend be your blocker from said annoyance.

Attend LLL meetings This is the perfect time of year to meet fellow nursing Mamas and learn from Leaders who have experience in nursing their own children. Visit www.lllofnc.org for schedules and locations

Revel in Your Awesomeness For many this is a time of renewal, birth and love. You have just experienced this in your own right. Take pride in your new family and know that your instincts are right and you have greater insight into your baby than anyone else on Earth.

You are not alone!

"No one told me it would be this hard", a New Mom recently confided. She continued that she wouldn't have believed the stories anyhow- and how could she have even understood until she was in the thick of it? Soon after this conversation, a friend hosted a lively debate about putting your best face forward on social sites such as Facebook, and whether or not it is a disservice to the Mothering community at large.Some respondents contended that incessant cheerful posts simply set an unachievable standard for New Moms to aspire to, or more dangerously, it isolates those who are having a trying time. Others believed that it was essential to share the beauty of Motherhood in order to combat the media's portrayal of it, which, much like birth, is negative.

My friend, who is a seasoned Doula, and IBCLC did make a very good point that has had me thinking for the past few days : if we don't share the good with the bad, then why would anyone possibly reach out to us for help? I don't know about you, but that rings true to me. Someone has to have some street cred if I'm going to be venerable with them.

I truly believe that every Mother has a challenge that she must face. For some, it is a struggle with fertility;others, pregnancy; for many, it is facing the journey of birth. For some, it is breastfeeding or redefining ones self in Motherhood. There are so many variables that I could list, but the point is, we are fierce because we have met our challenge. Your challenge, though unique, is natural, and YOU ARE NOT ALONE.

This is where creating a Tribe is so beneficial. I joke that pregnancy and birth (or the grueling process of adoption) is our sorority hazing. Once you are in, you have access to generations of knowledge. It may take meeting a few groups, but eventually, you find a tribe where you can ask questions, feel validated, and most importantly, know that you are not weird, crazy, or bad.

Here are some nuggets from groups :

  • "If I were a hamster, I'd eat my young"a frazzled Mother exclaimed one afternoon. 
  • Keep expectations low for the first year and you'll be less disappointed in yourself.
  • The first bowel movement after birth usually hurts. Stool softeners are your friends.
  • One could be ready for sex right away, or it could take six months.
  • A Mother loves her kid, but may not like them all the time.
  • No one on Facebook is THAT perfect. Promise.
Finding A tribe can be awkward, yes. Here you are a grown woman and literally asking folks to be your friend. I felt like the playground was a pick up scene when I first had Cora. I'd scout out women, strike up a conversation, and see if there was chemistry. I can guarantee that  almost every other Mom is at that playground to socialize- especially if they have a newborn. Mothers are not taking babies with no head control or depth perception to story time for the babe's sake- they are looking for fellow Mamas.

Attending a La Leche League (www.lllofnc.org to find one near you) or a Moms group, is a lower pressure way to meet Mothers, as you can participate as little or as much in the conversations as you wish. The groups are designed for New Moms, and you can arrive in pjs, your kid can scream, your boobs can leak and no one will bat an eye.

A tribe can consist of two or ten, or twenty, or two hundred. It can be online, in a church or at a shop. 
We are social animals, and by nature, we need to connect. I know that I am a far better Mother because of my group of Friends. It takes a village to raise a child and to support a Mother. 

Side note: After reconnecting with old friends and learning that no one has it figured out, the Mother above felt a whole lot better and is growing confident in her Mothering. I, a Mother to a toddler, am now meeting my challenges as my daughter grows into a wonderfully stubborn opinionated child who refuses to poop anywhere but in her pants. I would venture to say that my Mother has similar challenges ( sans poop. I'm potty trained). You are not alone.


Returning to Work as a Breastfeeding Mother


Prepare for Returning to Work in Your New Role as Mother.

This Class is designed to help you build confidence in your ability to breastfeed and to assist you in laying a strong foundation for returning to work. Topics include:
  • Making the Most of Your Maternity Leave
  • Choosing a Pump
  • How and When to Pump or Hand Express
  • Milk Storage
  • Feeding Preparation for the Breastfed Baby
  • Finding the Right Caregiver
  • Transitioning Back to Work
  • Setting the Scene and Creating a Routine at Work

Saturday September 28th  1-3pm

Cary Pediatrics 1001 Crescent Green  Cary, NC 27518