Supporting Babies with Reflux as a Postnatal Doula
By Victoria Greenly, Nov 23 2017 12:31PM
I will always remember when as a newly practicing postnatal doula a number of years ago, I went on to a local mums’ network on Facebook to promote my services and I read a post from a mother asking for support for her baby’s reflux from other mums. Her post received over one hundred comments in a couple of hours from other mothers whose babies had suffered in the same way and they wanted to share their knowledge and ideas.
I was shocked and disappointed that not only were so many babies suffering but also that their mothers were so distressed and overwhelmed. I started to research and try to understand what this new ‘epidemic’ was and how I could better support mothers in my role as a postnatal doula. As a result, I was often employed by mothers whose babies were afflicted by reflux. The parents themselves had felt that they were not being given good support from health professionals particularly GPs, especially as the first one-stop solution they were given was to feed the baby some Gaviscon – which often resulted in more pain for the baby due to constipation. There also seems to be little understanding on the correct usage of reflux medication. My clients were often confused and concerned as to whether the medication was a) really working and b) if there were possible side effects for the baby.
I knew I could give them better support if I improved my knowledge (additionally within my role as an infant feeding counsellor). There was very little published information despite all my research, so I had to collect information from a variety of sources and also through observing my clients’ babies. I developed new skills and became convinced that feeding babies optimally was one of the key elements in preventing reflux. Over the last couple of years more information is coming to light, but from my experience the key things that have helped the parents I have supported with baby reflux are:
getting breastfeeding going in the most optimal way right from the start ie troubleshooting any problems with a baby’s latch, particularly if there is suspected tongue tie - if there are any concerns then getting a proper assessment from a qualified breastfeeding specialist - and ensuring that feeds are completed by the baby in the way that preserves the baby’s natural feeding rhythm and so the baby gets a full feed
as little outside intervention as possible during breastfeeding, allowing babies some peace and quiet, not over-stimulating babies particularly during feeding and encouraging mothers to relax whilst they feed
not cramming too much in with young babies but following their natural rhythms, following their cues and giving them the time to develop at their own pace, particularly their fragile digestive systems
not delaying a feed – feeding on a baby’s cue
being consistent with feeding particularly when switching from breast to bottle and mixed feeding, particularly in the early days – this needs to be carefully managed by an infant feeding specialist
not expressing too soon – again this needs to be carefully managed by consulting an infant feeding specialist
ensuring that when bottle feeding, a mother practices ‘paced’ feeding and allows the baby to fully digest the milk at their pace, maintaining their feeding self regulation
when bottle feeding, checking a baby’s latch on the bottle and replicating breastfeeding as much as possible through position of the baby and bottle teat
exploring potential food intolerances particularly to cow’s milk protein and referring on to specialist support
I have used all these techniques with the clients I have supported and particularly encourage their use to prevent reflux occurring in the first place.
Of course, there are many other things that may relieve some of the pain symptoms and aid digestive relief, eg wearing baby in a sling, encouraging babies to sleep in a slightly more upright position (although sleep positioners have now been withdrawn from many retail outlets), baby massage, cranial osteopathy and other therapies eg Bowen technique etc, mixing some weak fennel tea in with bottle milk, probiotics. As a postnatal doula, I present my clients with the options out there and encourage them to make an informed decision on which course they may like to take. But overloading parents with multiple options to ‘cure’ reflux can also be very stressful for them, particularly when they don’t see an improvement in symptoms.
As a postnatal doula course provider, we also prepare doulas with good information through our reflux section on a workshop we provide called Understanding Newborns.
As a Maternity Nurse and Postnatal Doula I too have supported families with babies suffering from Reflux and Silent Reflux. I tell my clients that the the only real ‘cure’ is time... as their baby grows and develops their sphincter muscle at the base of the oesophagus will strengthen and, hopefully, all will be well.
In the interim I suggest feeding little and often, winding halfway through a feed, and keeping their baby in an upright position for 20 - 30 minutes after each feed.
I work with a lot of multiple mums, and as twins are generally smaller than the average baby - particularly if they are premature - feeding/latching can be quite a challenge, and reflux complicates things further.
I feel, like you, it is important to give mums tips and information so they feel less helpless and more capable of helping their baby/babies.
GER and GERD are of course a whole different matter once diagnosed, and I feel very strongly that GPs should differentiate much more between basic Reflux, Silent Reflux and GERD.