C-19 Updates in Birth and Postpartum Care in Regina

I’ve been keeping in touch with the good people managing the units at Regina General Hospital. Here are all of the recent updates of RGH Labour/Birth Unit and Mother/Baby Units here in Regina, Saskatchewan due to Covid-19. Please note that any of these may change on short notice due to the coronavirus pandemic.

Some additional tips for navigating your birth journey:

I lead RGH Tours live but online multiple times a month.

Article: How to Set Up your Birth Room (i.e. What Your Doula Would Normally Do!)

Easing Labour Pain: An online 2-hr class offered monthly that teaches partners how to provide hands-on birth-support, comfort, and decrease labour pain.

If anyone’s looking for online prenatal classes please contact me. I teach all the sessions live but online so you can ask questions.

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Hospital Update

◆ As of June 12, there are 2 support persons allowed in the BIRTH ROOM. From Saskatchewan Health Authority:

“Effective immediately, expectant mothers and families across Saskatchewan will now be permitted to have two designated family members/support persons present during their birthing experience. Designated family members/support persons are chosen by the mother and family and may include but are not limited to partners, family members, coaches, doulas or cultural support persons.

All maternal patients and their designated family members/support persons will be screened for COVID-19 upon arrival and be required to have a temperature check, wear a mask, participate in hand hygiene and follow physical distancing guidelines. Designated family members/support persons who are symptomatic for COVID-19 or who have other risk factors will not be permitted. The designated family members/support persons must be consistent during the duration of the patient’s stay. They may leave the facility but cannot be switched out for another family member or support person. Only designated family members/support persons will be permitted at this time, other visitors, including siblings, will not be allowed.

All maternal patients will be offered an optional COVID-19 swab upon admission. Family members/support persons will not be offered a COVID-19 swab.”

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◆ Support people coming in on their own, i.e. not with the labouring patient, can be screened 24/7 at the main RGH doors (14th St entrance). They do not have to go to the ER doors.
◆A 24-hr support person who’s joining a birth or going to MBU for a maternal patient that has already been admitted can enter through the main 14th St doors at any time, 24/7. No need to go through the ER.
◆ A support person entering the hospital with a maternal patient will be screened at whatever door the patient enters.

Please note that while the 14th Ave entrance is open 24/7 with a security guard that can screen and let people in, the registration desk is only open from 6am-6pm. Support people can enter this door 24/7 because they are not patients (don’t need to go through the registration process).
 
If you’re in labour and going to RGH as a patient, then you’ll have to go to an entrance that has an open registration desk. On weekends, holidays and evenings/overnights, that will be the ER.

If you have to step outside and get back in, here’s how:

◆ 14th St main entry has a security person around the clock. If you have your proof of screening and are wearing a band it’s easy to get back in 24/7. If you’ve not been screened yet, I recommend you start at this door. If they are unable to screen you, they will send you through the ER doors instead.
◆ The ER can screen 24/7 but please save the ER capacity for people who need it.
◆ 15th St admitting doors are locked overnight. The doors below MBU at 15th St parking lot are locked 24/7. You can not enter the 15th St side of RGH overnight. If you go out those doors, you’ll have to walk around to the 14th St entry.

If your 2nd support person is not at the birth but is invited to MBU, they will be screened on their way into the hospital. They must be named when you are admitted to LBU so remember to tell your nurse. You must get a coloured bracelet for them. I expect someone has to meet them outside the unit to give them the band that will grant them access to the MBU, but ask your MBU nurse about this.

“If the patient fails screening, she becomes a Person Under Investigation (PUI), therefore the support person now becomes a PUI as they have been in ‘close, prolonged contact with a PUI.’ The support will be sent home, however, the patient may have an alternative support person or people who pass screening. ” That means anyone who has been with the labouring woman for more than 2 hours will not be allowed in if she is suspected of C-19/exposure.

Folks – you need to plan for this. Plan C. New support people who have not been with you for more than 2 hours AND who pass screening will be allowed into isolation. They will be gowned, masked, gloved throughout and will not be allowed to leave the isolation room. Food will be brought in.

◆ Again, it’s up to you to ensure that a 2nd support person has been named so they can enter the unit. Ask your nurse about this.
◆ Supports must be 19 years and older. (No, I’m not sure what happens in the case of teen pregnancy, young doulas and so on. This is just what I was told.)
◆ The health region is not on the same timeline of relaxing restrictions as the SK gov’t. Restrictions are still in place at health care facilities.
◆ You’ll see staff wearing masks throughout your stay.
◆ Bring what you would normally bring for your birth and hospital stay. Support people will be given a wristband so they can go to car later for extras and car-seat. You are still allowed to bring your pillow, clothing etc – whatever you need for comfort.

Doctor

◆ Nitrous-oxide (“laughing”) gas is available for pain management.
◆ If you or baby are at high-risk for birth complications, you may be asked to use an epidural during labour to avoid the need for a general anaesthetic in case of an urgent/stat caesarean. Best to discuss this with your OB ahead of time so you can learn your options and make a plan.
◆ Waterbirth is currently not an option in the hospital. Midwives are not lending pools out for home birth. If you have your own then waterbirth at home is still an option (contact me for info on where to get one).
◆ The installed bath-tub is available for comfort in labour.
◆ Breastfeeding is still being supported at RGH.
◆ There are plans and protocols in place so that mother-baby can stay together if mom is at risk or has symptoms of C-19 in the immediate postpartum.
◆ Even though some community restrictions are being lifted, great care should be taken with newborns once the family is home. Physical distancing and being only with members of the same household are still recommended. Anyone who enters the house can bring in pathogens/bugs.

◆ Paid parking has resumed in the RGH parking lots. You will need cash for the main lot. Also, the 15th street parking is reserved only for people who have appointments or are being admitted to the hospital. Vehicles are being ticketed again on the streets around the hospital so no more free parking that way.

◆ There is nowhere for the second support person to wait as all waiting rooms are closed. The second support person should wait at home or somewhere outside the hospital until the labouring person is officially admitted and moved to a birth room.

◆ Partners/support persons will be provided with a mask at the entry doors. (Bring a big paperclip or string if you want to save sore ears.) Check out these tips for saving your ears from mask-pain.  Everyone must wear masks in the hallways. Labouring people do not have to wear a mask once they’re in their patient rooms in the birth unit and the mother-baby unit.

◆ Food outlets now allow people to sit in.

◆ Galleys are still closed to patients in both units. The nurses will get food for you in the birth unit but not in the mother-baby unit so people have to bring their own snacks. There is no access to the microwaves, kettles, food, water-ice machines. There is no access to the big fridges and freezers, but every room has a small mini-bar fridge.

Birth Room

𝐏𝐫𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞

● Attend appointments, diagnostics (ultrasound, lab) solo. Routine appointments might be done over the phone or spaced out. High-risk and special circumstances will still get the extra care they need.
● Midwifery offices are doing the discussion part of the consult by phone and then a quick in-person appointment for the hands-on part. They prefer pregnant patients attend alone but will allow partners. No other family members/friends/support are allowed.
● Anyone under midwifery or GP care who tests positive for C-19 at any point in their pregnant, birth or postpartum will be immediately transferred to OB care.
● If you’re an early-bird you may be asked to wait in your car until your appointment time.

𝐀𝐧𝐭𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞 (𝐋𝐚𝐛𝐨𝐮𝐫 & 𝐁𝐢𝐫𝐭𝐡)

● Early discharge is being offered as an option for those that are healthy and feel comfortable with newborn care. That means to go home a few hours after your birth instead of staying 24-36 hours.
● Anyone getting a cervidil induction will be monitored and then sent home to wait for labour to start, as per usual, then rescreened at RGH doors and LBU doors upon return.
● Support people are allowed at homebirths but must be screened. If anyone in the home (residents or support people) doesn’t pass screening, then the birth must be transferred to RGH. In that case, the one support person rule applies. Home birthers – screen your people before they come over!

𝐏𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐂𝐚𝐫𝐞

● Doors that don’t have an admitting desk are locked tight; security will not let anyone in. That includes the convenient door just below the MBU.
● Families are being asked to stay in their room as much as possible.
● Support people may not visit any other patient areas.
● Food trays are being provided for new moms in the MBU.
● Breastfeeding class in the unit is still running but only birth mother and baby attend (no partners) and only up to 3 participants.
● Midwives and public health nurses are still providing postpartum home-visits. Some may be done by phone or video, depending on your needs.

Please contact me if you have any questions about this information or any of my services.

Five more steps to the birth of your dreams

Many pregnant people look forward to their upcoming labour and birth with both excitement and apprehension. We’re here to tell you that it doesn’t have to be scary. As we shared in a recent blog post, once you have a plan, a vision of the outcome you want and begin taking steps to get there, all the unknown and loss of control starts to fade away.

To help you continue preparing for a birth experience that is satisfying and empowering, here are five more steps to the birth of your dreams!

6) Care for yourself and your baby

Take care of your general health as best as you can; this is proven to support better birth outcomes and it is another thing you can control. Healthy foods in as close to their natural state as possible, proper hydration (find a fun water bottle to carry around and refill), pregnancy teas, all help to build a healthy baby. (Note: obviously if you are dealing with extreme nausea that does not allow you control over what you eat and whether or not it stays down, skip to Step 7.)

Gentle physical exercise, particularly yoga, helps prepare women for birth and a faster recovery. FInd an online class that you like. Go for walks.

Ensure your non-physical self is healthy too. What nourishes your spirit and soul? Time alone? Time with others? Time to create? Time to nest?

I wish you ease and grace in caring for yourself during your pregnancy.

7) Choose the primary care-provider for your pregnancy and birth

Doctor

Depending on where you live you might have lots of choices or limited choices in this area.

In Regina we have some midwives, but not enough. Some family doctors that also catch babies. One birth centre in a near-by community. Lots of over-worked Ob/Gyns (IMO) too.

Do the best you can to chose someone whose values align with yours. Midwives are often the first choice for women who plan natural births, and they attend both home and hospital births. If there are in short supply, then call the office early to get on the wait list.

Family doctors who attend births are a great option for a healthy woman who doesn’t need the high-risk expertise of an obstetrician. Most family doctors in our area care for women for most of their pregnancy and then transfer care to another family doc or an obstetrician.

Obstetricians are highly skilled for women with known health issues or who are at increased risk of complications but they catch most of the babies in our area and are the most common option here.

8) Be aware of your stress triggers

What irritates or stresses you now can be a big clue to what might create or adds stress during your birth?

That varies with everyone and you are the only one who gets to decide on this. For some women it is noise, or smells, or chatter, or lack of information; for others it’s lack of modesty or privacy. Someone who is in the room who irritates you; someone you wish was there with you and isn’t.

Figure out what causes you stress and do everything you can to plan ahead so you can eliminate that possibility or at least minimize its effect.

9) Maximize comfort in your pregnancy and plan to be comfortable in labour

Baby

What brings you comfort? Think of your five senses. We are sensual beings!

Do you prefer to see dim or bright lights, hear silence, medical sounds, or music of your choice? How would you like to be touched, if at all?

Practice getting effective massage and counter-pressure. Reduce internal exams during labour is possible. Wear clothes that you chose for comfort and the level of modesty that suits you.

What do you wish to smell (hint – birth companions: pack a toothbrush)? Research helpful and appropriate aromatherapy oils to use at home. Take your own pillow so you can that comfortable smell and feel.

What kind of drink would you like to taste during your birth? What foods can you enjoy during labour or afterwards? What feast can you plan to celebrate the birth!

Comfort is only possible if we first feel safe and supported so review those essentials and get things in place so you can feel secure.

10) Bring joy, fun and calm into your birth

What makes you laugh?
What calms you down?
What do you enjoy?

Remember you can laugh, be loud, be silent; you can dance, move about, wear clothing in which you feel comfortable or beautiful, get snuggly with your partner, be in the dark, enjoy sunlight, create a big personal-space bubble in the bathtub or birth pool, watch a funny movie in early labour, walk in the fresh air, have a nap.

In my thirty years as a doula I have encouraged clients first to nap and stay well fed and hydrated, and then to do something nurturing or even mischievous – make out, go for a walk to get a tea or take-out treat, take some last-day-of-pregnancy photos, meet up with friends and have contractions while you visit. Make some banana bread for later – maybe it will still be warm when you are holding your baby. (True story.)

Respect your introvert or extrovert needs and explore the possibilities!

Know of other steps you would recommend to someone preparing for an upcoming birth? Want to know more about my online prenatal classes or in need of birth support? Please contact me!

 

Article written by my wise friend and work-partner, Karen Herriot – Master Doula, Doula Trainer, Yoga Teacher.

 

Five steps to the birth of your dreams

Most women anticipate labour and birth with a mix of excitement, and fear—of all the unknown and loss of control. In the face of that kind of vulnerability, it is good to have a plan, a vision of the outcome you want and then begin taking steps to get there.

Actively preparing with easy, practical measures will lead to a birth experience that is satisfying and empowering. No client of ours ever told us “I did too much to prepare for my birth.” That is why we are happy to suggest these five steps to the birth of your dreams!

1) Choose online prenatal education or yoga classes that reflect your vision of an ideal birth.

A virtual gathering with other pregnant women in online classes that discuss pregnancy, labour and birth will help you to find support and community in which to make your choices, share ideas, and learn together.

I also lead virtual Regina Hospital tours, allowing you to become accustomed to the setting in which your birth will unfold. Attending these classes is your start to finding your tribe and building vital connections that will help you thrive in the postpartum.

2) Create your circle of support and birth-power

Expecting Couple

Take a clear-eyed look at the others on your support team. Partners sometimes feel pressured to perform and provide a level of physical and psychological support that may exceed their capacities. Many times it feels unfair to expect them to take on such a new role all on their own.

What do they need to feel supported? What things can you both do in the prenatal time? Have they talked to other non-birthing partners? Birth is a shared experience so both of you need to be mindful of what you need and communicate your expectations.

If a friend or relative is invited, are they experienced, will they add calm or stress to your birth, will they come at any time and stay as long as needed? Have you invited them or did they invite themselves? You get to decide. Birth is not a spectator sport – as the birthing woman you get to choose.

If you’re a solo parent-to-be, consider inviting someone who brings you comfort. Any person coming to the birth should attend prenatal education classes with the mother. They should be familiar with the birth setting, the protocols there, their own availability and the ability to be a helpful presence, not a distraction.

3) Hire a Doula

It is hard to navigate all the decisions you will be faced in pregnancy, labour and birth. Why do it alone?

Professional doulas support the birthing woman and her labour team members. Women who have doula support have half the rates of cesarean births as those without. They also have significantly shorter labours, request pain meds at far lower rates (less than half as often), and experience significantly fewer interventions.

Doulas are experts in comfort measures and also great information resources. Whether it is a simple question or a complex decision, your doula is there to help you through every choice you make. Partners do more when there is a doula on their team!

Plus – doulas make the process fun! We are trained to smooth out the edges, show you the ropes and be your birth sherpas! Contact me for more information!

4) Make an effective birth plan that works for you instead of against you

There are many options for labour and birth, but many people don’t know they can do some research, ask some questions and design their birth their way. It is important to know what to expect from your time in the hospital (or home if that is your choice); it is important to be informed and prepared.

There are many things you can control in the face of the vulnerability of labour and birth.

We all want to feel safe first. For our babies to be born in a cocoon of safety. And then we are allowed to want other things as well.

You are allowed and encouraged to dream big and envision the birth of your dreams, not just a birth that is safe, not just the birth you dread.

  • What makes you feel safe?
  • What stresses you out?
  • What do you need?
  • What would you love to happen?
  • Quiet respectful space to labour in?
  • A less clinical feel to the room?
  • A more clinical and monitored space? So you know both you and baby are ok.
  • Want to catch your baby?
  • Keep the cord?
  • Use your own playlist to create the vibe?
  • Wear your own clothes?
  • Use your own pillow?
  • Labour in whatever position is most comfortable to you?
  • Birth in the posture of your choice?

Your plan should use positive language, including things that are unique and important to you. Including the things that are essential for you.

5) Find and Practise tools to manage the intensity of labour

Pregnant Yoga

Whether your labour is a sprint, a marathon or a surgical experience – many women describe birth as hard work.

There are things you can do to manage this intensity! Whether you plan to labour naturally or to use an epidural to support your experience, taking the time to strategize what tools might work for you – and practice the skills while you are pregnant is essential.

Be your sensuous self and amplify your senses to distract or soothe yourself – sight, sound, smell, touch!

Mindfulness, yoga, meditation, sound/music, and visualizations/affirmations are valuable tools. Hypnobirthing is a system many women find helpful. As are hynotherapy sessions with a trained therapist. Ask me for suggestions.

Control, control, control! Find things that you can control and control the heck out of them!

Looking for more information on your upcoming birth? Interested in taking one of my online prenatal classes or in need of birth support? Please contact me!

Article written by my wise friend and work-partner, Karen Herriot – Master Doula, Doula Trainer, Yoga Teacher.

Released Waters (aka Ruptured Membranes or Water Breaks) and What to Do!

Your waters just released – now what?  When you water breaks, it can be released as a few drops at a time or in a gush.  Only 10 per cent of women will experience waters releasing before labour has started.  When this happens, labour usually starts within 24 hours.  The other 90 per cent of women’s waters will release at some point during labour, usually in active labour.  Here is information on self-care and warning signs.

About 75 per cent of women with PROM at term (“premature rupture of membranes” i.e. before labour starts, from 37 weeks on) give birth within 24 hours. This increases to 90 per cent within 48 hours and 95 per cent by 72 hours.  People often worry about infection after waters release.  Note that risk of infection increases with internal exams (vaginal exams), fever in mother and being confirmed GBS-positive. So this is something to be aware of.

Warning Signs

If any of these occur, seek medical attention in a timely manner.

  • If waters release before 37 weeks, contact your medical care provider and/or go to hospital.
  • If fluid is coloured (yellow, green, brown) or has a strong smell, then contact your medical care provider.
  • If you have any signs of fever contact your medical care provider.
  • If your baby isn’t moving normally, then contact your medical care provider.
  • This is a 911 call! If you feel a cord between your legs or at the vaginal opening, assume a “child’s pose” with bum in the air (on hands and knees with chest on the ground) and call 911.
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“Child’s Pose” with bum in the air

Self-Care

  • Nothing inside! That includes internal examinations unless there’s a good reason to do one. There’s a correlation between time on first internal exam and onset of infection; the earlier the initial internal exam, the higher the risk of infection.  Risk of infections goes up with number of internal examinations.
  • Baths in your own tub at home are fine. Once you’re in active labour then baths are also fine in your private birth room.  Use showers instead when in public spaces (e.g. hotel, hospital assessment washroom).
  • Be aware of signs of infection such as fever. Take your temperature every 4-8 hours during awake hours.
  • Stay hydrated. Consider if you’ve had a steady stream of fluid or just that early trickle.  It’s also possible to have a little “high leak” without membranes fully  releasing.  A healthy mama/baby will continue to make amniotic fluid.
  • Take care of hygiene:
    • Wear a clean pad and change it often
    • When using the toilet, one wipe from front to back per tissue
    • Wash hands before and after using toilet or changing pads

Go to Hospital… or Not?

This should be discussed with your midwife or doctor at prenatal appointments ahead of time in case they have specific instructions for you.  If fluid is clear then you may have the  choice to stay home or contact your medical care provider for options. Generally there are 3 things assessed at hospital:

  1. Baby’s health (by listening to fetal heart tones)
  2. Maternal health (vital signs and interview)
  3. Presence (or absence) of amniotic fluid (the “waters”) present

If you go to hospital and you’re not in active labour, you will likely be offered a sterile-speculum exam (think PAP test); the purpose being to confirm your waters actually released.  This is optional, although it’s not usually presented as such.  Other ways to determine if waters actually released may included simply asking the pregnant woman or dipping the testing swab into her wet pad.

  • If you previously tested “GBS positive” then your medical care provider may recommend induction.
  • If you previously tested “GBS negative” then may be offered induction but will more likely be sent home to wait for labour to start.  If labour hasn’t started within 24 hours then your medical care provider may recommend induction.

Your Options

  1. Go to hospital for maternal and baby assessment but decline internal examination.
  2. Go to hospital and consent to all of it – sterile speculum exam, maternal and baby assessment.
  3. Stay home and wait for labour to start, barring any warning signs or health complications.  Practice good self-care, be aware of warning signs, and pay attention to your baby’s movements.

Further Info:

Here is an excellent article about obstetrical care of women with Premature Rupture of Membranes (PROM) at term (37+ weeks), including discussion of differences in outcomes with GBS positive and negative, options, and when labour typically starts.

You can also contact me with any questions you may have about your upcoming birth!

Pregnant Woman by ocean

I teach a variety of Child Birth Education classes and prenatal workshops online for students all over.  I have been a birth doula since 2002, and have helped over 300 mothers with their births and over 1000 through prenatal classes. Learn more about my birth doula services, and contact me with any questions you may have.

Hospital Birth Room Set-up 101

Birth Room
One of the important tasks I do for my clients is to set up their hospital birth room for comfort, safety and efficiency.  Here’s a list of what I take care of I go into a birth room.  In my local hospital the birth rooms all have a small closet, mini-fridge, blanket-warmer, some empty shelves and an adjoining private washroom with a tub. If you’re DIYing then find out ahead of time what your local birth rooms are like and modify as needed.

Doulas and Dads

Although the information here will reassure any partner, this article intentionally addresses dads-to-be. All the quotes, links and videos are made by dads for dads-to-be, about their most common concerns about birth support:  1) Value; why should I pay for a doula if I’m going to be there?  2) Why do we even need a doula; what does she have that I don’t?  3) How will I be included if a doula attends?

Use of Herbs During Pregnancy & Lactation

hers for pregnancy

Herbal medicine is specific category of health-care.  Many herbs, including essential oils, are safe and beneficial during the childbearing year, while others can be dangerous.  Pregnant women must be cautious with any remedies, especially during the first trimester when the fetus is most vulnerable.  There’s a lot of misinformation concerning herbs.  Here are lists of commonly used herbs that are considered safe and unsafe through pregnancy and postpartum.

Here We Go Again: Facts vs Fear-Mongering in Placenta Encapsulation

Placenta capsulesYesterday the CBC posted another article on placenta encapsulation.  The article is low on fact and filled with fear-mongering.  Certainly an article like this should lead service-providers to pay attention to their practices, ask questions, and re-evaluate protocols to ensure safe services are being offered.  An article of this nature should also lead clients to ask questions of their encapsulators.  Unfortunately, when a big media company publishes an article with an inflammatory headline, most people don’t read through, and of those that do, few know how to evaluate the information presented.

Let’s get to the facts.