Natural Birth Doesn’t Happen by Accident!

At least not in the North American Medical Model, in which the great majority of people give birth. It requires intentional preparation and planning. 

Here are Seven Things that Help Make A Natural Birth Happen:  

  1. Strong determination and mind-set. Birth requires us to dig deep.
  2. Intentional and deliberate preparation and planning
    1. Get informed through good prenatal classes, positive stories to find the faith
    2. A solid birth-plan that communicates your wishes
    3. Learn how the female body works in the birthing process
    4. Understand what makes the pain or intensity of labour increase and decrease
    5. Dealing with past trauma might be required
  3. Advocacy 
    1. Asking questions to make informed choices 
    2. Saying no; being prepared to say no over and over if needed
  4. Tools to deal with intensity
    1. E.g. hypnobirthing, meditation, mindful yoga practise
    2. Positions that help
    3. Touch / massage
    4. Setting the tone in your birthing space
    5. TENS machine
    6. Water – bath, birth-pool (natures epidural)
  5. Dream-Team helps a lot
    1. Support person(s) that:
      1. Are a loving and/or grounding presence 
      2. Aren’t afraid of a birthing person’s pain, sounds, behaviours
      3. Know how to provide comfort
      4. Will advocate for you
    2. Doulas – research shows the presence of a doula leads to:
      1. Shorter and less complicated births
      2. Half the rates of caesareans
      3. Significantly fewer requests for pain meds
      4. Significantly more eye contact and touch between the labouring person and their partner
    3. If giving birth in the medical model, a medical care provider who supports natural birth. Ideally: 
      1. You know them
      2. You feel comfortable with them
      3. Will respect your decisions
      4. Offer shared decision making / informed choice
      5. Their methods and ideas about birth gel with yours
  6. Baby being in the optimal fetal position before labour starts
    1. Big factor in determining length of labour and intensity
    2. Factor in some interventions being used
  7. Some good luck!
    1. Health of mother and baby going into labour
    2. Medical care provider working that day
    3. When labour starts
    4. How long it lasts

No matter how labour goes or what interventions are, or are not used, birth is hard work –  physically, mentally, emotionally and spiritually. But women have been doing it for millennia and you can too!

Delayed (Optimal) Cord Clamping

In spite of a mountain of evidence to support the benefits of leaving the newborn cord intact, immediate cord clamping is still routine care in many hospitals. At the time of birth, up to 40% of the newborn’s blood is in the placenta. Leaving the cord intact for at least 1-3 minutes ensures the baby gets the majority of their blood, including red blood cells, iron and blood volume. Iron deficiency can lead to anemia and neurodevelopmental delays. Adequate oxygenated blood is required to help the baby adapt to life outside the womb, including how their blood circulates and how well they breathe in the first minutes. 

The Cochrane Review, considered the highest standard globally in evidence-based health care information, contains countless articles on the benefits of delayed cord clamping. There are indisputable improved outcomes in babies born at full term and prematurely. 

The placental blood normally belongs to the infant, and his/her failure to get this blood is equivalent to submitting the newborn to a severe hemorrhage at birth.  (DeMarsh, 1941)

Yes, we’ve known since 1941!  Changing practise takes a long time indeed.

6 umbilical cords   Intact cord – birth to 15minutes (Elphanie, 2011)

Benefits of Optimal Cord Care

Benefits and positive effects last well past the newborn period!

  • 40% more blood volume.
  • 45-50% increased levels of red blood cell counts and blood iron levels.
  • Up to 45,000 stem cells (compared to 0 with immediate clamping). Stem cells provide therapeutic benefits to the baby, even into adulthood.
  • Protection from anaemia and iron deficiency for at least 6 months.
  • Better neurological development.
  • More stable vital signs; they thrive better.
  • Preemies are less likely to require blood transfusion, ventilation and oxygen therapy. 
  • Significantly lower rates and less severity of common, major newborn health issues in preemies.

 

What About Jaundice? 

Prevention of jaundice is often cited as the reason to rush the cord clamping. Leaving the umbilical cord intact does not lead to “pathological jaundice” (the kind that makes babies sick). The naturally occurring “physiological newborn jaundice” has no clinical significance, meaning it does not harm the baby. It is normal for healthy newborns to have some jaundice around day 2-3.

Objections by your medical care provider?

The World Health Organization recommends the cord stay intact for 1-3 minutes after the birth (WHO, 2014). 

The Society of Obstetricians and Gynaecologist of Canada (SOGC, 2021) states:  Delaying cord clamping for at least 1-3 minutes after delivery allows more of the baby’s blood to return from the placenta into the baby and is usually advantageous for the baby. Delayed cord clamping (anytime beyond 60 seconds after delivery) has benefits to the baby. This is because delayed cord clamping allows more blood to transfer from the placenta to the infant, which increases the baby’s red blood cells and iron stores, and reduces the risk of anemia.

“The WHO and the SOGC recommend that cord clamping should be delayed by ≥60 seconds in babies who do not require resuscitation, irrespective of the mode of delivery.” (Armson, Allan, Casper; 2018).

The practise guidelines of the Royal College of Obstetricians and Gynaecologists in the United Kingdom are to leave the cord intact for at least 1 minute and up to 5 minutes, and to leave it for longer than 5 minutes if requested by the birth mother (NICE, 2016).

Even the American College of Obstetricians and Gynecologists (ACOG) recommends a delay in umbilical cord clamping for at least 30-60 seconds after birth, “given the numerous benefits to most newborns” (ACOG, 2017).  It’s not enough but is a big step forward for ACOG, notoriously interventionist.

What About Stem-Cell or Cord-Blood Banking?

Delayed cord clamping can not be done with cord-blood banking.  Here’s some food for thought…

In British Columbia the maximum allowable blood draw volume in newborns is 5% of their total blood volume in a 30-day period. Other jurisdictions have the same guidelines. For example, a 7# baby has approximately 275ml of blood. Medical testing allows just under 14ml of that baby’s blood to be drawn and tested, total, in one month.  

The volume collected for cord-blood banking is normally 60-90 ml or more! That’s more than 5x the allowable monthly blood draws, taken all at once in the first seconds of the baby’s life. 

Have you ever noticed all the pamphlets for cord blood banking companies at your Obstetricians’ office? Have you ever seen any information on the benefits of optimal or delayed cord clamping beside those pamphlets?  “All pregnant women should be provided with unbiased information about umbilical cord blood banking options.” Society of Obstetricians and Gynaecologist of Canada (SOGC).

Did you know whoever collects the cord blood (usually a doctor or midwife) gets paid to do so by the blood banking company? 

Did you know cord-blood banking is a very expensive endeavor? You’ll pay for the kit, possibly for the courier, and then pay every year to store the stem cells. 

The Geeky Stuff: Basic Newborn, Placenta & Umbilical Cord Information

  • The placenta is nature’s neonatal life-support system.
  • The placenta will deliver oxygen to the baby until their newborn lungs transition to breathing air (30 to 90 seconds in a full-term infant).
  • Placental transfusion (blood moving from placenta to baby’s body) rate: 50% in 1 minute; nearly 100% over the next 2 to 5 minutes.
  • “Delayed” in research ranges from 30sec – 3min, depending on the researcher and study.
  • Newborns cope well with lack of oxygen for up to 20 minutes (only if the cord is intact) but low blood volume can quickly have catastrophic outcomes.
  • For comparison of the fact that up to 40% of the newborn’s blood is in the placenta, adults may go into shock and receive blood transfusions at 15 to 30% blood-loss.

References

ACOG American College of Obstetricians and Gynecologists. (2017).  Delayed Umbilical Cord Clamping After Birth. Obstet Gynecol 2017;129:e5–10. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

Armson, B.A., Allan, D.S., Casper, R.F. (2018). Delayed Cord Clamping and Umbilical Cord Blood Collection.  Journal of Obstetrics and Gynaecology Canada, 40 (2), 155.

Asfour, V., & Bewley, S. (2011). Cord clamping practice could affect the ratio of placental weight to birthweight and perinatal outcomes. BJOG: An International Journal of Obstetrics & Gynaecology., 118 (12), 1539-40.

Chaparro, C. M., Neufeld, L. M., Alavez, G. T., Cedillo, R., & Dewey, K. G. (2006). Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. The Lancet, 367 (9527), 1997-2004.

CRYO-CELL International Inc. (2019). Cord blood collection instructions. Florida.

De Marsh, Q. B., et al. (1941).”The Effect of Depriving the Infant of its Placental Blood.” Journal of the American Medical Association (J.A.M.A.), 116(23):2568-2573. doi:10.1001/jama.1941.02820230012004

Fogelson, D. N. (2011). Delayed cord clamping grand rounds. USC School of Medicine, A.P. Dept. Obstetrics and Gynecology. South Carolina: Palmetto Health Grand Rounds.

Frye, A. (2004). Holistic midwifery, vol 2, Care during labour and birth. Portland: Labrys.

Garofalo, Milena; Abenhaim, Haim A. (2012). Early Versus Delayed Cord Clamping in Term and Preterm Births: A Review.  J Obstet Gynaecol Can;34(6):525–531.  http://www.jogc.com/article/S1701-2163(16)35268-9/pdf

Greene, A. (2008). How much blood is too much guideline. Retrieved from Dr Greene: http://www.drgreene.com/article/how-much-blood-too-much-guideline.

McAdams, R.M. (2014).  Obstet Gynecol. 123(3):549-52. doi: 10.1097/AOG.0000000000000122.

Mercer, J. S., Vohr, B. R., McGrath, M. M., Padbury, J. F., Wallach, M., & Oh, W. (2006). Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemmorhage and late onset sepsis; a randomized, controlled trial. Pediatrics, 117 (4), 1235-1242.

NICE National Institute for Health and Care Excellence (UK). (2016). Clinical guideline [CG190] Intrapartum care for healthy women and babiesPub Dec 2014, revised/updated Nov 2016.  https://www.nice.org.uk/guidance/cg190/ 

Reed, R. (2011). Cord blood collection: confessions of a vampire-midwife. Retrieved from Midwife Thinking: http://midwifethinking.com/2011/02/10/cord-blood-collection-confessions-of-a-vampire-midwife/

Richmond, S., & Wyllie, J. (2010). European resuscitation council guidelines for resuscitation 2010. Section 7. Resuscitation of babies at birth. J. Resuscitation , 1389-1399.

SOGC. (2021). Delayed Cord Clamping. Society of Obstetricians and Gynaecologist of Canada.  https://www.pregnancyinfo.ca/birth/delivery/delayed-cord-clamping/

Tolosa, J. N., Park, D.-H., Eve, D. J., Klasko, S. K., Borlongan, C. V., & Sanberg, P. R. (2010). Mankind’s first natural stem cell transplant. J. Cell. Mol. Med. , 14 (3), 488-95.

University of British Columbia – Children’s & Women’s Health Centre of British Columbia. (2013). Pediatric Blood Draw Guidance. Version 3.2.

Usher, R., Shephard, M., & Lind, J. (1963). The Blood Volume of the Newborn Infant and Placental Transfusion. Acta Paediatrica – Nurturing the Child , 52 (5), 497-512.

WHO. (2014). Guideline: Delayed Umbilical Cord Clamping – for improved maternal and infant health and nutrition. Geneva: World Health Organization.

Checklist and Tips for Making a Birth Plan

Most people who give birth in a hospital are meeting their medical care team for the first time. Because of the circumstances, the staff do not have the time or bandwidth to get to know their patients in-depth.   

A good birth plan, which I prefer to call “Birth Preferences”, can build bridges with your medical team. It can help them get to know you and quickly understand what you’d like in your ideal birth. It’s also helpful to learn about the policies and practises at your birthplace, so you know what to put on your wish-list.

Your Birth Plan document should be only one page with lots of white space and an easy font – at least 12pt. Use respectful and positive, but firm language. “I prefer….” is wishy-washy for something that really matters to you. 

I recommend you use language that reflects who you are. If you have a great sense of humour, feel free to insert fun and levity in your plan. “If Jamie takes a nap, please kick him when he starts snoring.”

Checklist for an excellent Birth Preferences document

This section includes examples. Feel free to copy them or use your own language. 

  1. Start with an opening paragraph that includes:
  • An opening statement that encompasses your attitudes or overall vision e.g. “We’ve prepared for a natural birth” or “An epidural is part of my plan” or “We’re using Hypnobirthing as a tool.”
  • A statement about consent, such as “We’re open to changes after discussion with the medical staff so we can make informed choices.” or “I will ask questions whenever a procedure is recommended and then need a few minutes alone to think.”
  • A kindness to the staff. “Thank you for supporting us through our birth process” or “We appreciate the work you do.”
  1. An additional opening paragraph if there are special circumstances:
  • Medical conditions that need to be known urgently, such as “Lucy is allergic to penicillin”. 
  • Mobility issues or cognitive considerations.
  • Sensitive issues that may affect your birth, if it feels safe to share. (It’s been my experience that this level of personal sharing makes for better treatment.) “Due to previous trauma, no one is to touch me until I am aware of who they are, understand why and what’s involved, and have verbally agreed.”  Or “Robin faints at the sight of blood, even one drop.” Or “We’ve had a previous loss and do not want to discuss it. Please see the prenatal records.”
  1. Then a short list of points for your wishes. It could be titled, “These are our wishes”:
  • If anyone is joining you, name them. E.g. Your doula or “plus-one” such as a friend or mother.
  • The environment you’d like, such as quiet with dim lights, loud rocking music (bring your own), window blinds open for sunshine, privacy.
  • Continue this section with points that are unique to you. Here are a few of my favorite things from the hundreds of birth plans I’ve seen:
    • I must wear my purple socks at all times.
    • Do not offer pain medications; I’ll ask if I want anything.
    • Please run a bath and encourage me to get in.
    • Minimal cervical checks and only by experienced staff.
    • I will eat if I’m hungry; please provide a waiver.
    • Please provide the squatting bar and recommend positions to keep labour moving.
    • Please coach me through pushing. 
    • I will breathe my baby down and appreciate quiet during the bearing-down stage.
    • Essential staff only; no observers or learners. 
    • Students are welcome.

You get the idea!

  • Cord and placenta plans, if any. E.g. We’d like 3 minutes of delayed cord clamping. Or We’re keeping our placenta. Or Please show me the placenta before disposing of it.
  1. Some people add an “In case of Caesarean:” heading, with things that are important to them such as playing a certain song, delayed cord clamping, requesting someone to take photos if possible, keeping family together as long as possible in the OR.
  1. A closing sentence such as “Thank you for taking time to read this page” or “Thank you for being part of our big day!”

Do not include:

  • Disaster planning language e.g. “… unless something goes wrong.” or “… unless it’s needed”.  It’s a given. 
  • Things that aren’t issues. If your local hospital has a policy that all babies are held skin-to-skin by a parent immediately upon birth and for the first hour (that’s the policy in my local hospital), then there’s no need to ask for that. 
  • A shopping list of all the things you don’t want. You don’t have to tell your medical team that you don’t want an episiotomy or a caesarean – they know that. (Well, unless you’re in a place where episiotomies are routinely done – then add that to the list! In almost every Canadian hospital, episiotomies are not routinely done.)
  • The interventions that are only done after discussion, such as induction, which requires a conversation and signed consent form. 
  • Postpartum care of the maternal or newborn patient. “I will breastfeed” or “I will use formula” do not belong on the birth plan. 

Optimal Fetal Position – Turning Baby Prenatally

Fetal position (position of the baby in the maternal pelvis) at the onset of labour is one of the greatest determining factors of how the birth process will proceed.  The optimal fetal position is pictured below.  A good way to remember the best position is to be able to give your baby a back rub every time you rub your belly.

The terms “posterior” or “sunny-side up” describe a baby who faces out, or is spine-to-spine with the pregnant woman. “OP” is the medical jargon, meaning occiput posterior. The part of the head that enters the pelvis is bigger in this position and the baby doesn’t flex and rotate as well as if they’re in the optimal position.  That can make for a much longer, more painful and more complicated birth.

Problems Related to Posterior Position

  • More difficult for baby to drop into and through the pelvis
  • Pregnancy may last longer
  • Membranes are more likely to rupture before the onset of labour
  • Labour may progress slowly or not at all
  • Back-pain during labour that doesn’t disappear between contractions
  • Increased risk of tearing
  • Increased risk of instrumental or surgical birth
  • Increased stress on baby’s head and nervous system

Some women birth a posterior baby just fine.  Those include but are not limited to, women who’ve given birth without difficulty before, those with an average or smaller baby, a labouring woman who’s able to move about freely and allow her baby to rotate into an “anterior” (the optimal) position.

Fetus in WombBaby in optimal position:  head down and flexed, back out.

Signs of a Posterior Baby

  • Feeling kicks or flutters at the front
  • Frequent urination (more frequent than with anterior pregnancy)
  • Belly appears flat on top or lumpy
  • Your midwife or doctor can tell by palpating your abdomen or by doing an ultrasound
  • Fetal heart-tones may be difficult to hear
  • Head is not engaged or doesn’t drop into pelvis
  • Can be assessed during labour by a cervical check

Factors Contributing to Posterior Position
Babies can assume a posterior position with no risk factors, but the following increase the chances:

  • North American lifestyle – reclining in upholstered furniture, sedentary lifestyle, sitting in cars (it’s interesting to note this position is rare in cultures where pregnant women walk a lot or work bent-over, and lack Lazy-Boy style chairs and couches)
  • Sitting with legs crossed
  • Postural or anatomical issues
  • Issue of uterine / abdominal muscles (e.g. tight psoas)
  • First pregnancy
  • Epidural use early in labour (hinders rotation and descent of baby) is correlated with more than 3x the rate of posterior position at birth (Tully, 2008)
  • Labouring in bed or without adequate movement
  • Baby who was breech and turned to vertex
  • Pregnant person with history of breech or posterior baby
  • Short or tight cord around baby
  • Emotional issues – fear of birth or parenting, not paying attention to pregnancy, family history of breech, relationship issues, financial concerns, stress (Frye, 1998)

Tricks for Turning a Posterior Baby to an Anterior Position
Sometimes there’s an unknown reason for the baby to be posterior and nothing will turn them. But in many cases a baby can be turned. Please ask for details or referrals.

  • Visualization and “talking” to your baby. Focus on letting the baby know it’s easier to get out when facing the other way.  This works especially well if combined with changing your emotional environment e.g. dealing with fears, prepping for birth.
  • Look at a picture of baby in proper position (e.g. Fig. 1), or have it drawn on your belly!
  • Webster Technique with a chiropractor certified in its use. Pistolese (2002) cites an 82% rate of success in relieving the musculoskeletal causes of intrauterine constraint.  It’s beneficial to perform the Webster Technique starting at 35-36 weeks.
  • Sit with pelvis tilted forward – knees below pelvis with straight back. Instead of upholstered furniture, use a birth ball, the floor, a kneeling chair or a regular hard chair or stool
  • Hands and knees – read, crawl around, or do “child’s pose” modified for pregnant belly
  • Pelvic rocking while on all 4’s – gentle “cats and dogs” yoga postures – several times daily
  • Swimming or floating – anything with belly down like a hammock for baby to drop into
  • Movement and exercise
  • Sleep on left side with a body pillow – left leg straight, right leg bent on pillow
  • Homeopathic Pulsatilla 200CH, 1 dose every 3 days.
  • Acupuncture or moxibustion – see a Traditional Doctor of Chinese Medicine or an acupuncturist who specializes in women’s and pregnancy care.
  • Deal with fears around childbirth and parenting
  • Postural management – check out spinningbabies.com for some excellent postures and exercises that encourage babies to assume optimal positions for birth.
  • Exercises to prepare for birth and encourage pelvic floor health, and optimal fetal positioning, such as the Miles Circuit.

References

Frye, A. (1998). Holistic Midwifery, Vol 1, Care During Pregnancy. Portland, OR: Labrys Press.

Ohm, J. (2006). About the Webster Technique. Retrieved from icpa (International Chiroractic Pediatric Association): http://icpa4kids.com/about/webster_technique.htm

Pistolese, R. (2002). The Webster Technique: A chiropractic technique with obstetril implications. Journal of Manipulative and Physiological Therapeutics , 25 (6), E1-E9.

Tayler, R. (2000). Homeopathy for Pregnancy and Childbirth. Ottawa: Ottawa School of Homeopathy.

The Midwifery Group. (2008). Posterior Babies. Retrieved from The Midwifery Group: http://www.midwiferygroup.ca/downloads/position/Posterior%20Babies.pdf

Tully, G. (2008). Occiput Posterior – OP. Retrieved from Spinning Babies: http://www.spinningbabies.com/baby-positions/posterior

Perineum Care and Recovery

Calendula Pads

For swelling, pain, heat.  Make 5-10 pads 6 weeks before due date.
Calendula flowers promote healing and are soothing when applied topically.

  • Calendula Mixture: Make tea from dried calendula leaves (1 full tea ball per cup water steeped for 10 min) or use tincture (20-30 drops per cup water).  Add 1-2 drops of lavender essential oil or some lavender tea to mixture.
  • Partially dip maxi pads – preferably long, organic – in calendula mixture briefly, just to soak top layer. Another option is to use a sprayer to wet the tops.
  • Freeze pads in bowls so they’re curved like the female body. Store in Ziplocs (labeled with your name) in freezer.
  • Bring the pads to birth-place! Hospitals and birthing centers may have a freezer you can use. If not, consider bringing a cooler or just wait to use them until you return home.
  • Apply immediately after birth.

Perineum Care after your Birth

Peri-bottles are one of a new birth mom’s best friends. Kind of like a bidet in a bottle or “A soothing spritz for your lady-bits!” according to Ninja-Mama.

Here are some tips and advice about using peri-bottles:

  • Plan ahead – find out if your local hospital provides one. Most do for use during the postpartum stay and beyond. Your midwife may also provide one for homebirth.
  • If they provide at one the hospital, take it home. It’s not fancy but it works fine.
  • Plan to have one peri-bottle in each bathroom the birth mother will use. The Frida Mom (sold locally at Groovy Mama and Hello Baby) and Ninja Mama are genius peri bottles. Most hospitals provide the one pictured 3rd on the link above, and it’s also sold locally at Jolly’s.
  • Use it every time you use the toilet. Just spray while peeing or after as a rinse.
  • Warmed water or a peri-rinse such as calendula infusion feel best. Room temp will feel cold but it’s okay too.

Perineum Rinse

Soothing and healing for swelling, pain, abrasions, tears, bruising.  It’s safe to use with stitches.  This can be prepared during early labor or ahead of time and frozen/refrigerated.

  • Fill a peri- or spray-bottle with calendula mixture (above), a healing solution (below) or warm water.
  • Hospitals will provide a peri-bottle.  A spritz bottle works too.
  • Squirt solution on perineum after every washroom use, shower/bath, or in between if extra relief is needed. Do not rinse solution off.
  • If urination burns then squirt during urination – start just before releasing urine – or pee in the bath.
  • Allow the area to dry between applications. Air-time or even a cool blow drier can be helpful.
  • Note: if the rectum is sore or stitched, support the perineum with a cloth during bowel movements (like pooping into a cloth).

Sitz Bath

(Not sure why we call it that; it’s just a shallow bath! Full tub works just as well.)

  • Soak your perineum in a bath for 15 minutes, 3 times daily. Shallow water is fine.
  • Add Epsom salt and if you wish to use herbs, add 1-2 cups raw herbs or healing herb tea, ¼ cup tincture, or up to 5 drops of pure essential oil. If you wish to use plain water then spray the healing solution after the bath.
  • Some women like cool water for inflammation while others find warm water soothing. Experiment with temperatures but avoid extremes during the initial postpartum days, and keep the rest of your body warm.
  • Do not sit on a donut-shaped vessel in the bath as it adds pressure.

Healing Herbs

Calendula is healing, along with other herbs such as comfrey, lavender, witch hazel, tea-tree, yarrow.  Feel free to ask me about the various healing properties of the different herbs.  Nice sitz-bath blends can be purchased – look for an Epsom salts base with herbs or pure essential oils; no fragrance or additives.   There are some nice soothing perineum sprays on the market, such as Earth Mama Angel Baby New Mama Bottom Spray, sold in Regina at Head-to-Heal Wellness and Groovy Mama in Cathedral, or Hello Baby in East.

Recovery from a Difficult Birth

After a difficult birth follow the above recommendations plus:

  • Keep knees together as much as possible for the first 2 weeks, even while walking
  • Avoid stairs
  • Lift nothing heavier than the baby
  • Allow area to “breath” – air time or cotton panties (no synthetics)
  • Avoid sitting or standing for long periods of time
  • Avoid perfumes, chemicals
  • Avoid straining on the toilet – good nutrition and lots of water, support perineum with a cloth during bowel movements (like pooping into a cloth)
  • See a Physiotherapist who specializes in women’s pelvic floor to heal pelvic floor muscles; recover from perineum tears; avoid or heal incontinence, painful intercourse and pelvic pain
  • Consider seeing a complimentary practitioner who specializes in and is experienced with maternal postpartum recovery, such as a Webster certified chiropractor or an osteopath, to help ensure pelvic organs, bones, ligaments are healthy and aligned.

Angie The Doula – Tips and Recipes for Labour-Aid Drinks

Here are some alternatives to store-bought sport drinks, which are usually full of chemicals and unhealthy ingredients. High quality coconut water is full of electrolytes. Any bone broth works too for Labour-Aid.

Labour-Aid and broths are excellent for hydration, energy and electrolytes.  They help keep the powerful forces of labour progressing.  Stock the ingredients at home and prepare at the first sign of labour.  Or make ahead (this is a great task for someone who wishes to help out) and freeze as cubes, popsicles, or in a bottle, to be thawed and consumed as labour progresses.

Most labouring women prefer their labour-aid chilled and their broths warm.

LABOUR-AID DRINK – basic (recipe shared by many midwives and natural birth books)
1 L  water or Pregnancy Tea
1/3 C  raw honey or real maple syrup
1/3 C  juice, fresh-squeezed from a real lemon
1/2 t  salt, preferably Celtic or Himalayan
1/4 t  baking soda
2 crushed calcium tablets

LABOUR-AID DRINK – easiest (recipe by Head to Heal Wellness)
1L water (for hydration)
1 Tbsp honey (to give us fuel while being active)
1/4 Tsp salt (to replace the loss of electrolytes)
1/4 Tsp baking soda (to replace electrolytes lost)
1/2 a lemon
Combine all the ingredients into a glass container and stir. You can tweak the amounts based on your personal preference and needs. Squeeze as much lemon as you like until you find your favourite ratio. Voila!

These next two versions are from Mommypotamus.  See the website for details of ingredients.

LABOUR-AID DRINK – Lemon Labor Aide
4 C  water
1/2 C  freshly squeezed lemon juice
1/4 t  salt, preferably Celtic or Himalayan
1/4 C  raw honey (or more to taste)
a few drops concentrated minerals (available at health stores, optional)
a few drops Rescue Remedy (optional)

LABOUR-AID DRINK – Coconut & Lime Labor Aide
3 C  coconut water
1 C  water (or more)
1/2 C  freshly squeezed lime juice
1/4 t  salt, preferably Celtic or Himalayan
2 T  raw honey or maple syrup
a few drops concentrated minerals (available at health stores, optional)
a few drops Rescue Remedy (optional)

VEGGIE BROTH
Add fresh or dried veggies (e.g. carrots, celery, onion, garlic – anything) to boiling water
Simmer for 20-30 min
Add 1 T  apple-cider vinegar
Season with any herbs or spices you like
Add salt to taste, preferably Himilayan or Celtic (kelp powder can be used instead)
Blend to smooth consistency or strain veggie chunks out

BONE BROTH
Put bones and any left-over bits, including meat on bones in pot and cover with water.
Add 1-2 T  apple cider vinegar
Bring to boil then simmer (large bones such as beef for up to 24 hours; small animal bones such as chicken only need 3-4 hours)
Strain
Add salt to taste, preferably Himilayan or Celtic (kelp powder can be used instead)
Optional:  Add dried or finely chopped fresh veggies, herbs or spices and simmer for another 30min

Angie The Doula – Postpartum Warning Signs for Mother and Baby

CALL 811/DOCTOR/MIDWIFE WITH ANY WARNING SIGNS.  CALL 911 FOR EMERGENCY HELP!

If you call 911, have someone clear a path for EMT (halls, stairs etc), turn on outside light, put pets away, unlock door, clear driveway.)

Maternal Warning Signs

  • Vaginal bleeding heavy enough to soak a super-pad front to back in 1/2hr-1hr. Note: if blood starts to pour continuously, lay down immediately and call 911;
  • Foul-smelling bleeding or discharge
  • Passing clots bigger than a toonie
  • Temperature greater than 38C (100.4F)
  • Feeling flu-like
  • Uterus is painful to the touch
  • Uterus feels soft and is at or above the navel, and doesn’t respond to gentle massage
  • Sore, red, hot, tender area on leg or calf
  • Painful, swollen, red breasts or red / hot / lumpy spots
  • Sudden and extreme pain on nipples with feeding (may be thrush)
  • Persistent dizziness (call 911 if accompanied by bleeding)
  • Fainting (call 911 if accompanied by bleeding)
  • Feeling depressed, very anxious, unhappy or are crying without reason and cannot sleep or eat

Baby Warning Signs

  • Blue or grey in the lips, face or chest. Call 911.
  • Temperature of greater than 37.4C (99.3F) or lower than 35C (96.6F) (note: consider environment – e.g. is baby wrapped in layers in a hot room?)
  • Laboured breathing
  • Extra-sleepy and has not fed in the past 6-8 hours
  • Has not urinated or passed meconium (feces) in the first 24 hours
  • Yellow skin in the first 24 hours
  • Red patches, pimples or bumps
  • Vomits after every feed
  • High pitched cry or extremely irritable, inconsolable
  • Lethargic
  • Red, hot area around cord-stump; swelling of stump; discharge of pus, blood or meconium
  • Red blood in urine (note – some girl-babies get a little ‘period’ due to hormones)
  • Bright red diaper rash
  • White spots in mouth that don’t rub off (thrush)

Angie The Doula – Normal Postpartum Care of Mother and Baby

If you’re concerned, see Warning Signs for Postpartum.

In the first 24 hours after birth it is normal for birth mothers to:

  • Expect a fairly heavy flow for the first 24 hrs, like a heavy period in appearance and scent. Flow should gradually taper in the following few days, then continue lightly for approximately 4-6 weeks.
  • Pass small clots and gushes, especially after lying down for some time
  • Have a firm uterus that feels like a grapefruit below the navel
  • Experience night sweats
  • Urinate frequently
  • Feel exhausted and need rest

In the first 24 hours after birth it is normal for babies to:

  • Breathe irregularly, including pauses and some periods of rapid breathing
  • Spit up mucus
  • Have blue hands and feet with pink body, face and lips
  • Sleep for 4-6 continuous hours after birth then wake up every 2-3 hours to breastfeed
  • Pass stool (but may be within 48hours)
  • Urinate

Postpartum Care – Mother

  • In the first week, only responsibilities should be to eat, sleep and feed and cuddle baby
  • Sleep when the baby sleeps
  • Get assistance with getting up for the first day. Never get up while holding the baby (first 24hours), in case of fainting.
  • Do not lift anything heavier than the baby for 3 weeks after a gentle vaginal birth; 6 weeks after a Caesarean or traumatic birth.
  • Take temperature daily for the first 5 days; twice daily if membranes were ruptured more than 12 hours before birth or in case of traumatic birth.
    • Oral temperature: 15min after ingesting hot or cold, or being in hot water. Put tip under and against tongue to 1 side of frenulum, close mouth and wait for the beep (or 5min for glass thermometer; remember to shake well before use)
  • Light movement is fine during the first 6 weeks. Any increase in cramping, bleeding, or discharge going from brown to red means you’re doing too much!

Uterus recovery:

  • In the first 1-2 days, gently massage uterus (back and forth motion) several times daily to ensure it’s firm like a grapefruit
  • Urinate often
  • Breastfeed often
  • Nothing inside the vagina

Pain:

  • Take arnica to aid with tissue healing
  • After-pains are due to the uterine contractions and tend to be stronger with subsequent pregnancies and during breastfeeding. Lay or sit, apply pressure (e.g. pillow) and heat (hot water bottle), take extra calcium, and consider calling midwife for homeopathy.
  • It’s safe to take acetaminophen (Tylenol x-strength) every 6 hours (for pain) and ibuprophen (Advil) every 4 hours for swelling for the first few days after birth
  • Avoid aspirin, alcohol, herbal supplements with willow-bark as they promote bleeding

Perineum:

  • Keep area as clean and dry as possible
  • Use peri-bottle of warm water and 1 dropper of calendula tincture after using the toilet
  • Wear the lightest pad necessary and change it with every visit to the washroom.
  • Apply frozen calendula pads to perineum/hemorrhoids several times daily for 2-3 days
  • If any tears/suturing to perineum, soak in a clean bath each day with ½ cup of Epsom salts or sitz-bath herbs added. Keep knees together as much as possible, including while walking or on stairs.  Airtime helps speed recovery.
  • Begin light elevator-Keigels and pelvic floor exercises

Nutrition:

  • Drink plenty of water and nutritional drinks, including Pregnancy Tea Blend
  • Eat whole foods – 3 meals and 2-3 snacks daily (just like during pregnancy)
  • Continue prenatal vitamins, acidophilus, essential fatty acids for at least 6 weeks
  • Continue or begin to take iron supplements if they were prescribed

Normal Postpartum Care – Baby

  • Feed when the baby wants but a minimum of every 4 hours around the clock (see “breastfeeding” below). A breastfed baby shouldn’t be offered anything other than breast milk/ colostrum.
  • If baby’s definitely satiated and still wants to suck, it may save nipples to offer a clean pinkie; insert to first knuckle, pad up.
  • Keep the cord-stump dry (fold diaper below) and clean. No need to put anything on it, but calendula tincture is acceptable.
  • When changing diapers wipe from front to back, only once per cloth. Clean folds of skin but do not open genitals and never retract foreskin.
  • Clean baby’s hands, folds in neck, and face with a clean damp cloth daily
  • Bathing is recommended only once or twice weekly with gentle and “edible” soap
  • If fingernails are long then prevent scratching by cutting with newborn-clippers or gently chew them off
  • Keep the baby at a comfortable temperature. If concerned take baby’s temperature.  Put the end of the thermometer at deep centre of armpit, then the hold arm against side until thermometer beeps (or 5min for glass; remember to shake well before use).
  • For plugged tear duct gently but firmly press at the inner bridge of the nose with the pad of your finger beside the baby’s inner eye. Stroke up to remove blocked material, then downward 3 or 4 times to the nostril.  Repeat several times daily until it clears.
  • Sleep with the baby in your room. Baby should sleep on her/his back, on a firm surface away from puffy blankets and pillows.

Breastfeeding

  • Feed baby frequently, usually 10-12 times/24 hrs after first day or so. Baby may have long periods of sleep in the first 24 hrs so may feed less frequently. Feed the baby on cue, minimum every 4 hrs or so. Babies usually nurse for 15-20 minutes.
  • Baby’s mouth WIDE open before latching! If painful, retry the latch over and over until it’s correct.  This will prevent sore nipples. Don’t do even 1 feeding with improper latch.
  • Should feel a pull but not a pinch
  • Breast well supported in one hand, where an underwire goes, away from nipple
  • Baby position: skin to skin, belly to belly, nose to breast, pull in very close so that very little/none of areola is visible, with both baby lips open (not tucked in).
  • Nipple care: Expect nipples to be tender for a few days.  Express colostrums onto nipple /areola after each feed. Allow to air dry.  Do not use soap or chemicals on nipples.  In case of chaffed or dry skin, Lanolin or pure vitamin e-oil can be used (but try the colostrum first).  Change nursing positions
  • If breasts get engorged with milk (hard and full-feeling), apply refrigerated green cabbage leaves, and reapply new ones as they “cook”
  • Avoid the use of pacifiers or artificial nipples

PLEASE CALL IF YOU’RE TEMPTED TO USE FORMULA IN SPITE OF PLANNING TO BREASTFEED

Angie The Doula – Warning Signs During Pregnancy and Labour

Unusual sensations and some discomforts are part of normal pregnancies.  It is important, however, that any of the signs listed below be assessed right away.

CALL 811/DOCTOR/MIDWIFE WITH ANY WARNING SIGNS.  CALL 911 FOR EMERGENCY HELP!

If you call 911, have someone clear a path for EMT (halls, stairs etc), turn on outside light, put pets away, unlock door, clear driveway.)

Warning Signs – Seek medical advise soon, at least same day. Do not sleep on any of these or wait for them to go away on their own.

  • Reduced fetal movement that doesn’t respond to stimulation (see below) *
  • Maternal fever and chills
  • Dizziness
  • Persistent and severe mid-back pain
  • Prolonged nausea and vomiting
  • Initial outbreak of lesions or blisters in the perineal area
  • Change from normal urination – suspected bladder infection
  • Vaginal discharge with itching, irritation or a foul smell
  • Signs of bladder infection such as burning or urgent, frequent urination
  • Persistent negative feelings, low moods and/or overwhelming anxiety.
  • Gush of vaginal fluid or suspect ruptured membranes, with nothing felt to be falling out
  • Pinkish, brownish, sparse or suspected vaginal bleeding
  • Signs of labour (regular uterine contractions, waters releasing) before 37 weeks
  • If there’s a colour (yellow, brown, green) or foul odour when waters release

Danger Signs – The symptoms below may indicate a life-threatening condition, and require immediate medical attention.  Get to a hospital right away.

  • Accident or injury such as car accident or a fall (seek medical attention if required)
  • Sudden severe swelling of hands and face
  • Severe continuing headache
  • Visual disturbances (e.g., blurring of vision, spots, flashes of light)
  • Persistent, severe, sudden abdominal or pelvic pain
  • Severe epigastric pain (upper abdomen) – may feel like heartburn but more severe and not relieved by the usual tricks
  • Sudden and severe vomiting
  • Red flowing vaginal bleeding (CALL 911)
  • Persistent thoughts of self-harm, suicidal urges (CALL 911)
  • Convulsions (CALL 911)
  • Gush of vaginal fluid / suspected ruptured membranes, with a cord felt at or outside vaginal opening (cord prolapse) – get on hands and knees with buttocks higher than head (CALL 911)
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* Normal Fetal Movement:  If you’ve been busy or are unsure about movement then relax and have a meal, a small glass of juice or some fruit.  Palpate your baby to induce movement.  Pay attention to the movements.  Babies sleep.  If your blood sugar is low then so is your baby’s.  You should feel at least 10 movements over any 2 hour block and at least 1 in the first hour.   If not then seek medical attention.

Updated RGH policies for maternal patients and what doulas can do for you

As of April 2, 2021, RGH and all Sask hospitals are now closed to visitors and are restricting support to only ONE person in the Labour & Birth Unit and the Mother-Baby Unit. Each labouring woman can have one person with her throughout her stay; the same one person, no swapping or changing. The restrictions also affect patients in pretty much every unit throughout all hospitals.

The Sask Health Authority will re-evaluate weekly and get back to 2 support persons as soon as they deem it safe to do so. My fingers and toes are crossed that this happens before your birth! If it doesn’t, doulas are still here to help you.

I have been down this road a year ago for about 2 months with several clients and can still be immensely helpful to you. Here’s what doulas can do to help you prepare for your birth during this time:

  • Extra planning and education for your birth, given this new situation.
  • Answer your questions through pregnancy, birth and postpartum. You still have someone you can call anytime.
  • Early labour support in your home, while wearing masks.
  • Help you make the decision about when to go to hospital. We can do this by phone or in person.
  • Ensure you know which door to use, where to park, what you need to go through registration and admitting.
  • Be your back-up for support in case one of you “fails screening”. 
  • Be the primary support person if wanted or needed.
  • Phone and/or video support throughout your labour and birth. This works best if you resist the urge to “be polite and let your doula sleep”. If I have updates throughout your journey, I can advise you on questions to ask, positions to try, things to do for comfort, things to do to keep labour progressing as well as possible. I can watch for “cross roads” and help you towards what is your version of an ideal birth. I can still help you navigate detours. I supported 7 couples in this manner in 2020 and they were grateful for the guidance, even though it looked differently than we had originally planned.
  • Postpartum support will be offered as usual – at your home, by phone or video call – your choice. 

Here’s what you can do to make your birth as empowering as possible for both of you:

  • Extra planning and education, with a doula’s help.
  • Have a good solid birth plan.
  • RGH Tour with me
  • Easing Labour Pain class, which teaches partners how to do hands-on support. It also covers informed choice and many options for comfort and labour progress.
  • Print, read and bring to your birth Hospital Set-up 101. There’s a link to a YT video if you prefer that.
  • Check out my article, When to go to Hospital
  • Lots of communication with your doula!

My mantra lately, even with this latest development, is “everyone is doing the best they can”. The new restrictions are certainly frustrating (to say the least) and inconvenient but our health care providers are working hard to find the balance of patient safety and patient experience.  My fingers are crossed that this phase passes quickly and we can get back to our regular routines of attending hospital births in person. That said, I’m so sorry about the effect this has on your birth plans. Even if things change before you go into labour and we can be together in person, it does mean extra preparation and stress for you.

Please let me know if you have any questions. I am here to help.

I teach a variety of Child Birth Education classes and prenatal workshops online for people all over.  I have been a birth doula since 2002, and have helped over 300 clients 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.