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. 

Need help to make a birth plan that builds bridges instead of walls?

I can help you sort through your options and find the best wording. Check out my Birth Plan Prep Consultations which are available in person or on Zoom.

Summer pregnancies & hot births!!

Oh, the days are hot and even more so when we’re growing a baby or holding a newborn. If you don’t already know, profuse sweating is a normal part of postpartum recovery even during winter. 

Here are some tips for summer survival with a baby-bump that go beyond the obvious, typical lists – wear loose clothing, do things early in the day, stay hydrated, find AC. I think we all know that by now.  

Summer Pregnancy-Safe Drinks

Growing and/or feeding a baby both take a lot of energy and we burn through more electrolytes and minerals in the hot summer. Sugar drinks are not helpful. Pregnant and breastfeeding bodies are more susceptible to blood sugar shifts and the yeast / thrush infections that result from high sugar intake. I have 2 articles for you for healthy, refreshing and cooling drinks (other than plain old water which is of course, important every day). They’re all nutritive during pregnancy and postpartum recovery – actually any time. Kids and adults can consume these. 

Cooling Essential Oil Body Sprays / Mists

Even though every bottle says “don’t use during pregnancy”, there are a lot of oils that are safe. Consult a certified aromatherapist – that’s me, from way before it was cool (pun intended) to be into essential oils. You can make a spritzer with:

  • mint
  • lavender
  • cucumber
  • lemon – actually any citrus oil.

Add any combination of those to aloe, witch-hazel or a flower water such as rosewater.

If you prefer to buy a spray, check out the perineum sprays such as that made by Earth Mama Organics. They can be used all over, not just your bottom! 

Caution #1: Citrus oils can make your skin more sensitive to sun-burn; only use for an indoor spray.
Caution #2: Many commercial refreshers and cooling sprays contain Eucalyptus, which should never be used near babies and pets. Best to avoid it through pregnancy too. Some types are safe but the most commonly used ones are too strong. 

Angie’s Tips for a Cooler Birth:

  • Put a small wireless fan in your birth bag and/or birth place. Some of my clients use handheld fans and others use ones with a big clip. 
  • If you’re having a hospital birth, i.e. in a scent-free environment, then bring an empty squirt bottle and fill it with cold water for misting. 
  • Ice chips! They’re amazing during labour & birth. Suck on them, put them in a washcloth and use as a cold-pack all over the body, put them in a bowl of water and dip a washcloth in to apply on foreheads and necks, add them to juice and water. I rarely attend a birth without using at least a couple of cups of ice-chips. 
  • Temperature fluctuations are amplified during the birth process. This video has tips to regulate temperature during birth and what the partner / birth companions can do.  

Essential Herbal Tea for Pregnancy & Breastfeeding

Women have consumed infusions (tea) of Red Raspberry leaf and Nettle leaf through the ages for a healthy childbearing year, healthy reproductive organs at any stage of life, and to keep their skin soft and supple.  This blend is high in easily absorbed minerals.  If no milk or sugar is added then this drink counts toward your daily water intake.

Drink 1-3 cups of Pregnancy Tea, hot or cold, daily through first 2 trimesters, and 3 cups during last trimester. 

Combine these teas in any ratio you wish, but the general recipe is:

  • 2 parts Red Raspberry Leaf
  • 2 parts Nettle Leaf
  • 1 part Horsetail Leaf (added for calcium & strong bones)
  • Optional: 1 bag or small scoop of lemon, berry/fruit teas (ensure no licorice), mint or lemongrass to change up the flavour.

A batch can be stored in the fridge for up to 3 days.

Red raspberry leaf (Rubus idaeus)

  • Most commonly used and well-known pregnancy herb
  • Tones female reproductive system; also pelvic and uterine muscles
  • High amounts vitamin C, easily assimilated calcium and iron
  • Also vitamins E, A, B-complex, many minerals inc phosphorus and potassium
  • High mineral content helps tissues stretch, decreases stretch marks, helps prevent anemia
  • Lower rates of miscarriage and postpartum hemorrhage
  • Prepares body for labor. Therefore decreases pain and length of labor.  Doesn’t strengthen contractions but makes them more efficient.
  • Help expel placenta
  • Good for morning sickness
  • NOTE: Red raspberry leaf tea does not induce labour! Not sure where that rumor started but it’s not true. Don’t down buckets of this hoping to bring on labour.

Nettle (Urtica dioica)

  • High amounts of virtually all mineral & vitamins needed for health
  • Especially high in A,C,E,D,K, calcium, potassium, phosphorus, iron, sulfur
  • High amounts of chlorophyll (for energy and nutrients, vitamin K)
  • Nourish and strengthen kidneys; gently dislodge and dissolve any mineral buildup
  • Relax leg cramps and muscle spasms
  • Prevent hemorrhage after birth due to high vitamin K
  • Strengthens blood vessels, therefore good for hemorrhoid prevention
  • Astringent for hemorrhoids
  • Increases quality of breast milk

Other herbs high in easily-assimilated vitamins and minerals (alone or added to the above teas) include Horsetail a.k.a. Shavegrass (very high in calcium), Alfalfa and Kelp.

Several other herbs are safe during pregnancy and are tasty e.g. mint.  Some aid pregnancy related issues such as nausea, heartburn, cramping, and constipation to name a few.  These include but are not limited to ginger, chamomile, slippery elm bark, and fennel.  Consult a qualified herbalist with knowledge of pregnancy herbs before taking any.

By the way, this tea is healthy for the males in your life too, and is safe for all ages from infancy on.  It’s a lovely, mildly flavoured drink for the whole family.

Prefer pre-packaged tea?  Health stores and quality Mama/Baby stores sell pregnancy tea, e.g. Earth Mama Organics “Third Trimester Tea” (which you can take in any trimester).

Male Infant Circumcision

The info in this article comes from evidence-based info. In fact, I did a course about male circumcision and the purpose of the foreskin a few years ago in 4 x 2 hour classes – yup – 8hrs!!  (Who knew there was even that much info out there about down there?)  There is no high-quality, evidence based research that shows the benefits outweigh the risks under normal circumstances. 

Current research supports leaving boys intact. While it is not yet illegal to circumcise male babies in Canada, the Canadian Paediatric Society has recommended against routine circumcision since 1996. As early as the mid-70s, they stated there was no medical benefit to this surgery. Not one provincial health insurance plan covers the cost due to the lack of health benefit. In fact, it is considered cosmetic surgery. Several Canadian hospitals do not offer non-therapeutic neonatal circumcision.  Parents who wish to have this surgery performed on their sons must search for a doctor to do it and then pay out of pocket. Most health regions will not share the name of doctors who offer routine circumcision of male babies.

Circumcision rates vary by province but the national average is around 10-15%, with the great majority of those being done for religious practises.  Several European countries have banned the procedure. In most of the world, including Canada, female circumcision, called Female Genital Mutilation (FGM), is illegal. The movement to offer male babies the same protection is gathering momentum. The Canadian Children’s Rights Council’s position is that “circumcision of male or female children is genital mutilation of children”. The growing trend is to let each boy decide for himself when he’s old enough.  It can’t be undone but it can always be done later if desire or circumstances present a compelling reason. 

Genital surgery is painful. (Would any of you readers like to have surgery in this sensitive area with just a local freezing? Yikes!! No thanks.) A great benefit to waiting is that adequate anesthetic (general or spinal) can be used. THERE IS NO SUCH THING AS A “GENTLE CIRCUMCISION”! That’s just the name of a business that profits from doing non-medical circumcisions.

The foreskin has a purpose. In addition to a whole lot of nerves that send pleasure signals to the brain, there are cells and membranes in the foreskin that secrete antibiotic substances. The 2 main medical benefits cited for doing circumcision have both been discounted – it doesn’t prevent AIDS (condoms do thought) nor does it prevent infection (other than a part that isn’t there can’t become infected). Do we cut off our children’s ears off to avoid ear infections?  In the unusual circumstance of infection, it’s like any other body-part: treat it. Certainly there are medical reasons to do a circumcision but those are uncommon and should be evaluated on an individual basis. (Kind of like tonsillectomies, which used to be common-place but are no longer routine, and also hurt like mad!)

Many people who circumcise their baby boys claim it’s important for their son to “look like dad”. Well many of those dads are now intact, so that argument is diminishing. Not to mention, there are many, many ways infants and toddlers don’t look like their parents.

Caring for Your Intact Boy:

It’s important that intact boys are treated properly – no one except the owner of the foreskin should ever retract their foreskins! Never retract the foreskin and don’t let anyone else do so either. Most medical care providers know this, but be watchful anyway at your child’s check-ups. 

Summary of today’s research about cleaning an intact boy…  Until recently medical people advised parents to forcibly retract the foreskin.  This lead to inflammation, pain, infection, and complications.  Current recommendations are to ‘clean only what is seen’ and to never ever retract the foreskin.  Medical articles still advise soap and water but there are many holistic practitioners advising to avoid soap until teen years.  Soap is irritating.  A nice middle ground could be to use a very gentle soap such as castile (Dr. Bronners) or unscented baby soap if that’s one’s preference, and rinse very well without forcible retracting.  (People are using less soap in general (less often, only if needed) for infants and young children due to skin irritation.  Obviously lots of hand-washing is an exception to the less-soap trend.) 

If You’ve Been Circumcised:

Perhaps you’re totally happy with your body and that’s cool. I sometimes worry for grown men who learn the facts and then start to research the physiological functions of the foreskin.  Some get upset or angry at their parents (there are law-suits galore in the USA – yup, men suing parents) so I remind them we all do the best we can with the info we have at any given time.  Others mourn the loss of a part of their body.  There are some men undergoing medical procedures and little tricks to try to grow some back.    

For many men, getting informed helps them break the cycle set up a couple of centuries ago for the sole purpose of decreasing or preventing male masturbation.  Learning the physiological role of foreskin is quite helpful.   

Further Study:

Canadian Paediatric Society

National Organization of Circumcision Information Resource Centers

Circumcision Resource Centre

Canadian Children’s Rights Council

Function & Care of the Foreskin

Some Facts to Consider:

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.

*****

Hospital Update

ONGOING SUMMARY of Current Practises in the Labour & Birth Unit and the Mother-Baby Unit:

  • 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.
  • All maternal patients and their designated family members/support persons will be screened for COVID-19 upon arrival at RGH and be required to have a temperature check, wear a mask, participate in hand hygiene and follow physical distancing guidelines.
  • Support persons/visitors who are symptomatic for COVID-19 or who have other risk factors will not be permitted. 
  • Masks are mandatory for partners and support persons throughout the hospital, except for when there’s no staff present in the Mother-Baby Unit. Labouring patients who pass screening are asked to wear masks as long as they’re comfortable doing so. 
  • All waiting rooms are closed. One primary support person is allowed with each maternal patient through registration and the assessment areas. 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. 
  • 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). Do not use the ER doors unless you are a patient or are with one.
  • All maternal patients will be offered an optional COVID-19 swab once their admitted to the Birth Unit. Family members/support persons will not be offered a COVID-19 swab.
  • If the maternal patient tested positive for Covid at any time during their pregnancy, then their placenta will be sent for testing. 
  • There are 2 support persons (aged 18+) of the maternal patients choosing, allowed in the BIRTH ROOM; no swapping. 
  • The MOTHER-BABY UNIT allows new families to have 2 additional visitors at a time (11am-8pm). The “no-swapping rule” has been lifted in this unit. Visitors must be aged 18 and over, except siblings of the newborn who are permitted to visit with an adult.
  • Nitrous Oxide / “laughing-gas”/ Entonox is available, “𝑡𝑜 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑤ℎ𝑜 𝑠𝑐𝑟𝑒𝑒𝑛 𝑡𝑜 𝑔𝑟𝑒𝑒𝑛 (𝑎𝑠𝑦𝑚𝑝𝑡𝑜𝑚𝑎𝑡𝑖𝑐 + 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒 𝑃𝑂𝐶 𝐶𝑂𝑉𝐼𝐷 𝑡𝑒𝑠𝑡) 𝑜𝑛 𝐿𝑎𝑏𝑜𝑢𝑟 & 𝐵𝑖𝑟𝑡ℎ 𝑎𝑡 𝑡ℎ𝑒 𝑅𝑒𝑔𝑖𝑛𝑎 𝐺𝑒𝑛𝑒𝑟𝑎𝑙 𝐻𝑜𝑠𝑝𝑖𝑡𝑎𝑙.” 
  • Waterbirth is no longer an option in the hospital, even for those under midwifery care. The installed bath-tub is available for comfort in labour.  Waterbirth is an option at homebirths when one is under midwifery care.
  • Breastfeeding is still being supported at RGH regardless of Covid-status. There are plans and protocols in place so that mother-baby can stay together if the birth-mom is at risk, has symptoms, or tests positive for C-19 in the immediate postpartum. 
  • All waiting rooms are closed. Food outlets have limited seating.
  • Galleys are closed to patients/visitors in both units. The nurses will get food for you in the birth unit but not in the mother-baby unit. Bring 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.
  • The hospital does not provide warming tools other than blankets from the blanket warmer. If you like a hot-water bottle or heating pad, then bring your own. Staff are not allowed to take people’s heating devices to the microwave or kettle. You can use a plug-in device or fill a hot water bottle with hot tap water.
  • 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.
  • Even though 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.

03A47318

 

A TIMELINE OF PREVIOUS UPDATES

…. just in case you’re curious about what’s been coming and going and happening through the pandemic.  Note that several of these restrictions have been lifted. The list above is current.

June 08, 2022 – Good news! Nitrous Oxide / “laughing-gas”/ Entonox is available again in Regina, “𝑡𝑜 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑤ℎ𝑜 𝑠𝑐𝑟𝑒𝑒𝑛 𝑡𝑜 𝑔𝑟𝑒𝑒𝑛 (𝑎𝑠𝑦𝑚𝑝𝑡𝑜𝑚𝑎𝑡𝑖𝑐 + 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒 𝑃𝑂𝐶 𝐶𝑂𝑉𝐼𝐷 𝑡𝑒𝑠𝑡) 𝑜𝑛 𝐿𝑎𝑏𝑜𝑢𝑟 & 𝐵𝑖𝑟𝑡ℎ 𝑎𝑡 𝑡ℎ𝑒 𝑅𝑒𝑔𝑖𝑛𝑎 𝐺𝑒𝑛𝑒𝑟𝑎𝑙 𝐻𝑜𝑠𝑝𝑖𝑡𝑎𝑙.” All maternal patients are screened on the way in (answer the usual questions re travel & symptoms) and then offered a swab-test once they’re admitted to the unit.

March 2022

  • Due to Covid, the Nitrous Oxide (“laughing gas”) is not available. It may be available again, depending on some supply issues. 
  • The Mother Baby Unit now allows new families to have 2 visitors at a time (11am-8pm) and they can be anyone you want. (The “no-swapping rule” has been lifted.)
    That said, postpartum hospital stays are usually short – only 1-2 days. There are many benefits to just resting with your new baby and saving the visitors for once you return home.
  • Note: The Labour & Birth Unit remains as is – 2 support persons per maternal patient, no swapping.

Feb 2022. The proof of vaccination / negative test requirements have been lifted.  Support persons no longer have to show proof of anything. 

Nov 8, 2021, partners, visitors, doulas, support persons, everyone EXCEPT the patient being admitted, must show proof of double Covid vaccine or a negative test within the past 72 hours from an SHA approved tester in order to enter SHA hospitals. Anyone who is not double vaxxed and wants to attend the birth might consider serial testing every 72 hours in order to be ready anytime.  

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.

Summer 2020

◆ 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 screenedwith the maternal patient.

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 person for more than 2 hours will not be allowed in if they are 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 may 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

◆ Labouring women are asked to wear the mask as long as they can stand to do so. Postpartum patients are asked to wear their masks when staff are in the room.

◆ Masks are mandatory for partners and support persons throughout the hospital, except for when there’s no staff present in the Mother-Baby Unit.

◆ People can wear whatever mask they want to enter the building. Public Health does have recommendations on personal masks (on the SHA site). However, once inside the building, people will go through screening and will be given medical masks to wear in the building (the blue ones with folds). The blue medical masks must be worn in all public spaces and the assessment area.

◆ Nitrous-oxide (“laughing”) gas is available for pain management. If a tank is being used (instead of the tubes that go directly into the wall), then the maternal patient must have a negative Covid swab done prior to use. 
◆ 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.

◆I always tell people to bring their own hot water bottle or Magic Bag to the hospital. That’s because the hospital does not provide any warm tools other than blankets from the blanket warmer. They are lovely but they are not the same as a hot water bottle. The new update is that the staff are not allowed to take people heating devices to the microwave or kettle. Therefore if people want to use heat it will have to be a plug-in device or they can fill the hot water bottle with hot tap water in their own room. Stay warm and stay well during your visit!

◆ 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, and only up to 3 participants. If there are less than 3 maternal patients, then partners may be allowed to attend.
● 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.

5 Ways Labour Pain is Different than Broken-Bone Pain

Some people compare labour pain to that of breaking bones. Besides scaring pregnant people, that’s not an accurate comparison. On the other hand, some women share stories of pain-free birth. Here are 5 ways the sensations felt in labour are different than “broken-bone pain”.

  1. Broken-bone pain is unrelenting and doesn’t go away without strong pain meds; labour pain comes and goes in a rhythmical manner. In fact, throughout labour, much more time is spent in the rest between contractions. Even in advanced labour, most contractions last between 60-75 seconds but can sometimes get to 90 seconds. Then there’s a rest before the next once. In active labour that rest will generally be between 1-3 minutes. In earlier labour that rest will be up to 10 minutes. There is no rest with broken-bone pain. It’s constant.
  2. Broken-bone pain is all encompassing, resulting in the release of stress hormones and injury responses in our body. Labour pain is accompanied by powerful pain-killing hormones such as endorphins. The female body is equipped for labour with strong, naturally occurring hormones that are released as labour progresses. The effect of these hormones has been compared to morphine by physiologists. (However those hormones are not as concentrated and isolated like morphine. Still, that’s a powerful comparison!) Stress makes pain worse.
  3. Broken bones are a terrible injury; labour is a normal human process.
  4. Broken bones are due to an accident; labour is a known and sometimes planned event. Therefore we can prepare for the intensity of labour. There are many helpful tools and strategies for comfort measures that can be done by the labouring person or their birth companions. We teach many of these in our How to Ease Labour Pain Class.
  5. Doulas! Birth doulas can make a significant difference in how labour is experienced and felt. There’s ample research showing the benefits of doula support through birth, including shorter labours, half the rate of Caesareans, significantly fewer requests for epidurals. To my knowledge, there’s no such thing as “broken-bone doulas”. Everyone around someone with broken bones is providing medical care – good thing too. Ideally, labouring people will have someone knowledgeable with them whose only job is to provide comfort and support.
  6. Broken bone pain is measured in weeks and months; labour is measured in hours.

* It’s interesting to note that I’ve only heard men make this comparison. Many pregnant women fear this will be the case but I’ve never heard anyone who’s gone through labour and had a past experience of broken bones say they were the same thing. I’m one of them. A couple of years before being pregnant, I broke my pelvis. There is absolutely no comparison between the two events.

Angie The Doula – Postpartum Support and Maternal Mental Health Resources

In the first weeks and months postpartum, the realities of new parenthood can be a whopper. Many new parents find this time hard, especially during this pandemic when most people don’t have the support they’d normally have. Remember that “new normal” that most families find around 6 weeks? That might feel like forever at this point. 

This is a good time to check in about maternal mental health. Partners can struggle with mental health too. Here are some good resources:

Postpartum Support
  1. Maternal Mental Health Issues This online article includes risk factors (any of these that can be addressed can help make postpartum life easier), things to help, local resources, what partners can do.
    There’s a big range between thriving and needing clinical mental health services. This article has suggestions for things that can help in that space.
  2. Self assessment tool: This version of the Edinburgh Postnatal Depression Scale (EPDS), Edinburg Screening & Care Guide, includes valuable information about risk factors and where to find help. This is the form your health care provider would use if they screened for maternal mental health.
  3. Self assessment tool: The Postpartum Progress Checklist has more questions than the EPDS. It can be used to facilitate discussion between postpartum clients and their health care providers.  

If you’re struggling, then here are some things to consider as next steps:

  • Gather up support. Postpartum doulas come to your place and help with all manner of maternal, infant and family needs.
  • Ask the public-health nurse to come over for a chat.
  • Make an appointment with your doctor or midwife. Bring your self-assessment tools and/or concerns. 
  • There are private counsellors who are specifically trained in postpartum care. If you have a health plan at work or in-house mental health counsellor, then that will be your fastest route to get counselling and psych services.
  • Call 811 if you need non-emergent medical advice as they are often well-trained in postpartum mental health.
  • Get medical attention today, immediately if you have thoughts of harming self or baby. This usually means a trip to the ER and is a valid reason to call 911.
  • In case of psychosis, call 911.

I want to reassure you of two things in case medical help is needed:

  1. Breastfeeding is still possible with almost all mental health drugs and many physiatrists will help with that. (Many women are reluctant to get help for fear of not being able to BF.) One of my clients needed antipsychotic medications that weren’t good for breastfeeding. Her physiatrist and pharmacist came up with a schedule where she could pump and feed her baby for 8 hours daily. She recovered and went on to breastfeed her baby for over a year!
  2. Your local pharmacist is the most knowledgeable person about medications and breastfeeding. If you’re breastfeeding, then always ask them for advice before filling a prescription.
  3.  Families are kept together during mental illness, as long as there’s one healthy adult (parent, grandparent, relative or close friend as guardian) to care for the baby. If a parent has to be admitted to the psych unit then the baby stays with the other parent or guardian. Family visits with the mentally ill parent are arranged as soon as possible. A few of my clients have been down this road and it’s not easy but they received excellent care and recovered.   
postpartum support

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.

Choices in Planned Caesarean Births

One of the benefits of a planned caesarean is that there’s time to consider options, ask questions and make choices beforehand. 

Many hospitals are willing to take extra steps to make a caesarean birth more gentle and family friendly. The following is a list of practises that are being requested as part of a “Gentle Caesarean”. Yes I’m aware that the very nature of a caesarean and the postpartum recovery do not seem gentle to most people. However I appreciate that there are medical staff working hard to make the experience as positive, healthy and family-friendly as possible.  

  • Watching your baby being born. Clear surgical drapes, surgical drapes with a panel that can be lowered to a clear panel, or having the drapes lowered entirely.
  • Cord cutting. Most hospitals don’t allow anyone other than staff to cut the cord in the surgical field. But they can leave a longer cord and have the partner trim it – like a ceremonial cutting of the cord.
  • Skin-to-skin contact with the birthing parent, from the chest up.
  • Maternal heart monitors on their side or back, leaving the chest available for holding baby skin-to-skin.
  • Music of your choice – played on the sound system or your headphones.
  • Support through the entire procedure, from the moment of entering the O.R. until heading to the recovery room. Most hospitals allow one support person in the O.R. and recovery room. Some allow doulas to come in as well. 
  • Healthy baby stays with the parent(s); family stays together in O.R. and recovery room. In some hospitals babies born by caesarean are automatically taken to NICU or a medical nursery for observation.
  • Photos / videos – always bring your device. There’s often a nurse who is waiting for the baby to be born and will take some photos of the birth, the first time parents hold the baby, etc. There are many beautiful moments to celebrate at any birth, including caesareans.
  • Flora for the baby – vaginal seeding. You might ask for a GBS test a week before the surgery before going ahead with this. Note that this is still new enough that most medical staff will not participate. Plan to DIY.
  • Covid testing options – find out if this is something that will affect your birth. What happens if you take the test or don’t take the test?
  • Any cultural / spiritual aspects you might wish to include. I’ve seen an obstetrician lead a prayer before starting the surgery and have joined the surgical team in singing happy birthday to a newborn.
  • Obstetrician of your choice. Certainly a perk of scheduling your birth. 
  • Volume of monitoring machines – ask for the volume to be turned up or down if it’s reassuring for you, or not, to hear things like fetal heartbeat, maternal heart beat. 
  • Delayed cord clamping – up to 1 min is considered safe with caesareans. (I’ve heard of a hospital that keeps the placenta and baby attached after the placenta is removed – definitely not standard of care in most places. Never hurts to ask.)

In some facilities the things on this list may already be standard care. In others, requesting these things will provide an opportunity for staff to gain a new perspective. Patient safety is the primary concern. Some of these practices may be considered safe or not, possible or not, depending on patient health, the facility and/or the staff working in the O.R.

Speak with your doctor well ahead of time about the things that interest you from this list. 

If you get a sea of “no ways,” then ask why not. There could be valid reasons or it could be one unbending person. If it’s the latter then you might wish to explore working with another doctor or giving birth in a different facility, if that’s an option. 

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 we 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?

Infant Colic – What Can You Do?

Colic can make the new parenting journey grueling!  What can parents and care-providers do?

Babies are said to have colic if they cry for more than 3 hours daily on a regular basis. The cry is often high-pitched and relentless, accompanied by a red face and rigid body. It often happens later in the day or evening. Nothing seems to soothe the baby. Research shows 10-20% of babies experience colic. It’s heart-wrenching and exhausting for care-providers. 

There are theories about what causes colic but no certain answers. Colic resolves in most infants by 3-4 months, which is the entire “4th trimester”, when we expect babies to sleep a lot and when new families are typically bonding and getting to know each other.

The first thing to consider is your baby’s health. Is your baby gaining weight and soiling diapers as expected? Check out the handy Best Start Chart for signs that feeding is going well. Watch for signs of illness that require medical attention, such as lethargy (limp baby), fever, diarrhea, forceful vomiting.   

Is there a chance your baby is overstimulated? Some babies get overwhelmed by a seemingly low level of sounds, sights, and attention. Others can’t get enough. 

If your baby is fed, dry, healthy and the usual soothing techniques (rocking, walking, warmth, fresh air, holding, breastfeeding, singing etc) don’t help, then suspect colic. Here are some suggestions that can help an otherwise healthy baby who has colic. 

  • Infant Chiropractic care, from a Chiropractor who has specialized training and experience. Over 90% of colicky babies show improvement! It’s gentle and nothing like adult adjustments. I’ve heard countless stories from clients who’ve seen amazing results after only one or two treatments from their local baby-chiro.
  • Consult with a Lactation Consultant. Suggestions to help with latch and positioning can make a big difference, especially if the colic is related to swallowing gas while feeding. LCs spot all kinds of little or big things that can be easily corrected. 
  • Infant massage. There are classes and videos demonstrating how to do infant massage for colic. This can help move gas along, colic or not.  
  • Homeopathic remedies such as Cocyntal. I used to run the Vitamin & Supplement department of a busy health store and this was one product I could never run out of for fear of the pleas from desperate new parents. Many of our customers swore by this remedy. 
  • Fennel tea is a natural remedy for digestive issues such as gas, cramps, flatulence. It helps with colic too. Ready-to-use fennel tea is sold commercially; just add boiling water and steep for 5-10 minutes like any other tea. It can also be made by boiling fennel seeds (5ml seeds per 250ml water; 1 tsp per cup) for 10-minutes in a covered pot. The breastfeeding parent can drink 3 cups daily. For babies being formula fed, cooled fennel tea can be given to the baby orally with a dropper, 3-5ml (½ – 1 tsp) three times daily.
  • Break the stress cycle, if there is one. Never punish or shake a baby who won’t stop crying. Take 10. While it might go against your instincts, it’s better to put your baby down in a safe place and step away for 5-10 minutes to breathe slowly and deeply and regroup. Colic is one of the hardest parenting issues! 

I worked with one family who tried everything to no avail. Both parents were loving and kind but exhausted, distressed, anxious and at the end of their rope. Finally, in desperation, they asked a relative to come and stay for 2 nights so they could go sleep at a hotel. They figured they could go home to care for their screaming infant again once they’d restored some energy. When they went back home the colic was over. Done. Never came back. Coincidence or an environment of stress responses cleared up? We’ll never know but they sure were relieved. This is an extreme example but sometimes we have to ask for help and try something we’ve never done.