Author: Angie Evans

Choices in Planned Caesarean Births

Posted by on in Birth, Birth Prep, Birth Support, Caesarean, Hospital Birth

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 reveal 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 – at the baby warmer.
  • 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, healthy babies born by caesarean are automatically taken to NICU or a medical nursery for observation. This has to stop! In that case, the non-birthing parent, partner or companion can accompany baby.)
  • 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.
  • 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. Some people bring in a little card or symbol or small talisman.
  • 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. 

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.

Optimal Fetal Position Makes Labour Shorter and Easier!

Posted by on in Birth Prep, Pregnancy

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 that if you can give your baby a back rub every time through your belly, then they are likely in a good position.

There’s lots you can do to affect the baby’s position. Read on!

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-labour – back-pain during labour that doesn’t disappear between contractions
  • Increased risk of tearing
  • Increased risk of instrumental (vacuum or forceps) or Caesarean 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 (head down)
  • 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.

Birth Support on a Budget

Posted by on in Birth Support, Doula, Education, Fees, Prenatal Classes

If rates for full doula care seem too high, please read on.  There are many ways I can contribute to you being prepared and supported through your birth. I offer prenatal classes, birth prep consultations, a lower-priced doula package, birth-plan prep sessions, and creative ideas for paying your doula.  Details for all of this are below.

My current fees of $1500-1800 for full doula support are a fair reflection of my extensive experience, skills and knowledge.  Besides the often long and unpredictable hours, there are costs associated with being a professional doula. Some of these are monetary such as training, missing other work-shifts, association fees, parking and all the normal expenses related to self-employment.  Other costs are not measurable, such as missed family events, being on-call (700+ hours per client), and recovery time from long births.  Experienced doulas are worth the expense and in fact are the first to fill their client list.

I also offer a couple of lower-priced doula support packages starting at $1200. They are described below and as a doula support packages comparison chart.  

If you wish to benefit from my expertise but the cost is out of your range, then you might be interested in attending prenatal classes or accessing other services such as Birth Plan Preparation, or working with me and one of the doulas I’m mentoring.

Birth Preparation and Support Packages (please see the doula support packages comparison chart for details of what’s included in each)

  • Lower-cost doula mentorship package:  Work with me and one of the newer doulas I’m mentoring for $1200. Prenatal preparation is vital for having your ideal birth. Therefore you’ll have all prenatal consultations, including creating a birth-plan and any questions answered along the way, with me and the new doula, who is fully and professionally trained, and meets the requirements of mentorship with me. She’s a professional doula who is building her birth experience. The newer doula will be your primary doula for your labour and birth. We both attend the postpartum visit. (I train Birth and Postpartum Doulas of excellence through Birth Ways International.) Many happy clients have chosen this option.
  • Dial-a-Doula Prep & Birth Support for local or far away clients. Includes everything in the full birth doula support package but with virtual instead of in-person support. I’ve supported people in my own town and as far away as Singapore in this manner! $1000.
  • Birth Prep Package without birth doula support:  I educate and set up clients with the same care my doula clients get. It’s up to you to arrange for another doula or perhaps you are not working with a doula at all.  This involves 3 meetings prenatally to go over options, unpack previous births (if applicable), and create a vision of their ideal birth, and extensive educational support (e-mails, client hand-outs, referrals to local health practitioners, help with birth-plans and sibling-prep), a Directory for the Childbearing Year, a Roadmap to Optimal Birth Prep, and a Postpartum Prep list.  These clients have access to the “client-only” section of my site and lots of great info, and we prepare a birth plan together.  They can also ask me questions via e-mail any time through their pregnancy – to pick my brain or get answers to things that come up along their pregnancy. This is currently $500.

To understand doula fees, please see http://www.cordmama.com/blog/2015/3/23/why-doulas-are-expensive-and-why-youre-glad-they-are

If you have a partner who doesn’t understand paying for extra support, please see http://goodmenproject.com/families/new-dads-advice-just-hire-a-damn-doula-jrmk/

Other Options:

  • We can set up a payment plan.
  • Gift certificates for my services.
  • Raise funds e.g. a collection-box at your baby-shower or Mother-Blessing, or ask people to contribute to your doula rather than buying other gifts.
  • Find a less experienced doula, as they usually have lower fees. See The Doulas of Regina for a listing of local doulas.
  • If there’s no way you can pay for birth support, check out the Doulas of Regina  Relief Fund.  They pay for doulas to attend the births of women who qualify based on financial need.

Birth Trauma – Practical Tips for Preventing Trauma and Giving Birth After Trauma

Posted by on in Anxiety, Birth, Birth Prep, Comfort, Labour, Pain, Trauma

There is a relationship between birth and trauma. Some people are traumatized through their birth experience while others begin the birth process in a traumatized state. Past trauma can have a significant impact in the birth room, including presenting additional challenges and the possibility of being retraumatized. This article presents practical tips for being more empowered and minimizing trauma during pregnancy and birth. 

Before we go further, I would like to acknowledge there are many obstetrical care workers who treat their patients respectfully and kindly while doing the important work of providing medical care. They are aware of the vulnerability of birthing families and treat them in a way that leaves them feeling safe, happy and whole. However, that is not the case everywhere or with everyone; there’s still work to do.

For most people birth in and of itself is not traumatic. In most cases, trauma stems from how they were treated through their birth. There are too many birth stories that include coercion, disrespect, disempowerment, fears that aren’t addressed, being left alone, feeling unsafe and unsupported, and lack of choices. Birthing people don’t know what their options are and therefore they have none. They don’t know how to prepare and what to do. They are told what’s going to be done to them rather than being part of the decision making process. Many women report feeling like they were stuck on a runaway train.

Women need to feel safe while giving birth. In fact, birth is shorter, more comfortable, and usually uncomplicated when that’s the case. There are things we can do to decrease or negate the impact of some common practices in the North American medical model of birth that may lead to feelings of vulnerability or trauma. In many cases it’s just how things are done and set-up. 

Globally, 1 in 3 women have been subjected to physical and/or sexual violence. Every birthing person should be treated as a survivor but that is not the case yet. Fortunately in some hospitals, including ours, staff have special training in this area and provide extra respectful, sensitive and compassionate care to survivors.

Practises that may add to trauma in some people include…

  • Being exposed, naked, uncovered in front of others.
  • People who are fully clothed (and highly educated or seemingly “in charge”) standing over someone who is partially or wholly undressed, usually on their back, and possibly with their legs open, in a vulnerable state.
  • Being touched, especially from behind, without consent or even being told first. 
  • Language such as “good girl” and “honey” and “dear”.
  • Cervical checks in general. Exasperated by being told, “I’m going to check your cervix now,” without a conversion to explain reasons, options, and waiting for consent. Painful cervical checks. Staff not stopping when being told “No!” or “Stop!” or any of the many other ways women say no or stop. 
  • Being put into positions, often presented as, “You have to…”. Lack of choice.
  • Not being “allowed” to move freely.
  • Legs being held or put into leg rests / stirrups
  • “Put on this gown.” Being told what to wear, especially when that garment does not offer full coverage and is open in the back.
  • A room set up that results in “private parts” facing the door.
  • Technical language used in medical settings can be confusing and scary for some people.
  • Epidurals and the numbness that may result.
  • Not having timely access to pain medications, including epidurals.
  • Language related to failure or “not doing it right”, e.g. lack of progress, making too much noise, breathing wrong, being too stiff, reacting too much to pain, stop crying.
  • Lack of choice in birthplace and/or medical care provider.

Things you can consider doing to feel more in control, more empowered, and lessen the chances of being traumatized:

  • Expect excellent and compassionate care but be prepared in case not everyone you meet feels that way to you.
  • Remember you have the same rights in the birth room as you do in the coffee shop or anywhere else! No one is allowed to touch you or do anything without your consent. You have the right to say “yes”, “no”, “wait”, “stop” to any test and intervention. 
  • Be an active participant in your care. Consider your care providers as part of your team. 
  • Ask enough questions to make informed choices.
  • Pause. Normally things don’t have to happen right away. Ask your questions, gather your wits, get grounded and then proceed.  
  • Bring a companion who can help you find your voice and help advocate for you. Doulas play an important role in this. 
  • Ask for a few minutes alone or with your support person(s) before making decisions. You might regroup, realize you have more questions, find the strength or means to say no to something you don’t want, or yes to something you don’t want but feels like the best choice. 
  • Maintain control over cervical checks and other procedures that might feel invasive. Don’t proceed until the care provider has an understanding of how to help you feel as safe as possible.  
  • Share that you are coming into this experience with past trauma. No need to share details.
  • Hire a doula who is trauma-informed.
  • Say no. Use the word consent.
  • Wear clothing that feels safe and offers the level of modesty you need.
  • If you want touch comfort measures and also modesty, massage and touch can be done over a sheet or your clothing.
  • Consider how you might react to the intense sensations of birthing – pressure as the baby descends, pain and/or power of contractions, your body stretching. 
  • Tools to deal with the aforementioned sensations – meditation, hypnobirthing, comfort measures, pain medications including epidurals. Some people opt for cesarean. Discuss these options with your midwife/doctor if you are concerned. Your mental and emotional health are just as important as your obstetrical health.
  • Think about how it might feel to have an epidural that might cause legs to feel heavy or numbed. This can be a welcome relief or it might be frightening.
  • If you have a counselor or psychiatrist, have a meeting to help you prepare for birth and postpartum.
  • If it’s not possible to be covered or positioned in a way that offers privacy from the door, then a companion can hold up a sheet or stand between you and the door, acting like a visual block as people enter & exit the room.
  • Wear headphones.
  • Wear a sheet or blanket like a fort or super-hero cape.
  • All the other things that bring comfort and security during birth.
  • Stick a sign on the door if there’s a single point you wish everyone to know. It might be, “Please read my birth plan before meeting me.”
  • Consider warm compresses on the perineum during crowning if you’re on your back. This can offer warm comfort and a greater sense of privacy. On the other hand, some people would find this scary and like too much touch. 
  • Assume birthing positions other than being on your back, such as being upright, leaning forward, and hands & knees.  
  • If you normally wear glasses, consider the impact of leaving them on or off through labour. Seeing more or less detail may be helpful.

Things You Can Put on Your Birth Plan

You can create a nice Birth Preferences Document that builds bridges of communication and understanding with your medical care team. If you are a survivor or are vulnerable, then you may wish to include additional points related to trauma, which are listed below. It can be helpful to the staff if your document includes, “Due to past trauma, …..”.  You don’t have to disclose and won’t be asked to explain what that trauma was. 

  • Wait for verbal consent before touching me in any way.
  • I need to have complete control over cervical checks, including when they’re done, by whom, and the pace. I may say “yes”, “no”, “wait”, and “stop”
  • Please assume I have not consented to anything until I expressly say yes. 
  • Before we discuss options, procedures and next steps, ensure I… (options include: am fully clothed or covered, am sitting, am standing, have my partner/companion/doula nearby. Use any or all of those things in any combination). 
  • If I’m on the bed I will face the foot of the bed until the moment of birth. 
  • I will need a few minutes (alone?) to process information before making choices.
  • Please limit the team to essential staff only. No observers or students practicing on me.
  • Minimal cervical checks and only by experienced staff who will proceed only after obtaining my expressed verbal consent. 
  • Please use my name when addressing me; no terms of endearment such as honey or good-girl.
  • Please ensure I am covered as much as possible throughout my birth.
  • I would like warm compresses during crowning.
  • Hands off my bottom during crowning.
  • I would like to hear the baby heart monitor if it is being used.
  • Please silence the baby heart monitor if it is being used.

Preparing for your birth can include…

  • Getting as prepared as possible before giving birth. Learn about local practises and your options. Knowledge is power! My prenatal classes are designed with this in mind.
  • Work with a midwife or doctor with whom you feel safe and comfortable.
  • Hiring a doula. Most communities have a professional association with bios for a variety of doulas.
  • Practising saying no to things you don’t want and yes to those you want. Ask for what you want.
  • Taking steps to learn your options – prenatal classes, appointments with your medical care provider, counsellors, local birth-workers – and prepare a plan for your specific concerns.
  • Practising the things you might want to do in labour, such as a variety of positions, comfort measures, grounding practises, moving freely in clothing you wish to wear in birth.
  • A hospital tour. The fewer surprises the better.
  • Pack a birth bag that includes choices of clothing, things you can use for comfort, and even a couple of things that bring you peace.
  • Asking lots of questions along the way. Practise having discussions with your team in order to have shared decision making. When you say “no” that should be respected and when you say “yes” you’ll feel better about your decision. You will likely be pleasantly surprised.

Checklist and Tips for Making a Birth Plan

Posted by on in Birth, Birth Prep, Birth Support, Pregnancy

Most people who give birth in a hospital are meeting their medical care team for the first time. 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.

Before creating your Birth Preferences, learn about the policies and practises at your birthplace, so you know what to put on your wish-list. If you have special circumstances then you can incorporate those into your birth plan. Examples include choices in caesareans and considerations for trauma reduction.

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.

Doula Interview Questions

Posted by on in Birth Prep, Birth Support, Doula, Education

Most doulas offer a complimentary initial meet-n-greet to determine if you’d be a good fit to work together. It’s an opportunity to learn how the doula works, their point of view, what they offer, and also to share what you’d like for your birth and support, if you know. Many people don’t know much about what kind of birth they want to plan; experienced doulas can help sort that out.  After all, if you don’t know your options, you have none.

People learn all about their options and choices (there are many!!) in my Prenatal Classes.

Here are some questions you might wish to ask when you’re considering working with a doula for your birth.

BACKGROUND, EDUCATION, PHILOSOPHY

  1. How many births have you attended?
  2. How long have you been in practise?
  3. Where have you worked? (Hospitals, birth centres, homes. Which ones?)
  4. With which primary practitioners have you worked in my area? (Midwives, doctors, OBs).
  5. What’s your educational background in general?
  6. What experience, education and training do you have, specifically related to birth (childbirth education, birth support, breastfeeding, postpartum support and newborn care)?
  7. Do you have complimentary training e.g. natural remedies, modalities for pain management & comfort measures?
  8. What is your philosophy about pregnancy, birth and support?
  9. What’s one thing you wish all parents-to-be knew about birth?
  10. Are there limitations of support?  E.g., natural vs. medicated birth, time-lines for gestation & labour, home vs. hospital birth.
  11. What compelled you to start doing this work?

GENERAL PRACTISE ORGANIZATION

  1. What are you affiliations? e.g. Professional associations, memberships
  2. Do you provide community links and resources for and relationships with other practitioners with skills who may benefit pregnant and postpartum people?
  3. What’s your offer, in detail? e.g. # of prenatal visits, on-call schedule, post-partum support/schedule.
  4. Fees – cost, payment schedule, return policy. What payments do you accept? Do you offer payment plans?
  5. How do you support partners / birth-companions?
  6. How do you like to communicate with your clients?
  7. What expectations do you have of your clients?
  8. Do you have privileges in all or limited birth centres & hospitals?
  9. Do you work with out-of-town clients?
  10. Are there additional perks? Are they included or do they cost extra? e.g. Lending library of books & videos, informational resources, health related therapies, workshops or classes?

PRENATAL CARE

  1. What information is covered in prenatal meetings?
  2. Do you help create a birth-plan?
  3. What kind of preparation tools/materials do you offer?
  4. How do you help prepare clients for their ideal birth?
  5. Do you expect your clients to do any homework?
  6. Do you help your clients prepare for the postpartum stage? If so, how?
  7. Are you available for extra meetings, questions, phone calls? If so, are there additional fees?

LABOR & BIRTH

  1. Do you work with back-up? If so, who and can I meet them if I wish?
  2. Under what circumstances would the back-up attend?
  3. What if you miss the birth?
  4. What if I go into labour before on-call dates?
  5. When do you join your clients in labour?
  6. Where do you join your clients? At home or place of birth?
  7. How long do you stay?
  8. What are your methods or tools for support during the birthing process? e.g. Pain management techniques such as massage & knowledge of positions; complimentary therapies such as homeopathy, acupuncture, aromatherapy.
  9. How do you help keep labour progressing efficiently?
  10. What do you do to help with difficult labours (long, stalled, and/or back labour)
  11. Are you knowledgeable and comfortable supporting labour with medical interventions?
  12. How do you work with my partner and/or anyone else I might wish to be part of my labour?
  13. What if I have a Caesarean birth?
  14. What if I’m transferred to (another) hospital or city?

POSTPARTUM & NEWBORN CARE

  1. Do you help with breastfeeding? How? When? e.g. Immediately after birth or at home in the following days too?
  2. What if I need specialized help with breastfeeding and/or recovery from birth?
  3. What does your support look like in the postpartum stage?
  4. How long do you offer postpartum support?
  5. Do you have resources to help with postpartum recovery? For the birthing person and/or the baby?

MOST IMPORTANT NOTE FOR PARENTS-TO-BE:

  1. Do you feel comfortable enough with this doula to share your baby’s birth?
  2. Are they kind, warm, and have the other personality traits you’d like in a doula?
  3. Is the doula knowledgeable about your particular concerns?
  4. Do they listen and communicate well?
  5. Are they comfortable with your choices or do they seem to have their own agenda?

Angie The Doula – Guide on When To Go To The Hospital

Posted by on in Birth, Birth Prep, Birth Support, Hospital Birth, Labour

If you’re planning a hospital birth then you have to figure out when to go. This guide will help you make that important decision.

Most people don’t know that the majority of naturally-starting labours is usually done at home. Some people want to get to the hospital later in the birth process. They know the longer they’re in the hospital, the more likely they are to have interventions as part of their birth. They may simply enjoy being at home for longer. 

One of the benefits of working with a doula is that we help clients decide when to go. We will remind you that you won’t be officially admitted if you aren’t “far enough along” in labour. Most first time birthers without professional guidance go far too early, often by many hours. This leads to the disappointment of being sent back home. 

Please note that this is a general guide. At your prenatal appointments, ask your medical care provider if there are any specific recommendations for when you should go in. Some pre-existing conditions or medical issues lead to different recommendations from those below.

Photo by Paula O. Licensed under Attribution 2.0 Generic (CC BY 2.0)

When to go to hospital

Unless you’ve been told otherwise by HCP…

  • Pattern of contractions or sensations (explained below): 311 for a first birth or 411 for subsequent births; even sooner if you have a history of fast birthing. Hot tip: If you feel like eating, then it’s likely too early, based on labour pattern alone.
  • Lots of pressure down low. If contractions end with a grunt or feelings of needing to poop, then get going! 
  • Any signs of labour before 37 weeks.
  • Any health concerns (some “warning signs” are below).
  • Decreased fetal movement that isn’t remedied within an hour or two by eating and resting. This is not a 911 call but it does mean to go presently. Do not sleep on this.
  • When waters release? Maybe, maybe not.
  • If there’s a colour (yellow, brown, green) or foul odour when waters release.
  • Want pharmaceutical help coping with pain.
  • Feel safer at the hospital or want reassurance about your own or baby’s health. You will likely be sent home if all is well and you are not in ‘active labour’ but that’s OK. Consider it a trial-run and some good news that everyone is medically stable.

Before heading in:

  • Have some juice or snack (unless you’ve been instructed to not eat e.g. schedule c/s).
  • Pee before heading out the door.
  • Bring:
    • Health Card
    • Envelope with your prenatal records & birth-plan
    • Any prescription medications
    • Bonus: lip-balm and a hair-tie
  • Be ready to answer these 3 questions:

1.    What’s the labour pattern (just show an app if you’re using one)?

2.    Have waters released? If so was there a colour? 

3.    Is the baby moving normally?

Warning Signs

This is a partial list. Warning signs are covered in detail in prenatal classes and health region documents.

Seek medical attention (do not sleep on these signs or wait in hopes that they pass):

  • Decreased fetal movement
  • Visual disturbances
  • Sudden and severe headache
  • Pain in upper abdomen that doesn’t pass
  • Maternal fever

911 call:

  • Red, flowing bleeding or clots
  • Sudden, severe / intense / sharp pain that brings you to your knees and doesn’t pass
  • Cord prolapse when waters release

A note about “being sent home”: It’s OK. Perhaps it’s inconvenient but it can be reassuring to get checked out, be found healthy, and then be sent home. I’ve met a lot of nice staff at various hospitals who will tell you it’s better to come in for nothing than to miss a problem.  

Note about the contraction pattern: 

  • 311 means 3 minutes between the start of one contraction and the start of the next; 1 minute from start to end of the contraction; at least 1 hour of that pattern consistently. (411 is the same except 4 min between contractions.) 
  • Use 411 as your guide if you wish to get there soon into active labour, and likely stay but maybe sent home . 
  • Use 311 as your guide if you want to be more certain of being admitted and have no need or desire to go earlier in the process

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.

Making Informed Choices

Posted by on in Birth Prep, Interventions, Safety

You know informed choice is a legal right but how do you make those choices? Here’s some guidance to help you get information and ask questions, so you can be an active participant in your health care.

While tests and interventions may not be introduced in a way that implies they’re optional, they are. Everything is optional. In my experience personally and as a birth attendant, medical staff are patient, respectful and happy to answer questions when asked.

Read More “Making Informed Choices”

Brewer Pregnancy Nutrition

Posted by on in Birth Prep

Good quality nutrition, including adequate protein, is required for the increased metabolic functions that occur during pregnancy. Many midwives and practitioners recommend the Brewer Diet. There’s an overwhelming amount of evidence to support this recommendation. Studies from Harvard find that eating 75 grams of protein daily helps prevent diseases of pregnancy such as pre-eclampsia (Abubakar, A., & al. (2011, Aug)).

In the 1960’s Dr. Tom Brewer worked with a large, high-obstetrical-risk group in California: impoverished ethnic minority teen mothers in their first pregnancy.  During the same time in other areas of the USA, this group had up to 35% rates of serious pregnancy diseases, preeclampsia and eclampsia. Dr. Brewer worked with more than 7000 pregnant women over more than 12 years. He asked each woman about her diet and determined that malnutrition was prevalent.  All of his clients were required to attend nutritional counselling and were fed good nutrition and adequate protein.  The incidence of serious pregnancy illnesses  among his patients dropped to 0.5% (Brewer & Brewer-Krebs, 1977)! This is remarkable and well documented but as there was no “control group” (a group who didn’t receive “treatment”, because Dr. Brewer felt it would be unethical to withhold good nutrition from a group of pregnant women), most medical associations don’t consider this scientifically valid research.

The basic Brewer diet recommends a daily minimum of 2600 calories, 80-120 grams protein, salt-to-taste, green veggies, whole grains, fats, and vitamin-rich foods (Jones).  The Brewer diet can be easily integrated into general good pregnancy nutrition (see Basic Prenatal Nutrition handout (Evans, 2011)).  For example, while the Brewer Diet doesn’t specify types of salt or fat, whole-mineral salts (e.g. Himalayan or Celtic) and high quality omega-3 fats are healthiest.  Special needs such as food-sensitivities / allergies, ethical choices or cultural habits can all be incorporated into the Brewer Diet.  As usual, ensure you eat 3 meals and 3 snacks daily, including protein at each one.

If you wish to check out the actual “Brewer Diet”, see Dr. Brewer’s Pregnancy Diet Checklists, which include vegan and vegetarian options. Of course you can make substitutions based on your practices and preferences. If you don’t drink milk, sub it for another protein source with calcium. Below is a basic checklist you can use.

Brewer Pregnancy Diet Food Log

The list below is the minimum daily requirements according to Dr. Brewer.  You may wish to consult a holistic nutritionist if you have special needs or if you’re having trouble meeting these daily minimums as this requires prompt attention.

Check off a box each time you have a serving.  Each food counts as one checkmark on the lists e.g. a glass of milk counts as either “Milk” or “Protein”, but not both.  Examples for each category are presented.  Modify to fit any special considerations you have, such as vegetarian or a health issue to work around.

DAILY MINIMUMS:

□ □ □ □ □ □ □ □ (8) Calcium source; servings below.  Note 125ml = ½ cup

½ cup animal milk, yogurt or sour cream

¼ cup cottage cheese

1 small slice cheese

36 almonds

12 Brazil nuts

1 tbsp raw sesame seeds

1/3 cup cooked bok choy or collard greens

1 cup broccoli, cooked

½  cup kale

2 teaspoons blackstrap molasses

4 oz black olives

1 oz sardines

□ □ □ □ □ □ □ □ (8) Protein; servings below.  1oz = 7g.

Note:  See information about fish and mercury on Basic Prenatal Nutrition handout.

1 oz poultry, fish, red-meat, or organs

¼ cup canned salmon or tuna

3 sardines

1 oz cheese: cheddar, Swiss, other hard cheese

¼ cup cottage cheese

1/8 cup brewer’s yeast + 1/4 cup rice

1/8 cup sesame or sunflower seeds + ½ cup cup rice

1/8 cup beans + 1/4 cup whole rice or ½ cup cornmeal (measured before cooking)

□ □ (2) Fresh, dark green vegetables; servings below

1 cup broccoli

1 cup brussels sprouts

½ cup lettuce (preferable romaine)

½ cup endive

½ cup asparagus

½ cup sprouts: bean, alfalfa

2/3 cup greens e.g. collard, turnip, beet, mustard, dandelion, kale, spinach

□ □ □ □ □ (5) Whole grains; servings below

1 slice whole grain bread

1 corn tortilla

½ cup oatmeal, brown rice, quinoa,

1 shredded wheat biscuit

½ cup bran flakes or granola

¼ cup wheat germ

1 waffle or pancake made from whole grain

½  roll, muffin, or bagel made from whole grain

□ □ (2) Vitamin C foods; servings below

½ grapefruit

½ cup grapefruit juice

1 orange

½ cup orange juice

1 large tomato

1 cup tomato juice

½ cantaloupe

1 lemon or lime

½ cup papaya

½ cup strawberries

1 large green pepper

1 large potato, any style

□ □ □ (3) Fats and oils; servings below

1 tbsp butter

¼ avocado

1 tbsp nut-butter

1 tsp algae oil

1 tbsp first/cold-pressed vegan oil – olive, flax, avocado, hemp, coconut

1 tsp cold-pressed fish oil – cod-liver, sardine, mackerel, anchovy, krill

□ (1) Vitamin A foods; servings below

3 apricots

½ cantaloupe

½ cup carrots (1 large)

½ cup pumpkin

½ cup winter squash

1 sweet potato

Salt and other sodium sources—unlimited, to taste

kelp powder–to taste

soy sauce or tamari–to taste

full spectrum natural salt to taste – Himilayan, Celtic i.e. grey or pink salt

Water—unlimited; drink to avoid thirst, not in response to it

Purified water is best – see http://www.angieevans.ca/pdf/Water%20&%20Hydration.pdf

Fresh, home-made juice

Unsweetened herbal tea (see Safe Herbs in Pregnancy handout)

References

Abubakar, A., & al. (2011, Aug). Lipid Profiles and Platelets Counts of Pre-eclamptic women in Selected Rural Areas of Northern Nigeria.  WebmedCentral PHYSIOLOGY: http://www.webmedcentral.com/article_view/2121

ACOG. (2002, Jan). Diagnosis and Management of Preeclampsia and Eclampsia; #33. ACOG Practise Bulletin – Clinical Management Guidelines for Obstetrician-Gynecologists: http://mail.ny.acog.org/website/SMIPodcast/DiagnosisMgt.pdf

Brewer, D. T., & Brewer-Krebs, G. (1977). What Every Pregnant Woman Should Know. The Dr. Brewer Pregnancy Diet: http://www.drbrewerpregnancydiet.com/id74.html

Evans, A. (2011). Basic Prenatal Nutrition. Canmore.

Frye, A. (2007). Understanding Diagnostic Tests in the Childbearing Year, 7th Ed. Portland, OR: Labrys Press.

good nutrition… for healthier moms and babies. (n.d.).  BlueRibbonBaby.org: http://www.blueribbonbaby.org/

Haas, A. (1995). Preventing Preeclamsia, PIH, Toxemai and HELLP by Good Nutrition. Midwifery Today .

Jones, J. M. (n.d.).  The Dr. Brewer Pregnancy Diet: http://www.drbrewerpregnancydiet.com/

Maine, D. (2000). Role of nutrition in the prevention of toxemia. The American Journal of Clinical Nutrition , 72 (1), 298-300.

NICE. (2010, Aug). NICE clinical guideline 107: Hypertension in pregnancy. NHS – National Institute for Health and Clinical Excellence: http://www.nice.org.uk/nicemedia/live/13098/50418/50418.pdf

International Women’s Health Day

Posted by on in Pregnancy

Today is International Women’s Health Day.

Women’s health is terribly underfunded despite the fact we make up 50% of the population and in most cultures, women are the foundation of healthy families. A woman’s health affects her family and community. This is an issue that effects all people. We need to do better!

  • In Canada, less than 4 % of medical research dollars go toward women’s health.
  • Globally, half of all pregnancies are unplanned. While people may embrace these pregnancies, it’s a hardship for most. It can be a risk to their mental and/or physical health. For many, unplanned pregnancies are a fast-track to life-long poverty. Why so many unplanned pregnancies? This is a complex issue but most commonly they’re due to lack of availability of – and limited or no options in birth-control.
  • Globally, 800 women die daily (one every 2 minutes) from preventable pregnancy and birth complications. In many parts of the world this number is decreasing, however in North America maternal death is on the rise. Maternal deaths are most commonly due to postpartum hemorrhage, perinatal and postpartum infection, unsafe abortions, complications in birth (often due to mismanagement of labour), and preeclampsia. Generally, these are preventable and treatable issues. Women of colour are almost 3x as likely to die in childbirth compared to white women.
  • In almost all geographic areas, rates of postpartum mental illness far outweighs available treatment options. Women have no options or are told to wait 1-3 months for an appointment.
  • 1 in 10 women globally suffer from endometriosis, yet the first Canadian study into this condition began in 2019. Ten percent of women (190 million!) suffer from endometriosis. They are mostly dismissed and left without treatment options that exist, or they live in an area where there are no treatments options available.
  • In many places, women with fistulas after birth are shunned from their communities and left to fend for themselves. Many do not survive.
  • The stats on women’s heart health / cardiovascular illness is appalling. We’ve known for decades that heart-attacks in women present differently than men. However far too many are still misdiagnosed or not taken seriously. After a heart attack, women’s survival rates are considerably lower, especially if they are married and/or have children. (Married men who have heart-attacks often go home to be cared for during recovery. Married women who have heart attacks often go home and resume their role as primary caretaker of family and home.)
  • Women’s symptoms are more likely to be dismissed and their voices not taken as seriously during medical appointments and in the emergency room. They are less likely to be referred to specialists, and receive fewer diagnostic tests and prescription medications. This issue is amplified for BIPOC women and plus sized women.
  • Menopause negatively affects over 80% of women globally, yet there are very few medical treatment options. Research is vastly underfunded for an event that affects almost 50% of Earth’s population.

There are so many other examples of frightening outcomes, disparity and lack of resources for women’s health; too many to list here. We can do better.