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

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

Let’s get to the facts.

Exercise During Pregnancy – What To Know

Birth has been compared to climbing a mountain or completing a marathon.  Being physically fit is an advantage.  Exercise generally improves pregnancy, birth and newborn outcomes for people with normal pregnancies.  There may be a protective factor for gestational diabetes, congenital anomalies, miscarriage, placental problems, intrauterine growth restriction, high blood pressure or fetal death.  Evidence suggests that abnormal heart rates, cord entanglement, and the presence of meconium are significantly reduced.  While there is no increase in premies, there may be fewer postdate gestations.

Those who engage in regular, vigorous exercise require less intervention in labour, including a substantial decrease of cesarean birth rates.  They may have faster labours, both in stage-1 and stage-2, compared to those who are sedentary.   However, keep in mind that during pregnancy, ligaments and tendons soften, center of mass shifts, blood volume and oxygen levels change.  During pregnancy one is more prone to falls, muscle / joint injuries, and running out of steam.

Exercise During Pregnancy 1

There are many benefits to exercising during your pregnancy:

  • Feel comfortable in and enjoy your body
  • Increases circulation
  • Promotes tone in muscles and increases stamina
  • Promotes well-being; prevents depression
  • Oxygenates blood to reduce fatigue
  • Improves placental function
  • Reduces pelvic congestion and cramping, low backache, ligament pain and constipation
  • Prevents blood congestion in lower body, reduces leg cramps, tension, and varicosities
  • Recovery of organ tone and placement; prevents prolapsed pelvic organs post-partum
  • Gestational diabetes and blood sugar issues improve after exercise
  • Moderately high blood pressure may be lowered
  • Improves pregnancy, birth and newborn outcomes
  • Contributes to shorter labours and fewer medical interventions

(For more information on Easing Labour Pain, join me for my monthly workshop. Register here.)

Relaxation for Birth Prep

  • It’s important to do exercise and also practice relaxation.
  • Relaxation must be practiced daily to be effective, especially as a labour tool.
  • Yoga, meditation, tai-chi, or just listen to a relaxation CD.
  • Conscious awareness of relaxing muscles balance building and toning; especially important if you are muscle-bound or super-muscular.

(For more information on preparing for your birth, join me for my monthly Birth Essentials Live But Online series. Register here.)

Exercise During Pregnancy – Do’s:

  • LISTEN TO YOUR BODY; DO ONLY WHAT FEELS GOOD!
  • Continue your regular exercise program, but listen to your body; modify/stop as needed.
  • Exercise on a firm surface.
  • Balance exertion with relaxation periods.
  • Remember your center of balance / weight distribution is quickly changing.
  • Warm up and cool down well to prevent injury and pooling of blood in the extremities.
  • Feel your baby move inside you – pay attention.
  • Stay hydrated to ensure proper cooling and adequate blood expansion. Drink 4-8oz water before exercising and 2-4oz every 20-30 minutes during; double this amount at high elevations. This is in addition to your regular pregnancy water requirements.
  • Exercise in a cooled or air-conditioned room, especially in hot, humid weather.
  • Consume additional calories to sustain exercise. Moderate exercise in an average sized woman requires 600-700 additional calories daily.
  • Taper off gradually if you’re used to vigorous exercise and have to exercise less.  An abrupt drop in activity can cause constipation, circulatory problems, or nervous irritability.
  • Begin slowly if you have not routinely exercised.
    • If motivation is an issue, think of it as movement rather than exercise.
    • Start twice weekly and increase to 5 times. A 10-20minute walks is a great start!
    • Videos can help you learn to exercise but ensure they’re safe for pregnancy.
    • Discuss beginning an exercise program with your medical care provider.

Exercise During Pregnancy – Avoids:

  • Inversions and twists, especially during yoga.
  • Sit-ups or crunches as they stress abdominal muscles, weakening and lengthening them in the long run. Post-partum recovery of a tight core in this case is difficult or impossible.  In fact, every time you go from laying to sitting/standing, roll over on your side first.
  • Exercising to the point where you cannot carry on a conversation.
  • Weights or exercises that require holding your arms over your head for an extended period of time or for many repetitions.
  • Impact exercises (once they no longer feel 100% great, if you’re used to them).
  • Laying on your back for extended periods of time.
  • Any exercise that can cause trauma to the abdomen or pelvis.
  • Valsalva manoeuvres / inner pressure on pelvic floor (e.g. some breathing patterns that resemble bearing down).
  • Scuba diving due to increased pressures of submersion.
  • Sudden changes of position or level.
  • Exercises that require standing on one leg as that can cause pulling in the pubic symphysis, not to mention balance issues.
  • Starting a vigorous exercise program after 26 weeks if you’re new to exercise.
  • Strenuous exercise during last trimester, no matter how fit or used to high intensity you are (correlated with lower birth-weight babies).

Contraindications for Exercise During Pregnancy

  • Placenta previa
  • Tearing or separation of placenta (abruptio)
  • Premature rupture of membranes (PROM)
  • Incompetent cervix
  • Chronic heart disease
  • Premature labour
  • PIH (pregnancy induced high blood pressure)
  • Pre-eclampsia (a.k.a. toxaemia)
  • Fever (or presence of infection)
  • Acute and/or chronic life-threatening condition

Warning Signs or Symptoms – Stop IMMEDIATELY and seek medical attention in case of:

  • Pain or discomfort
  • Bleeding or fluid discharge
  • Feeling ill, dizzy, faint, disoriented, nauseated
  • Heart palpitations or chest pain
  • Severe headache
  • Difficulty walking or moving
  • Regular strong contractions
  • Cramps
  • Fever
  • Hyperventilation – take slow deep breaths until it passes

Conditions for Assessment

If any of these issues are a concern, then consult with a perinatal fitness specialist.  There are often things you can do to exercise during pregnancy safely with special circumstances.

  • Extremely sedentary lifestyle
  • Gestational diabetes or blood sugar issues
  • Marginal or low-lying placenta
  • History of IUGR (decreased or slow fetal growth)
  • High blood pressure
  • Irregular heartbeat or mitral valve prolapse
  • Asthma
  • Oedema / swelling of face and hands
  • Anaemia
  • Multiple gestations / foetuses (twins, triplets etc)
  • Thyroid disease
  • Three or more miscarriages
  • Excessive over- or underweight
  • Nerve compression injuries – don’t stretch to extremes or do weight bearing on the affected part

Exercise During Pregnancy – Suggestions:

  • Pelvic-floor exercises – see below
  • Prenatal yoga
  • Tai-chi
  • Walking
  • Cycling
  • Swimming
  • Dance (belly dancing is especially good for birth)
  • Daily squatting – start with supported squat for as long as feels comfortable (holding a pole or counter, or sliding down a wall) – maybe only seconds at first. Build flexibility and endurance in this position.  Feet should be parallel to each other.
  • Pelvic rocking – all fours and do cats & dogs. Start with 5 of each and build to 20 daily.
  • Any stretching that increases flexibility and flow to pelvis, such as cobbler-sit, pigeon pose, or straddles. A good prenatal yoga DVD or class can teach you these.
  • See special note below for those who participate in extreme sports or live in the mountains.

 Pelvic floor exercises are particularly important when preparing for birth:

  • Assists with relaxation of pelvis floor – prevents tearing
  • Tones pelvic floor to prevent prolapse, incontinence, haemorrhoids
  • “Elevator Kegels” – Kegels are often mentioned as a good pregnancy and post-partum exercise but need to be done properly, like an elevator, not just a urination squeeze. Relax all muscles except pelvic floor and vagina.  Tighten those muscles progressively, layer by layer, then release slowly.  Build up to cycles of 15, for a total of 50 contractions daily. Do not hold longer than 5 seconds at a time, nor perform regularly during urination, as this may contribute to urinary tract infection.
  • Squats are excellent for pelvic floor health

Posture – While Exercising or Resting

  • Maintain good posture to prevent low back pain, shortness of breath, and indigestion.
  • Hold head high (crown to sky), shoulders back, abs and lower back strong, tailbone tucked in and feet slightly apart.
  • Spend time on the floor! Carpet or a firm pillow can keep your bones comfortable.  Crawl on all-fours during the last trimester to ensure optimal fetal positioning.  Sit on the floor to open your hips.
  • Be diligent with posture, especially sitting postures, to ensure the best possible fetal position for labour and birth.
    • Sit tailor-style often – this strengthens the back
    • Sit straight up and on sitz-bones
    • Consider sitting on a ball, saddle seat, knee-chair, or sit-stand chair to ensure your knees stay below hips, and your back maintains healthy alignment following natural curves
    • Avoid slouching, reclining and upholstered furniture as much as possible

Exercise During Pregnancy 2

The rest of this article is a SPECIAL NOTE to those who are…

Extremely Fit / High Performance Athletes / and/or Living in Mountains

People in this category have a different reality.  The following are guidelines for those folks who have lived at high altitude longer than 6 months pre-pregnancy (and are therefore adapted to high altitude), are active in the mountains, accomplished in mountain or other extreme sports, addicted to Ashtanga yoga and/or super-fit compared to the general population.

Intense exercise is contraindicated in the last trimester and is correlated with lower birth weight babies.  It’s only 1 season in the grand scheme of life and could be an opportunity to try something new or softer.

The most important thing is to LISTEN TO YOUR BODY!!!  If it feels good, keep going.  However there WILL come a point where you feel tired.  You may also feel a bit clumsy as your body changes.  There is no benefit to pushing through at that point.  You’re growing a whole person inside and your baby deserves your energy and nutrients.  Play in the mountains if it feels good but be willing to stop, modify or slow down.

Anyone who exercises compulsively is particularly at risk for ignoring their body’s subtle calls of distress.  Balance exercise during pregnancy with rest and relaxation.  If you’re super-muscular or muscle-bound then consider decreasing exercise and increasing relaxation time.  Take a class specific for un-exercising muscles.  You might feel stir crazy, but learning to loosen and relax your body will pay off greatly during the birth process and for post-partum recovery.

Do your sports partners know you’re pregnant?  Is it fair to either of you to keep this a secret?  During early pregnancy, before you “show”, you’re likely to be tired and possibly nauseated.  Your play partners may assume you’ll push through.  Do not push through.  Even if they know you’re pregnant they may not understand it actually does affect your performance.  A good conversation might be in order before setting out.  I strongly encourage you to tell them, or at least think about why you’re not telling them.  Then look at those reasons and decide if you should be relying on each other for life and safety out there.

For any endurance activities lasting longer than a yoga class, be prepared to nourish yourself.  Eat and drink constantly.  Use a health electrolyte drink.  Take breaks – yes, breaks – as in rest.

Tips for Mountain Activities in addition to the ones above (see “Exercise do’s”).  Remember that high-intensity exercise is contraindicated in the last trimester, and LISTEN TO YOUR BODY!!  You absolutely must take rests and eat/drink LOTS to safely participate in these activities.

  • Cycling – tone it down before when your clipless pedals start releasing due to knees-out position. Be careful of weight distribution changes, and consider switching to fire-roads or road-biking rather than single-track.
  • Climbing – when your harness no longer fits, stop. (OK – maybe stop before that.) Do not borrow a bigger harness!  Top-roping is safest.  If you must lead use lots of pro and be extra diligent about falls.  Seriously consider leading about 3 points back from your pre-pregnancy ability.  Make your climbing partner carry the ropes and half the pro.
  • Ice climbing presents cold weather challenges in addition to the extra risks over rock-climbing. Even more moisture is lost through respiration and staying warm in the cold, so drink even MORE WATER than recommended above.  Also pay extra attention to fingers & toes and frost-bite; your blood volume and distribution are changing.
  • Altitude – almost all prenatal books warn about high altitude. If you’ve lived at altitude for longer than 6 months, then your physiology will have adapted.  Continue going to places you went pre-pregnancy but allow more time to get there.
  • Hiking – be diligent about pack weight distribution, and take rests. Yes – rests!!  Don’t wait until you feel light headed.  Take lots of snack & water breaks.  Carry that bear spray because you’re now likely the slowest runner in the group J.  Make your hiking-mates carry the heavy stuff!
  • Skiing – if it feels 100% good, do it. Seriously watch for back-country avalanche bulletins.  Make your ski-buddies break trail and carry extra gear.  Consider spending more time on track-set or groomers.  If using lifts take a big drink on every ride.
  • Yoga – if and only if you’ve been a dedicated yogi for years and are very body-aware, then it’s possible to continue your regular practise, modifying as your body tells you.

Effects of Stress and Adrenaline on Unborn Babies

The emerging field of perinatal psychology has fascinating info.  Pregnant adrenaline junkies make adrenaline junkie babies – great for fun but also a special challenge on adrenal health later in life and appropriate stress-coping mechanisms.  One big way to help baby cope is to explain what you’re about to do, that it may feel scary, but that baby is safe.  When the stressful event or adrenaline rush is over tell baby all is will now, baby is safe, and scary event is over.

Imagine you’re blindfolded, wearing ear-plugs, and can’t talk.  Then someone drops you into the craziest roller-coaster ever but doesn’t tell you anything about it.  That’s what it’s like for baby to accompany you for any event that raises your adrenaline – sports, argument with partner, work-related stress, and near-miss car crash.

A word about “they say”:

People will have strong opinions about what you’re doing and will be more than willing to share those opinions.  It’s frustrating to hear that you’re irresponsible to be climbing, especially from a non-climbing, flat-lander, possibly couch potato, who doesn’t know how much you’ve already changed your practise!  It’s even more frustrating to hear it from a well-meaning local athlete.  Some people will refuse to play in the mountains with you, feeling they’re contributing to your “irrational” behaviour.  Others may take your partner aside to try to convince you both how risky your actions are.  Fortunately many others totally “get it”!  Play with people who understand and are willing to accommodate and be safe.

What are some of your favourite exercises to do during your pregnancy? Want to know more about my online prenatal classes or in need of birth support? Please contact me!

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Avoiding Post-Dates Pregnancy

Post-term or post-date pregnancy is one that exceeds 40-42 weeks gestation, depending where you live.  If a woman is healthy and well nourished then her placenta is likely to thrive and nourish the baby at any gestation.  If there are signs that mother or baby will be healthier with baby Earth-side, then induction is warranted; otherwise it’s a much overused intervention that leads to a Cascade of Intervention.    

Drying Up Breastmilk

While breastfeeding is actively promoted in almost all Canadian communities, a new mother may need or want to prevent further lactation or dry up her milk.  Reasons include still-born, surrogacy, medical conditions requiring treatment contraindicated with breastfeeding, past abuse, and lifestyle choices.  For many women it’s a very difficult decision.  Women need acceptance and supported in their choices.  To that end, here’s information to help a woman cease lactation in the safest and least painful way.

Perineum Care

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

  • Calendula Mixture: Make tea from dried calendula leaves (1 full tea ball per cup water steeped for 10 min) or use tincture (20-30 drops per cup water).  Add 1-2 drops of lavender essential oil or some lavender tea to mixture.
  • Partially dip maxi pads – preferably long, organic – in calendula mixture briefly, just to soak top layer. Another option is to use a sprayer to wet the tops.
  • Freeze pads in bowls so they’re curved like the female body. Store in Ziplocs (labeled with your name) in freezer.
  • Bring the pads to birth-place! Hospitals and birthing centers have freezers.
  • Apply immediately after birth.

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

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

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

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

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

RECOVERY FROM DIFFICULT BIRTH
After a difficult birth follow the above recommendations plus:

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

SPECIAL INFANT CARE FOLLOWING DIFFICULT BIRTH

  • Lots of frontal contact, skin-to-skin if possible; helps establish breastfeeding and is reassuring for baby. Babies who are held feed better, poop and pee more, and are therefore less prone to jaundice and other illnesses.
  • See a complimentary practitioner who specializes in and is very experienced with newborn care, especially if there was any trauma to baby’s head (vacuum, forceps, caesarean, malposition, and/or long “pushing stage”) e.g. chiropractor, cranio-sacral therapist, osteopath.

Labour Drinks

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

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

These next two versions are from http://www.mommypotamus.com/how-to-make-a-labor-aid-electrolyte-drink/).  See site for details of ingredients.

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

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

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

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

 

Inaccurate Reporting on Encapsulation and GBS

The report alleging an infant being infected with Group-B Strep bacteria from placenta capsules is completely inaccurate. In reading through the details (summarized below), you’ll see that it’s impossible that the placenta capsules were the source of infection. This is not a study, but rather a media article.  One story is never a scientific study.  As is often the case in anything birth-related, the headline is misleading.

Postpartum Mood & Anxiety Disorders (PMAD)

This is the updated term for postpartum depression (PPD).  PMAD is a form of clinical depression or mental illness that can begin at any time after childbirth, from days to even years after in some cases.  PPD is not something that is anyone’s fault or that necessarily be controlled.  Between 3-24% of new mothers are afflicted, and up to 50% of male partners of women with PPD also experience PPD (Clinical Rounds, MCU Oct 2011).  Although hormone drops are often blamed, no causation has been proven.  PPD is more serious than postpartum blues; if the blues last longer than 2 weeks and aren’t resolved by rest and support then seek help.

Symptoms of PMAD include any of the following:  crying for no reason, inability to cope, feeling overwhelmed, sadness, anger, hopelessness, impaired memory or concentration, loss of interests, nightmares, bizarre / strange / intrusive thoughts, perceived or actual difficulties bonding with baby, feelings of resentment or aggression toward baby or family members, apathy toward baby, thoughts of suicide.  Call your midwife or health practitioner in case of any of these symptoms.

Risk Factors of PMAD

Note:  PMAD can hit any woman at any time postpartum – for no apparent reason.  However the following increase the risk.

  • Personal or family history of depression, related to birth or not
  • Traumatic birth
  • Pain
  • Fatigue
  • Inflammation
  • Low blood-iron levels
  • Twins or multiples
  • Being “run-down” e.g. fatigue, low blood sugar
  • Stress e.g. such as social, economic, relationship, health concerns, child-care issues
  • Lack of social support
  • Perceived or actual isolation
  • Formula feeding in place of breastfeeding
  • Cigarette smoking
  • Infant temperament
  • An affected partner

“Baby-blues” is a normal, natural emotional reaction to birth that last hours or a few days.  Symptoms are mild and transient and occur in 50-80% of new mothers around day 3, when your milk comes in.  You may experience tears, exhaustion, worry, irritability, and lack of confidence.  Mothers experiencing baby-blues need support, rest and care to prevent it from progressing to depression.  If it lasts longer then it’s prudent to follow the measures listed under “Prevention and Treatment Strategies.”

Postpartum psychosis is a rare but severe and sudden mental illness that requires immediate 911 medical attention.  Symptoms include those for PPD, plus some or all of the following:  refusal to eat, fatigue, frantic excessive energy, confusion, delusions, loss of memory, failure to recognize familiar people, visual or auditory hallucinations, irrational statements, distorted thinking, suicidal or infanticidal thoughts and behaviours.  Seek 911 medical help immediately.

Prevention and Treatment Strategies

Although there may be factors that can’t be controlled, the best defence against PMAD is a well supported, healthy mother.  There seem to be higher rates of PMAD in Western cultures, likely due to stress and isolation.  In almost every other culture, new mothers are surrounded by women and family to take care of them.  All they’re expected to do is rest, recover, breastfeed and bond with baby for the first 40 days.  In North America most new mothers are expected to take care of themselves, their baby, and the household; and of course entertain a steady stream of visitors who want to check out the baby.

  • Prevention starts during pregnancy
    • Learn as much as possible about birth, breastfeeding and life after baby
    • Arrange postpartum support to allow for rest and bonding i.e. circle of friends or family, postpartum doula, community resources
    • Learn to say no
    • Plan to do nothing for 8 weeks; have freezer full of healthy tasty prepped food, kitchen stoked with non-perishables, household items stocked, major home chores done, hire house-keeper, dog-walker etc, get groceries delivered
  • Early intervention leads to shorted duration
  • Limit visitors and length of visits!!! Have a visitor rule: everyone has to bring a healthy meal – fresh or frozen – and do a chore from a “to-do” list on your fridge.  Set a time limit.
  • Take one day at a time
  • Ask for help
  • Manage pain, even if that means taking pain meds while breastfeeding
  • Have and use a simple schedule, allowing for the unpredictability of newborns
  • Take it slow; re-enter world gently if hibernating with new baby (40 days highly recommended)
  • Adequate sleep; sleep when the baby sleeps
  • Breastfeed
    • Hormones of breastfeeding, prolactin and oxytocin, help reduce PPD
    • Several studies find breastfeeding mothers actually get more sleep on average than formula feeders
    • Benefits of breastfeeding for both mother and baby far outweigh any risk of anti-depressant drugs effecting baby
  • Do something that brings joy daily
  • Find a way to have a little time alone daily, including time to relax (meditation, rest, praying, reading – whatever’s rejuvenating)
  • Self-care e.g. shower, get dressed, eat, get out for walk
  • Healthy foods (see Postpartum Nutrition handout)
  • Ingesting placenta e.g. dry and encapsulate
  • Craniosacral therapy, especially in case of lost consciousness during birth process
  • Community support programs such as Y’s Moms and LaLecheLeague groups
  • Mental health professional, ideally one who specializes in postpartum mental health
  • For mild PMAD, take supplements of a fish oil high in EPA and St John’s Wort; can be taken with antidepressant medication; safe with breastfeeding
  • Psychiatric care may be required including antidepressant drugs, many are safe for breastfeeding
  • Many antipsychotic drugs are not recommended with breastfeeding, but there may be alternative schedules available for some women (e.g., taking high dose at night and then not using breastmilk until 8-12 hours later – do this only upon advise from psychiatrist, who will help determine safe dosages and timing on a case-by case basis)

Support Measures to Consider

  • Support with housework, meals, daily tasks from one with whom mother feels comfortable
  • Postpartum doula
  • Call midwife or health practitioner with any concerns or questions regarding blues or depression
  • Families Matter Postpartum Support 1-888-545-5177
  • Sask Health Link 811
  • Online support at Mothering Magazine’s Forum: mothering.com/community

What Partner Can Do

Be there. Be present and involved.  While PMAD affects the mother directly, it’s a family issue.  Partners can’t “fix” this, but can be supportive.

  • Call midwife or health practitioner right away with any concerns
  • Don’t wait for mother to reach out – find help for her
  • Remind partner that she’s loved and partner is there for her
  • This is no one’s fault – remain non-judgemental
  • If she cries just hug and hold – allow the tears
  • Remind mother to get fresh air or do something for herself daily.  Make it happen.
  • Do something as a family – take a walk, cuddle by the fire
  • Self-care as this is a difficult time for partners too.  New parenthood is an adjustment for both parents even without challenges such as PMAD.  Eat well, rest when possible, and get fresh air.
  • Remember anything that takes care of mother (food, chores etc) is also taking care of baby
  • If partner can’t be there and take care of food / home then arrange for people who can
  • Listen attentively – partner may be the only person she opens up to
  • Remind her that she’s not alone, this will get better and you’ll all get through together
  • Ask “what can I do” or “what do you need” rather than “do you need anything”
  • Point out triumphs such as growing a healthy baby, meeting with a counsellor
  • Guard the door – only supportive helpful visitors are allowed and only if mom truly has energy
  • Be open with those closest family / friends about what’s happening
  • Observe, as health practitioner will ask about patterns and behaviours
  • Be wary of partners mental health; up to 50% of male partners of women with PPD also experience PPD (Clinical Rounds, MCU Oct 2011)

For mild issues some women find just getting out for fresh air daily, or having a bath, time with girlfriends, a nap, or whatever their thing is, helps.

Local Resources

  • Healthline Phone (part of public health care) as they have the training to screen and refer now and alert crisis if needed (811 is the new number)
  • Smiling Mask www.thesmilingmask.com and/or book by Carla O’Reilly & Tania Bird (this is a brilliant resource started by 3 local Regina women who suffered from PPD)
  • Edinborough screening tool – self assessment.  This is now part of the EPDS Screening, available at http://skprevention.ca/?s=EPDS .  There’s some other good info on that page too.  Take this to a qualified care provider if you score in a range that needs to be addressed.  Do this test at regular intervals.
  • Marlene Harper (Private therapist) 306-584-2731, Regina (note i don’t know her personally but she comes recommended by other mamas)
  • Online Therapy – cognitive behavior treatment program for maternal depression (Pilot program; may or may not continue long term)
    • Includes 7 interactive evidence based modules
      Therapist-assisted via email and telephone
      Provided at no cost
      Inclusion criteria:  SK resident, > 18 years, minor-major depressive symptoms, have a child <1 year
      For more information or to refer:
      –Website: www.onlinetherapyuser.ca
      –Email: Nicole Pugh: pugh…@uregina.ca
      –Phone: (306) 585-5369; (306) 337-3331

Holistic helpers who may be able to offer help, and could certainly compliment any medical care.
Dr. Vanessa DiCicco, ND – http://wellfamily.ca/meet-nds/vanessa-dicicco/
Cheryl Lloyd, hypnotherapist www.tranquiljourneys.ca

Psych Unit at RGH
Visitors are welcome!

 

References

Calgary Health Region. (2007). From Here Through Maternity. Calgary: Alberta Health Services.

Corwin, E., Murray-Kolb, L., & Beard, J. (2003). Low Hemoglobin Level Is a Risk Factor for Postpartum Depression. The Journal of Nutrition , 133, 4139-42.

Kendall-Tacket, K. P. (2005). The Hidden Feelings of Motherhood (2nd ed.). Amarillo, TX: Pharmasoft Publishing, L.P.

Kendall-Tackett, K. (2010, Aug). Nighttime Breastfeeding and Maternal Mental Health. Retrieved Sep 2011, from Science & Sensibility: http://www.scienceandsensibility.org/?p=1398

La Leche League Canada Health Professional Seminar, Calgary AB.  Preserving the Simplicity of Breastfeeding in a Complex World: a Paradigm for Depression, Stress and Postpartum Healing. 1 day seminar; Dr. Kathleen Kendall-Tackett.  2008.

Lim, R. (2001). After the Baby’s Birth – A Complete Guide for Postpartum Women (Revised). Toronto: Celestial Arts.

Sarah Breese McCoy,  J. Martin Beal, Stacia Miller-Shipman, Mark Payton, Gary Watson. (2006). Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature. Journal of the American Osteopathic Association , 106 (4), 193-198.

The Mother Reach coalition . (n.d.). Postpartum Mood Disorder . Retrieved Sep 2011, from Mother Reach: http://www.helpformom.ca/

Varney, H., Kriebs, J. M., Gegor, C. L. (2004). Varney’s Midwifery, 4th Ed. Toronto: Jones and Bartlett Publishers.

 

Posterior Position – Turning Baby Prenatally

Fetal position at the onset of labour is one of the greatest determining factors of how the birth process will proceed.  During labour the fetus makes certain movements to descend through the pelvis.  The optimal fetal position is pictured below.  A good way to remember the best position is to think about giving your baby a back rub every time you rub your belly.

A spot near the back of the fetal head is used to determine fetal position.  The terms “posterior” or “sunny-side up” describe a baby who faces out, or is spine-to-spine with mother.   “OP” is the medical jargon.  The presenting part of the head is bigger in this position and the baby doesn’t flex and rotate as well as an anterior baby.

Problems Related to Posterior Position

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

However 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 position.

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

Signs of a Posterior Baby

  • Feeling kicks or flutters at your front
  • Frequent urination (more frequent than with anterior pregnancy)
  • Belly appears flat or lumpy
  • Your midwife or doctor can tell by palpating your abdomen, as is done at every prenatal visit
  • Fetal heart-tones may be difficult to hear
  • Head is not engaged or doesn’t drop into pelvis
  • Can be confirmed with ultrasound
  • During labour she can also tell during an internal examination

Factors Contributing to Posterior Position
Posterior-babies can occur 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 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
  • Mother 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 a reason (that we don’t know about) for baby to be posterior and nothing will turn her or him.  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 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
  • Keep belly warm (babies may turn back to keep warm against mother’s back)
  • 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.

 

References

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

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

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

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

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

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