Author: Angie Evans

Angie The Doula – Postpartum Support and Maternal Mental Health Resources

Posted by on in Depression, Postpartum, Recovery

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.

Doulas and Dads

Posted by on in Birth Prep, Birth Support, Dads, Doula, Labour

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?

Read More “Doulas and Dads”

Infant Colic – What Can You Do?

Posted by on in Baby Care, Breastfeeding, Comfort, Herbs, Homeopathy, Postpartum

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.

𝗗𝗼𝘂𝗹𝗮𝘀 𝗮𝗻𝗱 𝗣𝗮𝗿𝘁𝗻𝗲𝗿𝘀: 𝗪𝗼𝗿𝗸𝗶𝗻𝗴 𝗧𝗼𝗴𝗲𝘁𝗵𝗲𝗿. Top 3 𝗠𝘆𝘁𝗵𝘀 & 𝗥𝗲𝗮𝗹𝗶𝘁𝗶𝗲𝘀

Posted by on in Birth, Birth Support, Dads, Doula, Labour, Partners

Some couples worry that the partner will be relegated to a minor role if a doula attends the birth. On the other hand, some pregnant women worry that their partners will not be very helpful but are hesitant to suggest a doula for fear of hurting the partner’s feelings. Many partners want to help but feel insecure about their ability to meet all of their loved one’s needs.

𝗠𝘆𝘁𝗵 #1: Partners can do all the labour support on their own.

𝗥𝗲𝗮𝗹𝗶𝘁𝘆: While this may be true for a minority of couples, many partners are not equipped to be the primary birth support. Doulas are specifically trained in emotional and physical support such as comfort measures. They understand the birth process and what to do at various stages and situations. Besides, partners are going through their own birthing journey and need support too.

𝗠𝘆𝘁𝗵 #2: Doulas displace partners and interfere with the couple’s intimate experience.

𝗥𝗲𝗮𝗹𝗶𝘁𝘆: Research shows more eye-contact and physical touch between couples when a doula is present; they usually work more closely together. Doulas help couples clarify their expectations of each other and then make space for partners to participate at their comfort level. When the partner chooses to be the primary emotional support, the doula can supplement their efforts by running errands, making suggestions for comfort measures, etc. During a long tiring labor, she can give the partner a break. While the doula probably knows more than the partner about birth, hospitals and maternity care, the partner knows more about the woman’s personality, likes and dislikes, and needs. Moreover, they love the birthing woman!

𝗠𝘆𝘁𝗵 #3: Doulas are there only for the birthing client.

𝗥𝗲𝗮𝗹𝗶𝘁𝘆: Of course the labouring woman is the priority but doulas support partners too! Medical staff have other priorities that may compete with the emotional care of their patient; e.g. breaks, shift changes, clinical responsibilities, office hours and hospital policies. Client care is the doula’s priority. She is not just another stranger with the couple. They’ve met prenatally until they know each other and feel ready as a team. Doulas understand the dreams, wishes, goals of the birthing person and the partner. By making sure that the partner’s needs are met (e.g. food, drink, reassurance, and maybe even rest), the birthing woman and partner can work more closely together.

As one partner said, “I heaved a big sigh of relief when she (the doula) walked in. I hadn’t realized how much pressure I had been feeling. She not only calmed my wife, she calmed me down. I was able to support my partner MORE when the doula was with us!”

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

Posted by on in Induction, Interventions, Labour, Safety

Your waters just released – now what?  When you water breaks, it can be released as a few drops at a time or in a gush.  Less than 10 per cent of Pregnant people will experience waters releasing before labour has started.  When this happens, labour usually starts within 24 hours.  The other 92 per cent will release at some point during labour, usually in active labour.  Here is information on self-care and warning signs.

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

Warning Signs Regarding Released Waters

If any of these occur, seek medical attention in a timely manner. Contact your medical provider and/or go to hospital – calmly but don’t wait.

  • Waters release before 37 weeks.
  • Fluid is coloured (yellow, green, brown) or has a strong smell.
  • Any signs of fever.
  • Baby isn’t moving normally and doesn’t respond after you’ve had a snack, rested and paid attention.
  • This last one is a 911 call! If you feel a cord between your legs or at the vaginal opening, assume a “child’s pose” with bum in the air (on hands and knees with chest on the ground) and call 911.

20200408_121420
“Child’s Pose” with bum in the air

Self-Care After Membranes Release

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

Go to Hospital… or Not?

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

  1. Baby’s health (by listening to fetal heart tones);
  2. Maternal health (vital signs and interview); and
  3. Presence (or absence) of amniotic fluid (the “waters”) present, usually by doing a cervical check/internal exam.

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

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

Your Options

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

Further Info:

This is the best handout I’ve seen for clients – What to do When Your Water Breaks Before Labour. It has graphics and is research based. It’s easy to understand.

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

Pregnant Woman by ocean

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

Angie The Doula – New Parent and Baby Essentials

Posted by on in Baby Care, Books, Breastfeeding, Comfort, Supplies

What are the most important items for new parents and their newborns? Everyone has different opinions about this. Stores and ads would have us buy all kinds of things. What do you really need? Think about what you have to do with your baby. For example, a travelling family will have different needs than a family at home.

This New Parent and Baby Essentials list is from my experience along with comments from families with whom I’ve worked.  It’s biased toward being kind to the environment and keeping life simple.

Before we get started, I want to let you know that really all you need (other than love, food, shelter) is a warm safe place for your baby to sleep when they’re not in your arms, diapers (unless you’re doing EC) and a system for cleaning your baby, and a safe and comfortable way to transport them.  Note that babies will go from laying stationary to rolling over in the blink of an eye.  Save your babe from a fall and potential injury by never leaving them unattended on a flat surface such as a bed or table, unless they’re surrounded by little rails or something that will both prevent rolling and suffocation.

New Parent and Baby Essentials

Essentials:

  • For maternal postpartum recovery and wellness:
    • Bottom spray (postpartum perineum-saver!!)
    • Adult diapers for the first week – not pretty but awesome way to prevent postpartum leaks
    • See Breastfeeding section below
  • Something to wear or a way to hold the baby – sling, wrap, carrier or baby pack for newborn i.e. supports head
    • May need a couple of methods to accommodate different adults – sizes, abilities, preferences – and babies
  • For baby:
    • See Diaper section below
    • Car seat
    • Baby blanket or cover for car seat
    • Receiving blankets – 20
    • Mini-wash cloths can be used as wipes – 40-50 if you’re not using disposable wipes
    • Baby blanket for home
    • Digital thermometer
    • Q-tips, in case of care of umbilical cord
    • Baby nail clippers 
    • Saline-squirter or nose-sucker
    • Baby clothes – many people get much more than they need from family & friends
      • A few outfits including sleepers and undershirts
      • Socks & mitts
      • Outdoor clothing
      • For winter babes, outer clothing such as a fleece bunting-bag or something that covers hands and feet as part of the outfit.  Also a good hat that stays on.
      • For summer babes, a sun-hat, and thin clothing to cover up skin but not overheat
    • Baby ear-muffs (hearing protection), e.g. for music festivals, movie theatres
New Parent and Baby Essentials
  • For breastfeeding/chestfeeding:
    • Nipple cream or pharmaceutical grade lanolin (e.g. Lansinoh)
    • Nursing bras
    • Nursing pads (pref cotton, non-disposable)
    • For consideration: a little manual pump or milk collector device such as the Haakaa
    • Book: Womanly Art of Breastfeeding – quick answers for breastfeeding issues; easy to read and short fix-it suggestions
  • Diapering.  Set up a safe place and have supplies ready to use.
    • Change table with little rails, change pad (with sides) on a table or dresser, or towel on the floor
    • Diapers – what kind will you use?  Cloth or disposable (biodegradable, organic, or regular)
    • Wipes – washcloths / reusable, or disposable
    • If using cloth, you’ll need a storing, soaking and washing method.  Feel free to ask me.
  • Think about sleeping options:

CPS recommends baby sleeps in the same room as parents , ideally for the entire first year, but for a minimum of 6 months.

  • Baby blanket or quilt; no pillows needed
  • Some kind of washable pad for under baby – can be anything from a proper baby-pad to a folded sheet.  This goes under the baby-sheet to avoid scrunching and twisted bedding.
  • Family bed – a futon on floor, extra-wide bed against the wall, or 3 sided crib that attaches or goes against parents’ bed
  • Family room – a safe place for baby to sleep in your room but not necessarily attached to bed
  • Baby room – high quality crib with slats close enough so a pop-can won’t fit through 
  • In a pinch – box, drawer or laundry basket
New Parent and Baby Essentials

Other things that make life easier (and are worth every cent!)…

  • Really great nursing pillow 
  • Smart Medicine for Healthier Kids book has both allopathic and holistic advice on childcare from newborn to teens
  • Calms book – a short read with great tips for learning to communicate with your new baby
  • Medicine dropper – has many uses other than medicine
  • Stroller, or Burley/Chariot 
  • High quality and “clean” baby care soap and laundry soap

Nice to have but not essential

  • Swing or Rocker
  • Baby-bath or Tummy Tub but another option is to just have a bath with your babe to minimize buying stuff.
  • Baby monitor, depending on your lifestyle and home layout.
  • Breast pump and glass bottles in case of emergency or depending on lifestyle.
  • Playpen  

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.

Checklist: Things to Learn About Your Hospital / Birthplace Before Labour Begins

Posted by on in Birth Prep

This is also available as a Printable Birthplace Checklist.

Ideally, you will learn these things before 36 weeks of pregnancy. 

This list includes things available in most city hospitals, where units are specialized. In smaller hospitals, there may not be a specific birth and/or mother-baby unit and some of the services and amenities listed may not be available. Small town hospitals may have a birth room rather than a unit, and then the family stays in the general acute care unit. Sorting these details out is part of good birth-prep. 

General Planning

  • Name & location of hospital / birth centre
  • Do they offer pre-registration or do you register on the way in?
  • What you need to bring
    • Birth bag / supplies
    • Documents for registration
  • Support people 
    • How many
    • Ages
    • Requirements (e.g. hours, ID)
    • Payment required – covered by provincial health, private insurance, or out of pocket
    • General policies e.g. most hospitals have no-scent policies

Parking / Transit

  • Fees
  • Methods of payment 
  • Hours
  • Apps
  • Street parking? Hours/tickets
  • Access to hospital doors

Entry & Registration:

  • Entry to go in as a patient – which doors to use and hours for each
  • Entry for support persons 
  • Security / screening requirements
  • Documents / ID required
  • Who can be with you?

Birth Unit

  • Floor #
  • Elevator location
  • Path from door to elevator to birth unit
  • Assessment area (documents needed, support persons allowed?)
    • Private or shared space?
  • Support – who can go in, when, and in what areas
  • Caesarean / O.R. – who can be with you
  • Recovery Room / Post-op – who can be with you, how long are you there?
  • Food – Galley / kitchenette & rules
  • Food machines – location, form of payment, products
  • Washrooms for patients – shared or private?
  • Washrooms for partner / other supports
  • Sleeping arrangements
  • Fridges in the room?
  • Wifi?
  • Labour tools such as birth balls, birthing stools, squat bars, electric beds
  • Lighting – windows, blinds, dimmers?
  • Shower / bath – shared or private
    • Supplies – soap, shower curtain etc
  • Where to put your stuff

Mother-Baby / Postpartum Unit

  • Is it the same as the birth room or a separate unit?
  • Which floor
  • Path from the birth unit and also from the entry/exits
  • Length of admission
    • Early discharge and extra nights
  • Visitor policy – hours, numbers, ages
  • Shared or private rooms
    • If there are both, how do you get a private room 
  • Support people – who can stay overnight
  • Sleeping arrangements for baby
  • Sleeping arrangements for partner / support person(s)
  • Entry / exit doors & hours e.g. food run, visitors
  • Food – Galley / kitchenette / food machines
  • Are patient meals provided? How many daily, special requests/diets
  • Washrooms for patient
  • Washrooms for partner / other supports
  • Managing interruptions
  • Fridges in the room or availability of other places to store perishables
  • Security in the room
  • TV / wifi
  • Lighting
  • Shower / bath and supplies
  • What is supplied and what do you need to bring
  • Where to put your stuff

Discharge

  • What is the shortest / easiest way out
  • Need to show a car-seat to the staff?
  • Paperwork requirements
  • Hours

Services and Other Units

  • Food
  • Gifts
  • General supplies
  • Quiet spaces – chapel, multi-faith center, Indigenous services
  • Library
  • Neonatal Intensive Care Unit (NICU)
  • Special Care Nursery
  • Lactation Consultants
  • Meetings / classes available during admission
  • Special services – e.g. social workers, translators, spiritual/faith leaders, help for special circumstances or unexpected outcomes

Other

  • C-19 policy for maternal patient
  • C-19 policy for partner / primary support
  • C-19 policy for 2nd support
  • C-19 policy for other visitors (if applicable)

Optimal Fetal Position – Turning Baby Prenatally

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 to be able to give your baby a back rub every time you rub your belly.

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

Problems Related to Posterior Position

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

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

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

Signs of a Posterior Baby

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

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

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

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

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

References

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

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

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

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

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

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

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 $1400-1600 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 $900. 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 $900. 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.

Weight Gain During Pregnancy

Posted by on in Birth, Education, Placenta, Postpartum, Pregnancy, Recovery

Weight and fundal (abdominal) measurements are usually recorded at prenatal appointments. However avoiding weight gain is a concern for many women, even during pregnancy. If the number on the scale is an issue or trigger, people can ask their doctor or midwife to record the number in their chart without telling them. Another option is to decline being weighed; many other things are measured throughout a pregnancy that can provide information about pregnancy health and fetal growth.

There used to be strict guidelines for weight-gain ranges, but an increasing body of research indicates it’s most important to focus on good nutrition and a healthy maternal patient, rather than an exact number of kilos gained through pregnancy. 

There are too many variables to pick an ideal number. Factors include height, pre-pregnancy body composition, bone structure, carrying a single fetus or multiples, genetics, metabolism, health of the pregnancy, diet, activity level, pre-existing health conditions, cultural considerations, age, and pregnancy-related health issues.

Someone who eats well will almost always gain exactly what they need for a healthy pregnancy. 

Where does the weight come from and where does it go?

Many postpartum women are surprised to find they don’t return to their pre-pregnancy weight immediately after birth. Less than half of the weight gained makes up the baby, placenta, and amniotic fluid!

Here’s a list of approximate weight distribution for a healthy pregnant woman of an “average-size” with a single fetus:

  • Baby at birth – average of 6-8.5lbs / 2700-3900g
  • Uterus* expands during pregnancy – 2lbs / 900g
  • Placenta – 1.5lbs / 680g
  • Breasts* – may increase by up to 1-2lbs / 450-900g (total, not each)
  • Blood volume* increases by 150% during pregnancy – 4lbs / 1800g
  • Fluid* will be retained by pregnant woman – up to 4lbs / 1800g
  • Amniotic fluid surrounds the baby – 2lbs / 900g
  • Maternal fat & nutrients stores, muscle development* – 7lbs / 3175g (3.175kg)

* These things do not magically disappear through the birth but rather will take some time to resolve. Good thing! It takes months to grow all the extra blood volume and other elements and it would feel quite terrible to undo all of it in a few hours. These things are a normal part of pregnancy. Some people return to their pre-pregnancy shape and weight while others do not.