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

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

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

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

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

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

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

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

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

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

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

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 are 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. Other birth mothers simply enjoy being at home more. 

One of the benefits of working with a doula is that we help clients decide when to go. We will let you know 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 sensations or contractions (explained below): 311 for a first birth or 411 for subsequent births; even sooner in labour if you have a history of fast birthing.
  • Can’t walk or talk through sensations that fall into the pattern above
  • Tip: If you feel like eating, then it’s likely too early, based on labour pattern alone
  • Lots of pressure and contractions end with a grunt, the urge to poop, bear down or “push”. 
  • Signs of labour or waters releasing before 37 weeks
  • Any health concerns (some “warning signs” are below)
  • Decreased fetal movement that isn’t remedied by eating and resting
  • 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 (will be sent home if not in ‘active labour’)

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

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.

Angie The Doula – Complications and Congenital Issues

It’s one of the worst prenatal scenarios parent-to-be’s may have to face – being told their baby will have complications or congenital issues (a disease or physical abnormality present from birth). Complications can range from a variation of normal (e.g. extra digit) to one that’s moderate but can be managed with medical care (e.g. club-foot, cleft lip/palate) to something that can range from mild to having the potential to completely change a family’s life (e.g. Down’s syndrome, spina bifida). 

This article addresses some considerations for families that are expecting a baby with complications.

How severe will the Complications and Congenital Issues be?

With the testing and ultrasound schedule commonly recommended during pregnancy, surprises are uncommon. In most cases of complications, people are made aware before the baby is born.  

Until the baby is born, it’s impossible to know for sure what the severity will be. It’s important to maintain hope and a connection with your baby. Dr. Sarah Buckley writes extensively on prenatal screening, which includes false positives (a screening or test result showing an issue when there isn’t one). In that case, a suspected problem is found to be non-existant or milder than expected. 

I’ve seen several of my clients go through this terrible roller-coaster, waiting for news, expecting the worst, and then finding everything is normal on the next ultrasounds and at the birth. It’s hard for them to ever believe their baby is OK. When parents-to-be are in limbo like this, it can lessen their attachment with their unborn baby, even after further testing confirms all is well. 

Photo by Topato at Flickr. This file is licensed under the Creative Commons Attribution 2.0 Generic license.

What do I need to be aware of?

As you learn about a condition, the list of risk factors can leave parents – especially the pregnant ones – feeling like they are to blame. Find a counsellor or other parents in the same situation to help you work through these feelings. In many cases, no one is actually to blame.

Another sad reality about having a baby with complications is that it can be very hard on the parents’ relationship. Knowing that ahead of time can allow you to find resources, strategies and counsellors to help. 

Keep in mind:

  • You can have a smart, beautiful, amazing baby that happens to have a congenital complication.
  • Many humans far surpass the limits put on them by stats and well-meaning medical care providers. Don’t limit your child! Their environment and how they’re treated can really make a difference in how their potential plays out. (Of course, that’s true for most children.)
  • Focus on your child’s strengths while also being aware of their circumstances.
  • There are countless people living normal productive lives and accomplishing great things in spite of being told they’d never be able to do it…
  • Healing and thriving happens in the community. Humans are not meant to fly solo. 
  • Almost all parents struggle with worry, exhaustion, uncertainty, feel the pain of their child when they’re unwell, are learning to navigate life with a baby, love their baby and will do anything for them, have hopes and dreams for their child. This is common to parenting no matter if your baby is healthy or not.

To Prepare:

  • Seek out support groups – in person or online. Social media can be a bit of a minefield and provides a much different experience than a setting where you connect with actual humans. It can be scary, especially for introverts, to join a group but most people are glad they did so.  
  • Find an excellent online resource or two – not 10!  
    • Good sites will describe the condition in clear, understandable and kind terms.
    • Those sites will have a section directed at parents
    • Links to articles and resources that resonate with you
  • Look at images online, only from those vetted sites, so you’ll know what to expect
  • Find out what the policy is at your birth-place regarding family bonding and skin-to-skin contact in case of known complications, and yours specifically.
  • Learn about local resources from your medical community. Many places have an excellent team of social workers, occupational therapists, medical people, therapists, geneticists that can help you navigate.
  • Find out about social and government resources. You may be eligible for grants, programs, respite plans, and all manner of assistance available for families that have extra challenges related to a child with complications. Sometimes they’re hard to find.
  • Learn as much as you can about the complication:
    • Best and worst-case scenario / mild to severe case
    • Learn the language – technical terms, acceptable language
    • What future treatments might your child need? When? Is treatment invasive or painful? Is it necessary?
    • You have choices!  What does the future hold for your child without treatment or by taking a different approach?  

How can I manage my Baby’s health?

You will be your child’s best advocate and may have to become somewhat expert in their condition. Keep a binder or digital folder of every test-result, procedure, appointment. Also, have a section for resources. Do not assume every medical care provider you meet knows the full picture of the specifics of your child. 

If necessary and if you’re able, look outside of your own geographical region for treatment options.

What words and terms should I use?

The way people talk about your baby can be unknowingly hurtful. It helps everyone if you address this with those close to you. Many people want to be helpful or at least respectful but don’t know how. They tend to either stay away or blunder through, possibly adding stress or misery to your situation. 

Here are some suggestions you can share:

  • Use language that puts the human first e.g. baby with Down’s Syndrome
  • “Birth defect” is inappropriate. Terms that might feel better: Complication, congenital disability, variation of normal, congenital abnormality. 
  • A list of acceptable terms in general and for specific issues:  https://www.ncbi.nlm.nih.gov/books/NBK64884/ 

Prepare a cheat-sheet for loved ones and those that will be in your child’s life.

  1. Unacceptable terms
  2. Acceptable terms
  3. What makes the condition better and worse
  4. Special treatment the child may need e.g. can’t digest a certain food, needs a special baby-carrier
  5. What can they do that’s normal? e.g holding the baby won’t hurt them
  6. What you need – how can they help? How can they normalize life?
  7. Welcome them to visit or participate in your child’s life
  8. Links with more information
  9. Success stories, anecdotes

Online Resources:

Cochrane Review – https://www.cochrane.org/ the gold standard for reviewing and analysing medical research 
Stanford Medicine https://med.stanford.edu/ 
Johns Hopkins Medicine https://www.hopkinsmedicine.org 
Mayo Clinic https://www.mayoclinic.org/ 
Health Link British Columbia https://www.healthlinkbc.ca/ 
March of Dimes:  https://www.marchofdimes.org/complications/ (trigger alert: great info but some harsh language)

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.

Angie The Doula – Postpartum Support and Maternal Mental Health Resources

At two weeks 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 4-6 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. Regina Perinatal Health Network is a local organization.
  3. 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.
  4. 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. I have a list of postpartum doulas to share in a range of experience and fees. (My list includes several doulas not on the DofR site. I train them and only recommend people I trust. If fee is a barrier or consideration, I can likely help you find someone that fits your budget and needs.)
  • Ask the public-health nurse to come in for a chat.
  • Take your self-assessment tools and/or concerns to your 2-week medical checkup. 
  • Make an appointment with your doctor or midwife.
  • 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 supposed to be well-trained in postpartum mental health.
  • Get medical attention today if you have thoughts of harming self or baby. Unfortunately, that usually means a trip to the ER.
  • 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. (Many women are reluctant to get help for fear of not being able to BF.)
  2.  Families are kept together during mental illness, as long as there’s one healthy adult (parent, grandparent, relative or close friend as guardian). If a parent has to be admitted to the psych unit then the baby stays with the other parent or guardian. 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.

Angie The Doula – New Parent and Baby Essentials

What are the most important items for new parents and their newborns? Everyone has different opinions about this.  Think about what you have to do with your baby.  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 is a warm safe place to lay your babe, change your babe, and transport your babe.  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
  • Something to wear 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
  • For baby:
    • Car seat
    • Baby blanket or cover for car seat
    • Receiving blankets – 20
    • Mini-wash cloths can be used as wipes – 40-50
    • 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 way 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 for the first year ideally, 6m minimum

  • 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, 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.

Angie The Doula – Basic Prenatal Nutrition

Once pregnancy is achieved there are many transformations taking place in the body, such as hormonal changes and increased weight of the pregnant person and the developing child. Vital organs must work harder e.g. kidneys must filter up to 150% of normal blood volume throughout most of the pregnancy. All this building and changing is best done under optimal nutrition and function by the body.

Nutritional Guidelines

In a nutshell, do this EVERY day:

  • drink sufficient purified water or herbal tea
  • eat clean (organic) whole foods and lots of them to obtain high amounts of minerals, vitamins
  • be especially diligent about meeting daily requirements of calcium, magnesium and iron
  • whole food is colorful and looks pretty much like it did coming out of the earth
  • eat quality, health protein at every meal
  • take a high quality prenatal vitamin
  • ingest lots of essential fatty acids (usually through fish oil)
  • take acidophilus daily
  • relax when you eat
  • eat 3 healthy meals and 2 healthy snacks
  • obtain trace-minerals needed for every body function and baby development
  • liberal use of Himilayan (pink) or Celtic salt (grey)
  • drops of “Trace Minerals” added to water
  • avoid the “nasty whites” (sugar, salt, flour), chemicals such as coloring and artificial flavours or sweeteners,
  • artificial/processed foods, caffeine, drugs & alcohol

Nutritional requirements are fairly straightforward. Most sources agree on the nutrients needed for fetal and maternal health, with the exception of dairy, grains and essential fatty acids (EFA). Only the newer and more holistic sources of nutritional highly recommend EFA for pregnancy (see section below). These same sources may or may not recommend foods and portions/ratios that are an integral part of the Canada’s Food Guide. Education and awareness of one’s own health is important.

Proper nutrition is vital before and during pregnancy and breastfeeding.

Breastfeeding
Photo by Anton Nossik. This file is licensed under the Creative Commons Attribution 3.0 Unported license.

Any nutrients taken in or lacking directly affect the baby. The first step is in eating enough; 2400 calories is the daily minimum. Of course quality of food is as important quantity. Nutrient dense foods are best, such as organic whole foods. Raw or lightly steamed veggies provide many nutrients and fiber. Fiber is important to prevent constipation, a common pregnancy concern. Fiber also carries out toxins and used up hormones, which decreases liver load and morning sickness.

Water: Clean purified water is essential. Water is needed to maintain blood pressure with increased blood volume, to flush toxins safely and to provide transport for nutrients through blood to placenta. The best way to increase fluid intake is with clean pure water and herbal teas from the safe list.

Eat Mindfully: The manner in which food is eaten is important too. Eating mindfully and slowly, chewing food thoroughly, and keeping liquids to a minimum with food will ensure good assimilation of nutrients. Smaller more frequent meals and healthy snacks ensure nutrients are better assimilated and blood sugar stays constant. In the case of digestive problems consider using digestive enzymes.

Eat Organic: Organic foods are higher in nutrients, especially minerals, and of course much lower in chemical toxins. Watch for “certified organic” on labels or know your farmer.

Protein: 60-80g minimum daily. Deficiency tied to congenital abnormalities and pre-eclampsia.
Vegan sources of protein include spirulina, quinoa, beans and legumes, nuts and seeds. Animal sources are usually the densest and include meat, eggs, and dairy. Organic animal foods are important, as conventional farming may use hormones and antibiotics routinely, and poor quality feed.

Prenatal Nutrition

Essential Fatty Acids: The recommended daily intake of EPA plus DHA is about 650-1000mg/day during pregnancy and lactation. Omega-3 fats, especially DHA, are needed for fetal brain and spinal cord development. Fetal concentrations of DHA are directly correlated to maternal DHA levels. Reduced fetal DHA concentrations lead to decreased visual function and altered learning and behavior. Over the past 15 yrs, breast milk DHA concentrations have decreased by over 50% so it’s important that DHA levels are maintained throughout pregnancy and breastfeeding. DHA also helps prevent premature delivery. DHA is vital for fetal brain development and health throughout life. Most prenatal supplements have absolutely no DHA.

Current recommendations are to limit and even avoid certain fish during pregnancy. Generally, the larger the fish, the more mercury contamination and other toxins it contains. Wild small fish (e.g. sardines, mackerel, anchovies, salmon) are preferable. Avoid farmed and/or large fish due to lack of nutrients, mercury & other heavy metal contamination, and toxins due to feeding and farm practices. Examples of large fish are tuna, sea bass, marlin, and halibut. Mercury readily crosses the placenta and has a high affinity for nervous tissue i.e. brain and spinal cord. Fetal mercury exposure contributes to mental deficiencies and other neurological problems.

The safest way to ingest EFAs is by fish oil or micro-algae. Supplements are not all equal. Liquids are best as they are readily digested and one can smell rancidity (only rancid fish oil smells like fish). One has to take up to 14 caps daily to get the required amount of EFAs. Good brands start with quality oil and undergo strict cleaning / processing methods. They use 3rd party tests for EPA/DHA values and are tested for contamination. The label defines EFA values. And they taste good – really!

Vitamins & Minerals Supplement a.k.a. Prenatal Vitamin

Supplement means supplemental i.e. in addition to food, not replacing it. Food based nutrients are best but the addition of a high quality prenatal vitamin ensures certain requirements are met. High-quality supplements are important. There’s quite a difference between brands and sources in terms of ingredients (fillers, natural vs. synthetic vitamins, quality of nutrients) and absorbability (the form of nutrient used and method of processing). There’s also a cost difference – don’t waste money on low-grade supplements. Small doses need to be taken throughout the day; quality prenatals are never ‘one-a-day’.

Food-based vitamins are generally the best quality. The ingredients are more absorbable and bioavailable than isolated vitamins. More nutrients are absorbed with smaller doses and the micronutrients and enzymes are present, resulting in fewer issues such as constipation and nausea.

Minerals are usually best assimilated when taken in food form or herbal teas. Once a plant has ‘processed’ the mineral i.e. taken it from the soil and incorporated it into its structure, it’s much easier for us to absorb and lower amounts are required. Take your supplemental prenatal vitamins & minerals with food.

Why Prenatal Vitamins?

Prenatal vitamins are designed to meet most of the nutritional needs during pregnancy and breastfeeding.
High doses of Vitamin A have been linked to congenital abnormalities such as cleft palate and heart problems. Daily max during pregnancy = 10 000IU. Prenatals use Beta carotene a.k.a. “Pre-vitamin A” and the body will convert to vitamin A only what it needs.
Folic acid in higher amounts to ensure the neural tube forms properly.
Calcium requirements double.
Too many other vitamins and minerals to list all the benefits.

Iron (40-80mg) with vitamin C
If taken in supplemental form, an organically based one that has gone through plant or yeast is best. For example, Floravit™ or Floradix™ are 95% absorbable and therefore do not contribute to digestive problems and constipation.

Trace minerals are involved in most physiological and metabolic processes and are required to assimilate macro minerals. Sources include kelp and other seaweeds, trace-mineral supplements, and Celtic or Himalayan sea salt (i.e. not white salt).

Probiotics are the ‘good bacteria’ that live in human bodies, mostly in the gut. Functions include:
Helps stave off Candida overgrowth during this vulnerable time (pregnant women are especially susceptible)
Protect baby through birth canal
Assimilation of nutrients
Protects digestive system from invaders
Boost immune system

Decrease or Avoid:

  • ‘Junk’ food of any kind
  • Refined & processed foods deplete minerals and promote dehydration
  • Regular salt promotes edema
  • Alcohol is a teratogen (causes birth abnormalities)
  • Coffee is a possible teratogen and promotes dehydration and mineral deficiency. The research is mixed as to the safety of one cup daily.
  • Caffeine in other forms
  • Meats susceptible to parasites, bacterial infections and high in additives e.g. cold-cuts, raw fish
  • Candida promoting foods (sugars and alcohol)
  • Unnecessary medications. See a pharmacist, medical doctor and/or holistic health practitioner for help with health issues.
  • “Street drugs”
  • Smoking
  • Phenylalanine containing supplements. E.g. – Aspartame (Equal, NutraSweet) has high levels phenylalanine and may alter fetal brain growth / development
  • Mineral oil blocks absorption of fat-soluble vitamins
  • Shark cartilage (in joint-pain supplements) inhibits the new blood vessel growth needed during pregnancy

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.

Optimal Recovery from Caesarean Birth

After a Caesarean birth, you will be given a list of recovery tips from your medical care provider.  The following additional information contributes to optimal recovery following a surgical birth.

Taking care of a baby is a full-time job and deserves recognition as such.  Recovery from major abdominal surgery is also a full-time job.  For most people, in 6-8 weeks life will gain a new normal but it takes longer than that to fully recover from a Caesarean birth.

FOR BIRTH MOM:

REST, REST, REST!

This is essential for recovery. Although you have a newborn (perhaps other children too) at home, do the best you can to rest and recover. Get the support needed to do this, such as from a Postpartum Doula.

  • Sleep while the baby sleeps. Really, really!!! Let the house go for now! Enlist help if other responsibilities prevent you from napping.
  • No lifting or hard exercise. Listen to your body. Any pain means stop and rest right away. This will be humbling.
  • Hire a cleaner if you don’t have good live-in support. A weekly or bi-weekly cleaning works magic for your sanity.
  • Have an open house / meet-baby gathering to entertain all friends at once rather than spend hours daily with visitors.
  • Learn to accept help. Just say thank-you! Ask for help from friends & family. They’d love to make food, babysit siblings, walk the dog, feed the pets, do laundry etc. Your turn to help another will come later.
  • Make a “guest rule”. Any visitors must bring or prepare food (and clean up their mess), and/or do a chore from a list you’ve made. Make it clear they will not be entertained! They are there to help. This gets you help and decreases visitors.

For internal healing:

Osteopathy, Visceral Manipulation Therapy, and CranioSacral Therapy help resolve trauma and restore fluidity to organs & tissues, which speeds healing, decreases pain and facilitates long-term recovery. When internal tissues are exposed to air, adhesions can form. During surgery, organs are shifted from their optimal placement. Wait 4-6 weeks before starting treatment.

If you’re into Homeopathy: Traumeel (drops or tabs) during the entire post-surgical recovery phase, or homeopathic Arnica 200CH first 3-5 days (3 granules once daily).

Emotional Recovery:

Emotions following a Caesarean birth vary from woman to woman. One may feel completely satisfied with her birth and emotional recovery is not an issue. Conversely, another may feel loss, regret, blame or disappointment. There are infinite factors that lead to Caesarean birth.

Many people will say, “At least your baby is healthy”, but a woman’s birth journey is important too. Give yourself permission to feel sadness about your birth; it doesn’t mean you’d trade your baby’s health for your “ideal birth” nor that you don’t love and appreciate your baby. There’s room for being totally in love, feeling anger or sadness or happiness – all of it!

Other well-meaning folks might say at least you didn’t have to “suffer” in labour or that you got to take the “easy way out”. Forgive their ignorance. Many people don’t realize how difficult a Caesarean birth and recovery can be, often much more so than a natural birth.

  • Rescue Remedy as needed for grief, shock, disappointment.
  • Be kind and forgiving to yourself and allow space for grieving if you need it.
  • Several local health professionals can help with emotional trauma. Some use Flower Remedies, homeopathy, Reiki, other energy work, and/or verbal counselling styles.

For the scar:

  • After the stitches have dissolved, healthy high-quality oil such as rosehip seed oil (Rosa masquetta) on the incision site as often as possible to nourish the skin and decrease scarring. Combine with an essential oil blend to decrease itching, scarring, incidence of thick scarring and to speed healing (eg Blaine Andrusek Scar-B-Gone). If you don’t have these, vitamin-E oil will do.
  • From 6 weeks on, Castor Oil packs over the incision to help with healing. Soak a cotton cloth in castor oil. Put cloth against skin, cover with plastic bag or saran wrap (to protect bedding or clothing), then apply hot water bottle. Leave on for an hour daily or until you intuitively feel you’ve had enough. If the cloth is still clean it can be folded away in the plastic and reused. Once the cloth appears to have absorbed toxins use another one. This treatment can be done for as long as you wish – weeks or months.

To Counter the Antibiotics:

While antibiotics can prevent or treat infection, they also lead to an imbalance in normal flora by killing the good bacteria in our gut. Balance can be restored by ingesting unpasteurized, fermented foods (e.g. kombucha tea, kimchi, sauerkraut) or probiotics such as acidophilus powder or caps – high quality only.  That’s the ones found in the fridge at health stores or your holistic care providers office.

  • 3 caps or ¼ tsp, twice daily for 3-4 weeks. This decreases Candida albicans overgrowth, which in turn protects the digestive system from pathogens and boosts immunity. It protects you from diarrhea, vaginal yeast infections, and painful nipples commonly associated with antibiotics, and will protect the baby from thrush (mouth sores/diaper rash).
  • If you or baby show signs of such side effects, add a third dose until 2 weeks after symptoms disappear, then go back to the regular dose. Make a little paste to apply to nipples or pinkie-finger at feeding time to dose your baby.

Nutrition:

  • Eat whole, healthy foods and lots of them.
  • Continue your high-quality prenatal vitamin for the duration of breastfeeding or 8 weeks, whichever is later.
  • High quality, easily assimilated iron supplement such as Flora Dix or placenta capsules. You’ll take less of this type of iron, absorb more overall, and avoid constipation associated with most iron supplements. Helps after blood-loss associated with surgery. (Women lose an average of up to 1L of blood after a Caesarean birth, compared with 300-500 ml with vaginal birth.)
  • Eat well and drink lots of water. Continue drinking your raspberry leaf and nettle tea, optimally 3 cups daily, for at least a month. See herb tea recipe, “Essential Herbs for Pregnancy & Nursing”
  • Ingest healthy absorbable protein; your body’s doing a lot of rebuilding now.

FOR BABY:

Caesarean birth is also traumatic for the baby. Osteopathy, cranio-sacral therapy and newborn chiropractic care by someone who specializes in newborn-care is essential.

To Counter Antibiotics Side-Effects: Acidophilus powder (see above). Continue for 3-4 weeks. This will decrease Candida overgrowth, which in turn protects the digestive system, boosts immunity, protect thrush (mouth sores), diarrhea, and diaper rash commonly associated with antibiotics. Make a paste from 1/8 tsp and rub on nipples just before nursing, twice daily. Or dip a wet pinkie-finger into the powder and let baby suck it off.

If you’re into homeopathy, there are remedies that are safe and effective for baby too, in case you notice thrush, trauma, or other long term effects.

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.

C-19 Updates in Birth and Postpartum Care in Regina

I’ve been keeping in touch with the good people managing the units at Regina General Hospital. Here are all of the recent updates of RGH Labour/Birth Unit and Mother/Baby Units here in Regina, Saskatchewan due to Covid-19. Please note that any of these may change on short notice due to the coronavirus pandemic.

Some additional tips for navigating your birth journey:

I lead RGH Tours live but online multiple times a month.

Article: How to Set Up your Birth Room (i.e. What Your Doula Would Normally Do!)

Easing Labour Pain: An online 2-hr class offered monthly that teaches partners how to provide hands-on birth-support, comfort, and decrease labour pain.

If anyone’s looking for online prenatal classes please contact me. I teach all the sessions live but online so you can ask questions.

*****

Hospital Update

◆ As of June 12, there are 2 support persons allowed in the BIRTH ROOM. From Saskatchewan Health Authority:

“Effective immediately, expectant mothers and families across Saskatchewan will now be permitted to have two designated family members/support persons present during their birthing experience. Designated family members/support persons are chosen by the mother and family and may include but are not limited to partners, family members, coaches, doulas or cultural support persons.

All maternal patients and their designated family members/support persons will be screened for COVID-19 upon arrival and be required to have a temperature check, wear a mask, participate in hand hygiene and follow physical distancing guidelines. Designated family members/support persons who are symptomatic for COVID-19 or who have other risk factors will not be permitted. The designated family members/support persons must be consistent during the duration of the patient’s stay. They may leave the facility but cannot be switched out for another family member or support person. Only designated family members/support persons will be permitted at this time, other visitors, including siblings, will not be allowed.

All maternal patients will be offered an optional COVID-19 swab upon admission. Family members/support persons will not be offered a COVID-19 swab.”

03A47318

◆ Support people coming in on their own, i.e. not with the labouring patient, can be screened 24/7 at the main RGH doors (14th St entrance). They do not have to go to the ER doors.
◆A 24-hr support person who’s joining a birth or going to MBU for a maternal patient that has already been admitted can enter through the main 14th St doors at any time, 24/7. No need to go through the ER.
◆ A support person entering the hospital with a maternal patient will be screened at whatever door the patient enters.

Please note that while the 14th Ave entrance is open 24/7 with a security guard that can screen and let people in, the registration desk is only open from 6am-6pm. Support people can enter this door 24/7 because they are not patients (don’t need to go through the registration process).
 
If you’re in labour and going to RGH as a patient, then you’ll have to go to an entrance that has an open registration desk. On weekends, holidays and evenings/overnights, that will be the ER.
 

If you have to step outside and get back in, here’s how:

◆ 14th St main entry has a security person around the clock. If you have your proof of screening and are wearing a band it’s easy to get back in 24/7. If you’ve not been screened yet, I recommend you start at this door. If they are unable to screen you, they will send you through the ER doors instead.
◆ The ER can screen 24/7 but please save the ER capacity for people who need it.
◆ 15th St admitting doors are locked overnight. The doors below MBU at 15th St parking lot are locked 24/7. You can not enter the 15th St side of RGH overnight. If you go out those doors, you’ll have to walk around to the 14th St entry.

If your 2nd support person is not at the birth but is invited to MBU, they will be screened on their way into the hospital. They must be named when you are admitted to LBU so remember to tell your nurse. You must get a coloured bracelet for them. I expect someone has to meet them outside the unit to give them the band that will grant them access to the MBU, but ask your MBU nurse about this.

“If the patient fails screening, she becomes a Person Under Investigation (PUI), therefore the support person now becomes a PUI as they have been in ‘close, prolonged contact with a PUI.’ The support will be sent home, however, the patient may have an alternative support person or people who pass screening. ” That means anyone who has been with the labouring woman for more than 2 hours will not be allowed in if she is suspected of C-19/exposure.

Folks – you need to plan for this. Plan C. New support people who have not been with you for more than 2 hours AND who pass screening will be allowed into isolation. They will be gowned, masked, gloved throughout and will not be allowed to leave the isolation room. Food will be brought in.

◆ Again, it’s up to you to ensure that a 2nd support person has been named so they can enter the unit. Ask your nurse about this.
◆ Supports must be 19 years and older. (No, I’m not sure what happens in the case of teen pregnancy, young doulas and so on. This is just what I was told.)
◆ The health region is not on the same timeline of relaxing restrictions as the SK gov’t. Restrictions are still in place at health care facilities.
◆ You’ll see staff wearing masks throughout your stay.
◆ Bring what you would normally bring for your birth and hospital stay. Support people will be given a wristband so they can go to car later for extras and car-seat. You are still allowed to bring your pillow, clothing etc – whatever you need for comfort.

Doctor

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

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

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

◆ Nitrous-oxide (“laughing”) gas is available for pain management.
◆ If you or baby are at high-risk for birth complications, you may be asked to use an epidural during labour to avoid the need for a general anaesthetic in case of an urgent/stat caesarean. Best to discuss this with your OB ahead of time so you can learn your options and make a plan.
◆ Waterbirth is currently not an option in the hospital. Midwives are not lending pools out for home birth. If you have your own then waterbirth at home is still an option (contact me for info on where to get one).
◆ The installed bath-tub is available for comfort in labour.
◆ Breastfeeding is still being supported at RGH.
◆ There are plans and protocols in place so that mother-baby can stay together if mom is at risk or has symptoms of C-19 in the immediate postpartum.
◆ Even though some community restrictions are being lifted, great care should be taken with newborns once the family is home. Physical distancing and being only with members of the same household are still recommended. Anyone who enters the house can bring in pathogens/bugs.

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

◆ Paid parking has resumed in the RGH parking lots. You will need cash for the main lot. Also, the 15th street parking is reserved only for people who have appointments or are being admitted to the hospital. Vehicles are being ticketed again on the streets around the hospital so no more free parking that way.

◆ There is nowhere for the second support person to wait as all waiting rooms are closed. The second support person should wait at home or somewhere outside the hospital until the labouring person is officially admitted and moved to a birth room.

◆ Partners/support persons will be provided with a mask at the entry doors. (Bring a big paperclip or string if you want to save sore ears.) Check out these tips for saving your ears from mask-pain.  Everyone must wear masks in the hallways. Labouring people do not have to wear a mask once they’re in their patient rooms in the birth unit and the mother-baby unit.

◆ Food outlets now allow people to sit in.

◆ Galleys are still closed to patients in both units. The nurses will get food for you in the birth unit but not in the mother-baby unit so people have to bring their own snacks. There is no access to the microwaves, kettles, food, water-ice machines. There is no access to the big fridges and freezers, but every room has a small mini-bar fridge.

Birth Room

𝐏𝐫𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞

● Attend appointments, diagnostics (ultrasound, lab) solo. Routine appointments might be done over the phone or spaced out. High-risk and special circumstances will still get the extra care they need.
● Midwifery offices are doing the discussion part of the consult by phone and then a quick in-person appointment for the hands-on part. They prefer pregnant patients attend alone but will allow partners. No other family members/friends/support are allowed.
● Anyone under midwifery or GP care who tests positive for C-19 at any point in their pregnant, birth or postpartum will be immediately transferred to OB care.
● If you’re an early-bird you may be asked to wait in your car until your appointment time.

𝐀𝐧𝐭𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞 (𝐋𝐚𝐛𝐨𝐮𝐫 & 𝐁𝐢𝐫𝐭𝐡)

● Early discharge is being offered as an option for those that are healthy and feel comfortable with newborn care. That means to go home a few hours after your birth instead of staying 24-36 hours.
● Anyone getting a cervidil induction will be monitored and then sent home to wait for labour to start, as per usual, then rescreened at RGH doors and LBU doors upon return.
● Support people are allowed at homebirths but must be screened. If anyone in the home (residents or support people) doesn’t pass screening, then the birth must be transferred to RGH. In that case, the one support person rule applies. Home birthers – screen your people before they come over!

𝐏𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐂𝐚𝐫𝐞

● Doors that don’t have an admitting desk are locked tight; security will not let anyone in. That includes the convenient door just below the MBU.
● Families are being asked to stay in their room as much as possible.
● Support people may not visit any other patient areas.
● Food trays are being provided for new moms in the MBU.
● Breastfeeding class in the unit is still running but only birth mother and baby attend (no partners) and only up to 3 participants.
● Midwives and public health nurses are still providing postpartum home-visits. Some may be done by phone or video, depending on your needs.

Please contact me if you have any questions about this information or any of my services.

Five more steps to the birth of your dreams

Many pregnant people look forward to their upcoming labour and birth with both excitement and apprehension. We’re here to tell you that it doesn’t have to be scary. As we shared in a recent blog post, once you have a plan, a vision of the outcome you want and begin taking steps to get there, all the unknown and loss of control starts to fade away.

To help you continue preparing for a birth experience that is satisfying and empowering, here are five more steps to the birth of your dreams!

6) Care for yourself and your baby

Take care of your general health as best as you can; this is proven to support better birth outcomes and it is another thing you can control. Healthy foods in as close to their natural state as possible, proper hydration (find a fun water bottle to carry around and refill), pregnancy teas, all help to build a healthy baby. (Note: obviously if you are dealing with extreme nausea that does not allow you control over what you eat and whether or not it stays down, skip to Step 7.)

Gentle physical exercise, particularly yoga, helps prepare women for birth and a faster recovery. FInd an online class that you like. Go for walks.

Ensure your non-physical self is healthy too. What nourishes your spirit and soul? Time alone? Time with others? Time to create? Time to nest?

I wish you ease and grace in caring for yourself during your pregnancy.

7) Choose the primary care-provider for your pregnancy and birth

Doctor

Depending on where you live you might have lots of choices or limited choices in this area.

In Regina we have some midwives, but not enough. Some family doctors that also catch babies. One birth centre in a near-by community. Lots of over-worked Ob/Gyns (IMO) too.

Do the best you can to chose someone whose values align with yours. Midwives are often the first choice for women who plan natural births, and they attend both home and hospital births. If there are in short supply, then call the office early to get on the wait list.

Family doctors who attend births are a great option for a healthy woman who doesn’t need the high-risk expertise of an obstetrician. Most family doctors in our area care for women for most of their pregnancy and then transfer care to another family doc or an obstetrician.

Obstetricians are highly skilled for women with known health issues or who are at increased risk of complications but they catch most of the babies in our area and are the most common option here.

8) Be aware of your stress triggers

What irritates or stresses you now can be a big clue to what might create or adds stress during your birth?

That varies with everyone and you are the only one who gets to decide on this. For some women it is noise, or smells, or chatter, or lack of information; for others it’s lack of modesty or privacy. Someone who is in the room who irritates you; someone you wish was there with you and isn’t.

Figure out what causes you stress and do everything you can to plan ahead so you can eliminate that possibility or at least minimize its effect.

9) Maximize comfort in your pregnancy and plan to be comfortable in labour

Baby

What brings you comfort? Think of your five senses. We are sensual beings!

Do you prefer to see dim or bright lights, hear silence, medical sounds, or music of your choice? How would you like to be touched, if at all?

Practice getting effective massage and counter-pressure. Reduce internal exams during labour is possible. Wear clothes that you chose for comfort and the level of modesty that suits you.

What do you wish to smell (hint – birth companions: pack a toothbrush)? Research helpful and appropriate aromatherapy oils to use at home. Take your own pillow so you can that comfortable smell and feel.

What kind of drink would you like to taste during your birth? What foods can you enjoy during labour or afterwards? What feast can you plan to celebrate the birth!

Comfort is only possible if we first feel safe and supported so review those essentials and get things in place so you can feel secure.

10) Bring joy, fun and calm into your birth

What makes you laugh?
What calms you down?
What do you enjoy?

Remember you can laugh, be loud, be silent; you can dance, move about, wear clothing in which you feel comfortable or beautiful, get snuggly with your partner, be in the dark, enjoy sunlight, create a big personal-space bubble in the bathtub or birth pool, watch a funny movie in early labour, walk in the fresh air, have a nap.

In my thirty years as a doula I have encouraged clients first to nap and stay well fed and hydrated, and then to do something nurturing or even mischievous – make out, go for a walk to get a tea or take-out treat, take some last-day-of-pregnancy photos, meet up with friends and have contractions while you visit. Make some banana bread for later – maybe it will still be warm when you are holding your baby. (True story.)

Respect your introvert or extrovert needs and explore the possibilities!

Know of other steps you would recommend to someone preparing for an upcoming birth? Want to know more about my online prenatal classes or in need of birth support? Please contact me!

 

Article written by my wise friend and work-partner, Karen Herriot – Master Doula, Doula Trainer, Yoga Teacher.