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.

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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.”

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◆ 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

◆ 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.

◆ 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.

 

Five steps to the birth of your dreams

Most women anticipate labour and birth with a mix of excitement, and fear—of all the unknown and loss of control. In the face of that kind of vulnerability, it is good to have a plan, a vision of the outcome you want and then begin taking steps to get there.

Actively preparing with easy, practical measures will lead to a birth experience that is satisfying and empowering. No client of ours ever told us “I did too much to prepare for my birth.” That is why we are happy to suggest these five steps to the birth of your dreams!

1) Choose online prenatal education or yoga classes that reflect your vision of an ideal birth.

A virtual gathering with other pregnant women in online classes that discuss pregnancy, labour and birth will help you to find support and community in which to make your choices, share ideas, and learn together.

I also lead virtual Regina Hospital tours, allowing you to become accustomed to the setting in which your birth will unfold. Attending these classes is your start to finding your tribe and building vital connections that will help you thrive in the postpartum.

2) Create your circle of support and birth-power

Expecting Couple

Take a clear-eyed look at the others on your support team. Partners sometimes feel pressured to perform and provide a level of physical and psychological support that may exceed their capacities. Many times it feels unfair to expect them to take on such a new role all on their own.

What do they need to feel supported? What things can you both do in the prenatal time? Have they talked to other non-birthing partners? Birth is a shared experience so both of you need to be mindful of what you need and communicate your expectations.

If a friend or relative is invited, are they experienced, will they add calm or stress to your birth, will they come at any time and stay as long as needed? Have you invited them or did they invite themselves? You get to decide. Birth is not a spectator sport – as the birthing woman you get to choose.

If you’re a solo parent-to-be, consider inviting someone who brings you comfort. Any person coming to the birth should attend prenatal education classes with the mother. They should be familiar with the birth setting, the protocols there, their own availability and the ability to be a helpful presence, not a distraction.

3) Hire a Doula

It is hard to navigate all the decisions you will be faced in pregnancy, labour and birth. Why do it alone?

Professional doulas support the birthing woman and her labour team members. Women who have doula support have half the rates of cesarean births as those without. They also have significantly shorter labours, request pain meds at far lower rates (less than half as often), and experience significantly fewer interventions.

Doulas are experts in comfort measures and also great information resources. Whether it is a simple question or a complex decision, your doula is there to help you through every choice you make. Partners do more when there is a doula on their team!

Plus – doulas make the process fun! We are trained to smooth out the edges, show you the ropes and be your birth sherpas! Contact me for more information!

4) Make an effective birth plan that works for you instead of against you

There are many options for labour and birth, but many people don’t know they can do some research, ask some questions and design their birth their way. It is important to know what to expect from your time in the hospital (or home if that is your choice); it is important to be informed and prepared.

There are many things you can control in the face of the vulnerability of labour and birth.

We all want to feel safe first. For our babies to be born in a cocoon of safety. And then we are allowed to want other things as well.

You are allowed and encouraged to dream big and envision the birth of your dreams, not just a birth that is safe, not just the birth you dread.

  • What makes you feel safe?
  • What stresses you out?
  • What do you need?
  • What would you love to happen?
  • Quiet respectful space to labour in?
  • A less clinical feel to the room?
  • A more clinical and monitored space? So you know both you and baby are ok.
  • Want to catch your baby?
  • Keep the cord?
  • Use your own playlist to create the vibe?
  • Wear your own clothes?
  • Use your own pillow?
  • Labour in whatever position is most comfortable to you?
  • Birth in the posture of your choice?

Your plan should use positive language, including things that are unique and important to you. Including the things that are essential for you.

5) Find and Practise tools to manage the intensity of labour

Pregnant Yoga

Whether your labour is a sprint, a marathon or a surgical experience – many women describe birth as hard work.

There are things you can do to manage this intensity! Whether you plan to labour naturally or to use an epidural to support your experience, taking the time to strategize what tools might work for you – and practice the skills while you are pregnant is essential.

Be your sensuous self and amplify your senses to distract or soothe yourself – sight, sound, smell, touch!

Mindfulness, yoga, meditation, sound/music, and visualizations/affirmations are valuable tools. Hypnobirthing is a system many women find helpful. As are hynotherapy sessions with a trained therapist. Ask me for suggestions.

Control, control, control! Find things that you can control and control the heck out of them!

Looking for more information on your upcoming birth? Interested in taking one of 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.

Doulas and Dads

Although the information here will reassure any partner, this article intentionally addresses dads-to-be. All the quotes, links and videos are made by dads for dads-to-be, about their most common concerns about birth support:  1) Value; why should I 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?

Use of Herbs During Pregnancy & Lactation

hers for pregnancy

Herbal medicine is specific category of health-care.  Many herbs, including essential oils, are safe and beneficial during the childbearing year, while others can be dangerous.  Pregnant women must be cautious with any remedies, especially during the first trimester when the fetus is most vulnerable.  There’s a lot of misinformation concerning herbs.  Here are lists of commonly used herbs that are considered safe and unsafe through pregnancy and postpartum.

Exercise During Pregnancy – What To Know

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

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

Exercise During Pregnancy 1

There are many benefits to exercising during your pregnancy:

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

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

Relaxation for Birth Prep

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

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

Exercise During Pregnancy – Do’s:

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

Exercise During Pregnancy – Avoids:

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

Contraindications for Exercise During Pregnancy

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

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

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

Conditions for Assessment

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

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

Exercise During Pregnancy – Suggestions:

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

 Pelvic floor exercises are particularly important when preparing for birth:

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

Posture – While Exercising or Resting

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

Exercise During Pregnancy 2

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

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

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

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

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

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

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

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

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

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

Effects of Stress and Adrenaline on Unborn Babies

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

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

A word about “they say”:

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

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

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Avoiding Post-Dates Pregnancy

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