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.
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.
Post-term or post-date pregnancy is one that exceeds 42 weeks gestation. 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.
CALENDULA PADS – For swelling, pain, heat. Make 5-10 pads 6 weeks before due date.
Calendula flowers promote healing and are soothing when applied topically.
- Calendula Mixture: Make tea from dried calendula leaves (1 full tea ball per cup water steeped for 10 min) or use tincture (20-30 drops per cup water). Add 1-2 drops of lavender essential oil or some lavender tea to mixture.
- Partially dip maxi pads – preferably long, organic – in calendula mixture briefly, just to soak top layer. Another option is to use a sprayer to wet the tops.
- Freeze pads in bowls so they’re curved like the female body. Store in Ziplocs (labeled with your name) in freezer.
- Bring the pads to birth-place! Hospitals and birthing centers have freezers.
- Apply immediately after birth.
Soothing and healing for swelling, pain, abrasions, tears, bruising. It’s safe to use with stitches. This can be prepared during early labor or ahead of time and frozen/refrigerated.
- Fill a peri- or spray-bottle with calendula mixture (above), a healing solution (below) or warm water.
- Hospitals will provide a peri-bottle. A spritz bottle works too.
- Squirt solution on perineum after every washroom use, shower/bath, or in between if extra relief is needed. Do not rinse solution off.
- If urination burns then squirt during urination or pee in the bath.
- Allow the area to dry between applications. Air-time or even a cool blow drier can be helpful.
- Note: if the rectum is sore or stitched, support the perineum with a cloth during bowel movements (like pooping into a cloth).
- Soak your perineum in a bath for 15 minutes, 3 times daily. Shallow water is fine.
- Add Epsom salt and if you wish to use herbs, add 1-2 cups raw herbs or healing herb tea, ¼ cup tincture, or up to 5 drops of pure essential oil. If you wish to use plain water then spray the healing solution after the bath.
- Some women like cool water for inflammation while others find warm water soothing. Experiment with temperatures but avoid extremes during the initial postpartum days, and keep the rest of your body warm.
- Do not sit on a donut-shaped vessel in the bath as it adds pressure.
Calendula is healing, along with other herbs such as comfrey, lavender, witch hazel, tea-tree, yarrow. Feel free to ask me about the various healing properties of the different herbs. Nice sitz-bath blends can be purchased – look for an Epsom salts base with herbs or pure essential oils; no fragrance or additives. There are some nice soothing perineum sprays on the market, such as Earth Mama Angel Baby New Mama Bottom Spray, sold in Regina at Head-to-Heal Wellness in Cathedral, or Hello Baby in East.
RECOVERY FROM DIFFICULT BIRTH
After a difficult birth follow the above recommendations plus:
- Keep knees together as much as possible for the first 2 weeks, even while walking
- Avoid stairs
- Lift nothing heavier than the baby
- Allow area to “breath” – air time or cotton panties (no synthetics)
- Avoid sitting or standing for long periods of time
- Avoid perfumes, chemicals
- Avoid straining on the toilet – good nutrition and lots of water, support perineum with a cloth during bowel movements (like pooping into a cloth)
- See a Physiotherapist who specializes in women’s pelvic floor to heal pelvic floor muscles; recover from perineum tears; avoid or heal incontinence, painful intercourse and pelvic pain
- Consider seeing a complimentary practitioner who specializes in and is experienced with maternal postpartum recovery, such as a Webster certified chiropractor or an osteopath, to help ensure pelvic organs, bones, ligaments are healthy and aligned.
SPECIAL INFANT CARE FOLLOWING DIFFICULT BIRTH
- Lots of frontal contact, skin-to-skin if possible; helps establish breastfeeding and is reassuring for baby. Babies who are held feed better, poop and pee more, and are therefore less prone to jaundice and other illnesses.
- See a complimentary practitioner who specializes in and is very experienced with newborn care, especially if there was any trauma to baby’s head (vacuum, forceps, caesarean, malposition, and/or long “pushing stage”) e.g. chiropractor, cranio-sacral therapist, osteopath.
The report alleging an infant being infected with Group-B Strep bacteria from placenta capsules is completely inaccurate. In reading through the details (summarized below), you’ll see that it’s impossible that the placenta capsules were the source of infection. This is not a study, but rather a media article. One story is never a scientific study. As is often the case in anything birth-related, the headline is misleading.
Waterbirth provides a wonderful and gentle birth experience for both mother and baby. Often shorter labours with fewer complications are seen. This in turn leads to a better experience for dads. Mothers rate high satisfaction with waterbirth experiences, as do fathers and birth attendants.
Fetal position at the onset of labour is one of the greatest determining factors of how the birth process will proceed. During labour the fetus makes certain movements to descend through the pelvis. The optimal fetal position is pictured below. A good way to remember the best position is to think about giving your baby a back rub every time you rub your belly.
A spot near the back of the fetal head is used to determine fetal position. The terms “posterior” or “sunny-side up” describe a baby who faces out, or is spine-to-spine with mother. “OP” is the medical jargon. The presenting part of the head is bigger in this position and the baby doesn’t flex and rotate as well as an anterior baby.
Problems Related to Posterior Position
- More difficult for baby to drop into and through the pelvis
- Pregnancy may last longer
- Membranes are more likely to rupture before the onset of labour
- Labour may progress slowly or not at all
- Back-pain during labour that doesn’t disappear between contractions
- Increased risk of tearing
- Increased risk of instrumental or surgical birth
- Increased stress on baby’s head and nervous system
However some women birth a posterior baby just fine. Those include but are not limited to, women who’ve given birth without difficulty before, those with an average or smaller baby, a labouring woman who’s able to move about freely and allow her baby to rotate into an anterior position.
Baby in optimal position: head down and flexed, back out.
Signs of a Posterior Baby
- Feeling kicks or flutters at your front
- Frequent urination (more frequent than with anterior pregnancy)
- Belly appears flat or lumpy
- Your midwife or doctor can tell by palpating your abdomen, as is done at every prenatal visit
- Fetal heart-tones may be difficult to hear
- Head is not engaged or doesn’t drop into pelvis
- Can be confirmed with ultrasound
- During labour she can also tell during an internal examination
Factors Contributing to Posterior Position
Posterior-babies can occur with no risk factors, but the following increase the chances:
- North American lifestyle – reclining in upholstered furniture, sedentary lifestyle, sitting in cars (it’s interesting to note this position is rare in cultures where women walk a lot or work bent-over, and lack Lazy-Boy style chairs and couches)
- Sitting with legs crossed
- Postural or anatomical issues
- Issue of uterine / abdominal muscles (e.g. tight psoas)
- First pregnancy
- Epidural use early in labour (hinders rotation and descent of baby) is correlated with more than 3x the rate of posterior position at birth (Tully, 2008)
- Labouring in bed or without adequate movement
- Baby who was breech and turned to vertex
- Mother with history of breech or posterior baby
- Short or tight cord around baby
- Emotional issues – fear of birth or parenting, not paying attention to pregnancy, family history of breech, relationship issues, financial concerns, stress (Frye, 1998)
Tricks for Turning a Posterior Baby to an Anterior Position
Sometimes there’s a reason (that we don’t know about) for baby to be posterior and nothing will turn her or him. But in many cases a baby can be turned. Please ask for details or referrals.
- Visualization and “talking” to your baby. Focus on letting the baby know it’s easier to get out when facing the other way. This works especially well if combined with changing your emotional environment e.g. dealing with fears, prepping for birth.
- Look at a picture of baby in proper position (e.g. Fig. 1), or have it drawn on your belly!
- Webster Technique with a chiropractor certified in its use. Pistolese (2002) cites an 82% rate of success in relieving the musculoskeletal causes of intrauterine constraint. It’s beneficial to perform the Webster Technique starting at 35-36 weeks.
- Sit with pelvis tilted forward – knees below pelvis with straight back. Instead of upholstered furniture, use a birth ball, the floor, a kneeling chair or a regular hard chair or stool
- Hands and knees – read, crawl around, or child’s pose modified for pregnant belly
- Pelvic rocking while on all 4’s – gentle cats and dogs yoga postures – several times daily
- Swimming or floating – anything with belly down like a hammock for baby to drop into
- Movement and exercise
- Sleep on left side with a body pillow – left leg straight, right leg bent on pillow
- Keep belly warm (babies may turn back to keep warm against mother’s back)
- Homeopathic Pulsatilla 200CH, 1 dose every 3 days.
- Acupuncture or moxibustion – see a Traditional Doctor of Chinese Medicine or an acupuncturist who specializes in women’s and pregnancy care.
- Deal with fears around childbirth and parenting
- Postural management – check out spinningbabies.com for some excellent postures and exercises that encourage babies to assume optimal positions for birth.
Frye, A. (1998). Holistic Midwifery, Vol 1, Care During Pregnancy. Portland, OR: Labrys Press.
Ohm, J. (2006). About the Webster Technique. Retrieved from icpa (International Chiroractic Pediatric Association): http://icpa4kids.com/about/webster_technique.htm
Pistolese, R. (2002). The Webster Technique: A chiropractic technique with obstetril implications. Journal of Manipulative and Physiological Therapeutics , 25 (6), E1-E9.
Tayler, R. (2000). Homeopathy for Pregnancy and Childbirth. Ottawa: Ottawa School of Homeopathy.
The Midwifery Group. (2008). Posterior Babies. Retrieved from The Midwifery Group: http://www.midwiferygroup.ca/downloads/position/Posterior%20Babies.pdf
Tully, G. (2008). Occiput Posterior – OP. Retrieved from Spinning Babies: http://www.spinningbabies.com/baby-positions/posterior
What qualifies you to provide this service?
Proper training and a lot of experience: We’ve offered this service since 2009 and between us have done 500+ placentas, making us the most experienced encapsulators in Saskatchewan. We are both OSHA certified and trained in Universal Precautions, food science and preservation. We train placenta encapsulators through Birth Ways International.
How long does it take? The capsules are ready in 1-2 days from when we get the placenta.
How many capsules will I get?
That depends on the size of your placenta. Most women get over 100 capsules. The average is around 115. Bigger placentas can fill close to 140 capsules.
What’s the difference between gel and veg caps?
Gel caps are made from animal gelatin and veg caps are vegan, made from plant materials. See a detailed ingredients list for our high quality capsules.
How do you clean and care for your equipment?
The processing is done using OSHA Blood Borne Pathogen Standards. All surfaces and equipment are cleaned, then disinfected, then twice-sterilized using chemical methods. (This is “over-kill” but is reassuring to us and our clients!) We use high quality equipment that can be properly sterilized and is kept in like-new working order.
Can I keep my placenta if I have a caesarean birth?
Yes. The steps are exactly the same. Simply ensure your O.R. nurse knows you wish to keep it.
Am I “allowed” to keep my placenta? Do I need permission from my doctor?
It’s yours to keep. Simply write in your birth plan or tell your care-provider, “I’m keeping my placenta.” Other details are for you to share or not as you choose. Obstetrical staff at Regina General Hospital and nearby rural hospitals are quite used to women keeping their placenta. If you’re at another hospital that has concerns, then you can sign their Release of Live Tissue waiver. Remind the people attending your birth that you wish to keep it.
Can you make capsules from my placenta if I choose to use epidural or other medications in labour? Yes.
Is my placenta safe to encapsulate if there’s meconium (baby poops inside) during the birth?
Yes. The initial cleaning process and proper dehydration takes care of this.
Are there any cases where my placenta can’t be encapsulated?
In the rare case of uterine or placental infection during labour, your placenta will be taken away to the pathology department for analysis. We’ve processed well over 500 placentas and have never received one that was infected (we do watch for it though). All placentas are inspected after birth by midwives/doctors, who do not send infected placentas (or anything else) home with patients.
If your placenta is left at room temperature for too long then we are unable to process it.
Do you serve out-of-town clients?
Yes. We have systems in place to make this easy for you. We provide detailed, easy-to-follow instructions.
How do I package the placenta for you?
At Regina General Hospital, the placenta is usually put into a square plastic container; you can use that for storage and transport. We provide detailed instructions to bring your own container as a back-up. You can ask your nurse to get it ready. While it’s not her “job”, most are happy to help. At home births or other hospitals you’ll need to provide your own container (we provide detailed instructions). If you have your baby at night or are shipping the placenta, then you’ll keep it cold (detailed instructions provided) until the morning when it’s picked up.
How do I get the placenta to you?
One of us picks it up at Regina General Hospital or at your home in Regina city limits, depending where you give birth. If you have your baby out of town then you can have it delivered to us. We provide detailed instructions.
How do you ensure the capsules are returned to the right person?
This is one of the most important parts of the process! One of several advantages to working in partnership is that we can process two placentas at the same time in two separate locations. We have a triple labeling system in place to ensure 100% accuracy; your placenta is attached to a label at every stage of processing, from placenta pick-up through to delivery of capsules. These are a matter of routine, and are followed with every client’s placenta, even though we rarely have 2 placentas in the same building at the same time.
How do I get the capsules back?
We deliver the capsules anywhere within Regina city limits. If you live out of town then we can ship them or send them with someone going your way (we can drop the package off anywhere in Regina to that person).
How long do the capsules last?
They’re best used within 1 year, stored at room temperature in an airtight container (glass jar). After that they don’t necessarily go “bad”, but the nutrients start to diminish. If you wish to keep them longer, then the freezer can extend that for up to another year if they go in within the first few months. (We don’t recommend this because we hear from so many women who put them in the freezer and promptly forgot about them.)
How do I store the capsules?
Just keep them in the glass jar. There’s no need to refrigerate them. They’re good for up to a year at room temperature in a cupboard. If you wish to keep them longer, then store in a deep-freeze for up to two years.
Can you make capsules out of my frozen placenta? Yes.
How do we proceed?
Please contact me for next steps. You will receive a contract via e-mail that you sign and return, and an instruction sheet for your birth-bag. We need your estimated due date and contact info. You can send an e-transfer, post-dated cheque or provide cash with the placenta.
What if I Haven’t Made Arrangements Yet? We can usually accommodate you. In an ideal world everything will be set up ahead of time. However if you just decided to do this while you’re in labour – or even after your birth – and need to make quick arrangements, please text during normal “awake” hours. (If you have your baby after 9am or before 8am, please put your placenta in fridge or on ice and get in touch in the morning.)
Do you buy or sell placentas, or placenta products?
We do not! This is not only unethical and unsafe, but is illegal in Canada. (If anyone offers to do this, please report them to the Public Health Department.) We provide the service of turning your own placenta into capsules for your own use.
What’s a doula?
A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother and partner during pregnancy, birth & early postpartum. In much of the world today and throughout history, women support women through labour & birth.
What’s the difference between a midwife and a doula?
Doulas work as part of a team with doctors or midwives, but not instead of. They provide non-medical support and comfort measures (e.g. encouragement, massage, positioning suggestions). They do not perform clinical tasks such as heart rate, blood pressure, or internal exams.
Midwives are highly trained in the medical aspects of birth. The carry oxygen, medicines, resuscitation equipment and other gear, and are known as primary care-givers during birth. In North America primary/medical birth care is offered by either a midwife or a physician.
Why choose a doula over simply using a friend or family member as support?
Doulas are trained and experienced in childbirth support. They know the sounds and behaviors of laboring women, and what that may indicate about progress. Doulas are trained in pain-reducing comfort measures, natural methods to keep labor progressing, and to support both the laboring woman and her partner. Doulas are familiar with local hospital policies & practices and have often built a rapport with the doctors, nurses and midwives. See http://evidencebasedbirth.com/2012/06/26/why-wouldnt-you-hire-a-doula/
In most Canadian hospitals, women are allowed 2 support persons – usually that’s her partner and a support person. Some hospitals accommodate a 3rd support person. Homebirths and birth centers encourage women to have all the support they wish.
How does the doula fit in with nursing staff?
Doulas do not replace nurses or other medical staff, but rather work as part of the team. They are there to comfort and support the mother & her partner. Nurses change shifts; doulas stay.
How does a doula assist with communication in hospitals during labor & birth?
During prenatal meetings doulas learn what’s important to a couple and discuss how to make informed decisions. A doula may remind or encourage a client to ask the questions necessary to understand a procedure and make informed decisions. Doulas do not speak on a client’s behalf nor intervene in their clinical care. They do not make decisions for clients, nor judge the decisions clients’ make, but are there to support those decisions.
What difference does the presence of a trained doula have on birth outcomes?
The presence of a doula tends to result in shorter labours with fewer complications and less interventions. When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer caesareans and requests for medical intervention, and less postpartum depression. In case of unplanned circumstances, doula support helps reduce negative feelings about one’s childbirth experience. Studies ,,, have shown that babies born with doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.
Analysis of six randomized trials1 demonstrates that lack of doula presence correlates with:
- Double the overall caesarean rate
- 33% increase in length of labour
- 67% increase in oxytocin use
- 2 ½ times more requests for epidurals
Will a doula make my partner feel unnecessary?
A responsible doula compliments and enhances the father/partner in their supportive role rather than acting as a replacement. (While I respect people’s individual circumstances, I will use “father” words for most of this paragraph.) The presence of a doula allows the father to support his partner emotionally during labor & birth without the pressure to remember everything he learned in childbirth class! The father typically has little-to-no actual experience with the birth process, yet is expected to act as a coach. Some partners feel (accurately) that this is a huge expectation. Many fathers experience the birth as an emotional journey of their own and find it hard to be objective. A doula is supportive to both the mother and her partner, and plays a crucial role in helping a partner become involved in the birth to the extent he/she feels comfortable. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.
When a couple works well together during the birth process they’re better able to handle the challenges of early parenthood. An incredible bond forms or is made stronger.
How often and when do we meet?
We’ll meet 2-3 times before the birth. The introductory meeting is any-time – it’s never too early. The prenatal meetings are best done between 24-36 weeks. After your baby is born there will be a minimum of one postpartum visit, more if needed or desired.
Are doulas only useful if planning an un-medicated birth?
The role of the doula is to help attain a safe and pleasant birth, not to choose the type of birth. The presence of a doula is beneficial no matter what type of birth you are planning. In fact, women who choose a medicated birth need as much support as those who choose a natural birth, but a different kind of support. For women who know they want a medicated birth, the doula still provides emotional support, informational support and comfort measures to help the women through labor and the administration of medications. Doulas can help a mom deal with possible side affects and by filling in the gap that medication may not cover; rarely does medication take all discomfort away.
For a mother who faces a cesarean, a doula provides comfort, support and encouragement. Often a cesarean is an unexpected situation and moms are left feeling unprepared, disappointed and lonely. In this case doula support is especially helpful during the early postpartum period.
What if I planned a drug-free birth then change my mind during labour?
Doulas don’t make decisions for clients or intervene in clinical care, nor do they judge women’s choices. They provide informational & emotional support while respecting a woman’s decisions.
What kind of comfort measures do you use during the labour & birth process?
While there are common comfort measures taught in doula training courses, each doula also brings her own tools and methods. Ours include the following:
- Positioning suggestions
- Massage & various touch methods
- Homeopathy & Bach Flowers (optional; no extra charge)
- Encouragement & reassurance
- Heat or cold as desired
- Hydrotherapy (water for comfort in labour, and/or water-birth)
- Create space for partner, and recommendations to help partner to offer support
- A calm, reassuring presence who trusts the birth process
When do we call you in labour?
Please call at the first signs of suspected labour. We’ll discuss what those are. From then on you’ll keep us posted on your progress and what’s happening.
When and where do you join us in labour?
When depends on the woman, her partner, and the labour. Early support often takes the form of checking in by phone and/or dropping by your place. Your doula joins you either at your home or in hospital or birth center and remains with you until 1-2 hours after the birth.
How does shared-care work?
Doulas team up to provide enhanced service. Clients benefit from combined experience, education, and availability. Since doulas are on call for up to a month for each client, shared care allows them time for important life events and days off without having to turn clients away or rely on unfamiliar back-up. Clients meet both doulas prenatally so they’re familiar with whichever one attends birth.
What if you can’t be at the birth?
In the rare circumstance that one of your doulas can’t be there, you will be well supported. We work with reliable back-ups who offer excellent care. Fees remain the same. If the back-up is likely to be part of care, some clients wish to meet her prenatally, which can be arranged.
Do we pay more to work with 2 doulas?
No. Fees are outlined in the contract. The cost of working with both doulas is the same as hiring one of them individually.
What kind of postpartum support do you offer?
Your birth doula usually stays for 1-2 hours after the birth, until you’re ready to be on your own with your baby. We also visit in the first day or two postpartum, offering basic breastfeeding support, answering questions, and going over your birth. We are available for questions and can offer resources (educational and community). A second postpartum visit is offered.
What if I need extra help with breastfeeding or baby-care?
The information above describes our work as birth-doulas. Another kind of doula, a “postpartum doula”, specializes in extended care and breastfeeding support. There are also breastfeeding counselors and lactation consultants that can be arranged through public health or hired privately. We can provide resources and contact info. If you’re on the Mother-Baby Unit the nurses or unit Lactation Consultants can provide support.
Where’s that name from?
In ancient Greece “doula” meant the highest female servant who helped the lady of the house through child-bearing. Medical researchers Marshall Klaus and John Kennell, who conducted several randomized clinical trials on the medical outcomes of doula attended births, adopted the term to refer to labour support as well as prenatal and postpartum support.
 Klaus, M.H.; Kennel, J.H.; Berkowitz, G.; Klaus, P. “Maternal Assistance and Support in Labor: Father, Nurse, Midwife or Doula?” Clinical Consultations in Obstetrics and Gynecology 4 (December 1992).
 Sauls, DJ. Effects of labor support on mothers, babies, and birth outcomes. J Obstet Gynecol Neonatal Nurs. 2002 Nov-Dec; 31(6):733-41.
 O’Driscoll, K. and Meagher, D. Active Management of Labor. 2d ed. London: Bailliere Tindall, 1986.
 Klaus, M.H. and Kennel, J.H. Parent-Infant Bonding. St. Louis: C.V. Mosby, 1982.