Birth Prep – Page 2 – Pregnancy & Birth Support, Online Prenatal Classes & Preparation

Checklist and Tips for Making a Birth Plan

Posted by Angie Evanson November 25, 2023November 25, 2023in Birth, Birth Prep, Birth Support, Pregnancy

Most people who give birth in a hospital are meeting their medical care team for the first time. A good birth plan, which I prefer to call “Birth Preferences”, can build bridges with your medical team. It can help them get to know you and quickly understand what you’d like in your ideal birth.

Before creating your Birth Preferences, learn about the policies and practises at your birthplace, so you know what to put on your wish-list. If you have special circumstances then you can incorporate those into your birth plan. Examples include choices in caesareans and considerations for trauma reduction.

Your Birth Plan document should be only one page with lots of white space and an easy font – at least 12pt. Use respectful and positive, but firm language. “I prefer….” is wishy-washy for something that really matters to you.

I recommend you use language that reflects who you are. If you have a great sense of humour, feel free to insert fun and levity in your plan. “If Jamie takes a nap, please kick him when he starts snoring.”

Checklist for an excellent Birth Preferences document

This section includes examples. Feel free to copy them or use your own language.

Start with an opening paragraph that includes:

An opening statement that encompasses your attitudes or overall vision e.g. “We’ve prepared for a natural birth” or “An epidural is part of my plan” or “We’re using Hypnobirthing as a tool.”
A statement about consent, such as “We’re open to changes after discussion with the medical staff so we can make informed choices.” or “I will ask questions whenever a procedure is recommended and then need a few minutes alone to think.”
A kindness to the staff. “Thank you for supporting us through our birth process” or “We appreciate the work you do.”

An additional opening paragraph if there are special circumstances:

Medical conditions that need to be known urgently, such as “Lucy is allergic to penicillin”.
Mobility issues or cognitive considerations.
Sensitive issues that may affect your birth, if it feels safe to share. (It’s been my experience that this level of personal sharing makes for better treatment.) “Due to previous trauma, no one is to touch me until I am aware of who they are, understand why and what’s involved, and have verbally agreed.” Or “Robin faints at the sight of blood, even one drop.” Or “We’ve had a previous loss and do not want to discuss it. Please see the prenatal records.”

Then a short list of points for your wishes. It could be titled, “These are our wishes”:

If anyone is joining you, name them. E.g. Your doula or “plus-one” such as a friend or mother.
The environment you’d like, such as quiet with dim lights, loud rocking music (bring your own), window blinds open for sunshine, privacy.
Continue this section with points that are unique to you. Here are a few of my favorite things from the hundreds of birth plans I’ve seen:
- I must wear my purple socks at all times.
- Do not offer pain medications; I’ll ask if I want anything.
- Please run a bath and encourage me to get in.
- Minimal cervical checks and only by experienced staff.
- I will eat if I’m hungry; please provide a waiver.
- Please provide the squatting bar and recommend positions to keep labour moving.
- Please coach me through pushing.
- I will breathe my baby down and appreciate quiet during the bearing-down stage.
- Essential staff only; no observers or learners.
- Students are welcome.

You get the idea!

Cord and placenta plans, if any. E.g. We’d like 3 minutes of delayed cord clamping. Or We’re keeping our placenta. Or Please show me the placenta before disposing of it.

Some people add an “In case of Caesarean:” heading, with things that are important to them such as playing a certain song, delayed cord clamping, requesting someone to take photos if possible, keeping family together as long as possible in the OR.

A closing sentence such as “Thank you for taking time to read this page” or “Thank you for being part of our big day!”

Do not include:

Disaster planning language e.g. “… unless something goes wrong.” or “… unless it’s needed”. It’s a given.
Things that aren’t issues. If your local hospital has a policy that all babies are held skin-to-skin by a parent immediately upon birth and for the first hour (that’s the policy in my local hospital), then there’s no need to ask for that.
A shopping list of all the things you don’t want. You don’t have to tell your medical team that you don’t want an episiotomy or a caesarean – they know that. (Well, unless you’re in a place where episiotomies are routinely done – then add that to the list! In almost every Canadian hospital, episiotomies are not routinely done.)
The interventions that are only done after discussion, such as induction, which requires a conversation and signed consent form.
Postpartum care of the maternal or newborn patient. “I will breastfeed” or “I will use formula” do not belong on the birth plan.

Need help to make a birth plan that builds bridges instead of walls?

I can help you sort through your options and find the best wording. Check out my Birth Plan Prep Consultations which are available in person or on Zoom.

Doula Interview Questions

Posted by Angie Evanson October 12, 2023in Birth Prep, Birth Support, Doula, Education

Most doulas offer a complimentary initial meet-n-greet to determine if you’d be a good fit to work together. It’s an opportunity to learn how the doula works, their point of view, what they offer, and also to share what you’d like for your birth and support, if you know. Many people don’t know much about what kind of birth they want to plan; experienced doulas can help sort that out. After all, if you don’t know your options, you have none.

People learn all about their options and choices (there are many!!) in my Prenatal Classes.

Here are some questions you might wish to ask when you’re considering working with a doula for your birth.

BACKGROUND, EDUCATION, PHILOSOPHY

How many births have you attended?
How long have you been in practise?
Where have you worked? (Hospitals, birth centres, homes. Which ones?)
With which primary practitioners have you worked in my area? (Midwives, doctors, OBs).
What’s your educational background in general?
What experience, education and training do you have, specifically related to birth (childbirth education, birth support, breastfeeding, postpartum support and newborn care)?
Do you have complimentary training e.g. natural remedies, modalities for pain management & comfort measures?
What is your philosophy about pregnancy, birth and support?
What’s one thing you wish all parents-to-be knew about birth?
Are there limitations of support? E.g., natural vs. medicated birth, time-lines for gestation & labour, home vs. hospital birth.
What compelled you to start doing this work?

GENERAL PRACTISE ORGANIZATION

What are you affiliations? e.g. Professional associations, memberships
Do you provide community links and resources for and relationships with other practitioners with skills who may benefit pregnant and postpartum people?
What’s your offer, in detail? e.g. # of prenatal visits, on-call schedule, post-partum support/schedule.
Fees – cost, payment schedule, return policy. What payments do you accept? Do you offer payment plans?
How do you support partners / birth-companions?
How do you like to communicate with your clients?
What expectations do you have of your clients?
Do you have privileges in all or limited birth centres & hospitals?
Do you work with out-of-town clients?
Are there additional perks? Are they included or do they cost extra? e.g. Lending library of books & videos, informational resources, health related therapies, workshops or classes?

PRENATAL CARE

What information is covered in prenatal meetings?
Do you help create a birth-plan?
What kind of preparation tools/materials do you offer?
How do you help prepare clients for their ideal birth?
Do you expect your clients to do any homework?
Do you help your clients prepare for the postpartum stage? If so, how?
Are you available for extra meetings, questions, phone calls? If so, are there additional fees?

LABOR & BIRTH

Do you work with back-up? If so, who and can I meet them if I wish?
Under what circumstances would the back-up attend?
What if you miss the birth?
What if I go into labour before on-call dates?
When do you join your clients in labour?
Where do you join your clients? At home or place of birth?
How long do you stay?
What are your methods or tools for support during the birthing process? e.g. Pain management techniques such as massage & knowledge of positions; complimentary therapies such as homeopathy, acupuncture, aromatherapy.
How do you help keep labour progressing efficiently?
What do you do to help with difficult labours (long, stalled, and/or back labour)
Are you knowledgeable and comfortable supporting labour with medical interventions?
How do you work with my partner and/or anyone else I might wish to be part of my labour?
What if I have a Caesarean birth?
What if I’m transferred to (another) hospital or city?

POSTPARTUM & NEWBORN CARE

Do you help with breastfeeding? How? When? e.g. Immediately after birth or at home in the following days too?
What if I need specialized help with breastfeeding and/or recovery from birth?
What does your support look like in the postpartum stage?
How long do you offer postpartum support?
Do you have resources to help with postpartum recovery? For the birthing person and/or the baby?

MOST IMPORTANT NOTE FOR PARENTS-TO-BE:

Do you feel comfortable enough with this doula to share your baby’s birth?
Are they kind, warm, and have the other personality traits you’d like in a doula?
Is the doula knowledgeable about your particular concerns?
Do they listen and communicate well?
Are they comfortable with your choices or do they seem to have their own agenda?

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

Posted by Angie Evanson September 27, 2023September 27, 2023in Birth, Birth Prep, Birth Support, Hospital Birth, Labour

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 is 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. They may simply enjoy being at home for longer.

One of the benefits of working with a doula is that we help clients decide when to go. We will remind you 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 contractions or sensations (explained below): 311 for a first birth or 411 for subsequent births; even sooner if you have a history of fast birthing. Hot tip: If you feel like eating, then it’s likely too early, based on labour pattern alone.
Lots of pressure down low. If contractions end with a grunt or feelings of needing to poop, then get going!
Any signs of labour before 37 weeks.
Any health concerns (some “warning signs” are below).
Decreased fetal movement that isn’t remedied within an hour or two by eating and resting. This is not a 911 call but it does mean to go presently. Do not sleep on this.
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. You will likely be sent home if all is well and you are not in ‘active labour’ but that’s OK. Consider it a trial-run and some good news that everyone is medically stable.

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 (just show an app if you’re using one)?

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.

Making Informed Choices

Posted by Angie Evanson August 17, 2023November 25, 2023in Birth Prep, Interventions, Safety

You know informed choice is a legal right but how do you make those choices? Here’s some guidance to help you get information and ask questions, so you can be an active participant in your health care.

While tests and interventions may not be introduced in a way that implies they’re optional, they are. Everything is optional. In my experience personally and as a birth attendant, medical staff are patient, respectful and happy to answer questions when asked.

Brewer Pregnancy Nutrition

Posted by Angie Evanson July 15, 2023November 25, 2023in Birth Prep

Good quality nutrition, including adequate protein, is required for the increased metabolic functions that occur during pregnancy. Many midwives and practitioners recommend the Brewer Diet. There’s an overwhelming amount of evidence to support this recommendation. Studies from Harvard find that eating 75 grams of protein daily helps prevent diseases of pregnancy such as pre-eclampsia (Abubakar, A., & al. (2011, Aug)).

In the 1960’s Dr. Tom Brewer worked with a large, high-obstetrical-risk group in California: impoverished ethnic minority teen mothers in their first pregnancy. During the same time in other areas of the USA, this group had up to 35% rates of serious pregnancy diseases, preeclampsia and eclampsia. Dr. Brewer worked with more than 7000 pregnant women over more than 12 years. He asked each woman about her diet and determined that malnutrition was prevalent. All of his clients were required to attend nutritional counselling and were fed good nutrition and adequate protein. The incidence of serious pregnancy illnesses among his patients dropped to 0.5% (Brewer & Brewer-Krebs, 1977)! This is remarkable and well documented but as there was no “control group” (a group who didn’t receive “treatment”, because Dr. Brewer felt it would be unethical to withhold good nutrition from a group of pregnant women), most medical associations don’t consider this scientifically valid research.

The basic Brewer diet recommends a daily minimum of 2600 calories, 80-120 grams protein, salt-to-taste, green veggies, whole grains, fats, and vitamin-rich foods (Jones). The Brewer diet can be easily integrated into general good pregnancy nutrition (see Basic Prenatal Nutrition handout (Evans, 2011)). For example, while the Brewer Diet doesn’t specify types of salt or fat, whole-mineral salts (e.g. Himalayan or Celtic) and high quality omega-3 fats are healthiest. Special needs such as food-sensitivities / allergies, ethical choices or cultural habits can all be incorporated into the Brewer Diet. As usual, ensure you eat 3 meals and 3 snacks daily, including protein at each one.

If you wish to check out the actual “Brewer Diet”, see Dr. Brewer’s Pregnancy Diet Checklists, which include vegan and vegetarian options. Of course you can make substitutions based on your practices and preferences. If you don’t drink milk, sub it for another protein source with calcium. Below is a basic checklist you can use.

Brewer Pregnancy Diet Food Log

The list below is the minimum daily requirements according to Dr. Brewer. You may wish to consult a holistic nutritionist if you have special needs or if you’re having trouble meeting these daily minimums as this requires prompt attention.

Check off a box each time you have a serving. Each food counts as one checkmark on the lists e.g. a glass of milk counts as either “Milk” or “Protein”, but not both. Examples for each category are presented. Modify to fit any special considerations you have, such as vegetarian or a health issue to work around.

DAILY MINIMUMS:

□ □ □ □ □ □ □ □ (8) Calcium source; servings below. Note 125ml = ½ cup

½ cup animal milk, yogurt or sour cream

¼ cup cottage cheese

1 small slice cheese

36 almonds

12 Brazil nuts

1 tbsp raw sesame seeds

1/3 cup cooked bok choy or collard greens

1 cup broccoli, cooked

½ cup kale

2 teaspoons blackstrap molasses

4 oz black olives

1 oz sardines

□ □ □ □ □ □ □ □ (8) Protein; servings below. 1oz = 7g.

Note: See information about fish and mercury on Basic Prenatal Nutrition handout.

1 oz poultry, fish, red-meat, or organs

¼ cup canned salmon or tuna

3 sardines

1 oz cheese: cheddar, Swiss, other hard cheese

¼ cup cottage cheese

1/8 cup brewer’s yeast + 1/4 cup rice

1/8 cup sesame or sunflower seeds + ½ cup cup rice

1/8 cup beans + 1/4 cup whole rice or ½ cup cornmeal (measured before cooking)

□ □ (2) Fresh, dark green vegetables; servings below

1 cup broccoli

1 cup brussels sprouts

½ cup lettuce (preferable romaine)

½ cup endive

½ cup asparagus

½ cup sprouts: bean, alfalfa

2/3 cup greens e.g. collard, turnip, beet, mustard, dandelion, kale, spinach

□ □ □ □ □ (5) Whole grains; servings below

1 slice whole grain bread

1 corn tortilla

½ cup oatmeal, brown rice, quinoa,

1 shredded wheat biscuit

½ cup bran flakes or granola

¼ cup wheat germ

1 waffle or pancake made from whole grain

½ roll, muffin, or bagel made from whole grain

□ □ (2) Vitamin C foods; servings below

½ grapefruit

½ cup grapefruit juice

1 orange

½ cup orange juice

1 large tomato

1 cup tomato juice

½ cantaloupe

1 lemon or lime

½ cup papaya

½ cup strawberries

1 large green pepper

1 large potato, any style

□ □ □ (3) Fats and oils; servings below

1 tbsp butter

¼ avocado

1 tbsp nut-butter

1 tsp algae oil

1 tbsp first/cold-pressed vegan oil – olive, flax, avocado, hemp, coconut

1 tsp cold-pressed fish oil – cod-liver, sardine, mackerel, anchovy, krill

□ (1) Vitamin A foods; servings below

3 apricots

½ cantaloupe

½ cup carrots (1 large)

½ cup pumpkin

½ cup winter squash

1 sweet potato

Salt and other sodium sources—unlimited, to taste

kelp powder–to taste

soy sauce or tamari–to taste

full spectrum natural salt to taste – Himilayan, Celtic i.e. grey or pink salt

Water—unlimited; drink to avoid thirst, not in response to it

Purified water is best – see http://www.angieevans.ca/pdf/Water%20&%20Hydration.pdf

Fresh, home-made juice

Unsweetened herbal tea (see Safe Herbs in Pregnancy handout)

References

Abubakar, A., & al. (2011, Aug). Lipid Profiles and Platelets Counts of Pre-eclamptic women in Selected Rural Areas of Northern Nigeria. WebmedCentral PHYSIOLOGY: http://www.webmedcentral.com/article_view/2121

ACOG. (2002, Jan). Diagnosis and Management of Preeclampsia and Eclampsia; #33. ACOG Practise Bulletin – Clinical Management Guidelines for Obstetrician-Gynecologists: http://mail.ny.acog.org/website/SMIPodcast/DiagnosisMgt.pdf

Brewer, D. T., & Brewer-Krebs, G. (1977). What Every Pregnant Woman Should Know. The Dr. Brewer Pregnancy Diet: http://www.drbrewerpregnancydiet.com/id74.html

Evans, A. (2011). Basic Prenatal Nutrition. Canmore.

Frye, A. (2007). Understanding Diagnostic Tests in the Childbearing Year, 7th Ed. Portland, OR: Labrys Press.

good nutrition… for healthier moms and babies. (n.d.). BlueRibbonBaby.org: http://www.blueribbonbaby.org/

Haas, A. (1995). Preventing Preeclamsia, PIH, Toxemai and HELLP by Good Nutrition. Midwifery Today .

Jones, J. M. (n.d.). The Dr. Brewer Pregnancy Diet: http://www.drbrewerpregnancydiet.com/

Maine, D. (2000). Role of nutrition in the prevention of toxemia. The American Journal of Clinical Nutrition , 72 (1), 298-300.

NICE. (2010, Aug). NICE clinical guideline 107: Hypertension in pregnancy. NHS – National Institute for Health and Clinical Excellence: http://www.nice.org.uk/nicemedia/live/13098/50418/50418.pdf

Summer pregnancies & hot births!!

Posted by Angie Evanson July 18, 2022in Birth, Birth Prep, Birth Support, Comfort, Herbs, Labour, Nutrition, Postpartum, Pregnancy

Oh, the days are hot and even more so when we’re growing a baby or holding a newborn. If you don’t already know, profuse sweating is a normal part of postpartum recovery even during winter.

Here are some tips for summer survival with a baby-bump that go beyond the obvious, typical lists – wear loose clothing, do things early in the day, stay hydrated, find AC. I think we all know that by now.

Summer Pregnancy-Safe Drinks

Growing and/or feeding a baby both take a lot of energy and we burn through more electrolytes and minerals in the hot summer. Sugar drinks are not helpful. Pregnant and breastfeeding bodies are more susceptible to blood sugar shifts and the yeast / thrush infections that result from high sugar intake. I have 2 articles for you for healthy, refreshing and cooling drinks (other than plain old water which is of course, important every day). They’re all nutritive during pregnancy and postpartum recovery – actually any time. Kids and adults can consume these.

Labour-Aide drinks.
Herb Tea for Pregnancy & Breastfeeding can be made in batches of iced tea. Add mint and lemon for a cooling, tasty drink.
Coconut water

Cooling Essential Oil Body Sprays / Mists

Even though every bottle says “don’t use during pregnancy”, there are a lot of oils that are safe. Consult a certified aromatherapist – that’s me, from way before it was cool (pun intended) to be into essential oils. You can make a spritzer with:

mint
lavender
cucumber
lemon – actually any citrus oil.

Add any combination of those to aloe, witch-hazel or a flower water such as rosewater.

If you prefer to buy a spray, check out the perineum sprays such as that made by Earth Mama Organics. They can be used all over, not just your bottom!

Caution #1: Citrus oils can make your skin more sensitive to sun-burn; only use for an indoor spray.
Caution #2: Many commercial refreshers and cooling sprays contain Eucalyptus, which should never be used near babies and pets. Best to avoid it through pregnancy too. Some types are safe but the most commonly used ones are too strong.

Angie’s Tips for a Cooler Birth:

Put a small wireless fan in your birth bag and/or birth place. Some of my clients use handheld fans and others use ones with a big clip.
If you’re having a hospital birth, i.e. in a scent-free environment, then bring an empty squirt bottle and fill it with cold water for misting.
Ice chips! They’re amazing during labour & birth. Suck on them, put them in a washcloth and use as a cold-pack all over the body, put them in a bowl of water and dip a washcloth in to apply on foreheads and necks, add them to juice and water. I rarely attend a birth without using at least a couple of cups of ice-chips.
Temperature fluctuations are amplified during the birth process. This video has tips to regulate temperature during birth and what the partner / birth companions can do.

Essential Herbal Tea for Pregnancy & Breastfeeding

Posted by Angie Evanson July 18, 2022July 18, 2022in Birth Prep, Herbs, Nutrition, Recovery3 Comments

Women have consumed infusions (tea) of Red Raspberry leaf and Nettle leaf through the ages for a healthy childbearing year, healthy reproductive organs at any stage of life, and to keep their skin soft and supple. This blend is high in easily absorbed minerals. If no milk or sugar is added then this drink counts toward your daily water intake.

Drink 1-3 cups of Pregnancy Tea, hot or cold, daily through first 2 trimesters, and 3 cups during last trimester.

Combine these teas in any ratio you wish, but the general recipe is:

2 parts Red Raspberry Leaf
2 parts Nettle Leaf
1 part Horsetail Leaf (added for calcium & strong bones)
Optional: 1 bag or small scoop of lemon, berry/fruit teas (ensure no licorice), mint or lemongrass to change up the flavour.

A batch can be stored in the fridge for up to 3 days.

Red raspberry leaf (Rubus idaeus)

Most commonly used and well-known pregnancy herb
Tones female reproductive system; also pelvic and uterine muscles
High amounts vitamin C, easily assimilated calcium and iron
Also vitamins E, A, B-complex, many minerals inc phosphorus and potassium
High mineral content helps tissues stretch, decreases stretch marks, helps prevent anemia
Lower rates of miscarriage and postpartum hemorrhage
Prepares body for labor. Therefore decreases pain and length of labor. Doesn’t strengthen contractions but makes them more efficient.
Help expel placenta
Good for morning sickness
NOTE: Red raspberry leaf tea does not induce labour! Not sure where that rumor started but it’s not true. Don’t down buckets of this hoping to bring on labour.

Nettle (Urtica dioica)

High amounts of virtually all mineral & vitamins needed for health
Especially high in A,C,E,D,K, calcium, potassium, phosphorus, iron, sulfur
High amounts of chlorophyll (for energy and nutrients, vitamin K)
Nourish and strengthen kidneys; gently dislodge and dissolve any mineral buildup
Relax leg cramps and muscle spasms
Prevent hemorrhage after birth due to high vitamin K
Strengthens blood vessels, therefore good for hemorrhoid prevention
Astringent for hemorrhoids
Increases quality of breast milk

Other herbs high in easily-assimilated vitamins and minerals (alone or added to the above teas) include Horsetail a.k.a. Shavegrass (very high in calcium), Alfalfa and Kelp.

Several other herbs are safe during pregnancy and are tasty e.g. mint. Some aid pregnancy related issues such as nausea, heartburn, cramping, and constipation to name a few. These include but are not limited to ginger, chamomile, slippery elm bark, and fennel. Consult a qualified herbalist with knowledge of pregnancy herbs before taking any.

By the way, this tea is healthy for the males in your life too, and is safe for all ages from infancy on. It’s a lovely, mildly flavoured drink for the whole family.

Prefer pre-packaged tea? Health stores and quality Mama/Baby stores sell pregnancy tea, e.g. Earth Mama Organics “Third Trimester Tea” (which you can take in any trimester).

C-19 Updates in Birth and Postpartum Care in Regina

Posted by Angie Evanson June 8, 2022in Baby Care, Birth, Birth Prep, Birth Support, Dads, Homebirth, Induction, Labour, Pregnancy, Prenatal Classes, Safety

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.

*****

ONGOING SUMMARY of Current Practises in the Labour & Birth Unit and the Mother-Baby Unit:

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.
All maternal patients and their designated family members/support persons will be screened for COVID-19 upon arrival at RGH and be required to have a temperature check, wear a mask, participate in hand hygiene and follow physical distancing guidelines.
Support persons/visitors who are symptomatic for COVID-19 or who have other risk factors will not be permitted.
Masks are mandatory for partners and support persons throughout the hospital, except for when there’s no staff present in the Mother-Baby Unit. Labouring patients who pass screening are asked to wear masks as long as they’re comfortable doing so.
All waiting rooms are closed. One primary support person is allowed with each maternal patient through registration and the assessment areas. 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.
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). Do not use the ER doors unless you are a patient or are with one.
All maternal patients will be offered an optional COVID-19 swab once their admitted to the Birth Unit. Family members/support persons will not be offered a COVID-19 swab.
If the maternal patient tested positive for Covid at any time during their pregnancy, then their placenta will be sent for testing.
There are 2 support persons (aged 18+) of the maternal patients choosing, allowed in the BIRTH ROOM; no swapping.
The MOTHER-BABY UNIT allows new families to have 2 additional visitors at a time (11am-8pm). The “no-swapping rule” has been lifted in this unit. Visitors must be aged 18 and over, except siblings of the newborn who are permitted to visit with an adult.
Nitrous Oxide / “laughing-gas”/ Entonox is available, “𝑡𝑜 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑤ℎ𝑜 𝑠𝑐𝑟𝑒𝑒𝑛 𝑡𝑜 𝑔𝑟𝑒𝑒𝑛 (𝑎𝑠𝑦𝑚𝑝𝑡𝑜𝑚𝑎𝑡𝑖𝑐 + 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒 𝑃𝑂𝐶 𝐶𝑂𝑉𝐼𝐷 𝑡𝑒𝑠𝑡) 𝑜𝑛 𝐿𝑎𝑏𝑜𝑢𝑟 & 𝐵𝑖𝑟𝑡ℎ 𝑎𝑡 𝑡ℎ𝑒 𝑅𝑒𝑔𝑖𝑛𝑎 𝐺𝑒𝑛𝑒𝑟𝑎𝑙 𝐻𝑜𝑠𝑝𝑖𝑡𝑎𝑙.”
Waterbirth is no longer an option in the hospital, even for those under midwifery care. The installed bath-tub is available for comfort in labour. Waterbirth is an option at homebirths when one is under midwifery care.
Breastfeeding is still being supported at RGH regardless of Covid-status. There are plans and protocols in place so that mother-baby can stay together if the birth-mom is at risk, has symptoms, or tests positive for C-19 in the immediate postpartum.
All waiting rooms are closed. Food outlets have limited seating.
Galleys are closed to patients/visitors in both units. The nurses will get food for you in the birth unit but not in the mother-baby unit. Bring 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.
The hospital does not provide warming tools other than blankets from the blanket warmer. If you like a hot-water bottle or heating pad, then bring your own. Staff are not allowed to take people’s heating devices to the microwave or kettle. You can use a plug-in device or fill a hot water bottle with hot tap water.
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.
Even though 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.

A TIMELINE OF PREVIOUS UPDATES

…. just in case you’re curious about what’s been coming and going and happening through the pandemic. Note that several of these restrictions have been lifted. The list above is current.

June 08, 2022 – Good news! Nitrous Oxide / “laughing-gas”/ Entonox is available again in Regina, “𝑡𝑜 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑤ℎ𝑜 𝑠𝑐𝑟𝑒𝑒𝑛 𝑡𝑜 𝑔𝑟𝑒𝑒𝑛 (𝑎𝑠𝑦𝑚𝑝𝑡𝑜𝑚𝑎𝑡𝑖𝑐 + 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒 𝑃𝑂𝐶 𝐶𝑂𝑉𝐼𝐷 𝑡𝑒𝑠𝑡) 𝑜𝑛 𝐿𝑎𝑏𝑜𝑢𝑟 & 𝐵𝑖𝑟𝑡ℎ 𝑎𝑡 𝑡ℎ𝑒 𝑅𝑒𝑔𝑖𝑛𝑎 𝐺𝑒𝑛𝑒𝑟𝑎𝑙 𝐻𝑜𝑠𝑝𝑖𝑡𝑎𝑙.” All maternal patients are screened on the way in (answer the usual questions re travel & symptoms) and then offered a swab-test once they’re admitted to the unit.

March 2022

Due to Covid, the Nitrous Oxide (“laughing gas”) is not available. It may be available again, depending on some supply issues.
The Mother Baby Unit now allows new families to have 2 visitors at a time (11am-8pm) and they can be anyone you want. (The “no-swapping rule” has been lifted.)

That said, postpartum hospital stays are usually short – only 1-2 days. There are many benefits to just resting with your new baby and saving the visitors for once you return home.
Note: The Labour & Birth Unit remains as is – 2 support persons per maternal patient, no swapping.

Feb 2022. The proof of vaccination / negative test requirements have been lifted. Support persons no longer have to show proof of anything.

Nov 8, 2021, partners, visitors, doulas, support persons, everyone EXCEPT the patient being admitted, must show proof of double Covid vaccine or a negative test within the past 72 hours from an SHA approved tester in order to enter SHA hospitals. Anyone who is not double vaxxed and wants to attend the birth might consider serial testing every 72 hours in order to be ready anytime.

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.

Summer 2020

◆ 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 screenedwith the maternal patient.

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 person for more than 2 hours will not be allowed in if they are 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 may 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.

◆ 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 a tank is being used (instead of the tubes that go directly into the wall), then the maternal patient must have a negative Covid swab done prior to use.
◆ 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.

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, and only up to 3 participants. If there are less than 3 maternal patients, then partners may be allowed to attend.
● 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.

5 Ways Labour Pain is Different than Broken-Bone Pain

Posted by Angie Evanson May 9, 2022in Birth, Birth Prep, Birth Support, Comfort, Labour, Pain

Some people compare labour pain to that of breaking bones. Besides scaring pregnant people, that’s not an accurate comparison. On the other hand, some women share stories of pain-free birth. Here are 5 ways the sensations felt in labour are different than “broken-bone pain”.

Broken-bone pain is unrelenting and doesn’t go away without strong pain meds; labour pain comes and goes in a rhythmical manner. In fact, throughout labour, much more time is spent in the rest between contractions. Even in advanced labour, most contractions last between 60-75 seconds but can sometimes get to 90 seconds. Then there’s a rest before the next once. In active labour that rest will generally be between 1-3 minutes. In earlier labour that rest will be up to 10 minutes. There is no rest with broken-bone pain. It’s constant.
Broken-bone pain is all encompassing, resulting in the release of stress hormones and injury responses in our body. Labour pain is accompanied by powerful pain-killing hormones such as endorphins. The female body is equipped for labour with strong, naturally occurring hormones that are released as labour progresses. The effect of these hormones has been compared to morphine by physiologists. (However those hormones are not as concentrated and isolated like morphine. Still, that’s a powerful comparison!) Stress makes pain worse.
Broken bones are a terrible injury; labour is a normal human process.
Broken bones are due to an accident; labour is a known and sometimes planned event. Therefore we can prepare for the intensity of labour. There are many helpful tools and strategies for comfort measures that can be done by the labouring person or their birth companions. We teach many of these in our How to Ease Labour Pain Class.
Doulas! Birth doulas can make a significant difference in how labour is experienced and felt. There’s ample research showing the benefits of doula support through birth, including shorter labours, half the rate of Caesareans, significantly fewer requests for epidurals. To my knowledge, there’s no such thing as “broken-bone doulas”. Everyone around someone with broken bones is providing medical care – good thing too. Ideally, labouring people will have someone knowledgeable with them whose only job is to provide comfort and support.
Broken bone pain is measured in weeks and months; labour is measured in hours.

* It’s interesting to note that I’ve only heard men make this comparison. Many pregnant women fear this will be the case but I’ve never heard anyone who’s gone through labour and had a past experience of broken bones say they were the same thing. I’m one of them. A couple of years before being pregnant, I broke my pelvis. There is absolutely no comparison between the two events.

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

Posted by Angie Evanson March 9, 2022in Birth Prep

This is also available as a Printable Birthplace Checklist.

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

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

General Planning

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

Parking / Transit

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

Entry & Registration:

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

Birth Unit

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

Mother-Baby / Postpartum Unit

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

Discharge

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

Services and Other Units

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

Other

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