Natural Birth Doesn’t Happen by Accident!

At least not in the North American Medical Model, in which the great majority of people give birth. It requires intentional preparation and planning. 

Here are Seven Ways to Help Make A Natural Birth Happen:  

  1. Strong determination and mind-set. Birth requires us to dig deep.
  2. Intentional and deliberate preparation and planning
    1. Get informed through good prenatal classes, positive stories to find the faith
    2. A solid birth-plan that communicates your wishes
    3. Learn how the female body works in the birthing process
    4. Understand what makes the pain or intensity of labour increase and decrease
    5. Dealing with past trauma might be required
  3. Advocacy 
    1. Asking questions to make informed choices 
    2. Saying no; being prepared to say no over and over if needed
  4. Tools to deal with intensity
    1. E.g. hypnobirthing, meditation, mindful yoga practise
    2. Positions that help
    3. Touch / massage
    4. Setting the tone in your birthing space
    5. TENS machine
    6. Water – bath, birth-pool (natures epidural)
  5. Dream-Team helps a lot
    1. Support person(s) that:
      1. Are a loving and/or grounding presence 
      2. Aren’t afraid of a birthing person’s pain, sounds, behaviours
      3. Know how to provide comfort
      4. Will advocate for you
    2. Doulas – research shows the presence of a doula leads to:
      1. Shorter and less complicated births
      2. Half the rates of caesareans
      3. Significantly fewer requests for pain meds
      4. Significantly more eye contact and touch between the labouring person and their partner
    3. If giving birth in the medical model, a medical care provider who supports natural birth. Ideally: 
      1. You know them
      2. You feel comfortable with them
      3. Will respect your decisions
      4. Offer shared decision making / informed choice
      5. Their methods and ideas about birth gel with yours
  6. Baby being in the optimal fetal position before labour starts
    1. Big factor in determining length of labour and intensity
    2. Factor in some interventions being used
  7. Some good luck!
    1. Health of mother and baby going into labour
    2. Medical care provider working that day
    3. When labour starts
    4. How long it lasts
  8. Allow labour to start naturally. An induced labour is a completely different experience, usually more painful and birth turns into a medical event. Barring medical reasons, be patient and wait for labour to start on its own. 

No matter how labour goes or what interventions are, or are not used, birth is hard work –  physically, mentally, emotionally and spiritually. But women have been doing it for millennia and you can too!

Checklist and Tips for Making a Birth Plan

Most people who give birth in a hospital are meeting their medical care team for the first time. Because of the circumstances, the staff do not have the time or bandwidth to get to know their patients in-depth.   

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. It’s also helpful to learn about the policies and practises at your birthplace, so you know what to put on your wish-list.

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. 

  1. 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.”
  1. 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.”
  1. 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.
  1. 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.
  1. 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. 

Perineum Care and Recovery

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 may have a freezer you can use. If not, consider bringing a cooler or just wait to use them until you return home.
  • Apply immediately after birth.

Perineum Care after your Birth

Peri-bottles are one of a new birth mom’s best friends. Kind of like a bidet in a bottle or “A soothing spritz for your lady-bits!” according to Ninja-Mama.

Here are some tips and advice about using peri-bottles:

  • Plan ahead – find out if your local hospital provides one. Most do for use during the postpartum stay and beyond. Your midwife may also provide one for homebirth.
  • If they provide at one the hospital, take it home. It’s not fancy but it works fine.
  • Plan to have one peri-bottle in each bathroom the birth mother will use. The Frida Mom (sold locally at Groovy Mama and Hello Baby) and Ninja Mama are genius peri bottles. Most hospitals provide the one pictured 3rd on the link above, and it’s also sold locally at Jolly’s.
  • Use it every time you use the toilet. Just spray while peeing or after as a rinse.
  • Warmed water or a peri-rinse such as calendula infusion feel best. Room temp will feel cold but it’s okay too.

Perineum Rinse

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 – start just before releasing urine – 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).

Sitz Bath

(Not sure why we call it that; it’s just a shallow bath! Full tub works just as well.)

  • 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.

Healing Herbs

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 and Groovy Mama in Cathedral, or Hello Baby in East.

Recovery from a 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.

Angie The Doula – Postpartum Warning Signs for Mother and Baby

CALL 811/DOCTOR/MIDWIFE WITH ANY WARNING SIGNS.  CALL 911 FOR EMERGENCY HELP!

If you call 911, have someone clear a path for EMT (halls, stairs etc), turn on outside light, put pets away, unlock door, clear driveway.)

Maternal Warning Signs

  • Vaginal bleeding heavy enough to soak a super-pad front to back in 1/2hr-1hr. Note: if blood starts to pour continuously, lay down immediately and call 911;
  • Foul-smelling bleeding or discharge
  • Passing clots bigger than a toonie
  • Temperature greater than 38C (100.4F)
  • Feeling flu-like
  • Uterus is painful to the touch
  • Uterus feels soft and is at or above the navel, and doesn’t respond to gentle massage
  • Sore, red, hot, tender area on leg or calf
  • Painful, swollen, red breasts or red / hot / lumpy spots
  • Sudden and extreme pain on nipples with feeding (may be thrush)
  • Persistent dizziness (call 911 if accompanied by bleeding)
  • Fainting (call 911 if accompanied by bleeding)
  • Feeling depressed, very anxious, unhappy or are crying without reason and cannot sleep or eat

Baby Warning Signs

  • Blue or grey in the lips, face or chest. Call 911.
  • Temperature of greater than 37.4C (99.3F) or lower than 35C (96.6F) (note: consider environment – e.g. is baby wrapped in layers in a hot room?)
  • Laboured breathing
  • Extra-sleepy and has not fed in the past 6-8 hours
  • Has not urinated or passed meconium (feces) in the first 24 hours
  • Yellow skin in the first 24 hours
  • Red patches, pimples or bumps
  • Vomits after every feed
  • High pitched cry or extremely irritable, inconsolable
  • Lethargic
  • Red, hot area around cord-stump; swelling of stump; discharge of pus, blood or meconium
  • Red blood in urine (note – some girl-babies get a little ‘period’ due to hormones)
  • Bright red diaper rash
  • White spots in mouth that don’t rub off (thrush)

Angie The Doula – Warning Signs During Pregnancy and Labour

Unusual sensations and some discomforts are part of normal pregnancies.  It is important, however, that any of the signs listed below be assessed right away.

CALL 811/DOCTOR/MIDWIFE WITH ANY WARNING SIGNS.  CALL 911 FOR EMERGENCY HELP!

If you call 911, have someone clear a path for EMT (halls, stairs etc), turn on outside light, put pets away, unlock door, clear driveway.)

Warning Signs – Seek medical advise soon, at least same day. Do not sleep on any of these or wait for them to go away on their own.

  • Reduced fetal movement that doesn’t respond to stimulation (see below) *
  • Maternal fever and chills
  • Dizziness
  • Persistent and severe mid-back pain
  • Prolonged nausea and vomiting
  • Initial outbreak of lesions or blisters in the perineal area
  • Change from normal urination – suspected bladder infection
  • Vaginal discharge with itching, irritation or a foul smell
  • Signs of bladder infection such as burning or urgent, frequent urination
  • Persistent negative feelings, low moods and/or overwhelming anxiety.
  • Gush of vaginal fluid or suspect ruptured membranes, with nothing felt to be falling out
  • Pinkish, brownish, sparse or suspected vaginal bleeding
  • Signs of labour (regular uterine contractions, waters releasing) before 37 weeks
  • If there’s a colour (yellow, brown, green) or foul odour when waters release

Danger Signs – The symptoms below may indicate a life-threatening condition, and require immediate medical attention.  Get to a hospital right away.

  • Accident or injury such as car accident or a fall (seek medical attention if required)
  • Sudden severe swelling of hands and face
  • Severe continuing headache
  • Visual disturbances (e.g., blurring of vision, spots, flashes of light)
  • Persistent, severe, sudden abdominal or pelvic pain
  • Severe epigastric pain (upper abdomen) – may feel like heartburn but more severe and not relieved by the usual tricks
  • Sudden and severe vomiting
  • Red flowing vaginal bleeding (CALL 911)
  • Persistent thoughts of self-harm, suicidal urges (CALL 911)
  • Convulsions (CALL 911)
  • Gush of vaginal fluid / suspected ruptured membranes, with a cord felt at or outside vaginal opening (cord prolapse) – get on hands and knees with buttocks higher than head (CALL 911)
20200408_121420

* Normal Fetal Movement:  If you’ve been busy or are unsure about movement then relax and have a meal, a small glass of juice or some fruit.  Palpate your baby to induce movement.  Pay attention to the movements.  Babies sleep.  If your blood sugar is low then so is your baby’s.  You should feel at least 10 movements over any 2 hour block and at least 1 in the first hour.   If not then seek medical attention.

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

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

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

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

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

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

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

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

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

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

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

If you’re planning a hospital birth then you have to figure out when to go. This guide will help you make that important decision.

Most people don’t know that the majority of naturally-starting labours are usually done at home. Some people want to get to the hospital later in the birth process. They know the longer they’re in the hospital, the more likely they are to have interventions as part of their birth. Other birth mothers simply enjoy being at home more. 

One of the benefits of working with a doula is that we help clients decide when to go. We will let you know that you won’t be officially admitted if you aren’t “far enough along” in labour. Most first time birthers without professional guidance go far too early, often by many hours. This leads to the disappointment of being sent back home. 

Please note that this is a general guide. At your prenatal appointments, ask your medical care provider if there are any specific recommendations for when you should go in. Some pre-existing conditions or medical issues lead to different recommendations from those below.

Photo by Paula O. Licensed under Attribution 2.0 Generic (CC BY 2.0)

When to go to hospital

Unless you’ve been told otherwise by HCP…

  • Pattern of sensations or contractions (explained below): 311 for a first birth or 411 for subsequent births; even sooner in labour if you have a history of fast birthing.
  • Can’t walk or talk through sensations that fall into the pattern above
  • Tip: If you feel like eating, then it’s likely too early, based on labour pattern alone
  • Lots of pressure and contractions end with a grunt, the urge to poop, bear down or “push”. 
  • Signs of labour or waters releasing before 37 weeks
  • Any health concerns (some “warning signs” are below)
  • Decreased fetal movement that isn’t remedied by eating and resting
  • When waters release? Maybe, maybe not.
  • If there’s a colour (yellow, brown, green) or foul odour when waters release
  • Want pharmaceutical help coping with pain
  • Feel safer at the hospital or want reassurance about your own or baby’s health (will be sent home if not in ‘active labour’)

Before heading in:

  • Have some juice or snack (unless you’ve been instructed to not eat e.g. schedule c/s)
  • Pee before heading out the door
  • Bring:
    • Health Card
    • Envelope with your prenatal records & birth-plan
    • Any prescription medications
  • Bonus: lip-balm and a hair-tie
  • Be ready to answer these 3 questions:

1.    What’s the labour pattern

2.    Have waters released? If so was there a colour? 

3.    Is the baby moving normally?

Warning Signs

This is a partial list. Warning signs are covered in detail in prenatal classes and health region documents.

Seek medical attention (do not sleep on these signs or wait in hopes that they pass):

  • Decreased fetal movement
  • Visual disturbances
  • Sudden and severe headache
  • Pain in upper abdomen that doesn’t pass
  • Maternal fever

911 call:

  • Red, flowing bleeding or clots
  • Sudden, severe / intense / sharp pain that brings you to your knees and doesn’t pass
  • Cord prolapse when waters release

A note about “being sent home”: It’s OK. Perhaps it’s inconvenient but it can be reassuring to get checked out, be found healthy, and then be sent home. I’ve met a lot of nice staff at various hospitals who will tell you it’s better to come in for nothing than to miss a problem.  

Note about the contraction pattern: 

  • 311 means 3 minutes between the start of one contraction and the start of the next; 1 minute from start to end of the contraction; at least 1 hour of that pattern consistently. (411 is the same except 4 min between contractions.) 
  • Use 411 as your guide if you wish to get there soon into active labour, and likely stay but maybe sent home . 
  • Use 311 as your guide if you want to be more certain of being admitted and have no need or desire to go earlier in the process

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

Angie The Doula – Basic Prenatal Nutrition

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

Nutritional Guidelines

In a nutshell, do this EVERY day:

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

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

Proper nutrition is vital before and during pregnancy and breastfeeding.

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

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

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

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

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

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

Prenatal Nutrition

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

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

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

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

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

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

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

Why Prenatal Vitamins?

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

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

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

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

Decrease or Avoid:

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

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

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!

For more information, class updates, and fun, follow me on Instagram, Facebook and Twitter!