Category: Labour

Summer pregnancies & hot births!!

Posted by on in 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. 

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.  

C-19 Updates in Birth and Postpartum Care in Regina

Posted by on in 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.

*****

Hospital Update

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.

03A47318

 

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.

Doctor

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

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

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

◆ Nitrous-oxide (“laughing”) gas is available for pain management. If 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.

Birth Room

𝐏𝐫𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞

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

𝐀𝐧𝐭𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞 (𝐋𝐚𝐛𝐨𝐮𝐫 & 𝐁𝐢𝐫𝐭𝐡)

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

𝐏𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐂𝐚𝐫𝐞

● Doors that don’t have an admitting desk are locked tight; security will not let anyone in. That includes the convenient door just below the MBU.
● Families are being asked to stay in their room as much as possible.
● Support people may not visit any other patient areas.
● Food trays are being provided for new moms in the MBU.
● Breastfeeding class in the unit is still running but only birth mother and baby attend, 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 on in 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”.

  1. 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.
  2. 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.
  3. Broken bones are a terrible injury; labour is a normal human process.
  4. 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.
  5. 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.
  6. 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.

Doulas and Dads

Posted by on in Birth Prep, Birth Support, Dads, Doula, Labour

Although the information here will reassure any partner, this article intentionally addresses dads-to-be. All the quotes, links and videos are made by dads for dads-to-be, about their most common concerns about birth support:  1) Value; why should we pay for a doula if I’m going to be there?  2) Why do we even need a doula; what does she have that I don’t?  3) How will I be included if a doula attends?

Read More “Doulas and Dads”

𝗗𝗼𝘂𝗹𝗮𝘀 𝗮𝗻𝗱 𝗣𝗮𝗿𝘁𝗻𝗲𝗿𝘀: 𝗪𝗼𝗿𝗸𝗶𝗻𝗴 𝗧𝗼𝗴𝗲𝘁𝗵𝗲𝗿. Top 3 𝗠𝘆𝘁𝗵𝘀 & 𝗥𝗲𝗮𝗹𝗶𝘁𝗶𝗲𝘀

Posted by on in Birth, Birth Support, Dads, Doula, Labour, Partners

Some couples worry that the partner will be relegated to a minor role if a doula attends the birth. On the other hand, some pregnant women worry that their partners will not be very helpful but are hesitant to suggest a doula for fear of hurting the partner’s feelings. Many partners want to help but feel insecure about their ability to meet all of their loved one’s needs.

𝗠𝘆𝘁𝗵 #1: Partners can do all the labour support on their own.

𝗥𝗲𝗮𝗹𝗶𝘁𝘆: While this may be true for a minority of couples, many partners are not equipped to be the primary birth support. Doulas are specifically trained in emotional and physical support such as comfort measures. They understand the birth process and what to do at various stages and situations. Besides, partners are going through their own birthing journey and need support too.

𝗠𝘆𝘁𝗵 #2: Doulas displace partners and interfere with the couple’s intimate experience.

𝗥𝗲𝗮𝗹𝗶𝘁𝘆: Research shows more eye-contact and physical touch between couples when a doula is present; they usually work more closely together. Doulas help couples clarify their expectations of each other and then make space for partners to participate at their comfort level. When the partner chooses to be the primary emotional support, the doula can supplement their efforts by running errands, making suggestions for comfort measures, etc. During a long tiring labor, she can give the partner a break. While the doula probably knows more than the partner about birth, hospitals and maternity care, the partner knows more about the woman’s personality, likes and dislikes, and needs. Moreover, they love the birthing woman!

𝗠𝘆𝘁𝗵 #3: Doulas are there only for the birthing client.

𝗥𝗲𝗮𝗹𝗶𝘁𝘆: Of course the labouring woman is the priority but doulas support partners too! Medical staff have other priorities that may compete with the emotional care of their patient; e.g. breaks, shift changes, clinical responsibilities, office hours and hospital policies. Client care is the doula’s priority. She is not just another stranger with the couple. They’ve met prenatally until they know each other and feel ready as a team. Doulas understand the dreams, wishes, goals of the birthing person and the partner. By making sure that the partner’s needs are met (e.g. food, drink, reassurance, and maybe even rest), the birthing woman and partner can work more closely together.

As one partner said, “I heaved a big sigh of relief when she (the doula) walked in. I hadn’t realized how much pressure I had been feeling. She not only calmed my wife, she calmed me down. I was able to support my partner MORE when the doula was with us!”

Released Waters (aka Ruptured Membranes or Water Breaks) and What to Do!

Posted by on in Induction, Interventions, Labour, Safety

Your waters just released – now what?  When you water breaks, it can be released as a few drops at a time or in a gush.  Less than 10 per cent of Pregnant people will experience waters releasing before labour has started.  When this happens, labour usually starts within 24 hours.  The other 92 per cent will release at some point during labour, usually in active labour.  Here is information on self-care and warning signs.

About 75 per cent of those with PROM at term (“premature rupture of membranes” i.e. before labour starts but at full term from 37 weeks on) give birth within 24 hours. This increases to 90 per cent within 48 hours and 95 per cent by 72 hours.  People often worry about infection after waters release.  Note that risk of infection increases with internal exams (cervical checks), fever, and being confirmed GBS-positive.

Warning Signs Regarding Released Waters

If any of these occur, seek medical attention in a timely manner. Contact your medical provider and/or go to hospital – calmly but don’t wait.

  • Waters release before 37 weeks.
  • Fluid is coloured (yellow, green, brown) or has a strong smell.
  • Any signs of fever.
  • Baby isn’t moving normally and doesn’t respond after you’ve had a snack, rested and paid attention.
  • This last one is a 911 call! If you feel a cord between your legs or at the vaginal opening, assume a “child’s pose” with bum in the air (on hands and knees with chest on the ground) and call 911.

20200408_121420
“Child’s Pose” with bum in the air

Self-Care After Membranes Release

  • Nothing inside! That includes internal examinations unless there’s a good reason to do one. There’s a correlation between time on first internal exam and onset of infection; the earlier the initial internal exam, the higher the risk of infection.  Risk of infections goes up with number of internal examinations.
  • Baths in your own tub at home are fine. Once you’re in active labour then baths are also fine in your private birth room.  Use showers instead when in public spaces (e.g. hotel, hospital assessment washroom).
  • Be aware of signs of infection such as fever. Take your temperature every 4-8 hours during awake hours.
  • Stay hydrated. Consider if you’ve had a steady stream of fluid or just that early trickle.  It’s also possible to have a little “high leak” without membranes fully  releasing.  A healthy mama/baby will continue to make amniotic fluid.
  • Take care of hygiene:
    • Wear a clean pad and change it often
    • When using the toilet, one wipe from front to back per tissue
    • Wash hands before and after using toilet or changing pads

Go to Hospital… or Not?

This should be discussed with your midwife or doctor at prenatal appointments ahead of time in case they have specific instructions for you.  If fluid is clear then you may have the choice to stay home or contact your medical care provider for options. Generally there are 3 things assessed at hospital:

  1. Baby’s health (by listening to fetal heart tones);
  2. Maternal health (vital signs and interview); and
  3. Presence (or absence) of amniotic fluid (the “waters”) present, usually by doing a cervical check/internal exam.

If you go to hospital and you’re not in active labour, you will likely be offered a sterile-speculum exam (think PAP test); the purpose being to confirm your waters actually released.  This is optional, although it’s not usually presented as such.  Other ways to determine if waters actually released may included simply asking the pregnant woman or dipping the testing swab into her wet pad.

  • If you previously tested “GBS positive” then your medical care provider may recommend induction.
  • If you previously tested “GBS negative” then may be offered induction but will more likely be sent home to wait for labour to start.  If labour hasn’t started within 24 hours then your medical care provider may recommend induction.

Your Options

  1. Go to hospital for maternal and baby assessment but decline internal examination.
  2. Go to hospital and consent to all of it – sterile speculum exam, maternal and baby assessment.
  3. Stay home and wait for labour to start, barring any warning signs or health complications.  Practice good self-care, be aware of warning signs, and pay attention to your baby’s movements.

Further Info:

This is the best handout I’ve seen for clients – What to do When Your Water Breaks Before Labour. It has graphics and is research based. It’s easy to understand.

Here is an excellent, detailed research article about obstetrical care of women with Premature Rupture of Membranes (PROM) at term (37+ weeks), including discussion of differences in outcomes with GBS positive and negative, options, and when labour typically starts. This document contains studies and stats.

Pregnant Woman by ocean

I teach a variety of Child Birth Education classes and prenatal workshops online for students all over.  I have been a birth doula since 2002, and have helped over 300 mothers 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.

How to Avoid Birthing on Your Back

Posted by on in Birth, Birth Prep, Labour

Did you know you don’t have to lay on your back to give birth?

Even though almost no one says, “I want to lay on my back to give birth”, that’s how the majority of women in North America – probably other places too – do it. Why? Because even if they’re in a more comfortable position, they’re told, “OK it’s time to have your baby – get on your back.” 

I’ve seen many people give birth on all hands & knees, squatting, on their side or even standing. Midwives and many doctors know how to catch babies in any position. It’s just a habit for the staff to tell their patients to get on their back.

How can you avoid this uncomfortable and ineffective position?

  1. Don’t get into the position in the first place. It’s hard to get out of it once you’re there.
  2. Just say NO!!!  Or say nothing but give a good emphatic head shake.
  3. When you get bugged over and over, keep saying NO and shaking your head!!

Sounds obvious but saying NO and continuing to refuse is not that easy. Check out my video about the Tend & Befriend Stress Response that makes it so difficult to not just do what we’re told during labour.

Here are a few tips:

  1. We do the thing we’re used to when we’re in a stressful or vulnerable situation – which describes birth for many people. Practise getting on your bed on “all 4-s”. Every night, just get on your hands and knees and do a few little stretches – even 5 seconds – then lay down. It will start to feel normal to get on a bed without laying down.
  2. During labour, crawl up onto the bed and take positions that feel good for you. No one will wrestle you to your back. At least I sure hope not – if that happens, it’s assault.
  3. Ensure you have a birth companion who can advocate for you and help you find your voice and your best position.
  4. Avoid getting on your back for cervical checks when the birth is imminent, as it’s hard to get out of that position. If you know your baby is moving down well maybe there’s no need to check. Many MCP know how to check a cervix in a variety of positions.
  5. If you have an epidural and are confined to bed, there are still many positions available to you.

You don’t need to ask permission to assume positions of your choice!  However, if there’s a medical complication that requires certain interventions or positions, then it may be safest for you to give birth on your back – but those are not common.

Of course if it feels good to be on your back, then great – go for it!  It’s very uncommon but possible. In my dreamy, ideal birth world, everyone would be in the position that feels best for them.  

I’m AE, prenatal educator and doula. You can find all kinds of information about classes, pregnancy, birth and postpartum on my sites listed below.  I wish you an empowering birth. Thanks for watching.

Angie The Doula – Tips and Recipes for Labour-Aid Drinks

Posted by on in Birth Support, Labour, Nutrition1 Comment

Here are some alternatives to store-bought sport drinks, which are usually full of chemicals and unhealthy ingredients. High quality coconut water is full of electrolytes. Any bone broth works too for Labour-Aid.

Labour-Aid and broths are excellent for hydration, energy and electrolytes.  They help keep the powerful forces of labour progressing.  Stock the ingredients at home and prepare at the first sign of labour.  Or make ahead (this is a great task for someone who wishes to help out) and freeze as cubes, popsicles, or in a bottle, to be thawed and consumed as labour progresses.

Most labouring women prefer their labour-aid chilled and their broths warm.

LABOUR-AID DRINK – basic (recipe shared by many midwives and natural birth books)
1 L  water or Pregnancy Tea
1/3 C  raw honey or real maple syrup
1/3 C  juice, fresh-squeezed from a real lemon
1/2 t  salt, preferably Celtic or Himalayan
1/4 t  baking soda
2 crushed calcium tablets

LABOUR-AID DRINK – easiest (recipe by Head to Heal Wellness)
1L water (for hydration)
1 Tbsp honey (to give us fuel while being active)
1/4 Tsp salt (to replace the loss of electrolytes)
1/4 Tsp baking soda (to replace electrolytes lost)
1/2 a lemon
Combine all the ingredients into a glass container and stir. You can tweak the amounts based on your personal preference and needs. Squeeze as much lemon as you like until you find your favourite ratio. Voila!

These next two versions are from Mommypotamus.  See the website for details of ingredients.

LABOUR-AID DRINK – Lemon Labor Aide
4 C  water
1/2 C  freshly squeezed lemon juice
1/4 t  salt, preferably Celtic or Himalayan
1/4 C  raw honey (or more to taste)
a few drops concentrated minerals (available at health stores, optional)
a few drops Rescue Remedy (optional)

LABOUR-AID DRINK – Coconut & Lime Labor Aide
3 C  coconut water
1 C  water (or more)
1/2 C  freshly squeezed lime juice
1/4 t  salt, preferably Celtic or Himalayan
2 T  raw honey or maple syrup
a few drops concentrated minerals (available at health stores, optional)
a few drops Rescue Remedy (optional)

VEGGIE BROTH
Add fresh or dried veggies (e.g. carrots, celery, onion, garlic – anything) to boiling water
Simmer for 20-30 min
Add 1 T  apple-cider vinegar
Season with any herbs or spices you like
Add salt to taste, preferably Himilayan or Celtic (kelp powder can be used instead)
Blend to smooth consistency or strain veggie chunks out

BONE BROTH
Put bones and any left-over bits, including meat on bones in pot and cover with water.
Add 1-2 T  apple cider vinegar
Bring to boil then simmer (large bones such as beef for up to 24 hours; small animal bones such as chicken only need 3-4 hours)
Strain
Add salt to taste, preferably Himilayan or Celtic (kelp powder can be used instead)
Optional:  Add dried or finely chopped fresh veggies, herbs or spices and simmer for another 30min

Angie The Doula – Postpartum Warning Signs for Mother and Baby

Posted by on in Baby Care, Birth Prep, Interventions, Labour, Postpartum, Pregnancy, Recovery, Safety

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

Posted by on in Birth, Birth Prep, Interventions, 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)
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* 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.