Category: Safety

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.

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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.

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.

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“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.

Making Informed Choices

Posted by on in Birth Prep, Interventions, Safety

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

In my experience, medical staff usually don’t present things as options the first time around but they are happy to answer questions when asked.

Read More “Making Informed Choices”

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)

Exercise During Pregnancy – What To Know

Posted by on in Birth Prep, Exercise, Pregnancy, Safety

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

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

Exercise During Pregnancy 1

There are many benefits to exercising during your pregnancy:

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

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

Relaxation for Birth Prep

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

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

Exercise During Pregnancy – Do’s:

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

Exercise During Pregnancy – Avoids:

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

Contraindications for Exercise During Pregnancy

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

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

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

Conditions for Assessment

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

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

Exercise During Pregnancy – Suggestions:

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

 Pelvic floor exercises are particularly important when preparing for birth:

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

Posture – While Exercising or Resting

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

Exercise During Pregnancy 2

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

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

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

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

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

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

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

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

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

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

Effects of Stress and Adrenaline on Unborn Babies

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

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

A word about “they say”:

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

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

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Here We Go Again: Facts vs Fear-Mongering in Placenta Encapsulation

Posted by on in Placenta, Postpartum, Recovery, Safety

Placenta capsulesYesterday the CBC posted another article on placenta encapsulation.  The article is low on fact and filled with fear-mongering.  Certainly an article like this should lead service-providers to pay attention to their practices, ask questions, and re-evaluate protocols to ensure safe services are being offered.  An article of this nature should also lead clients to ask questions of their encapsulators.  Unfortunately, when a big media company publishes an article with an inflammatory headline, most people don’t read through, and of those that do, few know how to evaluate the information presented.

Let’s get to the facts.

Read More “Here We Go Again: Facts vs Fear-Mongering in Placenta Encapsulation”

Drying Up Breastmilk

Posted by on in Breastfeeding, Postpartum, Recovery, Safety

While breastfeeding is actively promoted in almost all Canadian communities, a new mother may need or want to prevent further lactation or dry up her milk.  Reasons include still-born, surrogacy, medical conditions requiring treatment contraindicated with breastfeeding, past abuse, and lifestyle choices.  For many women it’s a very difficult decision.  Women need acceptance and supported in their choices.  To that end, here’s information to help a woman cease lactation in the safest and least painful way.

Read More “Drying Up Breastmilk”

Inaccurate Reporting on Encapsulation and GBS

Posted by on in Birth Prep, Placenta, Safety1 Comment

The report alleging an infant being infected with Group-B Strep bacteria from placenta capsules is completely inaccurate. In reading through the details (summarized below), you’ll see that it’s impossible that the placenta capsules were the source of infection. This is not a study, but rather a media article.  One story is never a scientific study.  As is often the case in anything birth-related, the headline is misleading.

Read More “Inaccurate Reporting on Encapsulation and GBS”