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 – Complications and Congenital Issues

It’s one of the worst prenatal scenarios parent-to-be’s may have to face – being told their baby will have complications or congenital issues (a disease or physical abnormality present from birth). Complications can range from a variation of normal (e.g. extra digit) to one that’s moderate but can be managed with medical care (e.g. club-foot, cleft lip/palate) to something that can range from mild to having the potential to completely change a family’s life (e.g. Down’s syndrome, spina bifida). 

This article addresses some considerations for families that are expecting a baby with complications.

How severe will the Complications and Congenital Issues be?

With the testing and ultrasound schedule commonly recommended during pregnancy, surprises are uncommon. In most cases of complications, people are made aware before the baby is born.  

Until the baby is born, it’s impossible to know for sure what the severity will be. It’s important to maintain hope and a connection with your baby. Dr. Sarah Buckley writes extensively on prenatal screening, which includes false positives (a screening or test result showing an issue when there isn’t one). In that case, a suspected problem is found to be non-existant or milder than expected. 

I’ve seen several of my clients go through this terrible roller-coaster, waiting for news, expecting the worst, and then finding everything is normal on the next ultrasounds and at the birth. It’s hard for them to ever believe their baby is OK. When parents-to-be are in limbo like this, it can lessen their attachment with their unborn baby, even after further testing confirms all is well. 

Photo by Topato at Flickr. This file is licensed under the Creative Commons Attribution 2.0 Generic license.

What do I need to be aware of?

As you learn about a condition, the list of risk factors can leave parents – especially the pregnant ones – feeling like they are to blame. Find a counsellor or other parents in the same situation to help you work through these feelings. In many cases, no one is actually to blame.

Another sad reality about having a baby with complications is that it can be very hard on the parents’ relationship. Knowing that ahead of time can allow you to find resources, strategies and counsellors to help. 

Keep in mind:

  • You can have a smart, beautiful, amazing baby that happens to have a congenital complication.
  • Many humans far surpass the limits put on them by stats and well-meaning medical care providers. Don’t limit your child! Their environment and how they’re treated can really make a difference in how their potential plays out. (Of course, that’s true for most children.)
  • Focus on your child’s strengths while also being aware of their circumstances.
  • There are countless people living normal productive lives and accomplishing great things in spite of being told they’d never be able to do it…
  • Healing and thriving happens in the community. Humans are not meant to fly solo. 
  • Almost all parents struggle with worry, exhaustion, uncertainty, feel the pain of their child when they’re unwell, are learning to navigate life with a baby, love their baby and will do anything for them, have hopes and dreams for their child. This is common to parenting no matter if your baby is healthy or not.

To Prepare:

  • Seek out support groups – in person or online. Social media can be a bit of a minefield and provides a much different experience than a setting where you connect with actual humans. It can be scary, especially for introverts, to join a group but most people are glad they did so.  
  • Find an excellent online resource or two – not 10!  
    • Good sites will describe the condition in clear, understandable and kind terms.
    • Those sites will have a section directed at parents
    • Links to articles and resources that resonate with you
  • Look at images online, only from those vetted sites, so you’ll know what to expect
  • Find out what the policy is at your birth-place regarding family bonding and skin-to-skin contact in case of known complications, and yours specifically.
  • Learn about local resources from your medical community. Many places have an excellent team of social workers, occupational therapists, medical people, therapists, geneticists that can help you navigate.
  • Find out about social and government resources. You may be eligible for grants, programs, respite plans, and all manner of assistance available for families that have extra challenges related to a child with complications. Sometimes they’re hard to find.
  • Learn as much as you can about the complication:
    • Best and worst-case scenario / mild to severe case
    • Learn the language – technical terms, acceptable language
    • What future treatments might your child need? When? Is treatment invasive or painful? Is it necessary?
    • You have choices!  What does the future hold for your child without treatment or by taking a different approach?  

How can I manage my Baby’s health?

You will be your child’s best advocate and may have to become somewhat expert in their condition. Keep a binder or digital folder of every test-result, procedure, appointment. Also, have a section for resources. Do not assume every medical care provider you meet knows the full picture of the specifics of your child. 

If necessary and if you’re able, look outside of your own geographical region for treatment options.

What words and terms should I use?

The way people talk about your baby can be unknowingly hurtful. It helps everyone if you address this with those close to you. Many people want to be helpful or at least respectful but don’t know how. They tend to either stay away or blunder through, possibly adding stress or misery to your situation. 

Here are some suggestions you can share:

  • Use language that puts the human first e.g. baby with Down’s Syndrome
  • “Birth defect” is inappropriate. Terms that might feel better: Complication, congenital disability, variation of normal, congenital abnormality. 
  • A list of acceptable terms in general and for specific issues:  https://www.ncbi.nlm.nih.gov/books/NBK64884/ 

Prepare a cheat-sheet for loved ones and those that will be in your child’s life.

  1. Unacceptable terms
  2. Acceptable terms
  3. What makes the condition better and worse
  4. Special treatment the child may need e.g. can’t digest a certain food, needs a special baby-carrier
  5. What can they do that’s normal? e.g holding the baby won’t hurt them
  6. What you need – how can they help? How can they normalize life?
  7. Welcome them to visit or participate in your child’s life
  8. Links with more information
  9. Success stories, anecdotes

Online Resources:

Cochrane Review – https://www.cochrane.org/ the gold standard for reviewing and analysing medical research 
Stanford Medicine https://med.stanford.edu/ 
Johns Hopkins Medicine https://www.hopkinsmedicine.org 
Mayo Clinic https://www.mayoclinic.org/ 
Health Link British Columbia https://www.healthlinkbc.ca/ 
March of Dimes:  https://www.marchofdimes.org/complications/ (trigger alert: great info but some harsh language)

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.