Choice of Birthplace: First Time Moms

Choice of Birthplace: Second Time Moms

Video – Choosing Homebirth

Resources About Homebirths

Giving Birth in the Hospital

Deciding how to Give Birth after Cesarean Section (VBAC)

Pregnancy After Age 40

Ultrasound in Pregnancy

Prenatal Screening

Bleeding in Pregnancy

Nausea in Pregnancy

Weight Gain in Pregnancy

Iron Deficiency Anemia

Iron deficiency anemia and you > (For other languages click here.)

Blood Sugar Instability & Gestational Diabetes

Normalizing Blood Sugar: What are the benefits of maintaining stable blood sugar levels?

• Feel better and have more energy

• Minimize nausea

• Minimize strain on internal organs and body chemistry

• Minimize chances of hypertension

• Maintain stable internal body chemistry and prevent candida/yeast growth

• Maintain mineral stores. Sugar is associated with depleting minerals like calcium.

• Grow a average-sized baby, have an easier labour, increase your chance of spontaneous vaginal delivery without the need for intervention

• Minimize weight gain without “dieting”

• Return to your pre-pregnancy/ healthy weight easier and more naturally

How can I promote normal blood sugars?

Focus on a variety of healthy foods

As always, eat a variety of wholesome foods: fresh vegetables, fruits, grains, beans, quality dairy and meat (unless you are vegan/vegetarian), as well and unrefined oils and fat.

Balance your meals

Foods should be partnered together for taste, enjoyment but also to reduce a glycemic rise. For example, combining carbohydrates with protein (salad and fish, rice and chicken), and fruit with fat (pear with nuts, banana and yogurt). These combinations allow sugars to be released slowly, instead of all at once.

Eat small frequent meals

Eat smaller portions more frequently. Take the food you might normally eat in three meals and divide it into six, evenly spaced throughout the day. This can reduce digestive stress, and allow your meal to digest more easily, as well as keeping your blood sugar from having wide fluctuations throughout the day.

Be active every day

Developing a daily exercise program is as important as eating well. Being active helps in two ways. First, every time you exercise, you use up blood sugar and keep levels lower for several hours. Exercising for a few minutes after every meal (even just a ten minute walk around the block), when your blood sugar levels are elevated, is an excellent practice. Secondly, exercise that builds muscle will create more cells that use up blood sugar, even while you are sleeping.

Eat less processed, closer to whole and raw

Eat foods in their natural unprocessed form. For example, whole fruit causes a lower blood sugar rise than fruit juice. Grains cooked until they are mushy cause a greater blood sugar rise than when they are al dente. Processed foods breakdown much faster than their whole counterparts, thus quickly creating a sugar rise. For example, white rice will digest quicker than brown rice.

Reduce stress

Reduce stress, which causes blood sugar to rise. Meditate, breathe, do yoga, get a massage, take a bath with lavender & epsom salts, ask for support, or whatever it takes.

Take a good quality prenatal supplement

Taking a good quality prenatal supplement helps your body cope with the physiological stress of pregnancy. To help specifically with blood sugar control, choose a prenatal supplement that has about 20mg of zinc and 200mg of chromium. Both can be toxic in large dosages, so more is not better. B-vitamins and vitamins C and E are also important.

At the same time, it is always better to get your nutrients from whole food, so do not count on your supplement to cover gaps if you are skipping meals or eating fast food.

Eat some Omega-3s every day

Make sure you get a source of Omega-3 fatty acids every day (tip: get the burpless kind!). These help the insulin in your body work to lower high blood sugar and minimize weight gain. Omega-3 fatty acids are also essential for healthy fetal and infant brain development and for preventing pre-eclampsia and premature births.

Good sources of Omega-3s include:

• One serving of cold water fatty fish such as salmon, halibut, mackerel, or sardines

• 3 Tbsp of ground flax seeds

• 1 Tbsp of flax oil

• Fish oil supplements (DHA plus EPA)

• Grass fed meat & dairy

Choose healthy fats

Choose cold pressed olive oil, coconut oil, ghee or butter over refined vegetable oils. Reduce the amount of harmful fats you eat, such as “vegetable oils” and fried foods. Also avoid trans-fatty acids and partially hydrogenated fatty acids, which are found in most margarines and commercial crackers, cookies, cereals, and many other processed foods.

Choose lower Glycemic Index carbs

Choose foods with a lower glycemic index [see below]. Only carbohydrate foods raise blood sugar. Protein and fats don’t. Remember that a diet of all proteins and fats is not healthy as you need the fiber and nutrients of carbohydrate foods.

Avoid food binges

Be aware that binging – eating a lot of carbs at once, especially high Glycemic Index (IG) foods like fruit, bread, and pasta – can cause sharp rises in blood sugar. Whenever you have a sugar craving or an urge to binge, think about whether you have eaten enough protein in the last day – maybe you are just hungry for more nutrients. Also consider whether you might be dehydrated, as sugar cravings can be disguising thirst.

What about low Glycemic Index foods?

Some carbohydrate foods cause a significantly higher rise in blood sugar than others do. Predicting which ones will do this is not easy, so you will need to look them up on tables of what is called glycemic index (GI).

Low GI foods

All watery vegetables (as opposed to starchy ones like potatoes and parsnips) can be eaten in unlimited quantities. Beans are a carbohydrate food (also containing good protein) with a very low GI, so are good to eat.

Adding fat or protein to your meal will lower the GI index of a higher rated food. For example, a baked potato is a high GI food. When eaten with butter, a salad as a side and a chicken breast, the meal becomes well balanced and wholesome.

Intermediate GI foods

Rice is an intermediate glycemic index food. Eating it slightly undercooked, rather than mushy, is better. Parboiled and basmati varieties are better than others. Sticky rice, puffed rice cereal, and rice cakes, however, raise blood sugar a lot. You might try substituting barley sometimes, which takes a long time to cook, but tastes great (even for breakfast), and has a very low GI. You can make enough for several days and then heat up portions in the microwave.

High GI foods

Foods that cause an especially large rise in blood sugar include:

Any bread, cracker, cookie or pastry made from wheat flour (white or whole wheat). Bread with rye flour as the first ingredient is better, as is bread with a significant proportion of unground grains (such as whole wheat berries or rye berries or cracked wheat), oatmeal, seeds, nuts or barley

Most commercial breakfast cereals.

Potatoes, especially the large baking kind. Small new potatoes, slightly undercooked, are better

Watermelon and tropical fruits, especially overripe ones such as bananas with brown spots on the skin. Many other fruits, including cherries, grapefruit, and dried apricots, especially if not overripe are much better. Greenish bananas are okay.

This doesn’t mean that you can never eat these foods again. It would probably be okay to eat small servings of them occasionally (like one slice of bread or one pancake, several times a week), especially when eaten with proteins or with carbohydrates with a lower glycemic index.

Glycemic Index Foods:

Low GI (55 or less) - choose MOST often

Medium GI (56-99) - choose MORE often

High GI (70 or more) - choose LESS often

How can a nutritionist help me?

A nutrition consult is not just for those who have weight problems or are diagnosed with Gestational Diabetes. There are numerous issues a nutritionist can help with:

• Motivation & inspiration

• Recipe ideas

• General education

• Low energy

• Genetic susceptibility to disease

• Anxiety

• Depression

• Addiction withdrawal

• Frequent illness

• Pre-eclampsia

• Edema

• Itchy skin

• Abnormal weight gain

• Abnormal circulation

• Autoimmune disease

• Allergies

• Iron deficiency or anemia

• Gestational diabetes

• Spilling protein in urine

• Frequent urinary tract infections

• Frequent yeast infections

• Sluggish digestion

• Bloating

• Excessive gas

• Constipation

• Nausea

• Cravings

• Acid reflux

• Irritable bowel

• Postpartum meal planning

• Nursing nutrition

• Infant nutrition concerns

• Colic

What is Gestational Diabetes?

Gestational diabetes has many names: pregnancy diabetes, gestational diabetes mellitus, GDM, glucose intolerance of pregnancy. It is related to the normal change in sugar metabolism during pregnancy that promotes growth of your baby. In some inidividuals, pregnancy hormones may diminish the effects of insulin and blood sugar levels can get excessively high.

How might GDM affect me?

The primary risk of GDM is growing a large baby (more than nine pounds or four kilograms.) This puts you at higher risk of having a difficult labour or birth. The possibilities include induction, forceps delivery, shoulder dystocia, postpartum hemorrhage and/or cesarean section. Of course there are healthy reasons for having a large baby, such as genetics and good diet, and these are not reasons for concern. By far the majority of large babies are born to people who do not have GDM.

Often people with GDM may not have any diabetic symptoms: intense thirst, unusual hunger, and passing large amounts of urine.

Being diagnosed with gestational diabetes does make you at higher risk of developing adult-onset diabetes within 10-15 years if you are already overweight. Knowing this gives you the chance to implement lifestyle changes that may prevent this from happening. This fact may be a good reason to be tested for GDM.

How can GDM affect my baby?

Besides the effects of a difficult labour or birth, babies of individuals with GDM are at higher risk of hypoglycemia after birth (low blood sugar, as the newborn’s pancreas has been working at a high level to use up the blood sugar it was receiving in the womb). Feeding immediately after the birth can help to prevent this.

It is believed that complications for both clients and baby are proportional to the degree of glucose intolerance – the higher your blood sugar measurements, the more at risk you and your baby are.

What are risk factors for GDM?

• Previous gestational diabetes

• Previous baby >4kg

• Obesity (BMI >25)

• Age >25

• Sugar in the urine

• Mother/father/sibling with Type II diabetes

• Unexplained pregnancy losses

• Native, Black, Asian or Hispanic ethnicity

• Pregnancy induced hypertension

How is GDM diagnosed?

SCREENING: Oral Glucose Challenge Test – OGCT

At every prenatal appointment, your caregiver will palpate your growing abdomen, as well as measure your uterine size (symphysis-fundal height) after you reach 20 weeks. This can give feedback on whether your baby feels or measures larger than average.

A blood test specifically for GDM is offered between 24 and 28 weeks gestation. It is called the Oral Glucose Challenge Test (OGCT). Before this test, try to eat a breaskfast with protein (bacon and eggs), so that your blood sugars aren’t high before having this test! You will be asked to drink a 50g sugary drink at the clinic, and have your blood drawn in one hour after that. This screening test gives us an indication as to how your pancreas was able to “mop” up the glucose. If the lab values come back higher than 7.8 mmol/L, then the next step is the diagnostic test.

DIAGNOSTIC TEST: Oral Glucose Tolerance Test - OGTT

This test is a little different than the OCGT. It involves fasting the night before, drinking 75g of the sugary drink, and having your blood taken three times: before the drink, one hour after the drink, and two hours after the drink. Diagnosis of GDM is made if one of these three lab values are high.

Are there drawbacks to testing?

Some pregnant clients find that drinking the sugar causes them to be nauseous or even vomit. There may also be concerns about the effect on the baby of fasting and then sugar loading. It may help to make your last meal one of high quality protein such as eggs, beans or lentils to aid in stabilizing the blood sugars.

GDM is said to occur in 2-3% of pregnant individuals, but testing is not considered very reliable. Of those who test positive, 70% will have babies weighing less than 9 pounds even with no treatment. Also, the majority of babies weighing more than 9 pounds are born to mothers with normal blood sugars. Research has shown that people with diagnosed GDM – whether or not they receive treatment – have an increased risk of cesarean section without any demonstrated improvement in outcome for mom or baby.

Of note: if you pass the test, this does not mean that you are free to eat lots of sugar and forget about good nutrition! Even if you are not diabetic, you can still grow an overly large baby by eating a diet full of refined sugars and highly processed food.

What are my options for treatment?

If you are diagnosed with GDM, you will be referred to the Diabetic Clinic for counselling in testing your blood sugars, modifying your dietary habits, and using exercise to keep stable sugar levels.

Counseling at the Diabetic Clinic will include information about how to maintain a Low Glycemic Index diet and how to test and record daily blood sugars for a number of days. Follow-up will depend on the results of these blood sugars – if they are within normal limits, then you likely won’t need further follow-up; or you may need a few adjustments to your regime.

If your blood sugars are difficult to get within normal range, you may need insulin to control your blood sugars. Your midwife will arrange a referral with an Endocrinologist and an Obstetrician, who will manage your care, while your midwife will continue to provide supportive care.

What about follow-up after the birth?

For those with gestational diabetes, your baby will have its blood sugar tested two hours after the birth, to make sure that it is not experiencing hypoglycemia (low blood sugar due to their pancreas being used to high levels of glucose). Breastfeeding immediately after birth is the best way to prevent this.

After birth, your blood sugar levels usually return to normal right away. At six weeks postpartum, it is recommended that you be tested again with the two hour fasting glucose test (OGTT) to make sure you haven’t developed Type II Diabetes.

Natural/Alternative Treatments:

Some suggestions to try guava leaf tea. A 2010 review of evidence from clinical trials and animal studies suggests that guava leaf tea may help improve insulin resistance and lower blood sugar levels.

Answers About Rh Immune Globulin

Rh refers to your blood type. You are either Rh-positive or Rh-negative. In Canada, about 85% of pregnant people are Rh positive and 15% are Rh negative.

If you are RH negative, your red blood cells do not have a marker called Rh factor on them. If you are Rh positive, your blood cells do have this marker. If your blood is exposed to blood with this marker (D positive blood), your immune system will react to the Rh factor by making antibodies to destroy the blood cells carrying it.

The Rh factor can cause problems if an Rh-negative client and an Rh-positive partner conceive a baby that is Rh-positive. It is not possible to know if the baby is Rh-positive until birth.

Isoimmunization

There are two steps involved in “sensitization” (also known as isoimmunization) when the your blood sees your baby’s blood as foreign:

1. Transplacental hemorrhage: During pregnancy, although you and your baby have separate blood systems, blood from the baby can sometimes cross the placenta into the your system.

2. Antibody formation: If the baby’s blood has mixed into the your system, you can become sensitized. This means you produce antibodies to fight the baby’s blood as if it were a harmful foreign substance (Antibodies, for example, help us fight infections and viruses and are our body’s way of getting rid of whatever seems harmful to us). If these antibodies then cross the placenta to the baby, they will attack the fetal blood cells.

Once formed, antibodies are permanent. During the pregnancy when sensitization occurs, the baby is usually born before you develop enough antibodies to harm the baby. The concentration of antibodies becomes higher in later pregnancies, therefore the danger is greater for babies born after you have become sensitized, so in subsequent pregnancies.

What factors can cause Rh sensitization?

Sensitization can also occur after any physical violence, accident (such as a car accident) or procedure that might involve or cause bleeding from the placenta. These include, amniocentesis, chorionic villus sampling, abdominal injury, abruption of the placenta, miscarriage, placenta previa or external version of a breech baby.

Sensitization can occur even if a pregnancy ended in miscarriage, abortion, cesarean, or was an ectopic pregnancy.

How do I know if I have become Rh sensitized?

Your blood can be tested anytime to determine if you have any antibodies. This is usually done in the initial blood work, again at approximately 28 weeks, and then again shortly after the birth.

What happens if I become Rh sensitized?

Rh sensitization can result in hemolytic disease of the newborn. The seriousness of this condition can vary. Some babies have no symptoms. In more severe cases, problems such as hydrops can cause the baby to die before, or shortly after birth. Severe hemolytic disease of the newborn may be treated before birth by intrauterine blood transfusion.

In some babies, Rh sensitization becomes apparent during pregnancy, other times, the first sign is jaundice in the first 24 hours, which usually requires a transfusion and intensive care.

There are no immediate consequences to you if Rh sensitization occurs.

How can I try to prevent sensitization?

The most commonly accepted treatment is injection with Rh(D) immunoglobulin. In Canada, Rh(D)IG is packaged and sold as WinRho.

Although 90% of sensitizations occur during birth, 1-2% occur before the baby is born. Because of this, Rh(D)IG is offered at 28 weeks of pregnancy. It is protective till the birth, when there is the greatest risk of sensitization.

After the birth, the baby’s blood is tested for blood type. If baby is Rh+, you will be offered another dose of Rh(D)IG within 72 hours.

Rh(D)IG should also be administered within 72 hours of any other incident or indication (such as amniocentesis, abdominal trauma or any bleeding from your uterus).

How effective is the treatment?

Rh(D)IG reduces, but does not eliminate the possibility of Rh sensitization. The risk of sensitization after birth of an Rh+ baby is:

• 7 - 17% without treatment

• 1 - 2% with postpartum treatment only

• 0.1 - 0.2% with antenatal (at 28weeks) and postpartum treatment

What are the risks of treatment?

Rh(D)IG is developed by injecting human volunteer donors (Rh-negative) with the positive Rh factor, then drawing their blood once antibodies have been formed. This blood is treated and screened for viruses (such as HIV and Hepatitis) and concentrated into a serum for injection. Rh(D)IG is a human-blood product and therefore is at risk of containing unknown viruses.

Injection of Rh(D)IG carries the risk of anaphylaxis, an extreme and very rare allergic reaction.

Some brands of Rh(D)IG, such as RhoGam which is used in the United States, contain the preservative thimerosol, which is a mercury derivative. Mercury crosses the placental barrier. The Canadian version, with the brand-name WinRho, does not contain a mercury preservative

Are there any alternative treatments?

There are no known alternative treatments to Rh(D)Ig injections.

Q & A on Tdap Vaccination Against Pertussis (Whooping Cough) During Pregnancy in Canada

Tdap (Tetanus, Diphtheria, Pertussis/Whooping Cough)

Tdap vaccination should be offered to all pregnant people in every pregnancy, regardless of previous Tdap vaccination history, as a means of protecting the infant from pertussis. (2, 3)

The National Advisory Council on Immunizations recommends vaccination between 27 and 32 weeks (3); the SOGC recommends Tdap between 21 and 32 weeks. (2)

Tdap vaccination in pregnancy is generally not covered by OHIP and is outside midwifery's scope of practice, necessitating a referral to a physician. The cost is covered by OHIP only when a client has not received a Tdap vaccine.

Heartburn Causes: 

• Change in angle of gastroesophageal sphincter and increase in intragastric pressure due to gravid uterus

• Uterus displaces stomach upward, rotates stomach.  Delayed gastric emptying

• High levels of progesterone, relaxin, estrogen – decreases resting pressure of lower esophageal sphincter

• Intensifies with advancing gestation, ends after delivery

• Antacids – may provide relief but long-term use can impair iron absorption.

• Tums, calcium carbonates may cause rebound heartburn

Natural Health Tip:

Papaya Powder Capsules: This tropical fruit encourages digestion, eases indigestion (and constipation), and is known to relieve heartburn. The magic is in the enzymes papain and chyomopapain, which break down proteins and soothe the stomach by promoting a healthy acidic environment. Clients can also try TUMS, raising the head of their beds, etc.

Other management techniques:

• 4 almonds chewed very thoroughly in mouth

• dried papaya chips, yogurt, soy milk, peppermint tea

• elevate head of bed 5 inches

• stop smoking

• sleeping in a left lateral position

• avoid reclining 2-3 hrs post eating

• don’t drink and eat together

• eat smaller more frequently

• stress free mealtime

High blood pressure is also called Pregnancy Induced Hypertension (PIH). In pregnancy, some people's blood pressure can become elevated, which can lead to complications in pregnancy. Symptoms such as high blood pressure readings, frontal headaches, seeing spots in front of one's eyes, upper right quadrant pain, and swelling of the legs, feet, hands, and face are common when blood pressure becomes elevated. These symptoms would be a reason to page your midwife. High blood pressure may also affect your baby, as the pressure of the blood through the placenta increases. This may become a medical emergency and necessitate medication or delivery.

If you have had high blood pressure in a previous pregnancy, your midwife will recommend that you start on aspirin in this pregnancy to avoid PIH.

If your blood pressure is starting to climb, here are some things to try to slow or stop the development of clinically high blood pressure. Sometimes despite our best efforts to de-stress and support our body, it is impossible to avoid Pregnancy-Induced Hypertension:

• Drink 2-3 L of water daily

• Eat nutritious meals, not trans fats

• Eat tabbouleh (parsley minimizes swelling)

• Moderate exercise, especially if calming, such as yoga or walking

• Swimming (hydrostatic pressure minimizes swelling, decreases stress)

• Epsom salt baths – 2 cups in a tub, daily

• Lavender essential oil – 3 drops in bath

• Full body massage 1-2 x/week

• Foot massage, evenings

• Stop work

Baby Health:

Sometimes continuously high blood pressure can start to have an effect on your baby.

For this reason, we recommend:

Fetal movement counting, daily. Pick a time of day that baby is normally active and count how long it takes to get 6 movements. If you don’t get 6 movements in two hours, page your midwife.

Cervical ripening if over 36 weeks gestation: The cure for high blood pressure is birth. When your blood pressures get too high, induction is usually advised. For this reason, anything that speeds the ripening process and increases the chance of a natural labour or straightforward inductions is positive.

• Evening primrose oil: 3000 mg orally a.m., 1000 mg vaginally at bedtime (you can cut the top off the get capsule and put into your vagina as high up as possible).

• Homeopathic Caulopyllum: 200 c 4x daily

• Acupuncture labour stimulation

• Cervical sweeps: cervical massage, membrane stripping/sweeping

Your midwife may have these further suggestions:

• More frequent BP checks - possibly including checking your own BP at home (in morning after voiding)

• Calcium supplementation – 2 mg daily

• Magnesium supplementation – 150-200 mg 4 x daily

• Skullcap tincture – 15 drops, 3 x daily

• Hawthorne berry tincture – 15 drops, 3x daily

• Vitamin D

• Bed Rest

• Non-stress testing

• Ultrasound to measure fetal growth

Low Vitamin D and Vitamin K may be associated with blood pressure and hypertension >

The average adult should consume about 4,700 mg of potassium per day. You can also try the DASH diet.

Additional Information >

Printable Daily BP Log x 1 Week >

Natural Health Tip:

High Blood Pressure foods:

Especially for those with hypertension in the postpartum, taking a calcium/magnesium supplement can help.

Potassium helps your kidneys get rid of more sodium through your urine. This in turn lowers your blood pressure.

Leafy greens, which are high in potassium, include:

• romaine lettuce

• arugula

• kale

• turnip greens

• collard greens

• spinach

• beet greens

• swiss chard

Canned vegetables often have added sodium, however, frozen vegetables contain as many nutrients as fresh vegetables, and they’re easier to store. You can also blend these veggies with bananas and nut milk for a healthy, sweet green juice.

Berries, especially blueberries, are rich in natural compounds called flavonoids. One study found that consuming these compounds might prevent hypertension and help lower blood pressure. Blueberries, raspberries, and strawberries are easy to add to your diet. You can put them on your cereal or granola in the morning, or keep frozen berries on hand for a quick and healthy dessert.

Beets are high in nitric oxide, which can help open your blood vessels and lower blood pressure. Researchers also found that the nitrates in beetroot juice lowered research participants’ blood pressure within just 24 hours.

You can juice your own beets or simply cook and eat the whole root. Beetroot is delicious when roasted or added to stir-fries and stews. You can also bake them into chips. Be careful when handling beets — the juice can stain your hands and clothes.

Skim milk is an excellent source of calcium and is low in fat. These are both important elements of a diet for lowering blood pressure. You can also opt for yogurt if you don’t like milk.

According to the American Heart Association, women who ate five or more servings of yogurt a week experienced a 20 percent reduction in their risk for developing high blood pressure. Try incorporating granola, almonds sliced, and fruits into your yogurt for extra heart-healthy benefits. When buying yogurt, be sure to check for added sugar. The lower the sugar quantity per serving, the better.

Oatmeal fits the bill for a high-fiber, low-fat, and low-sodium way to lower your blood pressure. Eating oatmeal for breakfast is a great way to fuel up for the day.

Overnight oats are a popular breakfast option. To make them, soak 1/2 cup of rolled oats and 1/2 cup of nut milk in a jar. In the morning, stir and add berries, granola, and cinnamon to taste.

Bananas. Eating foods that are rich in potassium is better than taking supplements. Slice a banana into your cereal or oatmeal for a potassium-rich addition. You can also take one to go along with a boiled egg for a quick breakfast or snack.

Salmon, mackerel, and fish with omega-3s

Fish are a great source of lean protein. Fatty fish like mackerel and salmon are high in omega-3 fatty acids, which can lower blood pressure, reduce inflammation, and lower triglycerides. In addition to these fish sources, trout contains vitamin D. Foods rarely contain vitamin D, and this hormone-like vitamin has properties that can lower blood pressure.

One benefit of preparing fish is that it’s easy to flavor and cook. To try it, place a fillet of salmon in parchment paper and season with herbs, lemon, and olive oil. Bake the fish in a preheated oven at 450°F for 12-15 minutes.

Unsalted seeds are high in potassium, magnesium, and other minerals known to reduce blood pressure. Enjoy ¼ cup of sunflower, pumpkin, or squash seeds as a snack between meals.

Garlic and herbs. One review notes that garlic can help reduce hypertension by increasing the amount of nitric oxide in the body. Nitric oxide helps promote vasodilation, or the widening of arteries, to reduce blood pressure. Incorporating flavorful herbs and spices into your daily diet can also help you cut back on your salt intake. Examples of herbs and spices you can add include basil, cinnamon, thyme, rosemary, and more.

Dark chocolate: A 2015 study found that eating dark chocolate is associated with a lower risk for cardiovascular disease (CVD). The study suggests that up to 100 grams per day of dark chocolate may be associated with a lower risk of CVD. Dark chocolate contains more than 60 percent cocoa solids and has less sugar than regular chocolate. You can add dark chocolate to yogurt or eat it with fruits, such as strawberries, blueberries, or raspberries, as a healthy dessert.

Pistachios are a healthy way to decrease blood pressure by reducing peripheral vascular resistance, or blood vessel tightening, and heart rate. One study found that a diet with one serving of pistachios a day helps reduce blood pressure. You can incorporate pistachios into your diet by adding them to crusts, pesto sauces, and salads, or by eating them plain as a snack.

Olive oil is an example of a healthy fat. It contains polyphenols, which are inflammation-fighting compounds that can help reduce blood pressure. It’s also a great alternative to canola oil, butter, or commercial salad dressing.

Pomegranates are a healthy fruit that you can enjoy raw or as a juice. One study concluded that drinking a cup of pomegranate juice once a day for four weeks helps lower blood pressure over the short term. Pomegranate juice is tasty with a healthy breakfast. Be sure to check the sugar content in store-bought juices, as the added sugars can negate the health benefits.

High blood pressure may be helped with high protein diet. Cut out sugar and processed foods. If it is considered essential hypertension, “The “Susan Weed Cream of Tartar Recipe” may reduce blood pressure: 2 teaspoons cream of tartar in the juice of a half a lemon, add water. Drink once a day for three days, skip a day, and repeat.

The 17 Best Foods for High Blood Pressure >

Yeast infections are common in pregnancy because hormone changes can disrupt the pH balance of the vagina. Symptoms include vaginal itching and a white, thick “cottage cheese” looking discharge. Although incredibly itchy, yeast infections do not affect your baby. A 7-day treatment using Canesten or Monistat can help. Buy two 3-day treatments (including the vaginal tablet/plunger and external cream), and use for 6-7 days. The active ingredient in these treatments is Clotrimazole 2%.

Itching of the perineal area in pregnancy may also be associated with laundry soap. Any laundry soap that is scented may cause irritation. We suggest all natural laundry soaps and wearing cotton underwear.

We also suggest starting a probiotic (good, healthy bacteria) to counter yeast. Did you know that we have more bacteria cells in our body than human cells? Make sure to buy a probiotic with at least three different types of bacteria (e.g. lactobacillus acidophilus, lactobacillus salivarius, bifidobacterium longum, lactobacillus plantarum, lactobacillus paracasei, lactobacillus brevis, bifidobacterium bifidum). These bacteria help you body in different areas of your digestive system. Lactobacillus, for example is most active in the small intestine. Some strains of probiotic bacteria are designed to fight digestive issues, others protect your immune system, inflammation levels, reduce discomfort in your joints, help with weight loss, aid with problems such as leaky gut syndrome, help with sleep, mood, and even skin health.

You can increase the amount of good microbes in your body by including certain foods into your diet. Fermented foods (yogurt and pickles) are home to a host of good bacteria that benefit your body. Fermented drinks like kombucha or kefir will introduce extra probiotics into your diet. Also try sourdough bread, cottage cheese, tempeh, sauerkraut, and miso soup. Stay away from refined sugars.

You need to refrigerate your probiotics, as some may start to break down if they are exposed to heat, light, humidity and oxygen. Probiotics are also very important if you have been on antibiotics for urinary tract infections, gbs infections, etc. They help to restore the good bacteria that has been destroyed by the antibiotics.

Are probiotics and prebiotics safe for use during pregnancy and lactation? >

Marijuana in pregnancy info >

CDC Marijuana & Pregancy >

What are the potential health effects of using marijuana during my pregnancy? >

The following is a scoring system about alcohol use in pregnancy, which you can use for further self-awareness and your midwives may use as a tool to guide further discussions. Feel free to fill out and bring to your first or second visit.

Click here for TWEAK scoring >

What is herpes?

The Herpes Simplex Virus (HSV) is one of the most common human viruses. There are two types of HSV, Type 1 (HSV-1) and Type 2 (HSV-2).

HSV is a recurrent viral infection, which means that once acquired, a person will always carry the virus. Usually the virus will remain dormant, but occasionally the virus will reactivate and cause an outbreak. During this time, a person is contagious.

How is herpes transmitted?

HSV prefers mucous membranes, but it can affect any area of the body. Infections of the mouth, lip or face (e.g. cold sores) are usually, although not always, caused by Type 1. Genital infections are usually, although not always, caused by Type 2.

HSV can only be spread by direct contact with an infectious person. S/he may have visible sores, sores in difficult to see places (e.g. on her cervix), or not have sores but be “shedding” cells that contain the virus.

It is estimated that up to 30% of North Americans have genital herpes, and about 80% will suffer from a cold sore sometime in their life. As many as 80% of infected adults do not know they carry HSV, either because they never had overt symptoms or because they didn’t recognize their symptoms.

How can herpes affect me?

The initial infection with HSV of any type is referred to as a true primary episode.

A primary outbreak is usually worse than a recurrent episode; people often report serious symptoms, such as pain, tingling, tenderness, and flu-like symptoms (such as fever, chills, headache, fatigue, muscle and joint aches). Depending on whether they now have oral or genital herpes, they will usually have swollen lymph glands around the neck or groin respectively.

Lesions usually appear on the infected area 2-14 days after being exposed to the virus. The lesions from a primary outbreak are generally larger, more numerous and last longer than those from a recurrent infection. The lesions may last for three weeks if no therapy is initiated.

There is an increased risk of transmission of the virus due to viral shedding for up to three months after the lesions from a primary infection have healed. Symptoms may or may not be present during this period.

Recommendations for Primary HSV Outbreaks in Pregnancy

Treatment at the end of the pregnancy with the anti-viral drug Acyclovir

If the outbreak is in the third trimester, it is recommended to birth by cesarean section due to high chance of viral shedding and therefore transmission to baby during vaginal birth

Non-primary, first episode

If someone with HSV-1 is then infected with HSV-2 (or vice versa), this referred to as a non-primary, first episode. This is not a true primary episode, because the HSV-1 antibodies moderate the effects of the HSV-2 infection (or vice versa). These episodes are usually worse than recurrent infections, but less than true primary infections.

Recurrent episodes

A recurrent episode is a repeat outbreak triggered by an event that causes the virus to reactivate. Most people will have at least a few. Usually recurrences get milder and less frequent with time.

Sometimes the onset of an outbreak is preceded by symptoms such as tingling, pain, itching, burning, fatigue, fever and/or tenderness. Usually people with a history of herpes become aware of what their initial or prodromal symptoms are, as well as what can trigger outbreaks.

Sometimes the virus is present without any noticeable symptoms or lesions. This is called viral shedding.

How can herpes affect my baby?

Neonatal herpes infection occurs in 1 of every 2000-10,000 births. The most common time of transmission is as the baby passes through the birth canal, but it can also happen in the uterus or after the birth.

Almost all neonatal herpes infections occur as a result of true primary episode genital infection during late pregnancy when birth occurs before the development of protective maternal antibodies. Having a primary outbreak poses a higher risk to the newborn than a recurrent outbreak (up to 50% vs. 5%).

Neonatal herpes infection can be a variety of symptoms, ranging from an isolated sore to brain infection and, in rare cases, death. Neonatal herpes can be diagnosed only if it is looked for. The problem with treatment is less the difficulty of finding a useful drug and more the delay that often occurs before the diagnosis is made. If the mother has herpes, the pediatrician needs to know in order to consider the possibility of neonatal herpes when seeing a sick baby.

Recommendations for Maternal Herpes Outbreak in Labour

If you are in labour and you have herpes lesions around your cervix, vagina, labia, vulva, or anywhere where the baby might come in contact during the birth, it is recommended that you have a cesarean to avoid transmitting the virus to your baby.

If the lesions are not in an area where the newborn can come in immediate contact, we can cover these lesions with sterile tape and plan for a vaginal birth.

What are my options for testing?

You may already know you have HSV because your infection symptoms were obvious.

It is possible have a blood test to see if you carry antibodies to HSV-1 and/or HSV-2, which would indicate a past or present infection. This test will not tell us where on your body you were infected.

If you have an outbreak, a swab can be taken directly from the sores and used to verify that it is HSV, as well as determine which type.

Recommendation for HSV testing in pregnancy

If you have any lesions that could be HSV, it is recommended to do both a swab and a blood test.

If you have no history of HSV infection but your partner does, you may be at risk of having a primary outbreak. In this case, it is recommended that you have a blood test to see if you have HSV antibodies, and then practice safe sex for the rest of the pregnancy.

What are my options for treatment?

Prevention of infection:

The number one preventative against genital herpes is safe-sex, such as using condoms and other barrier methods.

If your partner has a history of genital herpes but you have never had an outbreak (confirmed by a blood test), it may be recommended that your partner take Acyclovir for the duration of the pregnancy to prevent transmission

If either you or your partner is experiencing any prodromal symptoms, it is best to refrain from any intimate contact, wash hands frequently and not share eating utensils, lip balms, etc.

It is also important not to participate in kissing or oral sex if you or your partner has a cold sore.

Prevention of Recurrence: Building your immune system

• Diet & nutrition: Eat foods high in lysine

  • Example: Dairy, Soy, Eggs, Fish, Meat, Potatoes, fermented foods (yogurt, sauerkraut, kiefer), whole, unprocessed foods

• Avoid foods high in arginine, that are acidic, or processed. An outbreak can be triggered by certain foods that are very acidic, spicy and/or high in a protein called arginine.

  • Example: Rice, Chocolate, Nuts, Coconut, Seeds, Sugar, Raisins, Wheat, Popcorn, Caffeine, Alcohol, Salt, Oats, Gelatin, Citrus, Tomatoes, Vinegar

HSV is often triggered by stress – emotional stress, illness, inadequate diet, lack of sleep, hormone surges, allergies, etc. It can also be triggered by certain foods that are very acidic, spicy and/or high in a protein called arginine.

Pregnancy is a state of lowered immunity and high hormones, as well as having other unique stresses; therefore some people find they experience more frequent outbreaks during this time.

Prevention centers around stress reduction – exercise, massage, meditation, and diets low in fat, sugar, and processed foods also contribute to lowered stress levels. For those with severe or frequent outbreaks, diet modification to decrease high arginine foods, and increase high lysine foods can help, as well as supporting the immune system with supplements of vitamins, homeopathics, etc.

Healing Supplements

• Vit C

• Vit E

• Zinc

• Vitamin B complex

• Acidophilus

• Lysine

Complementary medicines

• Homeopathics

• L-lysine cream

• Tea tree essential oil

There are numerous ways to deal with an HSV outbreak, depending on its severity and location.

Acyclovir is an antiviral drug that is commonly prescribed for people experiencing a primary HSV infection during pregnancy because of the increased risk of transmission to the fetus. This therapy is also an option for people experiencing frequent and/or severe recurrent outbreaks during pregnancy.

The current standard is to recommend Acyclovir to people with a history of genital herpes, to be taken from 36 weeks until the birth. The aim is to minimize the chance of an outbreak or viral shedding at the time of birth when it is most dangerous to the baby.

It must be understood, that Acyclovir, while it is given to many pregnant people in North America every year and there have not been any confirmed risks to the baby, long-term studies continue to be needed.

Recommendation for HSV treatment in pregnancy

Acyclovir should be offered to anyone having a primary HSV outbreak

Acyclovir should also be offered to anyone who is experiencing or at high risk of experiencing severe and/or frequent recurrent HSV outbreaks

Acyclovir should be offered at 36 weeks of pregnancy to people with known genital herpes, in order to prevent an outbreak or viral shedding during birth

If there is any suspicion of neonatal infection, the baby should receive immediate treatment with intravenous Acyclovir

Itching can an occur anytime in pregnancy, but is more likely to happen in the 2nd & 3rd trimesters.

Contact your midwife:

• If your itching is on the souls of your feet and palms of your hands

• If you have upper-right quadrant pain (i.e. pain in your liver area, under the right ribs)

• If the itching is interfering with your life. Even if the cause is benign, you made need prescription topical or oral steroids to help cope

What might cause itching?

• Increase in the blood circulating to the skin

• Rapid growth and stretching of the skin, especially of the belly

• Dehydration

• Deficiency of necessary oils in diet

• Allergies, which can be worsened by pregnancy

• Any kind of stress (physically, emotionally, mentally) can worsen existing symptoms

• PUPPS: Pruritic urticarial papules and plaques of pregnancy. It is an itchy rash that forms on your stretch marks and can spread to other parts of your body when pregnant. If diagnosed with PUPPS, you can use eminence stone crop, pine tar soap, or banana peel rubbed on the skin, to provide relief. Cool showers also help.

• In rare cases, liver problems resulting in a build-up of bile salts [Intrahepatic Cholestasis of Pregnancy]

• Infection (e.g. candida/yeast)

• Pemphigoid gestationis (PG)…a rare itchy skin irruption that usually happens in the second or third trimester of pregnancy. It often begins with the appearance of very itchy red bumps or blisters on your abdomen and trunk.

Comfort Measures for Itching:

Sometimes symptoms can be minimized or eliminated with diet/lifestyle changes.

• Minimize stress

• Hydration: 2-3L per day

• Olive/almond/apricot oil (2-3 tablespoons in bath)

• Flax seed oil (internally)

• Omega 3-6-9 oil (e.g. Udo’s oil)

• Homeopathic Apis

• Milk thistle tincture

• Dandelion root tincture

• Light therapy (time in the sun)

• Cold compresses, cool baths

• Baking soda – in bath or applied as paste

• Calamine lotion

• Topical Aloe Vera gel

• Oatmeal baths

• Antihistamine

• Cut nails really short to prevent damage from scratching (you may do it unwittingly at night)

• Hydrocortisone cream (needs prescription)

• Oral steroid (needs prescription)

It is recommended that all people try to be physically active throughout pregnancy.  Even if you were previously inactive or are overweight or obese, activity is recommended. Pregnant people should try to have at least 150 minutes of moderate-intensity activity each week. You should aim to participate in some sort of physical activity at least 3 days a week, and up to 7 days a week. Exercise is most beneficial when you do a variety of aerobic exercise and resistance training activities.

If you usually are active, continue on with your routine, but remember that your centre of balance will change in pregnancy. This may cause you to lose your balance.

We recommend low impact exercise.

Exercise during pregnancy

Exercise is part of a healthy lifestyle and most pregnant people can and should exercise. Exercise provides many benefits to all people. Pregnant people are no exception. These benefits include:

• Helping your body be strong and fit for labour and birth

• Helping you sleep better

• Helping prevent you from gaining excess weight

• Boosting your mood and your energy level

• Helping with constipation

• Reducing backache

• Reducing the likelihood of getting gestational diabetes

What are the best choices for exercise in pregnancy?

Most pregnant people should strive for 30 minutes of moderate exercise most days of the week. Choose activities that minimize your risk of contact with others or falling. Good options are exercises that you are already accustomed to like walking, swimming, low-impact aerobics, stationary cycling, and moderate strength training. Adding yoga or gentle stretching can also be beneficial. Pelvic floor muscle training (e.g., Kegel exercises) can be performed every day to reduce the risk of urinary incontinence. It’s important to warm up, cool down, and stay hydrated. If it’s very hot out, use caution. You don’t want to overheat because your baby has no way to cool itself. Try to keep the intensity in the zone where you can still hold a conversation and never exercise to exhaustion.

Tailor Sitting

When you sit throughout the day, sit on the floor in this position (cross legged). Try to get your knees to the floor. It might be hard at first, but with practise you will become more flexible. Tailor sitting helps the muscles on the inner upper thigh to be stretched and lengthened. If it takes you two hours to push your baby out (usual with first time clients!), your legs will not fatigue as quickly. You also won’t be as likely to get leg cramps during the second stage.

Squatting

Stand with your feet at least two feet apart, heels flat on the floor. Lean slightly forward and drop gently down into a squatting position. When you are squatting, keep your knees as far apart as possible. You might need to hold on the counter and wall for support. Every time you need to pick up something or bend down, squat! Come up bottom first to keep your balance. Squatting helps to prepare the leg muscles and also stretches the perineum, making it more flexible. This is a very effective exercise. Do 10-20 every day.

Pelvic Rocking

On your hands and knees, tuck your bottom under, tighten your abdominal muscles, and then relax. Don’t let your tummy sag too much when you relax. Do this at a slow and steady pace. The only movement should be in your pelvis, not your shoulders. Pelvic rocks help to ease backaches and help to prevent varicose veins, by taking the pressure off the large blood vessels.

Kegels

This exercise is for the pubococcygeus muscle (PC muscle). The PC muscle surrounds the birth canal. Exercising this muscle helps it to become more flexible and more functional, and permits you to have proper control at the time of birth. It also helps the muscle to return to normal quicker, helps prevent bladder and uterine prolapse, and helps with sexual intercourse. A good way to identify this muscle is when you are urinating. Sit with your legs apart and try to stop the flow of urine without closing your knees – this is the muscle you will be exercising. You simply squeeze this muscle throughout the day. A good way to do this is to pick a time (talking on phone, driving in the car, watching TV). Pelvic floor physiotherapy is an excellent way to identify any weakness or over-tight pelvic floor muscles.

Practise good posture when sitting, walking, and standing.

Practise relaxation each day – it can help you to relax during labour. For example, sit or lie down in a comfortable position. Try to pick a quiet time, when you will not be disturbed for about 20-30 minutes. If you want, put on some music that you find relaxing. Just focus on your breathing, in and out, and with each breath out, “breathe” away any tension in your body.

Walk 2 kilometers every day or two, as briskly as you can. Walking helps circulation, energy, and is great for your mental health (for 24 hours after exercise!)

2019 Canadian Guideline for Physical Activity Throughout Pregnancy

Recommendation 1

All pregnant people without contraindication should be physically active throughout pregnancy.

Specific subgroups were examined:

Pregnant people who were previously inactive.

Pregnant people diagnosed with gestational diabetes mellitus.

Pregnant people categorized as overweight or obese (pre-pregnancy body mass index ≥ 25 kg/m2).

Recommendation 2

Pregnant individuals should accumulate at least 150 minutes of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications.

Recommendation 3

Physical activity should be accumulated over a minimum of three days per week; however, being active every day is encouraged.

Recommendation 4

Pregnant individuals should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial.

Recommendation 5

Pelvic floor muscle training (e.g., Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction in proper technique is recommended to obtain optimal benefits.

Recommendation 6

Pregnant individuals who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position.

Contraindications

All pregnant individuals can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). People with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Pregnant people with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation.

Absolute contraindications to 
exercise are the following:

• ruptured membranes,

• premature labour,

• unexplained persistent vaginal bleeding,

• placenta previa after 28 weeks gestation,

• preeclampsia,

• incompetent cervix,

• intrauterine growth restriction,

• high-order multiple pregnancy (e.g. triplets)

• uncontrolled Type I diabetes,

• uncontrolled hypertension,

• uncontrolled thyroid disease,

• other serious cardiovascular, respiratory or systemic disorder.

Relative contraindications to 
exercise are the following:

• recurrent pregnancy loss

• gestational hypertension

• a history of spontaneous preterm birth

• mild/moderate cardiovascular or respiratory disease

• symptomatic anemia

• malnutrition

• eating disorder

• twin pregnancy after the 28th week

• other significant medical conditions

If you usually are active, continue on with your routine, but remember that your centre of balance will change in pregnancy. This may cause you to lose your balance.

We recommend low impact exercise.

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Click here for more information on exercise in pregnancy

Omega-3 fatty acids are incredibly important. It is important that women who have thyroid issues, take Omega 3s cautiously. Omega 3s can nurture your thyroid, and so medications for thyroid may need to be adjusted. They have many powerful health benefits for your body and brain. In fact, few nutrients have been studied as thoroughly as omega-3 fatty acids. Here are 17 health benefits of omega-3 fatty acids that are supported by science.

1. Omega-3s Can Fight Depression and Anxiety: Depression is one of the most common mental disorders in the world. Symptoms include sadness, lethargy and a general loss of interest in life. Anxiety, also a common disorder, is characterized by constant worry and nervousness. Interestingly, studies indicate that people who consume omega-3s regularly are less likely to be depressed. What's more, when people with depression or anxiety start taking omega-3 supplements, their symptoms may improve.

There are three types of omega-3 fatty acids: ALA, EPA and DHA. Of the three, EPA appears to be the best at fighting depression.

SUMMARY - Omega-3 supplements may help prevent and treat depression and anxiety. EPA seems to be the most effective at fighting depression.

Fish oil and depression: The skinny on fats >

Omega-3 fatty acids and the treatment of depression: a review of scientific evidence >

2. Omega-3s Can Improve Eye Health

DHA, a type of omega-3, is a major structural component of the retina of your eye.

When you don't get enough DHA, vision problems may arise.

Interestingly, getting enough omega-3 is linked to a reduced risk of macular degeneration, one of the world's leading causes of permanent eye damage and blindness.

SUMMARY - An omega-3 fatty acid called DHA is a major structural component of your eyes’ retinas. It may help prevent macular degeneration, which can cause vision impairment and blindness.

The Benefits of Fish Oil for Dry Eye >  

Essential n-3 fatty acids in pregnant women and early visual acuity maturation in term infants >

3. Omega-3s Can Promote Brain Health During Pregnancy and Early Life

Omega-3s are crucial for brain growth and development in infants.

DHA accounts for 40% of the polyunsaturated fatty acids in your brain and 60% in the retina of your eye.

Therefore, it's no surprise that infants fed a DHA-fortified formula have better eyesight than infants fed a formula without it.

Getting enough omega-3s during pregnancy is associated with numerous benefits for your child, including.

• Higher intelligence

• Better communication and social skills

• Fewer behavioral problems

• Decreased risk of developmental delay

• Decreased risk of ADHD, autism and cerebral palsy

SUMMARY - Getting enough omega-3s during pregnancy and early life is crucial for your child’s development. Supplementing is linked to higher intelligence and a lower risk of several diseases.

Omega-3 Fatty Acids and Pregnancy > 

4. Omega-3s Can Improve Risk Factors for Heart Disease

Heart attacks and strokes are the world's leading causes of death.

Decades ago, researchers observed that fish-eating communities had very low rates of these diseases. This was later linked to omega-3 consumption.

Since then, omega-3 fatty acids have been tied to numerous benefits for heart health.

These benefits address:

• Triglycerides: Omega-3s can cause a major reduction in triglycerides, usually in the range of 15–30%.

• Blood pressure: Omega-3s can reduce blood pressure levels in people with high blood pressure.

• “Good” HDL cholesterol: Omega-3s can raise “good” HDL cholesterol levels.

• Blood clots: Omega-3s can keep blood platelets from clumping together. This helps prevent the formation of harmful blood clots.

• Plaque: By keeping your arteries smooth and free from damage, omega-3s help prevent the plaque that can restrict and harden your arteries.

• Inflammation: Omega-3s reduce the production of some substances released during your body’s inflammatory response.

• For some people, omega-3s can also lower “bad” LDL cholesterol. However, evidence is mixed — some studies find increases in LDL.

Despite these beneficial effects on heart disease risk factors, there is no convincing evidence that omega-3 supplements can prevent heart attacks or strokes. Many studies find no benefit.

SUMMARY - Omega-3s improve numerous heart disease risk factors. However, omega-3 supplements do not seem to reduce your risk of heart attacks or strokes.

Omega-3 Fatty Acids and Heart Health >  

Omega-3 fats - Good for your heart >

5. Omega-3s Can Reduce Symptoms of ADHD in Children

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder characterized by inattention, hyperactivity and impulsivity.

Several studies note that children with ADHD have lower blood levels of omega-3 fatty acids than their healthy peers.

What's more, numerous studies observe that omega-3 supplements can reduce the symptoms of ADHD.

Omega-3s help improve inattention and task completion. They also decrease hyperactivity, impulsiveness, restlessness and aggression.

Recently, researchers observed that fish oil supplements were one of the most promising treatments for ADHD.

SUMMARY - Omega-3 supplements can reduce the symptoms of ADHD in children. They improve attention and reduce hyperactivity, impulsiveness and aggression.

Study Shows Omega-3s Benefit Some Children With ADHD >

Do Omega-3/6 Fatty Acids Have a Therapeutic Role in Children and Young People with ADHD? > 

6. Omega-3s Can Reduce Symptoms of Metabolic Syndrome

Metabolic syndrome is a collection of conditions.

It includes central obesity — also known as belly fat — as well as high blood pressure, insulin resistance, high triglycerides and low “good” HDL cholesterol levels.

It is a major public health concern because it increases your risk of many other illnesses, including heart disease and diabetes.

Omega-3 fatty acids can improve insulin resistance, inflammation and heart disease risk factors in people with metabolic syndrome. 

SUMMARY - Omega-3s can have numerous benefits for people with metabolic syndrome. They can reduce insulin resistance, fight inflammation and improve several heart disease risk factors.

Omega-3 fatty acids supplementation decreases metabolic syndrome prevalence after lifestyle modification program >

Omega-3 fatty acids in obesity and metabolic syndrome: a mechanistic update >

7. Omega-3s Can Fight Inflammation

Inflammation is a natural response to infections and damage in your body. Therefore, it is vital for your health.

However, inflammation sometimes persists for a long time, even without an infection or injury. This is called chronic — or long-term — inflammation.

Long-term inflammation can contribute to almost every chronic Western illness, including heart disease and cancer.

Notably, omega-3 fatty acids can reduce the production of molecules and substances linked to inflammation, such as inflammatory eicosanoids and cytokines.

Studies have consistently observed a connection between higher omega-3 intake and reduced inflammation.

SUMMARY - Omega-3s can reduce chronic inflammation, which can contribute to heart disease, cancer and various other diseases.

Could fish oil fight inflammation? >  

Omega-3 Fatty Acids and Inflammatory Processes >

Omega-3 Fatty Acids: A Natural Way to Lower Blood Pressure >

8. Omega-3s Can Fight Autoimmune Diseases

In autoimmune diseases, your immune system mistakes healthy cells for foreign cells and starts attacking them.

Type 1 diabetes is one prime example, in which your immune system attacks the insulin-producing cells in your pancreas.

Omega-3s can combat some of these diseases and may be especially important during early life.

Studies show that getting enough omega-3s during your first year of life is linked to a reduced risk of many autoimmune diseases, including type 1 diabetes, autoimmune diabetes and multiple sclerosis.

Omega-3s also help treat lupus, rheumatoid arthritis, ulcerative colitis, Crohn's disease and psoriasis. 

SUMMARY - Omega-3 fatty acids can help fight several autoimmune diseases, including type 1 diabetes, rheumatoid arthritis, ulcerative colitis, Crohn's disease and psoriasis.

Dietary omega-3 fatty acids aid in the modulation of inflammation and metabolic health > 

Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease >

Vitamin D and fish oil supplements reduce risk of autoimmune conditions >

9. Omega-3s Can Improve Mental Disorders

Low omega-3 levels have been reported in people with psychiatric disorders.

Studies suggest that omega-3 supplements can reduce the frequency of mood swings and relapses in people with both schizophrenia and bipolar disorder.

Supplementing with omega-3 fatty acids may also decrease violent behaviour.

SUMMARY - People with mental disorders often have low blood levels of omega-3 fats. Improving omega-3 status seems to improve symptoms.

Efficacy of omega-3 PUFAs in depression > 

Why You Need Omega-3s >

EPA omega-3 fatty acids improve depression symptoms >

10. Omega-3s Can Fight Age-Related Mental Decline and Alzheimer's Disease

A decline in brain function is one of the unavoidable consequences of aging.

Several studies link higher omega-3 intake to decreased age-related mental decline and a reduced risk of Alzheimer's disease.

One review of controlled studies suggests that omega-3 supplements may be beneficial at disease onset, when the symptoms of AD are very mild.

Keep in mind that more research is needed on omega-3s and brain health.

SUMMARY - Omega-3 fats may help prevent age-related mental decline and Alzheimer's disease, but more research is needed.

Omega-3 fatty acids and dementia > 

Omega-3 Fatty Acids in Early Prevention of Inflammatory Neurodegenerative Disease: A Focus on Alzheimer's Disease >

11. Omega-3s May Help Prevent Cancer

Cancer is one of the leading causes of death in the Western world, and omega-3 fatty acids have long been claimed to reduce the risk of certain cancers.

Interestingly, studies show that people who consume the most omega-3s have up to a 55% lower risk of colon cancer.

Additionally, omega-3 consumption is linked to a reduced risk of prostate cancer in men and breast cancer in women. However, not all studies give the same results.

SUMMARY - Omega-3 intake may decrease the risk of some types of cancer, including colon, prostate and breast cancer.

Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications >  

Vitamin D and Omega-3 Supplements for Preventing Cancer and Other Chronic Diseases >

Omega-3 fatty acids for breast cancer prevention and survivorship >

12. Omega-3s Can Reduce Asthma in Children

Asthma is a chronic lung disease with symptoms like coughing, shortness of breath and wheezing.

Severe asthma attacks can be very dangerous. They are caused by inflammation and swelling in the airways of your lungs.

What's more, asthma rates in the US have been rising over the past few decades.

Several studies associate omega-3 consumption with a lower risk of asthma in children and young adults.

SUMMARY - Omega-3 intake has been associated with a lower risk of asthma in both children and young adults.

Role of omega-3 fatty acids and their metabolites in asthma and allergic diseases >

Omega-3 supplements can prevent childhood asthma >

http://copsac.com/

13. Omega-3s Can Reduce Fat in Your Liver

Non-alcoholic fatty liver disease (NAFLD) is more common than you think.

It has increased with the obesity epidemic to become the most common cause of chronic liver disease in the Western world.

However, supplementing with omega-3 fatty acids effectively reduces liver fat and inflammation in people with NAFLD.

SUMMARY - Omega-3 fatty acids reduce liver fat in people with non-alcoholic fatty liver disease.

Effects of Omega-3 Fatty Acid in Nonalcoholic Fatty Liver Disease: A Meta-Analysis > 

Omega-3 fatty acids for treatment of non-alcoholic fatty liver disease >

14. Omega-3s May Improve Bone and Joint Health

Osteoporosis and arthritis are two common disorders that affect your skeletal system.

Studies indicate that omega-3s can improve bone strength by boosting the amount of calcium in your bones, which should lead to a reduced risk of osteoporosis.

Omega-3s may also treat arthritis. Patients taking omega-3 supplements have reported reduced joint pain and increased grip strength.

SUMMARY - Omega-3s may improve bone strength and joint health, potentially reducing your risk of osteoporosis and arthritis.

The Effect of Omega-3 Fatty Acids in Patients With Active Rheumatoid Arthritis Receiving DMARDs Therapy >

Power of Omega-3s >

The role of omega-3 derived resolvins in arthritis >

15. Omega-3s Can Alleviate Menstrual Pain

Menstrual pain occurs in your lower abdomen and pelvis and often radiates to your lower back and thighs.

It can significantly affect your quality of life.

However, studies repeatedly prove that women who consume the most omega-3s have milder menstrual pain.

One study even determined that an omega-3 supplement was more effective than ibuprofen in treating severe pain during menstruation.

SUMMARY - Omega-3 fatty acids can reduce menstrual pain and may even be more effective than ibuprofen, an anti-inflammatory drug.

Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea >  

Fish Oil, Vitamin B-12 May Offer Relief During That Time of the Month >

16. Omega-3 Fatty Acids May Improve Sleep

Good sleep is one of the foundations of optimal health.

Studies tie sleep deprivation to many diseases, including obesity, diabetes and depression

Low levels of omega-3 fatty acids are associated with sleep problems in children and obstructive sleep apnea in adults.

Low levels of DHA are also linked to lower levels of the hormone melatonin, which helps you fall asleep.

Studies in both children and adults reveal that supplementing with omega-3 increases the length and quality of sleep.

SUMMARY - Omega-3 fatty acids — especially DHA — may improve the length and quality of your sleep.

Differential Effects of DHA- and EPA-Rich Oils on Sleep in Healthy Young Adults >  

Higher levels of omega-3 in diet associated with better sleep >

17. Omega-3 Fats Are Good For Your Skin

DHA is a structural component of your skin. It is responsible for the health of cell membranes, which make up a large part of your skin.

A healthy cell membrane results in soft, moist, supple and wrinkle-free skin.

EPA also benefits your skin in several ways, including:

• Managing oil production and hydration of your skin

• Preventing hyperkeratinization of hair follicles, which appears as the little red bumps often seen on upper arms

• Reducing premature aging of your skin

• Reducing the risk of acne

Omega-3s can also protect your skin from sun damage. EPA helps block the release of substances that eat away at the collagen in your skin after sun exposure.

SUMMARY - Omega-3s can help keep your skin healthy, preventing premature aging and safeguarding against sun damage.

Cosmetic and Therapeutic Applications of Fish Oil’s Fatty Acids on the Skin >  

The Bottom Line

Omega-3 fatty acids are vital for optimal health.

Getting them from whole foods — such as fatty fish two times per week — is the best way to ensure robust omega-3 intake.

However, if you don't eat a lot of fatty fish, then you may want to consider taking an omega-3 supplement. For people deficient in omega-3, this is a cheap and highly effective way to improve health.

Original article and citations >  

Other sources: Omega-3 Fatty Acids Fact Sheet for Consumers >

Omega-3 polyunsaturated fatty acids and human health outcomes >

What is thalassemia?

Thalassemia is the name of a group of inherited blood disorders. There are two main types of thalassemia: alpha and beta, in reference to the alpha and beta proteins that form hemoglobin in the blood. Hemoglobin is the oxygen-carrying component of red blood cells, so if the body doesn’t produce enough of either of these two proteins, the result is anemia that begins in early childhood and lasts throughout life.

What are the effects of thalassemia?

Thalassemia ranges widely in severity. Babies born with thalassemia may have mild to severe anemia, may develop jaundice, organ damage or even die.

How is thalassemia transmitted?

Thalassemia is an inherited disease - it is passed on by parents who have the thalassemia gene. Because the gene is recessive, both parents must each pass on the thalassemia gene in order for the baby to have the full disease.

If the baby only inherits one gene, s/he may be a carrier but not express the full disease. Sometimes this carrier state is referred to as “thalassemia trait”. Most carriers lead normal, healthy lives. They may not even realize that they carry this gene.

When both parents are carriers:

• 1 in 4 chance that their child will inherit 2 thalassemia genes and have severe outcomes of the disease = Thalassemia major

• 2 in 4 chance that the child will inherit the thalassemia trait, i.e. become a carrier = Thalassemia minor

• 1 in 4 chance that the child will inherit 2 normal genes

How is thalassemia diagnosed?

When you do your routine blood test at the beginning of your pregnancy, one result we review is the Mean Corpuscular Volume, or MCV. The MCV reading determines the size of your red blood cells. For adults, if the MCV reading is less than 75 you may be a trait carrier. If your MCV reading indicates that you may have the thalassemia trait, additional blood tests can be performed to make sure.

Genetic counseling can also aid in identifying if you should have this blood test. Because thalassemia occurs most commonly among Mediterranean, Middle-Eastern, Asian, and African people, if you and your baby’s father are from any of these groups, you may want to consider genetic counseling and/or further testing.

During pregnancy, chorionic villus sampling (CVS) or amniocentesis can detect or rule out thalassemia in the fetus. Early diagnosis is important so that treatment can prevent complications.

What is the treatment for thalassemia?

The use of frequent blood transfusions and antibiotics has greatly improved the outlook for children born with thalassemia

What is Group B Streptococcus?

Group B Streptococcus has many names: Group B Strep, GBS, Strep B. It is part of the regular bacteria found in the intestinal and/or reproductive tracts of about 20% of healthy people in Ontario. Under normal circumstances it is part of the balanced system of gut flora that does not cause disease. It is not associated with bad hygiene, nor is it sexually transmitted. GBS may come and go in people’s bodies, so having had it previously does not mean you have it now.

How can GBS affect my baby?

If you have GBS colonization (GBS positive) around your vaginal/rectal area when you give birth, your baby may be exposed. Of those babies who are exposed, only 50% will become carriers of GBS - have GBS on their skin or in their system.

But about 1 in 200 babies who are exposed to GBS will develop a systemic infection. Symptoms can include fever, irritability, trouble breathing or lethargy. These babies will need hospitalization and IV antibiotics. Further, of those who do get sick, for 1 in 20 this infection will be fatal. Babies that survive, particularly those who have meningitis, may have long-term problems such as hearing or vision loss, or learning disabilities.

Most GBS infections appear at birth or within the first 24 hours. This is called Early Onset GBS Infection. An infection that begins after the first week of birth is called Late Onset GBS disease and is caused by transmission after birth.

What might increase my baby’s risk of getting sick from GBS?

The following risk factors multiply by 10 the chance of your baby getting sick:

• Previous baby that developed GBS infection

• Bladder infection caused by GBS at any time during this pregnancy (shows high colony counts)

• Preterm birth <37 weeks

• Maternal fever in labour >38°C

• Ruptured membranes >18 hrs

What are my options for testing and treatment?

Currently, the community standard is to test women at 35-37 weeks (which is a cotton-swab or “Q-tip” sample from your vagina and anus that you can do yourself). This swab is sent to the lab to be cultured and usually takes about a week to get results.

The test is done at the end of pregnancy because GBS bacteria can be present in your body temporarily. Testing within 5 weeks of your due date has been shown to be the most accurate way to determine your status at the time of birth.

If your test comes back positive:

The most common approach is to offer you treatment with IV antibiotics once you are in active labour OR if your water breaks before labor. The drug of choice is Penicillin, but there are other effective options for women who are allergic to Penicillin, or for strains of GBS that are resistant to Penicillin.

Once started on antibiotics, you will receive a dose every four hours until you have your baby. Ideally, you will receive at least one dose a minimum of one hour before the birth, as this reduces the chance of your baby getting sick to 1 in 4000. Subsequent doses reduce the chance even further. Between doses, which take about 15 minutes to complete, a saline lock will be place on the IV so you aren’t constantly attached to an IV pole.

If you are GBS positive, and your water breaks before labour starts, you will be offered the choice of inducing labour to minimize the chance of infection due to prolonged ruptured membranes. We know this may increase the chance that you will pass on GBS to your baby.

If your GBS status is unknown:

If you go into labor before test results are available, then you will be offered antibiotics especially if you develop any of the risk factors listed above.

What are the downsides of antibiotic treatment?

• Having an IV inserted can be uncomfortable or painful, and the plastic IV catheter in your arm can be somewhat annoying in labor. Antibiotics clear the body of all good and bad bacteria.

• Long term effects on baby of early antibiotic exposure are not fully researched.

Are there any alternatives to treatment with antibiotics?

• There are no other treatment alternatives that have enough data for us to know whether they are effective.

• Some parents may wish to avoid antibiotics, and will request an alternative approach to treatment with antibiotics where 1) they are found to be a GBS carrier, and 2) they develop any of the risk factors mentioned above which make it ten times more likely that the baby will get sick. This approach was based on a previous standard of care before universal testing and treatment for positive status was adopted.

Is it possible to still plan a homebirth or to labor at home as long as possible?

The short answer is yes! We can easily administer antibiotics at home once you are active labor.

In the general population, there is about a 1 in 10,000 chance of having a severe allergic reaction requiring emergency treatment to these antibiotics, which is considered extremely rare. If you have a strong history of antibiotic allergies (i.e. a higher chance of having an anaphylactic reaction), your midwife may discuss the option of doing at least the first dose in the hospital.

Can I prevent or eliminate GBS from my system?

The best strategy is to boost your own immune system by being as healthy as you can manage. Daily exercise and nutrient-dense food is always a good idea!

Additionally, throughout Your Pregnancy:

• Take a daily probiotic supplement

• Eat foods high in Vitamin C

• Eat fermented foods – a natural source of probiotics

• Minimize your refined carbs & sugars

• Keep hydrated – drink lots of water

FOR TWO WEEKS BEFORE YOUR TEST:

• Minimize heavy starches (potatoes, rice, bread, etc) or combine with proteins

• Cut out all refined sugars as well as high-sugar fruit (e.g. tropicals such as bananas, mangos, papaya, etc)

• [optional] Take a daily Vitamin C supplement of 500-1000mg

• [optional] Take Echinacea tincture – 1 dropperful 1-3x/day

• [optional] Do a nightly sitz bath with 1-2 drops of Tea Tree essential oil

Group B Streptococcus in pregnancy >

Group B Streptococcus: Postpartum Management of the Neonate >

Group B Streptococcus prevention and management in labour >

Self care

Eat, sleep, get some exercise, learn how to nap!

Nutrition

Drinking enough water and eating healthy, nutritious food will supply your body with the building blocks for the hormones necessary to ripen your cervix and start labour. This will also help prevent perineal tearing.

Herbs

Growing Belly Tea: Drinking a nutritive herbal tea that supports the reproductive system and prepares the uterus for birth has been a tradition practiced by many traditional cultures across the world. Local herb/health food stores supply tea blends which are considered safe in pregnancy and contain supportive herbs such as red raspberry leaf, nettles, oatstraw, and lemon balm, or you can have herbalist formulate your own personal mixture. A nice excuse to regularly take time for yourself and enjoy a cup of tea!

Herbal Blend

Below is an example of a tasty, nurturing tea blend that you can make yourself, or have a herbalist mix for you:

• 3 parts Partridgeberry

• 2 parts Red Raspberry Leaf

• 1 part Alfalfa

• 1 part Lemon Balm

• 1 part Nettle

Drink 1-3 cups daily as a hot tea (let steep for at least 15 minutes), or blend with a juice for a cool beverage.

Prenatal classes

Knowledge of what to expect, practice in pain coping techniques, exploration of fears and anxieties, as well as connection with other couples – all will help you to surrender into labour, and discover ways to support the healthy hormones of birth. If it’s not your first birth, there are refresher classes you can take. Sign up early to have your choice of class times, but you likely won’t attend until after 30 weeks.

Doula

Even before labour starts, a doula is an invaluable added support and a resource as your pregnancy progresses and due date approaches. They can assist you to establish a proactive and positive outlook on the journey ahead of you. Interview doulas early so that you have a wide range of choices available to you.

Acupuncture

Aligns energy, optimizing maternal and fetal hormones. Research shows acupuncture to be effective in changing malpositioned babies. Also good for dealing with numerous pregnancy discomforts and promoting better sleep.

Chiropractic

One factor in malposition may be a pelvis that is out of alignment. Chiropractic can be used for prevention as well as treatment. Because of relaxin, pregnant people are especially responsive to chiropractic adjustments. A well-aligned spine and pelvis also promotes nervous system health and excellent hormonal flow, not to mention relief of back, hip and pelvic aches.

Massage, Cranio-sacral therapy

Massage increases overall body awareness and relaxation, giving you a heightened sensory experience of your body, coping techniques, and an awareness of how to let go in labour. By treating all the muscles and soft tissue of the pelvis, back & legs, these areas are relaxed, open and more flexible.

Essential Oils, Epsom Salts

4-6 drops Lavender oil in the bath, at least once per week! Add the lavender to ½ cup milk or cream for a luxurious soak, or to 5mL almond oil prior to adding to your bathwater. Add 1-2 cups Epsom salts to increase the relaxation factor, minimize swelling and reduce blood pressure.

Relaxation, Meditation, Visualization

Practicing relaxation will serve you well for the labour process, however you find a way to do it. Some people also like to practice visualizations of a head down, well-positioned baby.

Sex

Orgasm strengthens the uterine muscles and ripens the cervix. For women with male partners: semen contains prostaglandins, which are hormones that act to ripen the cervix.

Optimal Fetal Positioning strategies

Once babies are head down, if they are anteriorly positioned, i.e. their face is towards the mother’s back (which presents a smaller diameter into the pelvis), they will be able to sink deeply into the pelvis and onto the cervix. This promotes cervical ripening, as well as minimizes back pain in late pregnancy and during labour.

In order to promote anterior positions:

• Float or swim with the belly down

• Garden. Clean your floors by hand. Crawl around on hands and knees.

• Practice yoga, including Child’s Pose and alternating Cat-Cow Poses

• Walk up stairs sideways two at a time

• Use forward leaning positions when relaxing or at work: sit on a birth ball, kneeler-rocker or chair facing the back

• Sleep sidelying (preferably left side), not on the back – but only if this is comfortable and doesn’t result in less sleep!

• Spend 15+ minutes a day in a “polar bear position”, i.e. with your knees and chest on the floor. Use pillows to make yourself more comfortable while you meditate, read, watch TV, etc. Also effective for reducing back pain in late pregnancy.

• Belly Lifting: use this technique during Braxton-Hicks contractions in the last weeks of pregnancy. It can also be used in labor. The theory is to change the pressure vector on the baby’s body and head, thus helping baby to better flex and/or rotate its head.

  1. Stand with knees bent. Put your hands around and under your belly, lifting up gently. It works best when having contractions but can really be done anytime.

  2. Two-person technique: have your birth partner stand behind you holding the ends of a towel or scarf that is wrapped under your belly. They will gently use this to lift your belly.

In order to avoid promoting posterior fetal positions:

• Avoid reclining in armchairs, sitting in bucket car seats, or anything where the knees are higher than the pelvis

• Avoid crossing the legs, which reduces the space at the front of the pelvis and opens it up at the back

• Avoid sitting with feet elevated

• Avoid deep squatting, which open up the pelvis and encourages the baby to move down, if the baby is known to be posterior.

The Miles Circuit: positioning to get baby into a good position >

Homeopathics

Homeopathics are sugar pellets which are impregnated with highly diluted substances or the “energy” of plants.  There are no associated side effects with taking homeopathics.  For maximum effectiveness, the pellets should be dissolved under the tongue, and should be taken at least 15 minutes before or after eating or drinking.

30c Pulsatilla daily from 33-36 wks, for optimal positioning UNLESS your baby is known to already be in an optimal position.


After 36+ weeks

Evening Primrose Oil (EPO)

EPO contains prostaglandin precursors – as well as essential fatty acids – which help ripen and soften the cervix. It is also used to help prevent postpartum depression, so keep taking any leftovers orally after your baby is born.

1. Take 1000 mg orally in the morning

2. Insert 1000 mg intravaginally at bedtime, as close to your cervix as you can reach. If this is too hard, then just take it orally. Cut the top off of the gel capsule before putting up into your vagina, as high as possible.

Homeopathics (see above re: how to take homeopathics)

• 200c Pulsatilla - Take one dose of five pellets at 36wks. Repeat 10 days later.

• 12c Arnica - Take five pellets once a day for 3 days.

• 12c Cimicifuga - Take five pellets once a day for 3 days.

• 12c Caullophyllum - Take five pellets once a day for 3 days.

Keep repeating the Arnica-Cimicifuga-Caullophyllum cycle until birth.

Don’t forget self care!

Eat, drink, take naps. Don’t exhaust yourself by the end of the day in case labour starts in the middle of the night.

After 40+ weeks

Stretch & Sweep

Sounds like spring cleaning, but actually refers to a procedure whereby your midwife inserts 2 fingers into your vagina with the intention of reaching your cervix. If the cervix is open, she will stretch your cervix; this action will help release prostaglandins, an essential hormone for labour. While this procedure is not related to a higher risk of infection or your water breaking prematurely, it has been shown to be associated with an earlier labour, especially if repeated over a number of days. Let your midwife know if you are interested.

Time/Patience

Ultimately, your baby will come at the most appropriate time. Even the most aggressive ripening techniques will not bring on labour if your baby isn’t ready!

We encourage first time parents to take prenatal classes. There are a variety of on-line and in-person prenatal classes

Click here for available classes in Sarnia and the surrounding area

Universally people worry about tearing during childbirth.

The following are answers to our most frequently asked questions.

What can I do before I give birth?

• Pick your parents … genetics plays the largest factor in tissue integrity ☺

• Eat healthy, drink lots of water – to make your tissue as strong & stretchy as possible

• Get some movement in your life – increased blood flow strengthens tissues

• Don’t smoke – toxic byproducts will weaken your tissues

• Take essential fatty acid supplements (Omega 3s)– to make your skin soft & stretchy

• Make pelvic floor exercises a habit (instructions below) – not only do strong muscles resist tearing, but you will also push your baby out faster

• Do perineal massage (instructions below) – to learn how to relax your muscles when stretched

TRUST that even if you don’t do any Kegels, perineal massage, etc, this does NOT necessarily mean you will tear

What about during the birth?

The physiology of the vagina is such that it has numerous small folds and pleats. During birth these open like an accordion in front of the baby’s head. The hard work of labour, especially pushing, brings blood and heat to the whole pelvic area, which in turn increases the pliability of the tissue.

What you can do:

• Know that you may push as hard as you can, except for the last few minutes when the baby’s head is crowning. Although the sensations may be very intense, you will not be in danger of tearing at this point. In fact, the faster this stage is over, the better for your tissue. This can be helped by using upright, gravity-positive positions.

• As the head starts to stretch the tissues open, apply counterpressure with your own hand to the areas that feel the most intensity

• In the last few minutes when the head starts to emerge, you will feel a burning sensation. At this point, it’s okay to slow your pushing efforts – as opposed to trying to push harder to get the intensity over with. Because it is hard to maintain control of a strong urge to push, your care provider will likely talk you through this part.

• Apply warm compresses (or cold if there is swelling) to your perineum once the head is visible – for comfort and increased blood flow

• During the last few minutes, have you use gravity-neutral positions to slow the crowning stage. A good position at this stage is semi-sitting.

*Your midwife will talk you through the last few minutes while the head is slowly emerging – to give your tissue time to stretch and open

Postpartum:

• Use frozen pads or apply ice to your perineum (like any injury – ice for the first 48 hours). It sounds uncomfortable now, but will feel great in the moment!

• Pee in the shower/bath if urination causes stinging

• Use a peri bottle after using the toilet – add herbs like witch hazel/lavender/tea tree oil for their antibiotic and healing properties. You will get a peri bottle at the hospital, or your midwife will take one to your homebirth

• Take Homeopathic Arnica 30C every 4 hours while awake (minimizes any swelling or bruising)

• If you feel you need pain relief medication, ibuprofen or acetaminophen can be taken according to the recommendations on the bottle

• Plan to not go outside for 7 days. Stay in bed and cuddle with your baby, minimizing activity as much as possible. Aim to only walk up/down stairs once or twice a day max.

• Sit with your legs together, like a mermaid! If you have stitches we want your perineal tissues to stay together. Sitting cross-legged pulls these tissues apart.

• Try a Sitz bath twice a day – add herbs (your midwife can give you some)/lavender/tea tree oil, epsom salt.

• Full bath x 10-20 minutes once a day (in addition or instead of sitz bath) – add 2 cups Epsom salts, perineal wash herbs – avoid bubble bath

• Avoid sitting on a hemorrhoid or “donut” pillow as this can cause stitches to tear. Sit evenly on your perineum.

• Eat healthy, drink lots of water

• It is normal to feel “heaviness” in your pelvis at the end of the day if you have had increased your activity. This is the pelvic floor muscles getting fatigued. Try to balance days of activity causing fatigue, with days of rest.

• Prolonged use of maxi pads can be very drying – occasionally try sitting on a blue pad while nursing, or use cloth pads. After a sitz bath, dry out your perineum well, then sit on a blue pad or towel and let your perineum fully dry and breathe for 1-2hours.

You will not have the same strength when doing kegels. Be patient, it will return.

Inform your midwife if:

• You have increasing amounts of pain in your perineum, not associated with increased activity or decreased use of painkillers

• You have discharge that is abnormal in color or foul smelling

• You continue to have serious urinary incontinence past the first few weeks

• Most clients are ready to resume sexual activity around 6 weeks. Use lots of lube when you have sex, as postpartum hormones cause dryness.

See a pelvic floor physiotherapist if you have any concerns or just want to improve your pelvic floor strength. You do not have to have serious incontinence before seeking physiotherapy. If your problem is assessed to need further medical intervention, they can provide a gynecological referral.

Bluewater Pelvic Floor Physiotherapy >

Pelvic Floor Toning - Kegels

“Kegel” is the name used to describe a conscious contraction of the pelvic floor muscles. Because there are many muscles in the pelvic floor, it may take awhile to learn how to contract all of them equally; a common mistake is to only contract the external muscles. If you are unsure or want some biofeedback as to how you are doing, you can ask a partner, your midwife or yourself to feel for muscle contraction throughout your vagina while doing a Kegel.

Initial Training Program

Do 2-3 times a day, for 8-12 weeks

Hold’ems – 10 sets, 2½ minutes

Do a Kegel for 10 seconds. Relax for 5 seconds.

Repeat nine more times

Speed’ems – 30 sets, 1½ minutes

Do a Kegel for 1 second. Relax for 2 seconds.

Repeat 29 more times

Urge Incontinence:

Do you have overactive bladder nerves?

• You experience situational urgency, such as whenever you arrive home, or whenever you hear water running

• You experience urgency, but when you go to the toilet your bladder is not full. Some of this is normal in pregnancy.

Here are some tips that may help:

• Aim to empty your bladder before it is full to avoid teaching your bladder nerves to overreact

• Practice using calm thoughts to quiet your nerves before you go to the toilet

Stress Incontinence:

Do a Hold’em before you cough, sneeze, lift, jump or anytime you might leak urine. The more this becomes a habit, the more your muscles will eventually do it automatically.

Advanced Training

Do 2-3 times a day, for 4 weeks

Hold’ems & Speed’ems

Try using different positions to challenge your muscles: standing with feet apart, leg up on chair, squatting, etc

Crowns – 5 sets, 2½ minutes

Combination of Hold’ems and Speed’ems: start as if doing a Speed’em but don’t fully relax your muscles until you have done 8 peaks.

Repeat 4 more times.

Maintenance Program

Do once a day

10 Hold’ems, 30 Speed’ems and 5 Crowns.

Perineal Massage

What is the goal?

The ultimate goal is to learn how to use your mind to relax your muscles, NOT necessarily to increase the flexibility of your tissues, although this will happen too. The key to learning this mind-body connection is to go to the place where you feel your body start to tense up – then take deep, relaxing breaths until those muscles loosen, which may take a few minutes. Over the course of a few weeks, your muscles (and your brain) will learn to know and trust that they can stretch quite far without injury. In turn, this confidence will cause your tissues to relax and stretch even further.

Instructions:

5-10 minutes daily from 34 weeks

If you are doing the massage on yourself, you may want to use your thumbs. If you have a partner doing it, they can use their index fingers. Sometimes it’s only possible to get one finger in until the area has learned to relax and stretch more. Partners: be sensitive to their body and what they are giving you as feedback on the amount of pressure to use.

Preparation:

If you have time, take a bath – the wet heat will start the relaxation process, especially if you add some bath salts, lavender, etc.

Wash your hands. Make sure your nails are not ragged.

Relax in semi-lying position. Bend your knees and let them relax to the side. Use lots of pillows for support behind your back and under your knees.

Apply some lubricant to your fingers and tissues (coconut oil works well).

Practice:

Place your fingers about an inch inside the vagina. Press downward and to the sides at the same time. Gently and firmly keep stretching until you feel your muscles tense up – you will probably be feeling a slight burning, tingling or stinging sensation; you should not feel pain. Hold this stretch for about two minutes or until the intensity eases. With each exhale concentrate on relaxing your muscles a little further.

To help your brain identify the muscles it wants to relax, try doing a Kegel. Or do a reverse Kegel and bulge those muscles out.

If you/your partner can feel more tension in certain muscles than others, use slight finger pressure or massage on those muscles for biofeedback.

As you keep pressing with your fingers, very slowly and gently massage in a sling motion over the lower half of your vagina, working the lubricant into the tissues. Some people find the motion of the fingers going in opposite directions more comfortable; others prefer to go in one direction at a time. Avoid the urinary opening. Keep this up for two minutes.

If you’ve had a previous tear or episiotomy, pay special attention to the scar tissue, which is especially non-elastic. Gently massage this area to help break down the scar tissue and help blood circulate in the area.

Pull gently outward (and forward) on the lower part of the vagina with your fingers. This imitates the stretch to the muscles and skin during birth.

CAUTION:

• avoid massaging the urinary opening or you may cause enough irritation to start a bladder infection

• avoid being overly vigorous or you may actually cause micro lesions which weaken your tissues: it should be intense but not painful

• use only good quality lubes (try Womyn’s Ware womynsware.com for a great selection) or oils (almond, coconut, olive or vitamin E); avoid petroleum-based oils such as baby oil or mineral oil

• use positive thinking about your body’s ability to open and stretch when it needs to – remind yourself about the hormones of birth, as well as intense blood flow during pushing, that will radically increase the pliability of your tissue

Don’t do perineal massage if:

• You have any kind of infection, including yeast or bacterial vaginosis

• It makes your tissues irritated or raw

• You have a herpes outbreak

• It makes you anxious

• It is not something you are comfortable doing

Why should I get Acupuncture during Pregnancy?

Pregnancy is an exciting and wonderful time. With the many physical and hormonal changes that occur, however, it can also be a time of discomfort. Many pregnant clients suffer from fatigue, nausea, backache and other conditions that are considered a “normal” part of pregnancy. Acupuncture is a safe, gentle and effective way to address these complaints, especially since many Western medications can’t be used during this time.

Regular acupuncture during pregnancy sets the foundation for a healthy client and baby. In addition, people who receive acupuncture during pregnancy often have a shorter and easier birth experience than people who don’t receive acupuncture. Several European studies concluded that people who received acupuncture once a week during the last month of pregnancy had significantly shorter labors than people who did not receive any acupuncture, in addition to less medical inductions, a reduction in epidurals, a lower rate of caesarean sections, and an increase in normal vaginal births.

Pregnancy and Postpartum Conditions Treated

Some of the conditions that acupuncture can treat are:

• Nausea, vomiting, and hyperemesis gravidarum

• Insomnia

• Low energy

• Anemia

• Anxiety/depression

• Constipation

• Heartburn

• Headaches & migraines

• Back pain and sciatica

• Symphysis pubis pain

• Pelvic girdle pain

• Carpal tunnel syndrome

• Gestational diabetes

• High blood pressure (pre-eclampsia)

• PUPPs & other pregnancy-related skin conditions

• Certain types of threatened miscarriage

• Placenta previa

• Breech presentation

• Posterior presentation

• Pre-term labor

• Delayed labor

• Labor pain

• Lactation problems

• Postpartum depression

• C-Section preparation and recovery

Is Acupuncture Safe during Pregnancy?

Yes. Prenatal acupuncture has been used for thousands of years to help patients support a healthy pregnancy and uncomplicated delivery. You may have heard that some acupuncture points are forbidden during pregnancy. While there is no real evidence for avoiding these points mentioned in the classic texts of Traditional Chinese Medicine; they are usually avoided during pregnancy on the small chance that they might stimulate uterine contractions. A practitioner trained in prenatal acupuncture & Obstetrics will know which points can safely be used and which should be avoided. Let the acupuncturist know of any complications or health issues.

General Treatment Plan for Pregnancy

Acupuncture and traditional Chinese medicine (TCM) provide specific treatments for each of the three trimesters of pregnancy, setting the foundation, maintaining balance/offering relief from common complaints, and preparing the body for labor and delivery.

Breech Presentation: The traditional Chinese medicine treatment for breech presentation has been used for thousands of years. It is successful 75% of the time and carries no risk to the people or their baby.

Labor Induction: Acupuncture for labor induction is safe for both client and baby as long as there are no serious complications with the pregnancy.

Postpartum Treatment: In addition to returning the body to a state of balance and optimal reproductive health, many postpartum conditions are successfully treated with acupuncture.

Helping your baby turn to head-down

Low intervention methods: 32-34weeks

Knee-chest exercise

Get on your elbows and knees, so your hips are higher than your head, and stay in this position for 15-20 minutes a couple of times a day. If the baby is sitting deep in the pelvis, this can bring it high enough that it can move easier and hopefully flip.

Postural inversion or *breech tilt*

Lie on your back with your hips propped up 12-18 inches higher than the head, two to three times per day, for between 10-20 minutes at a time. Like the knee-chest exercise, this helps to disengage the baby from the pelvis, and when the baby’s head comes up against the inside of the fundus, it is inclined to tuck its head in and do a somersault into the vertex position. It is sometimes recommended to try this with an empty stomach.

Swimming

Swimming may help to turn a breech baby. This is probably due to a relaxation of the abdominal muscles while being supported by the water, giving baby more room to flip.

Homeopathy

Homeopathic Pulsatilla causes the muscle fibers in the uterus to even out and may help to turn a breech baby. These are available at most health food stores.

Hydration

Dehydration can cause low amniotic fluid, decreasing the amount of room for your baby to move around. Make sure that you are drinking adequate fluid to stay well-hydrated, especially before any procedures like massage, acupuncture or ECV.

Deep relaxation or hypnosis

Practice self-hypnosis – some like to do this in a warm bath with 2cups of Epsom salts and/or three drops of lavender essential oil. The deep relaxation can help your abdominal muscles/diaphragm/pelvic floor to relax enough to allow the baby to turn. Visualize your baby being head down.

Medium intervention methods: 34-36 weeks

TCM: acupuncture &/or moxibustion

A professional acupuncturist will insert needles into acupoint BL67, which is on the outside of the little toe, right next to the nail, to promote breech babies turning. Its effect may be through increasing fetal activity.

Traditional Chinese medicine practitioners also use moxibustion (burning herbs, usually in a cigar shape) to stimulate acupoint BL67. It is possible to buy moxa sticks and try this yourself.

Massage therapy

An RMT experienced in treating pregnant women, especially those who have treated women with breech babies, will aid in releasing any muscle or fascia tension that has inhibited your baby’s ability to move into a vertex position. Often this will be in the mid-back, rib or diaphragm area; it may also include work on your hip flexors such as the psoas muscle.

Chiropractic: The Webster Technique

It is a simple technique, which involves a chiropractor, who is trained in this technique, working gently on the woman’s legs and vertebra, usually requiring a series of two or three appointments.

High intervention methods: 36+ weeks

External cephalic version (ECV)

ECV involves the external manipulation of the baby, done sometime after the 35th week of pregnancy. This is usually done by an obstetrician in the hospital using ultrasound to initially find out exactly how the baby is lying and locate the placenta, and then to monitor the baby throughout the actual procedure. A rare but serious risk associated with ECV is separation of the placenta; this is extremely uncommon due to the guidance of the ultrasound. A common side effect that some women experience is the discomfort caused by the deep pressure used to turn the baby, although some describe it only as a very intense massage. During and after the procedure, the fetal heart rate will be monitored. If you are interested in ECV, your midwife will refer you to a high-risk OB in London to attempt to turn your baby.

After all that, if your baby is still breech…

If your baby remains breech, there may be a good reason why: it may be because of the position of the placenta, or a short umbilical cord that is preventing the baby from moving to the vertex position, or your baby may just be “stuck” with its buttocks so deep in the pelvis that it is unable to move itself around to vertex. These things are not necessarily anything to worry about, and breech may simply be the best presentation for your baby.

If you are interested in the option of a vaginal breech delivery, talk to your midwife about what this would look like. There are a number of Obstetricians in our community who are experienced at breech deliveries.

If you think you would prefer an elective cesarean delivery, then your midwife can also review this option with you and arranged for a consult with an Obstetrician.

In most pregnancies, labor starts between 37 and 42 weeks after the last menstrual period. Labor is considered preterm labor when it starts before the beginning of the 37th week.

Signs of preterm labor:

• Ruptured membranes (your “water breaks” and fluid drips down your leg)

• Vaginal bleeding (bigger than a toonie)

• Low, dull backache (constant OR comes and goes)

• Pelvic pressure (feels like the baby is pushing down; feels heavy)

• Abdominal cramping (with or without diarrhea)

• Menstrual-like cramps (constant OR come and go)

• Uterine Contractions. If you are feeling uterine contractions, cramping or backache: Drink 16 oz. of a non-caffeinated beverage and empty your bladder. Then get in a warm bath or lie down, and count the contractions for an hour. Physical and/or emotional stress can increase the number and strength of Braxton-Hicks contractions, so relax and de-stress.

Call your midwife if:

• You have six or more contractions in an hour

• Your contractions/cramps/backache are increasing in frequency, duration or strength

You have risk factors for preterm labor, such as a personal or family history of preterm delivery

What causes preterm labor?

It is not known exactly what causes preterm labor. Preterm labor may be a normal process that starts early for some reason, or it may be due to infection. In most cases of preterm labor, the exact cause is not known and those who go into preterm labour had no known risk factors. Vitamin D during pregnancy has been shown to reduce the risk of preterm birth. Researchers recommend 4000 IU of Vitamin D every day in the second and third trimester.

A Randomized Trial of Vitamin D Supplementation >

Why are care providers concerned with preterm labour?

Growth and development in the last part of pregnancy is critical to the baby’s health. If preterm labor is found early enough, delivery can sometimes be prevented or postponed. This will give your baby extra time to grow and mature.

Obviously, the earlier the baby is born, the greater the risk of problems. Very preterm delivery before 30 weeks accounts for about 75% of newborn deaths that are not related to birth defects. Even “late preterm” babies, born between 34 – 37 weeks can have problems such as maintaining a normal body temperature, hypoglycemia, and poor sucking impacting breastfeeding. Thus, if you are planning a home birth but find yourself delivering before 37 weeks, it will be recommended that you birth in the hospital.

Diagnosing Preterm Labor

It can be hard to tell the difference between true labor and strong Braxton-Hicks contractions. Braxton-Hicks start at around 12 weeks of pregnancy, and increase in strength in the third trimester as the uterus gets stronger in preparation for labor. At this time, women may begin to notice that their bellies regularly get hard (especially with movement such as during exercise, or with fetal movement). These “practice contractions” may even be painful and regular, but usually go away within an hour or with rest. Braxton-Hicks contractions can also last for extended periods of time, even up to an hour – these are generally reassuring, unlike intermittent contractions that increase in frequency, duration or strength.

True preterm labor can only be diagnosed by determining if the cervix is making changes. Ultrasound may be used to confirm cervical shortening and/or dilation. Before 34 weeks, midwives can do a test called fetal fibronectin, which is a swab around the cervix. Fetal fibronectin is like the “glue” that sticks the membranes to the uterus. If fetal fibronectin is detected using this swab, then this correlates with possible preterm labour.

When clients are feeling contractions, efm will be applied to assess fetal heart rate and uterine contractions. Sometimes rehydration will stop preterm labour, so we may give IV fluids. Finally, morphine may be given, as sedation will often stop labour.

What is a doula?

Doulas (also called Childbirth Assistants, Labor Support Professionals, Birth Assistants, or Birth Companions) provide emotional, physical and informational support during pregnancy, labor, birth and immediate postpartum.

A doula provides continuous, uninterrupted support throughout labor and birth. They offer information, massage, suggestions for position changes, relaxation techniques, reminders to stay hydrated and keep your bladder empty, etc.

A doula does not replace a partner. Instead they also help support the partner in ways that help enhance the bond between the couple.

Labour doulas provide care, such as:

• Helping with labour support, making your labour easier

• Provide massage and other comfort measures for relaxation and focusing

• Labor and birth positioning suggestions for comfort and labor progress

• Suggest positions to ease back labor, aid relaxation, help with pushing

• Offer you cold/hot packs

• Bring you drinks, snacks, ice chips

• Stay by your side so that your partner can take a break when needed

• They may take notes during labor and provide you with a written record of the birth

• Take photographs of you, your partner, your baby, and other members of the birth team before, during and after birth

• Help you with initiating breastfeeding

• Telephone support during early labor, before you need physical support

Interview doulas to find a good fit. You want someone you are comfortable with, and who you feel will work well with you and your partner. You won’t necessarily “click” with the first one you meet. Don’t worry, nobody will take it personally!

Midwives and doulas do have much overlap in styles and skills. There are also a number of key differences:

Increased labor support: Because a midwife’s primary responsibilities are clinical – to make sure that you and baby are safe – certain situations will take her away from focusing on just labor support

Early labour: Midwives do not attend you until you are in active labor – 4 cms dilated and having regular contractions. If you are like many others, chances are you will have hours of early labour – ranging from 2-24 – when having a doula to reassure and support you could be very helpful for you and your partner. Rather than navigating this time alone, you and your partner could have the additional support offered by your doula. A doula will be there when your partner needs to eat or sleep, if you run out of coping strategies, or even just need a reminder this is still normal.

Precipitous labour: If you have a very fast labour, your midwife will be occupied with getting ready for the birth. When things need to be done quickly, a doula can be an extra set of hands that frees your partner to stay with you during this intense experience. A doula can also be the person whose voice is constantly in both your ears reminding you this is normal, just fast, and will be over soon.

Moment of birth: As mentioned, at the moment of birth the midwife is focusing on her many clinical duties, most which are below your belly button (including reducing your chance of tearing). A doula will still be available to do all other forms of physical and/or emotional support that you and your partner may need.

Midwives and doulas have been working together for centuries. Historically, doulas were women from the neighborhood who attended births and helped out a friend in need. In the last century when birth became more medicalized, the labouring client was expected to be alone. Partners have been invited into the labouring rooms only for the past several decades. For centuries, birth was an event where families, and experienced women, supported the natural birthing process. Our intention is to offer you resources so that you can make decisions that suit you and your family best.

See DONA International >

Doulas in our community >

Pre-registration

You will spend 30 minutes on the phone with a nurse to:

1. Record a health and pregnancy history so we can respond appropriately to changes in your condition. (Remember to complete the forms you received from your doctor or midwife and have them ready for your clinic appointment.)

2. Discuss when to come to the hospital for delivery and where to park.

3. Discuss what you might expect during labour, delivery and your postpartum stay.

4. Begin talking about infant feeding, baby care and caring for yourself.

5. Discuss when you will go home with your new baby.

6. Discuss what you will be expected to bring with you for your hospital stay.

7. Spend time talking about anything else that is important to you and your partner in planning for your new baby.

Please be prepared approximately 30 minutes prior to your appointment time. Remember to have your Ontario health card with you.

For women of 34 weeks gestation or more, we offer labour, birth, recovery and post-partum care (LBRP) all in one unit to support family-centred care. We have eight private rooms available to improve patient comfort and provide a calm and more home-like setting. We believe in keeping families together before, during and after their birth experience. One of the birthing rooms was specially designed for Indigenous births. Its size accommodates larger families and traditional ceremonies, and features Indigenous art. Traditional birth customs such as cedar baths, and liquid smudging can be performed on-site.

Please let your nurse know of your room preference as soon as possible. Ward rooms are covered by OHIP. Please let us know if you prefer a private or semi-private room for an additional premium. Most insurance plans cover all or part of these charges, but please check your policy.

Bluewater Health has implemented an Obstetrical Triage Acuity Scale (OTAS) to improve quality of care and ensure women with the highest need are seen first. By reducing time delays, increasing patient flow and decreasing the patient length of stay we are aiming to achieve enhanced patient outcomes. OTAS is now built into Bluewater Health’s computer system. When a patient arrives at the obstetrical unit, the nurse’s computer displays all the pertinent questions to ask the patient.

If you are under the care of a midwife, one of the midwives from your team will delivery your baby. There are very few instances, when your on-call midwife will be on sleep relief, and another midwife from a different team may need to fill in for her.

If a consult is needed with an Obstetrician: The obstetricians at Bluewater Health deliver on an ‘on call system.’ The physician who is on call delivers all the babies from all the obstetrical doctors during their 24-hour shift, including midwife transfers of care. The on-call physician will deliver your care, and could be male or female.

Our healthcare team includes male and female staff who may need to attend your delivery. This includes an Operating Room assistant and an anaesthetist. If your baby needs to be delivered via caesarean-section, or if it is anticipated your baby may need some assistance at delivery, a paediatrician, respiratory therapist and Special Care Nursery nurse may also be required to attend.

Our staff provides therapeutic support to labouring moms and offers measures to improve comfort and manage pain during labour and birth. Epidural service is also available 24 hours per day.

Our level II Special Care Nursery is well equipped to care for fragile newborns that require additional support after birth. If baby is born at another hospital, they can be transferred here when appropriate so care can be provided closer to home for Sarnia-Lambton families.

Blue Water Health Labour & Delivery:

Maternal, Infant, Child Unit - Third floor Norman Building

89 Norman St. Sarnia ON N7T 6S3

Virtual Hospital Tour >

More information about Bluewater Health, including COVID protocols >

NON-URGENT Calls: Please call the office Monday–Friday: 519-337-2229. You can leave a message with Roxanne or Stacey and they will send your midwife an email. If you do not need a midwife immediately, please wait until morning.

Please respect that after-hours calls are welcome if they are for urgent concerns only. An urgent call includes any falls, accidents, bleeding, active labour, etc.

URGENT Calls: Call pager number: Give the team you are paging, your name, phone number, and your concern. If you have not heard back from your midwife within 10 minutes, please page again. Sometimes your midwife will be in the middle of a birth, and the page will go to another team member who will then report back to your primary midwife once they are available.

You will receive a paging sheet on intake.

Planning for birth is like building your dream home … you envision the ideal structure beforehand, and then once everything is underway you may need to revise and redraw your blueprints as circumstances arise. Sometimes the final outcome looks very little like the original plan, but is no less beautiful.

In answer to our client’s most common questions – as well as the numerous internet birth plans – we have written our own “birth plan” to help you know what to expect from us. Of course, the following is for a textbook spontaneous vaginal birth and your labor may demand a few variations, or a completely new plan!

Early Labor

24/7 telephone support from your midwife team

In-person assessments of labor progress as necessary. These are usually done at home, although occasionally are done in the clinic or hospital.

Active Labor

Every attempt will be made for a midwife known to you to be designated your primary care provider for labor, and to remain so until the birth is over. Certain circumstances may make this impossible, such as illness, injury, extreme fatigue, etc.

If your labor extends over your midwife team’s designated call-change time, the next primary midwife from your team will come on.

When a student midwife has been part of your care prenatally, she will usually be available for additional continuity and hands-on care during labor. The more clinical care that your midwife can delegate to her (under supervision), the more opportunity the midwife has to support you directly.

Any and all proposed procedures will be explained and discussed, except in emergency situations, when permission will be assumed and every effort will be made to debrief and explain afterwards

Internal exams will be minimized

Intermittent monitoring of the fetal heart rate with a handheld Doppler will be used every 15-30 minutes once you are established in active labor, unless medically indicated to use continuous fetal monitoring. During pushing, monitoring will increase to about every 5 minutes.

If continuous monitoring is indicated, a cordless & waterproof monitor can be used so you can still walk around and/or use water (when available and appropriate).

Movement and position changes will be encouraged throughout labor

You will be reminded to drink as much as possible

You will be encouraged to eat to keep up your energy, unless medically inappropriate such as during an induction – in these situations clear fluids may still be encouraged

You will be reminded to void frequently

A calm atmosphere is our goal: low lights, soft voices, etc.

You are welcome to bring your own music to play – cell phone + speaker works best.

Lots of verbal encouragement when needed

As many support people as deemed appropriate by the labouring client will be welcome – on the understanding that if the situation gets hectic and there are too many people to maintain a safe and supportive atmosphere, or if anyone is found to be hindering effective labour, some or all may be asked to leave (currently only one support person at one time)

Your other children are welcome at a home birth, as long as they each have their own support person and the option to leave if they are bored, tired or frightened. They are also welcome to participate in whatever way you and they feel comfortable.

You will not be shaved – except minimally for cesarean section. What you choose to do for yourself is fine!

Unless you have extreme constipation, you will not be offered an enema.

Your midwives will usually not offer you drugs. We trust that you know your options and will ask for what you need. Occasionally in the hospital other care providers may do this – most commonly, the nurse – so your support people should know what your wishes are surrounding this.

There are a number of situations where induction of labor may be offered or advised. If any of these arise for you, we will discuss risks and benefits of all options to help you make an informed decision as to how to proceed.

If your labour needs to be induced, or your contractions need stimulation to continue to be strong, more natural methods such as walking, nipple stimulation, positions, breaking your waters, etc, will be offered before pharmaceutical methods, unless deemed clinically inappropriate or not preferred by you.

We often wait for your bag of waters to break on its own, unless a clinical reason indicates that artificial rupture (breaking the bag of waters) may be helpful or necessary.

IV fluids will only be used for medical indications, such as epidural use, administration of oxytocin, serious dehydration causing a slowing of labor, or if you are attempting a VBAC

If it becomes necessary to transfer the care of you or baby to a doctor, we will stay with you in a supportive role throughout active labor, birth and postpartum

Homebirth

A second midwife will be called to attend once the birth is judged to be imminent

Hospital birth

Until the birth is more imminent, or there is a clinical indication for early transfer into the hospital, we can labor with you at home as long as safety and comfort allow (factoring in weather, traffic, distance to hospital, speed of your labor, etc.)

If we have done a complete maternal and fetal assessment at home, your midwife will phone ahead to let the hospital know we are coming.

You will have a private room to labor in. It will have either a shower or a tub.

You will have your choice of wearing your own clothes, a hospital gown, or nothing.

Verbal encouragement or silent birth

Sterile water injections for back labor

TENS machine for pain relief (to be arranged prenatally by parents)

Tub for pain relief (rental may need to be arranged if at home; subject to tub availability if in hospital)

Pushing

Instinctive and spontaneous pushing, unless our client asks for direction or it is deemed clinically necessary to help speed the birth, then calm encouragement

Encouragement of position changes

Use of gravity-positive positions, squatting bar/birth stool where available

Everything possible to help prevent tearing: positions, warm compresses, verbal coaching through crowning, etc.

No episiotomy! Unless deemed absolutely crucial that the baby needs to be born quickly (about 1/1000 chance)

Optional:

Using a mirror to see when pushing

Touching baby’s head as it starts to emerge (client, partner)

Birth

Unless requested, we will not announce the sex of your baby

Unless there is an overriding clinical or practical reason not to, baby will be delivered up to their parent’s chest

Suctioning of baby after birth will be avoided except where medically necessary. See Report >

Our standard is to practice delayed cord clamping, i.e. the cord will not be clamped and cut until it has stopped pulsing (at least a number of minutes), unless there is a clinical or practical reason to do so. More information >

Optional:

Choice of approach to Third Stage Management (delivery of placenta)

Waterbirth (only possible at home)

Client or partner to help catch the baby

Donation of cord blood – must be arranged by clients

Client’s choice of who to cut the cord (except in OR, or emergent situation)

If birthing in the OR:

Midwife and one support person chosen by mom to be present after regional anesthetic effectively placed – in the event of general anesthesia, hospital policy is to not allow support people, including partners, in the OR

Baby and mom to be reunited as soon as possible – depending on circumstances, this may average 2 minutes or 2 hours

Postpartum

As much skin-to-skin contact as possible with mom will be encouraged. If not possible, then skin-to-skin with partner or other support person.

Breastfeeding will be initiated as soon as possible, initiated by baby’s cues

Placenta tour will be offered

24/7 pager availability for serious concerns

3 home visits in the first week

2-3 clinic visits in first six weeks

Flexible visit schedule, geared to mom & baby’s needs

Eye ointment – see tab below for info

Vitamin K – if chosen, usually given during breastfeeding to minimize pain to baby - see tab below for more info

Delay of the Newborn Exam until parents have had bonding time, if possible

If hospital birth, discharge as soon as mother and baby clinically stable and ready to go home… on average 6-12 hours after a normal, vaginal delivery with no drugs

Midwife will see at home around 24 hours, if client chooses early discharge

Exclusive breastfeeding will be supported: donor milk where available; formula to be used only for medical reasons; cup/syringe feeding instead of artificial nipples

Rooming-in with baby, unless needing to be in the nursery for medical reasons

Feeding on demand (including guidelines to recognize when baby is demanding to be fed)

Optional:

Placenta to be kept by parents

If it is necessary for baby to be taken to the nursery, partner to go with baby

Longer hospital stay for special circumstances/convenience

Now that you know what is “standard” or “routine” for midwifery care, you can create a birth plan that is more personal and specific to your needs and desires.

If you are choosing to give birth at home, you will be given a list of supplies to collect, between 32-34 weeks. At 36 weeks, you will be given a bag with supplies (blue pads, peri-cleanse bottle, etc) from us, a binder for charting, and some postpartum medications to put in your fridge (we suggest in your fridge door).

Once you have all your supplies at home, it is extremely helpful if you have a designated box or a basket that you will use to store everything, including the receiving blankets and towels – a laundry basket works well.

Please collect the following items at least 3 weeks before your due date.

Home Birth Supply List: Click here for a printable version

• 1 small table or dresser cleared for birth supplies

• 4-8 clean older wash cloths

• 6 large clean older towels

• 3 receiving blankets

• 2 medium stainless steel or glass bowls

• Plastic container with fitted lid for storing placenta (ice cream container works well!)

• 2 large cardboard boxes or containers with garbage bags in them – one for garbage, one for used laundry

• 1 roll of paper towels

• Extension cord (we need to plug in multiple things)

• Large sanitary pads (not Always brand pads as they can cause irritation)

• A comfortable outfit to change into when you get out of the shower

• Baby diapers

• Baby hat

• Baby Sleeper

Suggested extras:

• Hydrogen peroxide to remove blood stains in laundry, if needed

• Crock pot with lid to keep compresses (facecloths) warm

• 6 frozen pads in freezer (pantiliners with witch hazel sprayed on them work well!)

• Gatorade, juice, coconut water to keep well hydrated

• Light snacks for you and your attendants

• Postpartum medications – enough for 24hrs: Ibuprofen & Tylenol

• Epsom salts (1-2kg) for healing baths in the postpartum

• Sitz bath herbs (from midwife)

• Postpartum recovery tea (calms afterpains, promotes healing)

• Mother’s Milk tea or tincture (helps promote breastmilk supply)

• Witch hazel & cotton balls (soothes & shrinks hemorrhoids)

To protect your mattress and pillows, please prepare the bed as follows when you are in early labour:

1. Make your bed with a clean fitted and flat sheet.

2. Cover your bed with a plastic mattress cover or shower curtain. You can secure it with duct tape.

3. On top of the plastic sheet, put a clean, older fitted sheet for the birth.

4. Next, a clean, older top sheet and any other blankets you wish to use.

5. Prepare 2-4 pillows in the same way with a clean pillowcase, then a garbage bag over top to protect the pillow, and then a clean older pillowcase on top.

Sometimes plans change and a planned homebirth can turn into a hospital birth, so we suggest that you have a hospital bag or suitcase ready should we need to transfer in (clothing and toiletries for you, clothing, diapers, and car seat ready for babe). Have your health card readily available and your Pre-anesthesia/Room Type forms ready in your bag.

Nourishment

We can’t say enough how important food and hydration is in labour. Your body is working hard – keeping nourished and hydrated is essential. It is great to have different beverage options as well as easy and healthy snacks for when you are in labour. Think about something nourishing after the birth when you are ravenous… Don’t forget to have some nutritious snacks for your labouring partner as well.

Here are some ideas for you:

• Beverages

• Labour-Ade

• Electrolyte drinks

• Teas with honey

• Less-acidic juices, such as coconut water

• Smoothies

• Snacks

• Fruit (frozen grapes are great!)

• Broth

• Energy balls/bars

• Crackers & cheese

• Yogurt

• Food for birth partner/team

• Protein-rich food definitely helps when you are tired

• Coffee/tea – nobody wants a withdrawal headache when they are meeting their baby

• Victory Meal

Hospital Bag supplies:

• OHIP card

• Car seat

• Going-home clothes

• Going-home outfit & blankets for baby

• Cell phone

• Camera

• Hair ties, if needed

• Credit/debit cards for food, parking, etc.

• Music (e.g. cellphone & speaker)

• Water bottle, other drinks (e.g. coconut water)

• Food/snacks for labor

• Toiletries for client & partner(s)

• Change of clothes for partner(s)

• Large T-shirt/comfy nightie

• Flip-flops or slippers

• Pillow & colorful pillowcase, if you like your own pillow

• Extra diapers & wipes (hospitals only supply a few diapers)

Postpartum Supplies:

• Overnight maxi pads (1 box)

• 6 Frozen pads (made in advance)

• Panty liners

• Nipple cream – Lansinoh, Purelan, Natural Nipple Butter

• Baby oil (Burt’s Bees, olive, coconut oil)

• Ibuprofen

• Homeopathic Arnica 30C pellets

• Lavender &/or tea tree essential oil

• Epsom salts (1-2kg)

• Sitz bath herbs (midwives can give you these)

• Postpartum recovery tea (calms afterpains, promotes healing)

• Witch hazel (soothes & shrinks hemorrhoids)

• Nursing bras

• Breast pads

• FOOD for immediate postpartum

• Pre-prepared meals in freezer

• Healthy snack foods

Spinning Babies Maternal Positioning

Spinning Babies Tips for Labour Progress

Water is revered in every culture for its life-sustaining and healing properties. Women have been using water in labour and birth for millennia. Ancient Egyptian petroglyphs depict water births of babies destined to become priests or priestesses. The oral histories of indigenous peoples on every continent – from New Zealand to Mongolia, Panama to Japan – include stories about women giving birth in the ocean tide pools, in streams and in shallow lakes.

In the 1960s, Igor Tjarkovsky, a swimming instructor and midwife, popularized water birth in Russia. In 1983, Herman Ponette, an obstetrician, began installing birthing tubs in his hospital in Belgium. Since then, he has attended over 5,500 water births.

In the United Kingdom, even the government recognizes the potential benefits of water birth. In 1992, the UK House of Commons recommended that whenever possible, women have the option to birth in water. Nearly half of all maternity hospitals in the UK have installed birthing pools and there are at least 2,000 water births per year.

What are the benefits of water birth?

Many women find that being immersed in water during labour and birth gives them an increased sense of control, comfort and relaxation. If you are the kind of person who enjoys spending time in water, you may enjoy the following benefits from birthing your baby in water:

• You may feel more relaxed and better able to cope with your contractions

• You may need less pain medication because your contractions are easier to cope with

• You may find it easier to move intuitively to ease your baby through your pelvis

• Your cervix may open faster and your labour may be shorter

• You may have less need for medication to help your labour because your contractions work better

• You may have less need for help from forceps, vacuum or caesarean to give birth to your baby

• You may have less need for an episiotomy and less chance of having a serious tear

• Some people have also suggested that water birth is a gentler experience for baby as well as for mom.

Is water birth safe?

The research about the safety of water birth is not conclusive. However, the existing studies seem to suggest that birthing in water is a safe option for women with healthy pregnancies and uncomplicated labours.

To understand the available evidence about water birth, you need to know a little about medical research. The gold standard for a research study is a Randomized Controlled Trial (RCT), meaning that the subjects are randomly assigned to either a treatment group or a control group. However, there have not been any good RCTs about water birth because most women would not be willing to be randomly directed to birth in water or on land.

The next best thing to an RCT is a cohort study. A cohort study compares a treatment group with a control group but the subjects are not randomly assigned so there is a chance for bias. There are a number of large cohort studies looking at water birth. They have all found that when compared with land birth, water birth is associated with:

• Similar or lower rates of infection in mothers and babies

• Similar or better results on tests that evaluate the baby’s wellbeing after birth

• Similar or lower rates of babies admitted to special care nurseries

• Similar or lower rates of baby deaths

A case study describes the experience of one patient or a few patients. Case studies are the weakest form of evidence, although they are sometimes the only way to learn about very rare problems. A number of case studies have reported on babies who have become sick or died after being born in water. However, these problems have not been reported by any of the larger, better quality studies.

What stops babies from breathing underwater?

A number of factors inhibit babies from breathing underwater at the time of birth:

Hormones: You might be surprised to learn that your baby has already begun practicing breathing before birth, inside the uterus. Researchers have observed breathing movements in the human fetus as much as 40% of the time. However, in the days before labour begins, breathing activity decreases dramatically because of prostaglandins, hormones released by the placenta which also play a role in starting labour.

Temperature: Newborn babies are sensitive to temperature. They are stimulated to breathe by the cooler temperature of air compared to the warm environment inside the mother. However, when born into water that is at a similar temperature to the mother’s body temperature, they are not stimulated to breathe.

Dive Reflex: Humans have a powerful dive reflex which maximizes their ability to hold their breath underwater. This reflex is associated with the larynx, the opening to the lower airway. The opening to the larynx is covered with more taste buds than the entire surface of the tongue. These taste buds can distinguish between bodily fluids (like mucus, urine, blood, or amniotic fluid) and other foreign fluids (like water). When they encounter a foreign fluid, they elicit the dive reflex. The opening to the airway closes and the fluid is swallowed, not inhaled. In addition, nerves in the face sense when the face is immersed in water and send messages to the brain. The brain responds by inhibiting breathing, decreasing heart rate, and redirecting blood to the brain and heart where it is needed most. This reflex helps to prevent babies from gasping for air when they are born underwater.

Hypoxia: Babies are born experiencing acute hypoxia, meaning they are temporarily lacking oxygen. This inhibits breathing. However, babies born experiencing severe, prolonged lack of oxygen may gasp for air. As a result, your midwife will monitor your baby’s well being during labour. If there are any signs that your baby may be experiencing a prolonged lack of oxygen, your midwife will ask you to get out of the water.

Guidelines for water birth

There are some situations where birthing in the water may not be clinically advisable and your provider may ask you to get out at the last minute. Certain providers have different levels of experience and comfort with delivering the baby and/or the placenta in the tub, therefore you should ask beforehand, if this is important to you.

If you are planning to birth in hospital, you should know that Bluewater Health hospital policy is against waterbirth, therefore mothers are required to get out of the tub once they are in second stage (i.e. pushing). There is a tub available in Labour Room 1. All other birthing rooms have large showers.

To help keep you and your baby safe while having a water birth you need to:

• Be having a healthy pregnancy

• Be 37 weeks gestation or later

• Be in a warm (not hot) bath (between 36-37.5°C)

• Have no strong medications such as morphine

• Leave the water if your care provider has any concerns with your or your baby’s wellbeing

Can I have a water birth in the hospital?

Unfortunately, midwives only attend waterbirths at home.

What supplies do I need for a water birth at home?

To provide optimal pain relief, the water level needs to be deep enough to cover your whole belly. Therefore, unless your home has a deep soaker tub, a labor tub will likely need to be rented or bought.

• Birth pool – cheaper to buy; rentals usually have a heater (Lovewell rents tubs)

• Garden/waterbed hose, new (may come with rental)

• Sink faucet attachment for hose, with reverse/draining ability (Y adaptor) – from aquarium/pet store (confirm with rental company)

• Pump – foot or electric for inflatable pool (may come with rental)

• Plastic and towels to surround pool

• Fish aquarium net (large size)

• Yoga mat for floor close to the pool

• Lots of extra towels

• Bath pillow, if sides not soft (optional)

Water Birth Resources:

www.waterbirth.org

www.waterbirthinfo.com

www.babycenter.ca/pregnancy/labourandbirth/waterbirth

www.geocities.com/hotsprings/2840/whywater

www.geocities.com/hotsprings/2840/whywater

www.yourwaterbirth.com

Birth Day Video (66 min): Shows the birth of a midwife’s third child in her hot tub at her home in Xalapa, Mexico

Birth Into Being: The Russian Waterbirth Experience Video (28 min): Shows two births in the Black Sea and two births at home in a clear birthing pool

Research:

Gilbert RE. Tookey PA. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey >

Keirse MJ. Challenging water birth — how wet can it get? >

Cluett ER. Nikodem VC. McCandlish RE. Burns EE. Immersion in water in pregnancy, labour and birth >

Johnson P. Birth under water–to breathe or not to breathe >

With so many social expectations around the “due-date”, it is hard for a pregnant person not feel like there is a clock that starts ringing ferociously on that magic day. We know that our due-dates are the best guess for a birthday that can take place several weeks before or after. There seems to be a fine line between letting nature take its course and being proactive so that our bodies are as prepared for the birth as possible. Numerous strategies can support your body’s innate ability to give birth naturally and possibly decrease your chances of going far past your due date. We have tried to outline the strategies we have found to be the most effective in nurturing and ripening your mind and body for labour. Awaiting baby after your due date has passed may be stressful, especially if you are considering electing a medical induction at some point, which carries a degree of risk as well as benefit, and may not look like the birth you had envisioned for yourself.

For the most part, when you will start labour is determined by a complex interplay of maternal and fetal hormones that starts in early pregnancy. Another factor is the fetal position in late pregnancy that in turn can be influenced by various other factors including personal energy, pelvic alignment, and lifestyle habits. Of course, there is also much to be said for the mind/body connection – we know that people rarely start labour if they are sick, and the same can be true if they have overwhelming fear or anxiety as both of these can slow down the production of necessary hormones.

Another factor is the fetal position in late pregnancy, which in turn can be influenced by various other factors including fetal size, maternal energy, pelvic alignment, pelvic floor tension, and lifestyle habits.

When your pregnancy goes past your due date >

Management of uncomplicated pregnancy beyond 41 weeks gestation >

Induction & Augmentation >

Prelabour Rupture of Membranes

Labour usually begins with mild contractions. Contractions are very hard to describe – they feel somewhat like strong menstrual cramps usually starting in the lower back and moving to the front. Try as long as possible not to let them interfere with your usual activities. If it is nighttime, please try to sleep. It is very important to rest while you can, since you may easily be up all the next night without sleep! If this is your first baby, you may even be up for two nights. It is not uncommon to have a long latent phase, where it takes a couple of days to dilate to the place where active labour starts, usually around 4 cm. Try to pay as little attention as possible to the early labour phase. It is best NOT to call friends and family to put them on alert – you will need your rest, and this may take a long time yet.

During real labour, contractions will usually be getting longer, stronger, and closer together. In fact, it is helpful to think of the earlier uterine activity as CRAMPS, instead of contractions. This makes them easier to ignore, so that you can continue on with normal living, including rest and sleep.

Contractions are timed from the beginning of one to the beginning of the next. Usually active labour contractions are about 5 minutes apart, and each contraction is about 60 seconds long (from beginning to the end), and they require your focus.

If you are not sure whether it is “real” labour, try changing your activity. If a change in activity decreases the contraction, this likely still not real labour. For example, if the contractions occur when you are active, trying taking a warm bath. If this slows down the contractions, it’s not time yet – try to go to bed and get some sleep. If you have been resting, try walking around. If you have to keep walking to make the contractions regular, please stop and rest. If you have had a good night’s sleep, and it is daytime, you could try some activity and try staying upright as much as possible to enlist the aid of gravity. Rest, eat light nutritious food, drink lots of fluids, and void often!

Page your midwife when you have regular, strong contractions:

• FIRST BABY: 4-1-1 Rule Consistent contractions every 4 minutes (beginning of one, to the beginning of the next), lasting 1 minute long (beginning of contraction to the end), for over 1 hour

• SECOND & Subsequent BABY: 5-1-1 Rule Contractions every 5 minutes, lasting 1 minute long, for 1 hour

Page your midwife immediately if these occur:

• You have not reached 37 weeks gestation but having contractions that don’t go away with rest, warm bath, and hydration

• Your water has broken and you are GBS positive

• Your water has broken and the water has a strong odor OR is any color other than clear

• Constant abdominal pain that does not go away

• Large amount of bleeding, more than mucousy “show” (larger than a toonie)

• Persistent and severe mid-back pain

• You have a fever > 38°C (if you feel hot or shivery, take your temperature)

• An outbreak of blisters appear anywhere around your genitals

• You have blurry vision, double vision or spots before your eyes

• Concerns about fetal movement (less than 6 movements in 2 hours)

Urgently call your midwife!

Spotting or bleeding with any of the following:

• Nausea or vomiting

• Fever

• Foul discharge

• Shock symptoms … cold, clammy, shivery, dizziness, mental fog

• Severe abdominal pain

• Known placenta previa

• Preterm labor symptoms

• You have fallen or been in an automobile accident

When to call 911:

If your water has broken and you feel something hanging in your vagina (Urgently get in a knees & chest position on the floor)

If the birth is suddenly imminent and the midwife is not going to make it in the next few minutes

AFTER you call 911, call your midwife IMMEDIATELY if possible.

Positions for Labour

The Evidence on: Birthing Positions

Effect of maternal birth positions on duration of second stage of labor

Whether you are planning a home or a hospital birth, unless you plan on being induced or having a booked cesarean (i.e. being in the hospital before contractions start), this information is for you.

Parents planning either to birth at home or to experience the majority of their labors at home, often inquire about the situations in which we would recommend transport to hospital. Once labour is established, we monitor you and your baby carefully during labour and then the immediate postpartum, with the aim to act on concerns before a serious problem arises. Both research and experience tell us that when midwives transport a client to the hospital it is almost always for a non-emergent indication.

Described below are the most common reasons for hospital transfer, listed loosely in order from most to least common. We recognize that it can be frightening to think about what could go wrong, so while reading, try to remember that the incidence these complications is quite low. Fortunately, a vast majority of the time the birth process remains normal for healthy clients. Please speak to your midwife if you have any questions.

TRANSPORTS to Hospital (usually by personal car)

1. Slow or no progress in labour

This is the number one reason for FIRST-TIME moms to transport to hospital, and includes over half of our transports.

Early labour (<4cm dilation): Duration of early labour varies—there is no “time limit”. There are many strategies for coping with a long early labour. Sometimes this includes using medications to help clients to get rest. These must be prescribed and administered in hospital, but clients can return home afterwards.

Active labour (First stage: dilation from 4-10 cm): Everyone’s rate of progress through labour will be different. Midwives and doulas have many tools to assist labour to progress. If none of these has worked and progress is truly stalled, then transport to the hospital will be recommended. Some medications can help facilitate pain management/rest and for labour augmentation with oxytocin. In cases of prolonged labour (very slow but still progressive), there may be a small associated increase in risk to client and baby, and increased monitoring in the hospital may be appropriate.

Pushing (second stage): The average first-time client pushes for 1-2 hours. For some people, second stage is prolonged or progress may be completely stalled. In these cases, physician consult for labour augmentation with oxytocin or for assisted delivery (vacuum/forceps/cesarean) may be recommended. Sometimes the baby is found to be presenting in a position that is unlikely to successfully deliver, in which case a physician consult to manually turn the baby may be recommended before pushing any further – and after which, if successful, the birth would continue as a low-risk planned-hospital event.

If you have had a previous vaginal birth, it is average to push for 20-60 minutes. Because second babies come so much faster and easier, it would be exceptionally rare to recommend transport in the pushing stage as there would be a good chance of baby being born enroute.

2. Meconium stained fluids

This is the second most common reason to transport to hospital, and the number one reason for second time parents.

If meconium is seen in the amniotic fluid, an informed discussion will occur regarding transport into the hospital – if there is time. Meconium stained fluids mean that the baby has had a bowel movement before or during labour, and it may be a sign that the baby possibly is feeling stressed. Alternatively, it also may indicate that the baby has a mature gut which has already started working (which is why this is more common in overdue births). Whatever the reason, if the baby inhales the sticky meconium with its first breath, it may make it difficult to fully inflate its lungs. The risk of this happening increases according to the amount of meconium in the fluid. Your midwife may recommend transport into the hospital so that continuous monitoring can assess whether your baby is stressed by labour. At the hospital, the Special care nursery and Respiratory therapist will be asked to attend the birth.

If the birth is imminent, then your midwives will prepare to provide extra care of your baby if needed.

3. Fetal heart rate concerns

We monitor your baby at home in the same way as we do in the hospital for normal birth. This includes assessments of your baby’s heart rate frequently once you are in active labor, and even more so once you are pushing. If we hear something that is atypical during one of these checks, we will increase our assessments to verify if this is a pattern versus a one-time event.

If there is a pattern of atypical heart rates – which could potentially indicate future problems – we may recommend transport in order to have access to increased monitoring and interventions if they become necessary. We usually transfer by private car. The exception to this is if the birth is imminent, in which case we would take measures to expedite the birth. In cases of concern, we may have an ambulance standing by should transport be necessary.

We try to make the decision about transport early, before a true problem arises.

4. Maternal vitals

Blood pressure

High blood pressure (>140/90) is associated with an increased risk for client and baby, and transport to the hospital allows access to lab work, extra monitoring of client and baby during labor, physician consultation and medications if necessary.

Temperature

Fever (>38.0 C) is a sign of infection. This would need to be treated in hospital with medications to combat infection (antibiotics, IV fluids), extra monitoring of client and baby’s health during labor, and potentially specialized pediatric care for an ill newborn.

5. Pain medications

It is rare for clients to request pain meds unless they are experiencing a long and/or non-progressive labour. In the first case, usually by the time client wants pain meds, the midwife has tried every other trick they have to help labour progress. In these cases, pain meds are actually a recommended option, usually in combination with oxytocin augmentation. Obviously these are only available in hospital.

If the birth is too imminent for transport or pain medications, the best strategy is to reassure clients that it will be over soon, while quickly getting ready for the birth.

Midwives are able to provide nitrous oxide (laughing gas) at homebirths.

6. Third or fourth degree tears

These large vaginal tears are rare, and most commonly associated with instrumental deliveries. Since management requires special instruments and clinicians experienced in advanced repair, transport to hospital and physician consultation would be indicated. Often it is done as an outpatient, so that you are only in hospital for about an hour and can come home directly afterwards.

7. Previously undetected twins or breech presentation

All midwives are trained in how to deliver twins/breeches, but obstetricians have more experience with this. There are associated risks for these babies, so if there is time we recommend transport to hospital for the birth in order to have access to specialized obstetric and pediatric care. Ultrasound in pregnancy has reduced the incidence of these circumstances.

8. Excessive bleeding

During labour: Occasionally, clients have a cervix that bleeds heavily during labour as part of the normal dilation process. Almost all people have bleeding (bloody show) in the last few centimeters of dilation, but if the amount of bleeding is assessed as excessive in volume, especially if combined with sudden fetal heart concerns, this is concerning. This bleeding could indicate one of a few possible concerns including the start of a placental abruption (placenta coming away from the uterine wall). Due to potential risks to client and baby, emergency transport to hospital for further monitoring and assessment would be advised.

After birth: Most postpartum hemorrhages can be managed at home with good outcomes, as we carry a number of anti-hemorrhagic medications and IV fluids. Serious blood loss, although rare, requires transport by ambulance to hospital, allowing increased access to obstetric support and maternal stabilization interventions.

9. Cord prolapse

In the very rare event that the umbilical cord prolapses (falls down) in front of the baby’s head, blood flow to the baby can be compromised and a cesarean is emergently required to safely deliver the baby. If this happens when the midwife is at your house, the midwife may insert their hand into client’s vagina to lift the head up and off the cord to prevent or decrease cord compression during transport. Enroute, obstetric and pediatric support will be notified prior to arrival to the hospital to prepare a team to receive the transport. These transports, while awkward with client and midwife on the stretcher, usually have good outcomes.

10. Newborn having difficulty transitioning

Acute: Immediately after birth, most newborns transition quickly and easily to breathing. About 1 in 10 babies need some assistance transitioning — usually this will be in the form of vigorous rubbing, suction and/or oxygen by mask for 1-2 minutes. In rare situations it can mean full CPR up to and including intubation. Midwives are trained in neonatal resuscitation, carry oxygen and emergency resuscitation equipment, and are skilled in responding quickly if a baby has difficulty breathing at birth. A small percentage of babies needing resuscitation will require specialized pediatric care and ongoing observation, and these babies will be transported to hospital by ambulance. If the client is stable, they will be allowed to come with baby.

Ongoing: Sometimes newborns are vigorous at birth but do not completely stabilize in the next few hours – their breathing is labored and fast, their temperature is unstable. In this case, transport to hospital is advised for further pediatric observation and supportive care. This may not involve an ambulance if they are mostly stable but just need further observation.

What is the third stage of labour?

In medical terms, the ‘third stage of labour’, or simply ‘third stage’, describes the time from the birth of the baby until the placenta is delivered.

Third stage represents the time just after your baby has been born, when your body stops being pregnant and you become a parent. As in labour, your pituitary gland is releasing the hormone oxytocin that causes your uterus to contract, and thus expel the placenta in a similar process to birthing the baby. Oxytocin increases in response to being close to your baby (especially when there is skin-to-skin contact). An adrenaline-filled atmospheres can slow oxytocin production, so it is best for the third stage to be peaceful.

Why do I need to think about the third stage while I am pregnant?

The third stage, and shortly after, is when the potential for bleeding is the highest. In the some parts of the world, postpartum hemorrhage (PPH) is still the leading cause of death for people of childbearing age. Of course, in Canada we have access to emergency medications/surgery. But even in Canada, PPH can still have serious consequences, including the need for further medical intervention.

Short term consequences of PPH:

• Administration of emergency drugs

• IV fluids

• Separating client from their baby during emergency intervention

• Manual removal of the placenta

• Blood transfusion

• Increased hospital stay, possible ICU admission

• In extreme cases, hysterectomy

• PTSD for client, support people

Longer term consequences of PPH:

The longer term side-effect of PPH is anemia. The complications of being anemic postpartum include:

• Extreme exhaustion, beyond normal postpartum expectations

• Slow milk production as the body’s resources go into producing blood cells

• Interference with bonding due to extreme exhaustion

• Increased susceptibility to infection

• Constipation from taking iron supplements

• Increased chance of postpartum depression

Are there risk factors that increase the chance of PPH?

• Bleeding disorders

• Uterine fibroids >5cms,

• Previous PPH, previous retained placenta

• High blood pressure

• Large baby (>4kgs or 9lbs)

• Polyhydramnios (large amount of amniotic fluid)

• Twins

Labour factors:

• Prolonged labor

• Prolonged pushing stage

• Prolonged third stage (>30 minutes)

• Full bladder

• Uterine infection

• Induction/Augmentation

• Shoulder dystocia

• Mode of delivery

• Forceps or vacuum

• Cesarean section

Are there any ways to minimize the chance of PPH?

Delivering the placenta as quickly as possible has also been shown to decrease the chance of PPH. Clients will be asked to push during uterine contractions to help with delivery of the placenta. In combination with the client’s efforts, the care provider may choose to use careful traction on the umbilical cord to ease the placenta out.

If you have any risk factors (pre-existing or arising during labor), then it is recommended to use active management of the third stage. Active management involves giving a prophylactic shot of synthetic oxytocin right after your baby is born. This oxytocin can be given in the thigh or in through an IV. Then cord traction will be used as soon as there are clinical signs of the placenta starting to deliver (a gush of blood and lengthening of the cord). Active Management to prevent PPH has become the default standard of care in many places including most hospitals.

If you have no pre-existing risk factors and have had a straightforward labor of average time with no drugs or interventions, it would be fair to assume that your body will be able to keep producing enough oxytocin to complete the third stage of labor efficiently. In this case you will be offered the choice of using an expectant management approach of this stage. Generally this is a more hands-off style. Research shows that for low-risk mothers and care providers with appropriate training and experience, the judicious use of this approach can be the most effective option to minimize bleeding.

Most placentas are delivered within 10-15 minutes, and almost all by 30 minutes. For this reason, if your placenta is not out after 30 minutes of expectant management, it would then be recommended to switch to an active management approach, starting with giving you an injection of oxytocin.

After the placenta:

Whether you have active or expectant management of the third stage, once the placenta is out, promoting efficient contraction of the uterus will minimize bleeding. Your nurse or midwife will gently feel your abdomen as soon as the placenta is out to assess whether the uterus is tightly contracted. If not, this can be promoted by massaging or rubbing the uterus from on top of your abdomen.

If at any time you are bleeding significantly, you should prepared for your careproviders to act quickly to perform various medical procedures including giving emergency drugs.

If I choose Active Management, does this mean the cord will be cut right away?

Immediate clamping of the umbilical cord used to be part of Active Management but has not been shown to be effective in minimizing blood loss. Because of this, and because there are other useful reasons to not clamp the cord immediately, your baby’s cord will be left intact until it has stopped pulsing UNLESS the baby needs to be resuscitated and this cannot be done with the cord intact OR you are actively hemorrhaging and emergency measures are hampered by having the baby still attached.

Erythromycin Eye Ointment

In Canada, it became standard practice after World War II to give prophylactic treatment to newborn’s eyes with an antibiotic ointment. Since then, the antibiotic most commonly used is erythromycin.

Why is this treatment done?

The purpose of this prophylactic treatment is to prevent eye infections caused by the sexually transmitted diseases Chlamydia and Gonorrhea. If these organisms are present in the mother’s vagina during birth, they can be passed onto the baby and lead to infection. Eye infection due to Chlamydia is the leading cause of blindness in the developing world (where antibiotics are not readily available). In Canada, this result is extremely rare.

How and when is the medication given?

The ointment is similar in texture to petroleum jelly. It is squeezed from a tube directly into the baby’s eyes within an hour after birth.

What are the downsides of treatment?

There is no method of treatment that is 100% effective in preventing infection. According to the American Centre for Disease Control, after antibiotic prophylaxis 15-25% of infants exposed to Chlamydia will still develop conjunctivitis (eye infection or irritation).

In some cases the treatment itself causes an irritation of the eyelids, also known as chemical conjunctivitis, which may create a route of entry for various infections.

Treatment will cause blurred vision for a few hours after being given. Because of this, some parents are concerned that the ointment may interfere with bonding by blurring vision or causing the baby to become fussy.

Another concern is exposure to antibiotics, which can cause system imbalance: antibiotic-resistant, infection-causing bacteria continue to grow, while other normal and healthful bacteria are killed. Because of the minimal amount of antibiotics in this treatment, this is not considered a large concern.

What if I know I don’t have an STD?

You were probably tested for Chlamydia and Gonorrhea earlier in your pregnancy. Parents in Ontario can now opt out of this treatment.

Are there any alternative treatments?

Some mothers will express breastmilk, and apply this to their baby’s eyes. We know that breastmilk is full of antiviral, antibacterial and healing properties, but it has never actually been proven effective in preventing eye infections due to Chlamydia or Gonorrhea.

What do I do if I suspect infection in my baby?

Please note that some redness and swelling on your baby’s eyes is normal, especially in the first few days. Whether your baby had treatment or not, if you suspect infection, report this immediately to your caregiver. Cultures can be taken to determine which organism is responsible and appropriate treatment given.

What is Vitamin K?

Vitamin K is a fat-soluble vitamin that is necessary for normal blood clotting.

Vitamin K does not easily passed through the placenta to the fetus so newborns are born with low levels of Vitamin K. Vitamin K is synthesized by the bacteria in their guts. Because babies are living in a sterile environment in the womb, it takes days to weeks to develop the necessary bacteria to make Vitamin K.

Why do we offer a Vitamin K supplement?

Because of low levels of Vitamin K, baby’s blood may be less likely to clot. A serious clotting disorder could occur called Vitamin K Deficiency Bleeding (VKDB).

Sometimes this bleeding is visible to parents and care providers, for example if the baby is bleeding incessantly from the cord site. Sometimes, however, there can be internal bleeding that can’t be detected until serious and potentially life-threatening damage has occurred. Because of this, The Canadian Pediatric Society recommends that all babies receive Vitamin K through an injection in their thigh within 6 hours after birth.

Without Vitamin K supplementation, the incidence of VKDB is thought to be between 0.01%. - 1.5% (the wide variation is due to different feeding patterns and risk factors). VKDB usually occurs from birth up to 12 weeks of age, but the risk remains until the baby is about a year old. The most common form of VKDB occurs within the first week of life. Giving newborns Vitamin K after birth has been done in North America since the 1950s, and has reduced the incidence of VKDB to 1 in 1 million.

How is Vitamin K given?

Vitamin K is given as an injection in the baby’s upper thigh, usually within about 1 hour of birth. The injection is made up of the active ingredient (phytonadione) and a preservative (benzyl alcohol).

Are there any risks or side effects to Vitamin K?

Side effects include pain or even bruising or swelling at the place where the shot is given, and the potential for infection or nerve damage at the injection site (as with any blood draw or injection). A few cases of skin scarring at the site of injection have been reported. Only a single case of allergic reaction in an infant has been reported, so this is extremely rare. There were two studies done that linked Vitamin K injection to childhood leukemia, but this link has not been seen in follow-up studies.

Some parents worry that the pain of the injection may interfere with breastfeeding and bonding. In order to minimize this, we use the smallest dose with a very small needle. The injection can wait until you have dad an opportunity to do skin to skin with your baby and have started breastfeeding. It is preferable to give the injection when babies are breastfeeding since they feel less pain when nursing.

Are there risk factors for VKDB?

The general incidence of VKDB among babies who do not receive Vitamin K is thought to be about 1 in 10,000.

However some babies have risk factors that include:

• Some medications taken during pregnancy (including: anti-convulsants, anti-coagulants, tuberculostatics and cephalosporins)

• Instrumental birth (vacuum or forceps)

• Need for resuscitation after the birth

• Bruising or birth injury

• Liver or bowel disease in the newborn

• Late onset of feeding (colostrum has a higher concentration of Vitamin K than breast milk)

• Inadequate breast milk intake

• Exclusive breastfeeding (formula has Vit K)

• Surgical procedures after birth (doctors will not perform circumcision on babies who have not had a Vitamin K injection)

• More common in summer months

Are there any alternatives?

It is possible to give Vitamin K orally. It must be administered at the first feed, then again at 2-4 weeks, and again at 6-8 weeks.

Oral Vitamin K is thought to reduce the incidence of VKDB to 4 in 1 million. The disadvantages of oral Vitamin K include that there are no long term studies on its efficacy, that it is not absorbed as well as injected Vitamin K, and there may be unreliable intake of oral Vitamin K to start with (e.g. variable absorption or regurgitation). Some also question the effect on the baby of the sugar content in certain preparations of oral Vitamin K, especially since it is given so soon after birth.

There are a number of different preparations of oral Vitamin K. If you choose to use an oral preparation, it is your responsibility to purchase it. It can be purchased through on-line stores such as Amazon. Your midwife will administer the first dose shortly after the birth, but it will be your responsibility to administer the other doses according to the schedule. The injectable form can also be given orally, however, there are other ingredients in it.

Treating for Risk Factors

While the aforementioned risk factors increase the risk of VKDB, one third of babies who develop VKDB have no risk factors or prior warning.

What signs and symptoms might show that my baby has VKDB?

Symptoms include, but are not limited to:

• Bruises, especially unexplained bruises

• Bleeding from the mouth, nose, umbilicus, circumcision site, and anus

• Hematomas

• Blood in the urine, stool or vomit

• Poor feeding

• Prolonged bleeding from puncture sites

• Difficulty breathing

• Bleeding within the abdomen or chest

• Enlarged liver

VKDB can also cause intracranial hemorrhage. Of the babies who contract late onset VKDB (after 8 days of life), half will have severe brain damage or death as the result of intracranial bleeding. Symptoms of intracranial hemorrhage include, but are not limited to:

• Unusual sleepiness

• Apathy

• Irritability

• Agitation/screaming

• Vomiting

• Tense fontanels

• Spasms

• Touch sensitivity

• Unusual posture

Additional Material:

Frequently Asked Questions (FAQ’s): Vitamin K and the Vitamin K Shot Given at Birth >

Intracranial bleeding due to vitamin K deficiency >

Vitamin K Deficiency Bleeding in Infancy >

Congratulations!!! You finally had your baby! You may be feeling tired, sore and uncomfortable, or you may be feeling wonderful. You may be feeling confident of your parenting abilities or you may be feeling unsure. This information has been put together to help guide you through your first days and weeks postpartum:

Birthday!

Alert phase: After birth, the baby has a two or three hour alert phase. S/he will look around, respond to your voices and begin to adjust to “life on the outside”. This includes coordinating her/his breathing, feeding once or twice and possibly passing meconium and/or urine.

Sleep phase: After this initial alert period, baby will go to sleep. It is not unusual for babies to have an extended sleep on the first day, anywhere from 2-12 hours. Make sure you take advantage of this by sleeping yourselves.

Feeding phase: After this first sleep, you should nurse the baby every 2-3 hours, with only one 4-hour sleep period every 24 hours until your baby is over its birthweight. It is nice when this sleep period happens at night, but no matter when it happens you should sleep too.

Breasts and nipples

Breastfeeding is a learned skill for both mother and baby. Have patience. Use nipple cream to prevent or deal with nipple damage. Useful creams may include lanolin-based creams or natural coconut oil. If your nipples are so painful that you cannot breastfeed, your midwife may be able to help with you with a prescription cream called All Purpose Nipple Ointment.

Latch

For the first few days it is common to feel tenderness in the nipples when the baby begins to suck. This should not last more than 5 or 6 sucks and should pass within a few days. If there is pain when the baby nurses, double check that the baby is latched on well. Do NOT tolerate a bad latch, as this can cause damage in as little as five minutes, which then will take days to heal. If you need help, click here for lactation consultants.

Milk & engorgement

In the first days of infant feeding, your breasts produce a rich substance called colostrum. Colostrum is nutrient-dense and is high in antibodies and antioxidants to build a newborn baby’s immune system. Your newborn’s stomach is the size of a chic pea, so drops of colostrum will keep your baby nurtured. Your milk will “come in” somewhere between 2 and 4 days after birth. Most people will experience a certain degree of fullness at this time. It may be mildly uncomfortable and the baby should be able get on the breast to nurse. It may last for up to 48 hours after the milk comes in.

On the other hand, engorgement is excessive fullness which makes the breast completely hard and painful. When the breast is engorged it may be difficult for the baby to latch on, leading to nipple damage. The best way to prevent this condition is to feed frequently and as long as possible from birth on, in order to drain the breasts. If you become engorged, some strategies for dealing with it are:

Feed frequently

Before feedings, apply wet heat (shower, bath, wet face cloth) to your breasts, and then express some milk to soften the areola. This helps baby get a good latch.

After feedings, use cold cloths or cool cabbage leaves to minimize any pain. It is best to use green cabbage, since purple will stain your breasts and clothes! Cabbage has enzymes that reduce inflammation

Once breastfeeding is well established, it is good to vary the positions used for nursing as this encourages complete drainage of different areas of the breast. As a general rule, the area toward which the baby’s chin is pointing is the area which is being drained the most.

It is also good practice to drink when your baby drinks. When you sit down, try to have a glass of water or juice handy.

Contact your midwife if you have a possible breast infection (mastitis):

• A red or tender area on the breast

• A fever, chills or flu-like symptoms

Vaginal flow

After birth, your uterus begins to undergo changes that will return it to its non-pregnant condition. Involution is the term used to describe this process of change. This whole process may take anywhere from 2 to 6 weeks. The vaginal discharge you are having is the normal response of your body to these changes.

Right after birth, the discharge (lochia) will be red and heavier than your usual menstrual period but will decrease rapidly in the first week. It is normal to pass clots, which form from pooled blood in your vagina while sitting or lying down. Over the first few weeks the discharge will change to pink or brownish in color and become thinner. Eventually the discharge may turn yellowish or cream colored.

Between days 7 and 14 many women have an episode of increased flow. This happens when the blood that formed a type of wet scab called “eschar” is passed. This scab covered the area where the placenta was implanted. This increased discharge should not last more than 1-2 hours before diminishing.

Often an increase in the amount of discharge is your body’s way of telling you to get more rest. Lying down or relaxing will help to decrease the flow.

If you find that you are saturating a pad in 30 minutes, take these actions:

• Empty your bladder

• Lie down with your feet up

• Massage your uterus to make it firm

• Nurse your baby

Call your midwife if:

• There is an extremely foul or fishlike odour to the discharge

• You are completely soaking a pads in 30 minutes or less

• You pass more than one clot the size of your fist.

Afterpains

Afterpains, or afterbirth pains, are caused by contractions of the uterus, which constricts the flow of blood from the blood vessels which fed the placenta. This is one of the ways that bleeding is controlled. Afterpains are often felt more strongly during breastfeeding, especially by women who have had a baby before, because breastfeeding stimulates the release of the hormone oxytocin, which in turn causes both the milk to let down and the uterus to contract intermittently.

Some ideas to reduce afterpains:

• Massage your uterus

• Keep your bladder empty

• Use a hot water bottle or heating pad

• Drink raspberry leaf tea

• Try lying face down with a pillow placed under your abdomen

• Use pain medications: take ibuprofen 400mg, and then in 3 hours, 1000mg Tylenol, and in 3 hours, ibuprofen again, etc. as needed.

Care of your perineum

Whether or not you have had stitches, your perineum (the area between your vagina and rectum) will need some care. Treat it like an athletic injury (Pushing a baby out is like an Olympic event!).

First days:

• Use frozen pads or apply ice to your perineum (like any injury – ice for the first 48 hours). It sounds uncomfortable now, but will feel great in the moment!

• Pee in the shower/bath if urination causes stinging

• Use a peri bottle after using the toilet – add witch hazel or herbs/lavender/tea tree oil for their antibiotic and healing properties

• Take Homeopathic Arnica 30C every 4 hours while awake (minimizes any swelling or bruising)

• If you feel you need pain relief medication, ibuprofen or acetaminophen can be taken according to the recommendations on the bottle

• Plan to not go outside for 7 days. Stay in bed and cuddle with your baby, minimizing activity as much as possible. Aim to only walk up/down stairs once or twice a day max.

• Sit with your legs together – sit like you are a mermaid!

• Sitz bath twice a day – add herbs/lavender/tea tree oil.

• Full bath x 10-20 minutes once a day (in addition or instead of sitz bath) – add 2 cups Epsom salts, perineal wash herbs – avoid bubble bath

• Do NOT sit on a hemorrhoid or “donut” pillow which can cause stitches to tear out

• Eat healthy, drink lots of water

• It is normal to feel “heaviness” in your pelvis at the end of the day if you have had increased your activity. This is the pelvic floor muscles getting fatigued. Try to balance days of activity causing fatigue, with days of rest.

• Prolonged use of maxi pads can be very drying – occasionally try sitting on a blue pad while nursing, or use cloth pads. Avoid Always products, as they are known to cause chaffing and pain. After a sitz bath, dry out your perineum well, then sit on a blue pad or towel and let your perineum fully dry and breathe for 1 - 2hours.

• You will not have the same strength when doing kegels. Be patient, it will return.

Inform your midwife if:

• You have increasing amounts of pain in your perineum, not associated with increased activity or decreased use of painkillers

• You have discharge that is abnormal in color or foul smelling

• You continue to have serious urinary incontinence past the first few weeks

• Use lots of lube when you have sex, as postpartum hormones cause dryness.

• See a pelvic floor physiotherapist if you have any concerns or just want to improve your pelvic floor strength (see information in Resources section). You do not have to have serious incontinence before seeking physiotherapy. If your problem is assessed to need further medical intervention, they can provide a gynecological referral.

Urination

It is important to prevent your bladder from becoming overly full during this postpartum period. Try to urinate at least every few hours when awake. You may find yourself urinating more often and in very large quantities in the first few days after birth. This is a way your body uses to get rid of extra fluid built up during pregnancy and is normal. It is especially important to drink lots of fluids, even if you feel like you are urinating frequently as it is easy to become dehydrated when trying to produce breastmilk. It may take a few days for the nerves of the bladder to return to normal, so you may need to pee by the clock if your body isn’t warning you when your bladder is full.

Signs of a urinary tract infection (if you feel any of these, call your midwife):

• Burning or pain with urination

• Difficulty starting to urinate

• A sensation that you have to urinate immediately

• Cloudy urine with or without a foul odour

Bowel function

It is normal not to have a bowel movement until 2 or 3 days after birth, as your digestive tract has slowed for labor and it takes time to get back to normal. Sometimes women fear that they will hurt themselves or any stitches by moving their bowels. This will not happen! Please follow your urge when it comes, and it will not be as bad as you fear.

To minimize discomfort:

• Drink at least 8 glasses of water a day

• Eat foods that will keep you from getting constipated: lots of fruits, vegetables and whole grains

• Drinking prune juice or eating prunes, figs and bran can be helpful, but beware of overdoing it and getting diarrhea!

• If other methods haven’t worked, you can try a bulk laxative such as Metamucil or an over-the-counter stool softener.

• If you have not had a bowel movement after the 4th day and are concerned, call your midwife.

Hemorrhoids

Some people develop hemorrhoids during pregnancy or during pushing at the birth.

To relieve pain, speed healing and avoid irritating the hemorrhoids, use any combination of the following:

• Apply ice

• Use a warm sitz bath (witch hazel, tea tree oil, herbs)

• Apply a cotton ball soaked in cold witch hazel

• Use a hemorrhoid cream or suppository – there are various herbal preparations, as well as over-the-counter preparations.

• Do Kegel exercises to increase circulation in the area

• Try to avoid constipation - don’t strain during bowel movements

• Lie on your side whenever possible

• Regular exercise such as walking is also beneficial after the first week

• Do NOT sit on a donut pillow as this may tear out your stitches

Sleep - Rest - Activity

It is very important to get plenty of rest and sleep and to not become stressed with too much activity. Your job as a new parent is to take care of yourself and your baby. You need to spend the early weeks recovering and getting to know your new baby. Recovering from the birth and caring for a newborn can be very tiring. Sleep deprivation can result from frequent night feedings and the demands of baby care. It has been shown that being overly sleep deprived can push susceptible women from normal baby blues into postpartum depression.

Plan on having a “babymoon,” which includes not going out of the house for the first seven days, and being pampered for at least two weeks. This is not as easy as it sounds. It takes advanced preparation, but it is vitally important for your long term health. Your efforts now will be well spent:

• Beware of the “week one high,” which fools people into thinking they are fine, when in fact they are still on an adrenaline high from the birth and the excitement of having a new baby.

• The key to adequate rest is to sleep when baby sleeps.

• Turn the phone off when you are sleeping, and change the answering machine message to let people know that you are both resting but will phone when you can.

• Plan meals ahead. Prepare extra portions when you cook and bake now, and put them in the freezer.

• If friends offer to have baby showers, request a “casserole shower,” with guests bringing a frozen (hopefully homemade) entrée. When you are recovering someone can just add a salad or veggie, and dinner is served.

• Consider hiring a postpartum doula.

• If you have other children, it is a good idea to plan some babysitting, quiet activities, and general household help to allow you to rest whenever you get the opportunity. At the very least, arrange time for naps during the day and go to bed as early as possible.

• Minimize visitors. Have a list ready of things that need to be done, for friends and family who do come over.

It is common for people to have emotional fluctuations after birth. We sometimes refer to this as “the blues” – a period of days feeling very weepy and sad – but you may also feel happiness at the same time. People feel overwhelming love for their baby, but also overwhelming responsibility - all combined with fatigue and hormone changes. This can affect your emotional state. Just let the tears flow. Normal postpartum “blues” usually last no more than a week or two. Getting adequate rest can help. Ask others to help with your baby or with providing meals. If your mood worsens and you have difficulty doing the activities of daily living, or are having a difficult time taking care of your baby, please call your midwife. You may be suffering from postpartum depression and may require a consult with a doctor. Partners may also suffer from postpartum depression.

If you have had a difficult birth, there may be some grief for you to work through. Even under the best circumstances, the birth may not be exactly what you had hoped and dreamed about. This is a period of readjustment as you accept how your birth has impacted you, the pain that you may be feeling, combined with lack of sleep as you care for a demanding baby. Writing down your birth experience may help to “get it out of your thoughts” and onto paper. Please let your midwife know how you are feeling, and let us help you. See our counselling resource page.

Baby blues or postpartum blues occur in many new mothers. This is different from postpartum depression or anxiety. These blues can include:

• Feeling mildly down

• Being easily upset or irritable

• Feeling unexplainably sad or tearful

• Feeling restless

• Having difficulty sleeping

• Having little or no appetite

• Headaches

• Feeling “flat” or unable to fully experience emotions.

One or more of these symptoms may appear anytime in the first week after the birth, but are most common from the third to fifth day (as the milk comes in – part of the same hormonal process). It is believed that the tremendous physical and hormonal changes that your body is experiencing as it returns to the non-pregnant state are responsible. Discomfort and fatigue can also play a part. Reassurance, support and lots of rest are usually all that is needed.

If the blue feelings last longer than the tenth day or make it difficult to look after yourself or your baby, call your midwife.

Breasts and nipples

Breastfeeding is a learned skill for both mother and baby. Have patience. Use nipple cream to prevent or deal with nipple damage. Useful creams may include lanolin-based creams or natural coconut oil. If your nipples are so painful that you cannot breastfeed, your midwife may be able to help with you with a prescription cream called All Purpose Nipple Ointment.

Latch

For the first few days it is common to feel tenderness in the nipples when the baby begins to suck. This should not last more than 5 or 6 sucks and should pass within a few days. If there is pain when the baby nurses, double check that the baby is latched on well. Do NOT tolerate a bad latch, as this can cause damage in as little as five minutes, which then will take days to heal.

Milk & engorgement

In the first days of infant feeding, your breasts produce a rich substance called colostrum. Colostrum is nutrient-dense and is high in antibodies and antioxidants to build a newborn baby’s immune system. Your newborn’s stomach is the size of a chic pea, so drops of colostrum will keep your baby nurtured. Your milk will “come in” somewhere between 2 and 4 days after birth. Most people will experience a certain degree of fullness at this time. It may be mildly uncomfortable and the baby should be able get on the breast to nurse. It may last for up to 48 hours after the milk comes in.

On the other hand, engorgement is excessive fullness which makes the breast completely hard and painful. When the breast is engorged it may be difficult for the baby to latch on, leading to nipple damage. The best way to prevent this condition is to feed frequently and as long as possible from birth on, in order to drain the breasts. If you become engorged, some strategies for dealing with it are:

Feed frequently

Before feedings, apply wet heat (shower, bath, wet face cloth) to your breasts, and then express some milk to soften the areola. This helps baby get a good latch.

After feedings, use cold cloths or cool cabbage leaves to minimize any pain. It is best to use green cabbage, since purple will stain your breasts and clothes! Cabbage has enzymes that reduce inflammation

Once breastfeeding is well established, it is good to vary the positions used for nursing as this encourages complete drainage of different areas of the breast. As a general rule, the area toward which the baby’s chin is pointing is the area which is being drained the most.

It is also good practice to drink when your baby drinks. When you sit down, try to have a glass of water or juice handy.

Contact your midwife if you have a possible breast infection (mastitis):

• A red or tender area on the breast

• A fever, chills or flu-like symptoms

For breastfeeding resources, including lactation consultants in the Sarnia area, click here

During the first few weeks after birth, you and baby are perfecting the art of breastfeeding. Occasionally you may experience problems or setbacks that can be solved by using what is known as the 24-Hour Cure.

What is the 24-Hour Cure?

The 24-Hour Cure is the name given to a treatment advised for a number of breastfeeding problems. In essence, it involves you and baby spending 24 hours in bed together. The forced rest and constant skin-to-skin contact has a dual purpose:

• To nurture the YOU by giving you complete rest, plenty of good food and drink, and freedom from all responsibility other than feeding and fondling your baby

• To nurture the BABY, by encouraging prolonged skin-to-skin contact with you and constant access to your breast

What problems can be addressed by the 24-Hour Cure?

The 24-Hour Cure can solve a number of breastfeeding problems, such as the following:

• Doubts about whether you are making enough milk

• Fatigue, lack of sleep or anxiety in you

• Lack of appetite, poor nourishment or low fluid intake by you

• Slow weight gain or weight loss by the baby

• “Nipple confusion” – that is, the baby seems to prefer an artificial nipple or nipple shield to the your breast

• Plugged ducts

• Mastitis, if fever has not lasted for more than 24 hours yet

When should I not do the 24-Hour Cure?

It is important that you not have sore, blistered or cracked nipples when you begin the cure. The causes for the soreness need to be addressed before starting the cure.

How to do the 24-Hour Cure:

• Organize a full 24 hours when you can have help. Help is essential!

• Mama goes to bed with the baby. They both wear as little clothing as possible under the bedcovers so the baby can get lots of warm skin-to-skin contact, which heightens the baby’s rooting reflex and interest in feeding.

• No visitors please! You may read, watch television, or most importantly, doze. The extra sleep makes a big difference even though it comes in short snatches.

• You get out of bed only to go the bathroom – not to eat, answer the phone, do housework or anything else.

• You are supplied with liquids; place water or juice within your reach. You should drink about two quarts of liquid during the 24 hours.

• Tasty, nutritious meals are according to your appetite. A good milk supply is dependent on eating a healthy amount of calories.

• The baby should stay in bed with you, except when a diaper change is necessary, or when the baby is fussy (and clearly not willing to nurse) and needs to be walked or rocked.

• Whenever the baby awakens or seems at all interested in suckling, mama offers the breast. The whole process is to get the baby to suckle as much as possible. Do NOT give the baby a bottle of either formula or breast milk, unless advised by your midwife for medical reasons such as severe weight loss.

There is no reason to not extend into a 48-Hour Cure if results are promising after 24-Hours!

If you suddenly feel anxious, stressed, and sad when you are breastfeeding, you may have this condition: Dysphoric Milk Ejection Reflex (DMER).

DMER is more often reported in the first weeks of breastfeeding. For some, these feelings decrease as their baby gets older. Some people only get relief once they cease nursing.

“Online support groups are great ways to connect with other parents experiencing dysphoric milk ejection reflex, too. For example, you may consider joining the Facebook group started by Alia Macrina Heise, a parent and lactation consultant who’s considered an authority on D-MER and first brought it to light in 2007.” Source >

D-MER treatment may include:

• Wellbutrin (buproprion)

• Rhodiola (roseroot or golden root)

• Bach flower essences

Diet:

Foods high in tyrosine and phenylalanine, fava beans supplements:

• DHA

• L-tyrosine

• Vitamin B6

• Vitex

Hypnotheraphy has also been known to work.

You may have many questions after your caesarean. Hopefully this will help provide some answers. If you have any other questions, please feel free to contact your midwife.

What can I expect the first few days?

You will be in the hospital 2 to 3 days after a caesarean. The trend is toward a shorter stay for those with a normal recovery. During this time your dressings will be changed, IV and catheter removed, vital signs taken, uterus massaged to keep it firm, and urine output measured. Like vaginally born babies, unless your baby has any signs of respiratory problems, infection or other problems, you can have them room-in with you.

How long will my stitches stay in?

Your internal stitches will start to dissolve within a couple of days after the birth. They do not need to be removed.

If you have external staples, they are usually removed on day 3. Your midwife can remove them during a home visit. If you have external stitches, they will likely dissolve on their own.

Should I be resting in bed the whole time?

Following any major abdominal surgery it is important that you rest. However, it is also important that you spend some time each day up and walking around. The sooner you do this, the better you will feel. As you stand up, you may be afraid that your insides are going to fall out, but don’t worry, you have been stitched securely in separate layers. You may have a gush of blood from your vagina, since the lochia (blood and tissue from the uterine lining) pools in the vagina while you are lying down. Your instinct will be to slump forward and do the “caesarean shuffle.” Stand as tall as possible from the very beginning, because it becomes more difficult later.

Walking will help prevent or relieve gas pains. Try to walk to the toilet rather than using the bedpan. Remember to regularly do circles with your ankles and feet since this helps reduce risks of complications after abdominal surgery. If you have any odd pains in your legs, be sure to let the nurses know. Once you have passed gas, make sure you are keeping well nourished. It will be very difficult to establish breastfeeding and keep up your own energy if you do not eat properly.

What can I eat?

Most physicians require a liquid diet to begin with while your digestion returns to normal. When you progress to solid foods, eat a balanced diet, which includes lots of fiber. Drink at least 8 glasses of water a day. To help reduce gas, which can be very painful, avoid very hot or very cold or bubbly drinks.

I am in pain a lot of the time. What can I do about it?

Ask for painkillers. You cannot effectively rest or take care of your baby if you are in pain. Over the first week or so you will find you need fewer painkillers each day.

Is there anything I can take to help the physical healing process?

Yes. Many herbs and natural remedies help the body’s healing process without any harmful side effects for you or your baby. You can take the following herbs, made up as tinctures (available from health stores) and take them three times a day for up to a month after your birth: Comfrey, Echinacea, Raspberry Leaf and Marshmallow.

Homeopathic Arnica can be of enormous benefit in preventing infection and promoting tissue healing. The recommended dosage is one dose of 200C, followed by 30C each day of Bellis Perennis for 5 days. If your wound seems slow to heal or you still have a lot of discomfort after several weeks, homeopathic Staphysagria can help – one dose of 200C is usually enough.

A compress made from adding a few drops of lavender, tea tree and myrrh oils to warm water can be placed over the wound for healing and soothing inflammation. Once the wound has closed, comfrey ointment can be massaged in each day to reduce scarring.

Will my cesarean affect breastfeeding success?

It can be more difficult to establish breastfeeding after a caesarean but not impossible. You may need some extra support from someone to help you lift the baby into your arms for each feed over the first few days. It may take a few extra days for your milk to come in but this should not be a problem – your baby can get all of her/his nutrition from colostrum. Make sure you are eating and drinking enough to help your milk supply become established (you can eat once you have passed wind after the operation).

Is there anything I should be careful of?

A caesarean is major abdominal surgery. You must take care of yourself, making sure you are resting enough and eating a healthy balanced diet. Try to find someone else to take over all the household chores in the first few weeks as well as prepare your food, so you are able to concentrate on your baby and yourself. Don’t lift anything heavy like a toddler or a baby bath full of water, until at least six weeks after your birth.

How long will my scar feel uncomfortable?

Your scar will itch, feel numb or have sharp pains for a while. Most people find the scar becomes less uncomfortable by about six weeks postpartum. However, for some people the scar can be still uncomfortable for several months. If you are concerned about the way your scar feels or looks discuss this with your midwife. Of course, if you notice anything unusual, such as swelling, oozing or a bad smell, report it to your doctor immediately.

Will I always be able to see my scar?

The scar will fade over time and once your pubic hair begins regrowing it will be difficult to see.

Who can I talk to about the reasons for my cesarean?

For many people it is important to understand the reasons for their caesarean – especially if they had hoped for a vaginal birth. Your midwife will have a copy of your labour notes, which she can talk through with you. This may help answer some of your questions.

I’m feeling very emotional. Is this normal?

Many feelings accompany a caesarean birth – from wonder, gratefulness and joy, to anger, disappointment and despair. This is normal. A caesarean often means the loss of a dream of a natural birth or a perfect outcome. You may have positive and negative feelings at the same time. You might feel tremendous gratitude and love for your healthy baby while at the same time feel very disappointed that you had to have a caesarean. Caesarean parents often experience feelings that come and go: anger, sadness, relief, guilt, fear, disappointment, depression, inadequacy, jealousy of people who had natural births, powerlessness, confusion and hopelessness. Negative feelings are stronger if your labor had been traumatic, if you feel you were misled by your caregivers or unprepared by your childbirth educator. It doesn’t help that a common reaction by caring but misinformed people is to feel that if you have a healthy baby that you should be happy and satisfied. In reality the issue is much more complicated. Resolving your feelings and healing take time.

Certain things make the emotional recovery easier. Cry if you need to – tears are very healing. Talk about your feelings. Join a caesarean support group. Find a knowledgeable counselor. Write in a diary or journal. Write letters to those involved and tell them exactly how you feel (you don’t have to send the letters.) Write the story of the birth experience and what you have learned from it. Acknowledge your incredible courage: you were willing to undergo major surgery for the sake of your baby! Educate yourself about caesareans and when you are ready, reach out to another caesarean mother and help her with your experience and knowledge. There are many good books available, as well as information and support on the internet.

Will I ever be able to have a vaginal birth?

Many people go on to have subsequent children vaginally – called VBAC, Vaginal Birth After Caesarean. Research now shows that vaginal birth, even after caesarean, is usually safer, except in rare cases. People having VBAC births have their own special needs: while many are eager for the opportunity of a vaginal birth, others find it difficult to convince themselves to go through labor again and try to have their baby vaginally. It is good to do lots of research and find lots of support.

Will I be able to have midwifery care with my next pregnancy?

Midwives often take care of people who have had a previous cesarean section. Many of these people go on to have wonderful vaginal births. Ideally you will have had 24 months between pregnancies to give your uterus time to fully heal and form a strong scar.

International Cesearean Awareness Network >

Right after birth, we will be doing checks on your uterus, to make sure that it is firm and contracted. In doing this, we are making sure that there is no extra blood accumulating in your uterus – which could then turn into clots that are much harder to expel from your uterus. This accumulation of clots would then lead to heavier bleeding, as your uterus can’t clamp down on the placental wound. Midwives need to consult with the Obstetrician if this happens, to manually remove the clots.

As uncomfortable as abdominal rubs are after birth, they are really important!

If you soak a large pad side to side, front to back, in 20-30 minutes – PAGE YOUR MIDWIFE URGENTLY!

As you wait for your midwife to arrive, do the following:

1. Empty your bladder

2. Lay down and firmly massage your uterus (like your midwives did after birth)

3. Nurse your baby (this will create oxytocin, which contracts your uterus)

4. Call 9-1-1 if you feel like you may be losing consciousness!

Uterine bleeding, called lochia, characteristically changes colour and amount as the uterus returns to its pre-pregnant size. Here’s the facts:

• You can expect red bleeding for two to seven days.

• When you stand up, you may feel a gush of blood.

• You may also pass a clot about the size of your fist.

• Usually by the fourth day, the discharge will become more pink or brown in colour.

• Your discharge will eventually turn white or yellow and last two to six weeks.

Clients are encouraged to use pads (not Always brand!) rather than tampons during this time of healing.

Often clients page around 10-14 days after delivery with more bleeding. This is usually due to excessive activity around this time, as people begin to feel much better. Remember that the placental site in the uterus has to heal – it is a large wound. Please take it easy for the first few weeks after delivery.

People having their second or third babies will often experience uterine contractions after their babies are born – these are called “after pains.” This cramping is usually stronger when you nurse your baby, as oxytocin is released from the pituitary gland to contract your milk ducts and it also contracts your uterus. After pains can be quite painful! Ibuprofen or Acetaminophen can help to give relief. Sometimes taking calcium and magnesium can give some relief as well.

After birth, people may have fear about their first bowel movement. This is especially true, if you had a tear that needed stitches. You may have pain, bruising or swelling around your perineum. Especially after having stitches in your perineum, people may have fear about doing a bowel movement.

Here are a number of things that may help:

1. Put your feet on a small stool in front of the toilet

2. Press a warm washcloth on your perineum to give some stability while you attempt to pass stool

3. Take stool softeners, or drink a cup of flax tea (One teaspoon ground flax seeds in a cup of boiling water. Cover and let sit for 20-30 minutes. It will become gelatinous, but have a mild and pleasant taste – and it works!)

4. Drink a hot cup of tea (with lemon and honey) first thing in the morning before you eat. This stimulates the bowel to eliminate.

5. Eat oats, bran, fruits, vegetables (especially raw ones)

You will be given a Peri bottle after your birth. Use this with warm water, to rinse your perineum as you void, and after. It may give some relief to any stinging on your perineum by diluting your urine. If you have any stitches, you can use your peri bottle with diluted witch hazel. Taking warm baths with Epsom salts or having a herbal bath will speed healing and give relief to your perineum (ask your midwife for these herbs). The herbs have antibacterial and healing properties. In the first week, pat to dry your perineum. Don't use soap for the first couple days.

Your perineum may be very sore – bones, muscles and tissues have been stretched! If you needed stitches for your perineum, they will dissolve on their own in about 10-14 days, and up to four weeks. We recommend ice for the first few hours after the birth to reduce inflammation. Apply ice (with witch hazel) for 20-minute intervals.

See here to make padsicles in advance of birth >

Sometimes, people have a very difficult time voiding after birth. A full bladder may increase bleeding, as the uterus can’t contract down. Sometimes, people just need quiet time on the toilet before they can relax enough to void. Using the peri bottle to spray warm water over the perineum can help. Smelling peppermint or putting peppermint oil in the toilet water may help. Sometimes lifting your abdomen or peeing in the shower can aid your ability to void.

Page your midwife immediately if your temperature is over 38 degrees Celsius, or if your vaginal discharge is foul smelling, or if you are experiencing intense uterine pain. If you feel flu-like (achy, unwell, chills, and sweats), and have a fever, please page your midwife.

Often clients will feel slightly flu-like around day three when their milk comes in. This is normal “inflammation” that occurs as milk begins to come in. If your symptoms get worse, please call.

You may find that you are perspiring more than usual in the first few days. This is another way your body uses to get rid of extra fluid built up during pregnancy and is normal. To cope with sweating:

• Wearing natural fibers

• Dress in layers.

• Try taking a couple of showers a day

Hemorrhoids are quite common after delivery, and often come with the second stage of pushing. Sometimes clients have them just because of the weight of the baby in pregnancy. Hemorrhoids are swollen veins in the rectum. Hemorrhoids can be alleviated by drinking lots of fluids and eating plenty of roughage in your diet. Nuts, bran, whole grains, beans, and dried fruit have roughage. Avoid straining and prolonged sitting on the toilet. There are a number of things that you can try to reduce varicose veins:

1. Tucks pads can help. You can also just buy the main ingredient in Tucks pads – witch hazel. Soak a cosmetic pad with witch hazel and leave on your hemorrhoids (good to do at night)

2. Use Anusol or Preparation H, sold in drug stores

3. Eat radishes to shrink hemorroids. Slice 7-8 a day and eat with ranch dressing

If hemorrhoids are persistent and painful, please discuss this with your midwife.

What is yeast?

We can have both yeast (aka candida) and bacteria in our gastrointestinal and vaginal tracts. In a healthy state they are in balance, and are essential for optimal health. Probiotics can be very helpful to reduce yeast infections.

However with a yeast overgrowth, the yeast overpopulates our system and we have what we call a “yeast infection”. This overgrowth can be on your nipples and in your milk ducts, as well as in your baby’s mouth and gastrointestinal tract. It causes sore nipples and can cause intraductal pain in your breasts (burning, shooting pain during and after feedings). Your baby may not have symptoms, or may have a sore mouth and tongue (white spots inside gums and white tongue). Babies may have red, sore skin in the diaper area, and may be more irritable and have more gas.

It is important to remember that the yeast overgrowth is throughout your whole system, and you want to restore a healthy balance between the yeast and the bacteria. Just killing off yeast doesn’t resolve the problem. It will always return unless the proper balance is restored, and this takes diligence.

External yeasts

• Good hand washing, especially before and after touching any affected area.

• Remember: use clean hands or a new swab every time medication is touched.

• Boil any bottle nipples, pacifiers, and toys as well as any breast pumps the mother may use for at least 20 minutes

• Wash all baby clothes, bras, breast pads, breastfeeding tops, bed linens, baby blankets, etc, frequently in hot water. Dry well in hot dryer or sunlight.

• Add 15-20 drops of GSE OR 1C vinegar to rinse water of all laundry loads

• This treatment plan seems very complex, but after a few days it will seem simpler, especially when you are feeling better because of all of your efforts. REMEMBER: Continue the recommended treatments and dietary restrictions for 2 weeks after all symptoms are gone. There is a temptation to grow lax after you and your baby are feeling better, but the yeast overgrowth can come back if your system is not restored to its proper balance.

Ask your midwife for medications if you are unable to get rid of yeast or thrush.

During the postpartum period, it is important to maintain the same amount of nutritious food and fluids that you ate during pregnancy. Your body needs 500 extra calories per day to produce enough breastmilk. You should focus on eating a well-balanced variety of high-quality, nutritious foods. Fluid intake needs to be maintained to help replace fluids lost during labor, aid in the elimination process, and provide a good supply of milk. A beneficial practice is to have a snack and fluids during the night if you are awake to feed the baby.

Weight loss should not be a concern at this time. Due to the extra calories required by milk production, most people find that they can continue to eat 2500 to 2700 calories per day and still lose the extra weight gained during pregnancy. Rapid weight loss is never healthy. With breastfeeding, the weight will come off gradually over 6 to 9 months in much the same way that it was gained.

At the birth, you lose around 10-15 pounds from the baby, placenta, and amniotic fluid. This leaves another 10-20 pounds above your pre-pregnancy weight. Don’t be discouraged. Right after birth, you may still have a large abdomen, but as your organs find their way back into the spaces where they used to be, this will soon disappear.

The extra weight from the pregnancy serves as an essential cushion of nutrients and calories that will help ensure an adequate supply of milk for breastfeeding. Remember that your body is still serving as this infant’s sole source of nutritional support, and the baby is a lot bigger than when they were in the womb.

While nursing, it is common to have a ravenous appetite. Trust the wisdom of your body. You will find that the demands of nursing and caring for an infant will gradually take off all your extra weight. Most people lose weight sometime between six and twelve months. Getting exercise can help with getting your muscles and tone back. Please don’t consider dieting, as the nutrients you consume are very crucial to your baby’s growth. Be sure to continue with a high protein diet and continue to take your prenatal vitamins, and drink plenty of fluids.

In order to minimize the chance of uterine infection, it is important not to resume intercourse until all bleeding has stopped and the cervix is closed. When you resume intercourse, go slow and use lubrication, if you need it.

Remember that there are other ways to pleasure each other besides intercourse. The most important thing during this period is to communicate. Be sensitive with each other and discuss levels of desire. Many women find that it takes a little while before their sexual desire returns due to lack of sleep, fear of pain, the demands of nursing a baby, not feeling attractive, and hormone changes.

The return of regular periods varies from person to person depending, largely, how frequently and how long you breastfeed. Often periods will not resume until you wean your baby. Many people do not ovulate while exclusively breastfeeding (on demand and without supplementation).

Remember, ovulation usually precedes menstruation, so it is possible to get pregnant before having a period. Even if you think now that you will never be interested in sex again, it will happen! It’s wise to plan a method of contraception and have it available before the mood hits.

Your midwife will discuss contraception options with you at your discharge visit at 6 weeks.

The return of menstruation varies according to the individual pattern and whether or not you are exclusively breastfeeding. Most non-breastfeeding people resume menstruating between 6 and 8 weeks after the birth.

The longer the you exclusively breastfeeds, the longer the delay in the return of periods tends to be generally. The return of periods for breastfeeding people is associated with the length of time she continues breastfeeding and whether or not supplements – formula or solid foods – are used for infant feeding. It also depends on length of time between feedings. The sooner baby “sleeps through the night”, the sooner your period will return.

You can begin simple exercises such as Kegels shortly after birth. Be aware that increased vaginal flow and pain means that you should re-evaluate the type and amount of exercise that you are doing. If this occurs you should decrease or modify your activities. Listen to what your body is telling you, gradually increase your exercise and don’t overdo it.

Phase 1: First Week

Deep breathing and abdominal wall tightening

Lie on your back, knees bent. Place hands on abdomen. Take a deep breath in through your nose. Keeps ribs still and let abdominal wall expand upward. Part lips slightly and slowly but forcibly blow air out through the mouth, pulling in your abdominal muscles until you feel you have completely emptied your lungs. This exercise works the transverse muscles, which compress the abdominal contents and prevent the abdominal wall from bulging.

Pelvic Tilt

Rock the pelvis back by flattening the lower back down onto the floor or bed. On exhale tighten the abdominal muscles and buttocks. Hold the position for 3 seconds. Concentrate on flattening the hollow in the small of the back while also contracting the abdominal wall muscles. This should feel good.

Kegels

Consists of alternately contracting and relaxing the pelvic floor muscles. Contract the muscles surround the urethra, vagina and rectum, all at the same time. Imagine you are on an elevator going up five floors. Tighten these muscles slowly as you go up each floor, 1-2-3-4-5. Hold for the count of five, then slowly relax. To check if you are doing the exercise correctly, begin to urinate then stop the flow. Do this only to check the exercise; do not interrupt the flow on a regular basis. Do a minimum of 20 Kegels per day.

Phase 2: One to two weeks after birth

Leg Sliding

Lie on back, knees bent, pelvis tilted backward and lumbar spine flattened. Breathe normally throughout. Slowly slide heels down until legs are straightened. If the abdominal muscles won’t stay flat, draw knees up again, one at a time, to the point where the spine began to arch. Work in the range until abdominal muscles maintain a straightened back with the legs outstretched.

Bridging

Lie on back, knees bent. Raise the hips so the knees and chest form a straight line. The closer the feet are to the buttocks, the more leverage you achieve. Do not arch the back. You can strain ligaments and stretch the abdominal muscles. Contract both abdominal muscles and buttocks together. Progress by moving the feet farther away from the buttocks.

Abdominal Tightening

Lie on back, knees bent. Cross hands over abdomen so you can pull toward the midline as you raise your head. Breathe out and raise your head at the same time, then relax.

https://www.ontariomidwives.ca/sites/default/files/Normal-newborn-behaviour-English.pdf

“The Canadian Pediatrics Society does not recommend the routine circumcision of every newborn male.”

VIDEO: Child Circumcision: An Elephant in the Hospital by Professor R. McAllister

Additional Videos:

Circumcision: Sexual Harm?

Circumcision: The Whole Story

Law & ethics of child genital cutting across race, religion, sex + gender

The Real Reason You're Circumcised - Adam Ruins Everything

Canadian rates of circumcision:

Approx. 31.9% in 2006-2007, currently around 25%

(Jews, Muslims circumcise for religious reasons)

Some complications midwives have seen:

• Pain experienced by newborn

• Bruise around the penis

• Burn from the cleaning solution

• A suture had to be done on penis to stop vessel from bleeding

• Excessive bleeding

• Poor feeding after circumcision 

• Maternal trauma from experience

Canadian Pediatric Society

Potential risks of circumcision >

Surgical procedures, including circumcision, are painful. Even with procedural analgesia, individuals experience postprocedural pain that must be treated. Newborns who experience procedural pain have altered response to later vaccinations, with demonstrated higher pain scores.[38]

Acute complications of neonatal circumcision include minor bleeding, local infection and an unsatisfactory cosmetic result. Severe complications, such as partial amputation of the penis and death from hemorrhage or sepsis, are rare occurrences. A recent meta-analysis reporting on prospective and retrospective studies investigating circumcision found a median complication rate of 1.5% in neonates or infants. When circumcision was performed during childhood, the complication rate increased to 6%, a rate similar to that reported in studies of circumcised adolescents and adults.[39]

The most common late complication of circumcision is meatal stenosis (2% to 10%), which may require surgical dilation.[40] This condition can be prevented almost completely by applying petroleum jelly to the glans for up to six months following circumcision.[41] Partial re-adherence of the penile skin to the glans is not uncommon. Such adhesions often resolve spontaneously by puberty but, when they are extensive, may also benefit from treatment with a topical steroid preparation. Surgical lysis is rarely required.[42]

The foreskin serves to cover the glans penis and has an abundance of sensory nerves,[5] but medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners.[43]-[45] It has been reported that some parents or older boys are not happy with the cosmetic result, but no specific data from the literature to quantify this outcome could be found.

Health care providers should be aware of potential contraindications to neonatal circumcision. Hypospadias requires an assessment by a urologist before circumcision is considered. Any risk of bleeding diathesis requires further investigation and discussion with appropriate professionals and decision makers before proceeding with circumcision.

Ethics and legalities of circumcision

Neonatal circumcision is a contentious issue in Canada. The procedure often raises ethical and legal considerations, in part because it has lifelong consequences and is performed on a child who cannot give consent. Infants need a substitute decision maker – usually their parents – to act in their best interests. Yet the authority of substitute decision makers is not absolute. In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices.[46]

With newborn circumcision, medical necessity has not been clearly established. However, there are some health benefits, especially in certain populations. Furthermore, performing circumcision in older boys, who are able to provide consent, can also increase risk and costs to the individual.[39] Therefore, some parents view circumcision as being in their child’s best interest. A complete discussion of ethical and legal issues associated with newborn male circumcision is beyond the scope of this statement. Readers are referred to the July 2013 issue of the Journal of Medical Ethics, which is devoted to the topic.[47] Both parents and health care providers should be familiar with the legal issues related to consent.

Recommendations:

• The CPS does not recommend the routine circumcision of every newborn male.

• Physicians and other health care professionals caring for newborns must stay informed about circumcision and assist parents in understanding potential risks and benefits of the procedure.

• The parents of male newborns must receive the most up-to-date, unbiased and personalized medical information available about neonatal circumcision, so that they can weigh specific risks and benefits of circumcision in the context of their own familial, religious and cultural beliefs.

• Parents who choose to have their sons circumcised should be referred to a practitioner who is trained in the procedure.

• Neonatal male circumcisions must be performed by trained practitioners whose skills are up-to-date and strictly adhere to hygienic and analgesic best practices.

• Close follow-up in the early postcircumcision time period is critical. The parents of circumcised boys must be thoroughly and accurately informed about postprocedural care and possible complications.

• At the time of hospital discharge, health professionals should ensure that the parents of uncircumcised newborn boys know how to appropriately care for their son’s penis and are aware that the normal foreskin can remain nonretractile until puberty.

• Quality Canadian data are required to understand the clinical and economic issues involved with neonatal male circumcision, including its potential risks, benefits and costs, in the Canadian context

Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants >

Sponge baths or tub baths are okay, although not necessary, right from birth. Research has shown that babies who are not bathed for the first 2-3 days find the breast easier which makes breastfeeding more successful. Babies don’t shiver in the first days of their lives, so they are prone to have cold stress when bathed too early. When you do start bathing, it may be easiest for a parent to get in the tub, then have someone hand them the baby.

• Use water to clean eyes and face

• Use mild soap to wash hair and body

• Use non-petroleum-based oil or lotion (olive oil works well) daily for dry or peeling baby, or if the environment is very dry

Babies are influenced for several weeks by the maternal hormones passed through the placenta. This can caused small red “acne” which usually is on the face or trunk, and disappears quickly

The cord usually falls off within the first few days or weeks.

• Keep the cord dry and clean, placing the diaper, diaper wrap and plastic pants below the cord

• If desired, clean the cord daily, or when it is soiled, with warm water, then let it dry thoroughly. This will delay the cord falling, since it washes off the necrotizing bacteria, but will cut down on odor (for the same reason).

Problems to report include a large halo of redness around the cord area (some redness is normal due to irritation from diapers, etc), or excessive bleeding when the cord falls off (enough that it stains the blanket the baby is lying on).

Healthy, term babies are built to lose some weight after birth before the breastmilk comes in. This allows them time to take in the highly concentrated antibodies in the parent’s colostrum before they get the higher volume and hydration of breastmilk. Sometimes they get dehydrated enough that their urine forms crystals. These are called urate crystals and are pinky orange. More common in boys, they are often mistaken for blood in the diaper. This means your baby is a little dehydrated. Continue to feed often.

Problems to report:

• Temperature >37.5C

• Temperature <36.3

• Skin color changes to pale, grey or bluish

• Difficulty breathing: nasal flaring, grunting, retraction of sternum

• Apnea >20 seconds

• Lethargic or difficult to arouse

• Extremely irritable

• Excessive, high-pitched crying

• Blisters, boils, pustules or other unusual rash

• Red halo or bleeding cord area

• Urate crystals after first 48 hr

• Jaundice that appears in first 24 hours, extends into extremities, or rapidly increases

• If circumcised: if there is discharge or the penis becomes increasingly red or swollen

Newborn Screening is a blood test done on the newborn after 24 – 72 hours, which screens for approximately 30 metabolic diseases. This test is done after the baby has had a chance to try to digest food, as there is a high chance of a false negative if done before the first 24 hours.

What if your baby screens Positive?

Newborn screening helps find babies who have serious diseases but may seem healthy at birth. When these diseases are picked up early in life, treatment can help prevent health problems, mental retardation, and in some cases, death.

A “screen positive” result does NOT mean that a baby has the disease. It means that the baby has a higher chance to have the disease and that more testing is needed to find out for sure. You will be referred to a specialist at Genetics in London.

Click here to see the diseases that will be screened for in this test. You can find the incidence, the marker measured, what the screening prevents, and the treatment.

How is the test done?

A few drops of blood are collected from the heel of your baby’s foot. The same blood sample is used for all tests. We are happy to do the test when you are feeding in order to minimize the pain to the baby.

Pulse oximetry screening for Critical Congenital Heart Disease (CCHD) is now available for babies in Ontario. CCHD refers to conditions where a baby’s heart or major blood vessels around the heart have not formed properly. They are called critical because they require surgery or intervention in the first year of life to ensure healthy outcomes for the baby. Pulse oximetry screening can assist in the detection of these conditions before clinical deterioration. As is the case with all screening, early detection results in better outcomes. Early diagnosis and follow-up are essential first steps in preventing infant morbidity and mortality.

A CCHD screen involves a pre-ductal (right hand) and post-ductal (either foot) oxygen saturation measurement. Incidence of CCHD in Canada is 3/1000 live births.

What is jaundice?

Jaundice is a common condition in newborns, and refers to the yellow coloring of the skin and eyes caused by excess bilirubin in the blood. Bilirubin is a yellow pigment of red blood cells. Bilirubin is produced by the normal breakdown of red blood cells.

Normally bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than it is cleared from the body.

What causes jaundice?

There are several types of newborn jaundice. The following are the most common:

Physiological (normal) jaundice: occurring in more than 50% of term newborns, this jaundice is due to the immaturity of the baby’s liver, which leads to a slow processing of bilirubin. It generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age.

Jaundice of prematurity: this occurs in 75% of premature babies since they take longer to adjust to excreting bilirubin effectively.

Breast milk jaundice: in 1-2% of breastfed babies, jaundice can be caused by substances produced in their mother’s breast milk that can cause the bilirubin level to rise. These substances can prevent the excretion of bilirubin through the intestines. It starts at 4 to 7 days and normally lasts from 3 to 10 weeks.

Blood group incompatibility (Rh or ABO problems): if a baby has a different blood type than the mother, the mother might produce antibodies that quickly destroy the infant’s red blood cells. This creates a sudden buildup of bilirubin in the baby’s blood. Incompatibility jaundice usually begins during the first 24 hours of life.

Are there risk factors for jaundice?

There are a number of risk factors for jaundice. These include:

• Prematurity

• Infection

• Vacuum/forceps birth

• Resuscitation

• Bruising

• Delayed feeding

• Birth weight <2500g

• Rh incompatibility

How can jaundice affect my baby?

Newborn jaundice usually appears around the second or third day of life. It begins at the head and progresses downward. A jaundiced baby’s skin will appear yellow first on the face, followed by the chest and stomach, and finally, the legs. It can also cause the whites of an infant’s eyes to appear yellow.

Jaundice can make babies sleepy, which in turn can lead to feeding problems (a sleepy baby may not wake itself to feed and/or maintain a strong latch). This in turn can lead to significant weight loss (>10% of body weight). Because of this, it is recommended that jaundiced babies be fed frequently, even if it means waking them.

Extremely high levels of bilirubin can cause deafness, cerebral palsy, or brain damage in some babies. In rare cases, jaundice may indicate the presence of hepatitis.

How is jaundice diagnosed?

Your midwife will use a bilimeter briefly applied to your baby’s ear, for a quick check of your baby’s bilirubin levels. If bilirubin levels are high, and in the phototherapy range, your midwife may take a small sample of your baby’s blood with a heel-prick and bring it to the lab, to measure the bilirubin level a little more accurately.

A simple test for jaundice is to gently press your fingertip on the tip of your child’s nose or forehead. If the skin shows white, there is no jaundice; if it shows a yellowish color, your baby has jaundice. It is most accurate to do this while holding your baby in natural light. It should be noted that this is a subjective test, resulting in over-diagnosis of jaundice in babies of Asian descent.

How is jaundice treated?

• Mild increases in bilirubin level usually don’t require treatment.

• Frequent feedings (at least 10 to 12 times in 24 hours) can speed up the rate that stool passes through the intestine. This can reduce the amount of bilirubin that is reabsorbed from the bowel.

• Moderate jaundice may not need any treatment, but your midwife will follow up on it. If it is a warm, sunny summer day, you could place your baby (with as little clothing as possible) on your chest and sit in filtered sunlight for 10-15 minutes. The blue spectrum of light may help with jaundice. Make sure not to let baby get chilled or sunburnt!

• Higher bilirubin levels may need be treated with in-hospital phototherapy. Your midwife will attend your home every day to check your child’s bilirubin levels and consult with a pediatrician if your baby is in the phototherapy zone. Phototherapy includes placing your baby, with as little clothing as possible, under a special type of light (often called a bili-lamp). This light causes a chemical change to occur in the bilirubin molecules in the tissues under the skin. Once this chemical change occurs, the bilirubin can be excreted by the liver without the liver having to convert (conjugate) it. During the treatment, the baby will be placed in an isolette to keep them warm and their eyes will be protected from the bright light, with eye patches.

Dangerously high bilirubin levels, can also be treated by performing exchange blood transfusions (replacing the blood high in bilirubin with blood that is lower in bilirubin).

When to call your midwife

You should call your midwife if jaundice is noted within the first 24 hours of life, or if jaundice can be seen in the arms or legs. Also page your midwife if your baby develops a fever over 37.5 degrees Celsius (under the arm pit) or if your child starts to look or act sick.

Ontario Midwives Hyperbillirubinemia Information > (additional languages available here)