Blush: A doula’s toolbox – Guest Post by Tricia Surette

Read Part 1 here.

Part 2: A doula’s toolbox

Doulas have many tools in their repertoire that can help a woman in labour.

“When I first go to a birth, I observe what my client is doing and ask her some questions,” says Anderson. “For instance, if the mother says the pain is all in the back, I would start straight away with counter-pressure and ask her, ‘does that feel better?’”

Communication with your doula is key. Anderson will check in with her clients repeatedly about what is working, what’s not, and will change up her techniques accordingly. She can offer the use of a TENS machine, which can help some woman cope with the pain better. Anderson will also remind the labouring woman to stay hydrated, to rest, to breathe.

Doulas provide both physical and emotional support during labour. They have many tools to help a labouring person cope with the pain as their bodies move through the stages of labour. Here a doula uses a rebozo, basically a large scarf, to provide counter pressure to a client’s lower back. Image taken by Nicky Rhea De Souza and shared here with permission.

It’s not uncommon in birth for emotions to come up.

“If somebody gets really emotional, if they need to cry, I tell them, ‘Just cry’,” says Anderson. “I can ask them questions as to what’s coming up, what are you worried about and sometimes they’re very valid worries.”

And if something comes up on the medical side, Anderson can help remind the woman or the couple that it’s okay to ask questions. Rarely is there ever anything in birth that requires such an immediate response that there isn’t time to ask questions and find out what’s happening before making a decision.

“Sometimes in a hospital setting people can find it overwhelming where [information] is often presented as ‘this is how it is’ and some people have a hard time going against it,” says Anderson. “Sometimes it’s really hard to collect your thoughts when people are looking at you waiting for an answer, so I might say to them, ‘Ask for five minutes’.”

The discussions a couple has with their doula at their pre-meetings, as well as work they did on the birth plan, will make all of this easier to navigate, as there will be a bond and the couple will already be privy to a foundational understanding of the choices they may face during labour.

“Many times, at the hospital,” says Anderson, “the nurses would say to me, ‘You’re really lucky because you got to know these people. I just met them and they’re in labour’.”

The support a doula can provide for the non-birthing partner is amazing as well.

“[Partners] have a hard time because they feel like ‘oh, my love is in this much discomfort and I can’t do anything’. They feel helpless and that’s a difficult place to be.”

Doulas can help partners learn massage and counter-pressure techniques to help reduce pain, which gives the partner something to do and can help them feel more connected to their labouring partner and the birthing experience as a whole. Doulas can remind partners to breathe and to take time to rest, eat, or drink, especially if it’s a long labour as was the case for Chris Brown’s wife Debbie. Her labour went on for several days and they were sent home from the hospital a number of times, plus there were other complications such as meconium, a complication where the baby poops inside the amniotic sac and runs the risk of aspirating it into their lungs before they are born.

“I actually hyperventilated and left,” said Brown. “I think it was because I was afraid for Debbie and the obvious pain she was undergoing.”

But he credits their doula with providing them with a lot of information ahead of time, that allowed he and his wife to navigate the overwhelming elements of their daughter’s birth.

“She was genuinely there for us when we needed her and she did provide a lot of comfort and knowledge,” says Brown.

There have been some studies conducted on birth outcomes for woman with labour support and while some of the results are harder to quantify, in general most woman did better with continuous labour support. According to the Journal of Perinatal Education, “Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.”

(At the end of the article there will be an additional of list of resources and recommended reading that you might want to explore if you are contemplating a doula for your next birth.)


References

Oakville Family Birth
NCBI
Science Direct
Dona

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Blush: What’s a doula? Why do I want one? – Guest Post by Tricia Surette

Follow Tricia Surette here!

Part 1: What’s a doula? Why do I want one?

Pregnant women often say that what matters most is the health of their baby or babies. Our society focuses heavily on the arrival of baby often to the detriment of the mother. One of my favourite quotes is, “the moment a child is born, the mother is also born,” and according to the internet it is attributed to Osho, a controversial figure. But the quote captures a truth about childbirth.

The woman is as integral to the process of birthing as the baby is, and her importance and her need for support is just as important as the health of the child. The act of labour is a symbiotic relationship between the woman’s body, mind, and soul working along with the movements of the newborn descending through her birth canal. The more we can allow that process to happen unhindered and for women to be free to listen to the intuition of their bodies, often the better the outcomes are for both the mother and child.

Here a doula holds a woman in early labour, providing support through the intense surges of her labour, as her body works to bring her baby earthside. Image taken by Nicky Rhea De Souza and shared here with permission.

Unfortunately, our highly medicalized birthing system in North America has forgotten the power of the female body – but this is starting to change.

Women are remembering, they are learning to trust themselves, and they are demanding more support. One of the forms that support might take is a doula.

“[A doula] is somebody who helps you see your strengths, helps plan, helps craft questions for your healthcare provider,” says Courtney Holmes, the family outreach and birth companion support worker at Mothercraft Ottawa. “They really help instill a sense of confidence and empowerment moving through the experience.”

Mothercraft Ottawa provides doula services to at-risk women in Ottawa. At-risk includes new immigrants and low-income mothers. The support the doulas provide those women is invaluable.

“How women feel about their labour and delivery is a huge marker for postpartum mental health issues afterwards,” says Holmes.

Pia Anderson, a local doula and Hypnobirthing teacher, has been a doula for over 14 years and has supported hundreds of women physically, emotionally, and informationally through their journeys of birthing their children.

Anderson tries to meet with each family at least three times prior to the birth. This helps build her relationship with the woman and her partner.

She is a big supporter of a birth plan, not because she expects everything will go according to the plan, but it gives a chance for the woman and her partner to explore their options and be aware of the different scenarios that might come up, as well as to explore questions they might want to bring up with their healthcare provider. It also gives them a chance to voice any fears or worries. Anything that can be addressed ahead of time or can be anticipated to come up during the birth, can help increase the chances of a positive birthing experience.

Anderson worries about the mothers who make a birth plan that they are too attached to.

Birth is not a predictable process and getting too entrenched into an idea of how it should go, ie. having your heart set on a “natural” birth (meaning no epidural, vaginal delivery, etc…) can set a woman up for disappointment if anything deviates from her vision. The birth plan is a great tool for educating yourself on what could happen and to help you be prepared for various outcomes, but it’s important that it’s viewed as a tool to help create an optimal birth in spite of anything that happens, and not a carved in stone agenda. Very few births go completely according to plan.

Melaina Landriault is a mother of three in Ottawa. Her first birth was a c-section as her daughter was full breach and stuck, but her two subsequent pregnancies were homebirths with doulas. Her second birth didn’t quite go as planned. It was supposed to be a hospital birth, but the hospital sent her home thinking she was still hours away from delivery. Her daughter had other ideas.

“I delivered her myself,” says Landriault. “[My doula] caught the baby!”

“We really believed what the doctor and midwife had told us and I’d never birthed before,” continued Landriault. “Then I remember pushing and [my doula] was like ‘Don’t push!’ and I was like, ‘I can’t stop this!’”

Landriault’s daughter was born in her living room with only her doula to support her. Her midwife arrived after the birth and an ambulance arrived to check everyone out as well.

This is not a typical scenario for a doula and most doulas will actively avoid a birth without any medical practitioners in attendance, but this one thankfully had a happy ending.

Unfortunately, if a doula attended a birth with no medical support and it didn’t have such a happy outcome, the doula could be open to a lawsuit with devastating results and charges could even be laid if the outcome is deemed the fault of the doula in any way.

Doulas are not medical practitioners and should never provide medical advice on your pregnancy or how you choose to birth. They can provide information to help you make a decision and will direct you back to your OB/GYN or midwife for answers, but they should never tell you how or how not to do something. The main goal of a doula is to support you in whatever choices you make and to help you achieve the best outcome for your birth so that everyone, including the mother, is healthy.

Stay tuned for Part 2 and Part 3 in two and four weeks respectively.

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Blush: Lactation pre-birth

Any lactation that starts before the birth of the child is made up of colostrum, the nutrient-rich, high antibody early milk.

I noticed that I’ve been producing it for a while now, but I’m not sure when it started, as mine doesn’t really interfere with daily living. My nursing pads aren’t even wet.

I talked with another person who had nursed their first-born for 3 months, and he said that he had also started lactating early while pregnant with his second.

It is nice to know that it’s normal, although I was fairly certain that it was, especially given that I had nursed my toddler until Christmas (end of first trimester).

Anyways, I thought I’d take a look into the actual facts about lactating before giving birth and see what the professionals say.

I am very glad that I did.

Apparently, it is recommended that people who have gestational diabetes (GDM) express some of this early milk and freeze it in anticipation of the baby’s birth, because the baby will have a drop in blood sugar after birth (hypoglycemia) and the extra colostrum will help regulate the blood sugar levels much faster.

Umm…okay… I didn’t know that! Good thing I received some milk storage bags from Baby Box University. And I guess I know what I’m doing sooner rather than later. (I’m 37 weeks and 5 days as of the writing of this post.)

This is the pump that I have. I loved it with Dragon – hopefully I’ll still love it for Pegasus! Image from walmart.ca.

The other option, of course, is formula feeding.

But if I’m already producing a slight amount of colostrum, I’m definitely going to try to collect it!

And hey, if the only danger in doing so is inducing labour, at my stage of pregnancy, I’m REALLY not going to complain.

Please note: there are other risk factors in expressing milk early, including to people who are supposed to receive a caesarean, if there is excess weight gain, if the baby is too small, or if there is too much fluid in the womb. Expressing milk might also reduce blood flow to the womb.

If you are considering expressing milk pre-delivery, please talk to your healthcare professional before doing so.

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References

theconversation.com
nhs.uk

I can’t remember if I’ve done this

Hello My Imaginary Friends,

I’m Bisexual… I have no idea if I’ve ever officially come out. It’s not something I talk about a lot unless I see Jason Momoa…

I’ve been attracted to all genders for as long as I can remember. The few same sex relationships I saw I could never understand why people made a big deal about. It wasn’t until I got older and people started to use Gay as a slur that I realized I wasn’t the norm. I didn’t have a word for what I was until university when I met other people in the LGBTQ+ community.

It wasn’t a positive interaction. I was told I was just confused and couldn’t choose a side. That I should come back if I decided to be gay. (Yep, a gay man actually told me that.) It wasn’t until I met some really good friends in my mid twenties that I realized I wasn’t just confused. Then I saw Jack Harkness on Doctor Who and it was great to see a character like me.

All that to say, if I hadn’t told you… I’m bisexual and to me that means I can be attracted to anyone, regardless of their gender.

For pride month, the wonderful Cait Gordon wrote an awesome tweet about me:

For #PrideMonth, I want to shout out some awesome books and authors. @EricDesmarais‘ YA series is based in a town called Baker’s City with Elizabeth Coderre solving paranormal mysteries in a Sherlock-esque sort of way! Book 2, Sign of Faust is an Aurora Award nominee! #AmReading pic.twitter.com/E6fX5368Dw— Cait Gordon 👽🍰♿️ (@CaitGAuthor) June 11, 2019

Thanks Cait!

And to everyone out there still trying to understand themselves, you’ll get there and there are people like you out there. Be brave and find friends who support you.

Later Days,

Éric

Blush: Symphysis Pubis Dysfunction

One of the benefits of being the author of this blog is if I have a question about my own health, researching doesn’t feel like a waste of time because I can then write about it.

One of the negatives of being the author of this blog is that everyone knows what is going on with my health. (Not that every post is about me. I usually say if it is.)

Good thing I don’t mind sharing?

So I’m pregnant.

Is anyone surprised? I guess you haven’t seen me lately.

I’m 35 weeks and 6 days today.

Image of myself pregnant, with my daughter happily reaching up to my belly.

It’s also our ten year anniversary, but that’s irrelevant to my health. I’m just excited about it and want to share.

The thing about being so close to the end of the pregnancy is that, well, you’re close to the end. Very mixed feelings about this. On one hand, it’s so cool to feel movement from another being inside of you and you’re never alone (that doesn’t really go away if you have a clingy baby/toddler). On the other hand, you’re sore, it’s hard to move/roll over in bed, and the number of doctor’s appointments increases dramatically (a pain to get to and a pain to arrange around your schedule).

Today, I want to talk about soreness. Specifically the soreness that comes once hormones like relaxin kick in.

Relaxin is pretty great, to be perfectly honest. It’s the hormone that loosens the ligaments and muscles in the hips and pelvic region and allow for the human body to stretch enough to deliver a baby vaginally. Remember, the pelvic area, on a regular day, is only so big. The bones have to be able to accommodate the head and shoulders in order to push a baby out. Hence, relaxin.

However, relaxin starts its work in the third trimester (usually. Sometimes it’s early). So not only are you gaining extra weight from the baby gaining weight, but your ligaments and muscles are no longer supporting you the way that they did before. This can cause quite a lot of pain.

Enough that there’s a name for it.

Symphysis Pubis Dysfunction (SPD).

I’d like to make a quick note here that although this is most often referred to as a symptom of pregnancy, you can have it and not be pregnant.

So how can I minimize the pain from SPD?

Avoid triggers like standing or sitting for too long, crossing your legs, and lifting or pushing.

Whew. That’s a lot.

But you do a lot with your hips without realizing it.

Physiotherapy is very helpful. Your physiotherapist can give you exercises that will help to minimize the pain and recommend other ways of improving muscle function and joint stability.

Personally, the things I find the most helpful are icing the outside of my hips and doing Kegels. Even if it hurts at the beginning of my Kegel reps, by the time I get to rep 5-6, I feel so much better. Sleeping with a pillow between my knees has helped immensely as well, especially since I don’t normally lie on my side – I much prefer sleeping on my stomach. Not exactly an option right now for some reason.

I hope this helps those of you who are feeling pain, and for those who know me, it helps you understand why I wince every time I move to stand up or try to get into a car. (Widening legs or taking a big step is rather painful for me, especially at the end of the day.)

If you’re not in pain and don’t know me, I hope you at least found this interesting.


References

If you’re enjoying the Blush blogs, consider learning more with Blush: The Card Game from Renaissance Press.

Blush: Menstruation Changes Article

I read this article from Heathline yesterday, and I loved it so much that I’m going to recommend it for today’s post.

It’s all about how menstruation changes throughout a person’s life (and it uses neutral pronouns!).

Image from healthline.com.

If you’re enjoying the Blush blogs, consider learning more with Blush: The Card Game from Renaissance Press.

Blush: Breaking Water

It occurred to me the other day that I don’t remember what to do if my water breaks. That didn’t happen with Dragon.

And hey, look at that, I need a topic for my Blush blog this week. If I’m going to research it anyways, might as well write about it, right?

What is the “water”?

Water. Image from shutterstock.com

In pregnancy, the water is the amniotic fluid that fills the sac that protects the baby in utero. This protection is both macroscopic (bumps and falls) and microscopic (keeps bacteria and other foreign microbes away from the baby).

How does water “break”?

The membranes of the amniotic sac tend to tear or rupture during labour, allowing for the amniotic fluid (water) to leave the body.

Will it be like in the movies, where there’s all of a sudden a huge pool of fluid on the ground?

Apparently this is rather rare (10-15% rupture before labour starts, and only a fraction of THOSE experience a gush of fluid). It will most likely feel like a sudden popping sensation followed by a slow trickle of fluid. Contractions are most likely going to be the first sign of labour, not the water breaking.

What’s the difference between “water” and urine?

The amniotic fluid is usually clear with a slight yellow or pink tinge and odourless (or sometimes sweet-smelling). If it is green or brown, it means the baby had a bowel movement and the health care team in charge should be notified. Urine is yellow (usually) and has a scent.

You can find out more about water breaking too early, what to do if labour doesn’t start, etc in the references. Check it out if you’re concerned or interested.


References

Today’s Parent
Baby centre
Mayo clinic
What to Expect


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Blush: GDM

GDM, or Gestational Diabetes Mellitus, has taken over my life.

In week 24, most OB’s/midwives recommend a blood sugar screening. You go in, drink an orange drink (I’ve heard there are other flavours, but the place I went to only had the one) that tastes like flat Orange Crush with 50 sugar packets added to it, wait an hour, and get your blood taken. They are testing your blood sugar level (at a higher accuracy than a diabetes monitor would be able to).

My results from that test came back at 8.4. The upper limit (to not have GDM) is 7.8.

So my OB had me go and do the whole thing again, but the two hour test this time.

The two hour test is slightly different. It must be a fasting test. They take your blood when you arrive before you drink, one hour in, and at the end of the two hours.

This time, one hour in, my blood sugar was at 12.2.

I had GDM.

Dammit.

Sugar cubes. Image from nytimes.com.

I was told this on April 5th. My appointment at the hospital with the nurse and nutritionist was on April 18th. I was given no further information.

Not wanting to endanger our unborn child more than necessary, we started doing research into how to control my blood sugar, and found the low GI diet.

Fortunately, not only was this very easy to follow (especially since I love veggies) but it ended up being the recommended diet to follow by the nutritionist that I saw two weeks later.

At the meeting with the nurse and nutritionist, I was given a diabetic monitor, test strips, and needles. (and a prescription for more of the latter two – thank goodness for insurance!) I was to prick my finger when I woke up and one hour after every meal (not snack).

Dragon insists on watching me do it and has started “pricking” her finger with a crayon and saying a random number.

I’m seeing the doctor at the hospital today, two weeks after the meeting with the nurse and nutritionist. She will hopefully say that my numbers are okay and I don’t need to go on insulin. We shall see. I’ve had a couple pretty weird readings.

On top of watching my blood sugars and eating a mildly strict diet, I also get to have more ultrasounds. One a month for the next two months, and then one a week until the baby arrives. These are to monitor his growth, to make sure he doesn’t get too big.

One of the biggest risk factors with GDM is the baby growing too large. Another is the risk of the pregnant parent developing type 2 diabetes in the future (ugh, fun).

I’m sure there will be more appointments that I’m not yet aware of. For someone with a toddler who sleeps until 11am and doesn’t have a car (but has awesome parents who give me access to theirs or drives me to the appointments, yes I know I’m very lucky), these extra appointments are very trying.

Let’s hope I don’t need insulin on top of the rest of this.


References

Diabetes Canada
Glycemic Index

Blush: Surrogacy in Canada

A few weeks ago, an article on surrogacy crossed my timeline. It was incredibly interesting to read; to get the perspectives of both the surrogates and the intended parents.

Image from
www.surrogacy.ca

The article states, at the end, that there is still a lot of misinformation surrounding the topic of surrogacy, and that the ethics surrounding surrogacy and gamete donation are still under debate.

Let’s clear up some misinformation:

In Canada, surrogates do not get paid. In fact, it is illegal to be paid to be a surrogate. There is usually allowance for expense reimbursement, and if the intended parents and surrogate agree to do IVF instead of traditional surrogacy (most surrogacies in Canada are done through IVF) then the expenses of that are paid by the intended parents. The bulk of expenses for surrogacy seem to be for legal fees and IVF.

Another myth is that it is hard for the surrogate to give up the baby at the end of the pregnancy. It has been found that, for the most part, the surrogates have no problems with this, as they are fully aware straight from the beginning that the child they are carrying is not theirs. (source)

If you do wish to either be a surrogate or have a surrogate, do your research. Evaluate your options. No matter your decision, I wish you the best!

If you’re enjoying the Blush blogs, consider learning more with Blush: The Card Game from Renaissance Press.


References

Surrogacy in Canada Online

The greatest gift (Parenting Times)

Surrogacy in Canada: What you need to know (Global News)

Blush: Chest pain during pregnancy

The past few nights, I have slept with my Teddy.

This is not my Teddy. This one looks more like Raoul, Dragon’s sleep bear. Image from www.chapters.indigo.ca

He was given to me by my grandfather when I was born, and he is VERY well worn. I haven’t really slept with him since I was a teenager (possibly earlier, but I don’t remember the exact age when I stopped cuddling him in my sleep).

So why am I all of a sudden cuddling him again?

Because yes. (Sorry. Inside joke.)

I am cuddling my Teddy because I need the extra support between my arms as I lie on my side, otherwise my rib cage feels like it’s being crushed. And Teddy is exactly the right size to give that support and allow for easy rolling over.

Chest pain was not something I experienced in my first pregnancy. Heartburn, yes. Feeling like my upper arm was too heavy and crushing my sternum, no.

This seems to be a fairly common symptom, or at least, it was easy to find a reason why I was feeling this way. The expanding uterus puts pressure on the diaphragm, causing the rib cage to widen. Poof, pain. It’ll go back to normal once the baby is here because my internal organs will go back to their normal places.

If I had to guess, I would say that the placement of the placenta is what is causing the differences between this pregnancy and the last. The last one, I had an anterior placenta (forwards), and this time it’s up top.

Differences:

  • last time, I couldn’t stand the pain and nausea of being on my stomach, even at the very beginning; this time, I have woken up on my stomach several times and the only thing that hurts is my back
  • last time, no chest pain; this time, chest definitely hurts
  • last time, baby was mostly on the right side of my body (I felt very lopsided in third trimester); this time, baby is hanging out at the very bottom almost constantly (we’ll see what happens in third trimester)
  • last time, didn’t really grow out very much; this time, I feel like I’m already the size I was when I delivered

Hmm…that last one doesn’t really fit the hypothesis – you’d think the anterior placenta would mean a bigger belly because it’s taking up more room.


Reference

UPMC

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