Tag Archive | langley

I recently welcomed my fourth child into the world

I am absolutely ecstatic to announce that I had my fourth kid, and 2nd daughter in January 2015. She was welcomed into the world by her older brothers and sister with so much love.

Of course as a doula and prenatal teacher, I was very interested in putting all the skills I teach in my classes to good use in my own labour.

First of all, right from the beginning of my pregnancy, I wanted to choose the best health care provider that would be a good fit with my birth preferences. This is one of the most important things I tell my clients that will affect the kind of birth you have. Don’t just choose any random maternity care provider. Find the ones who best fit with the kind of person you are, and the kind of birth you want.

Secondly, birth can be unpredictable, so when things don’t follow the textbook version of labour, you have to make informed decisions regarding what to do. There are ALWAYS options. When my water broke and my labour didn’t start for over 24 hours, it was stressful because, of course, as a mom, you naturally worry. But I kept reviewing my options and the potential risks of all the options available and kept discussing things with my midwives. Just to be clear, I felt totally fine with having any medical intervention that was clearly necessary and helpful, but I also know when interventions are not entirely necessary. There are always risks to both sides – having a medical intervention or declining it. In my situation I had the options of going to the hospital to start an induction, using non-medical ways of starting labour (herbs/ acupuncture etc which can be highly effective), or simply waiting it out. That’s another reason moms love having a doula with them in pregnancy and labour – if unexpected situations arrive, the doula can often talk moms through the decision making process, empowering them with a range of information on options so that moms can make an informed choice and feel good about it.

I knew the risks and possible outcomes of all scenarios and decided to take various herbs to get labour started. I also know that emotions and ’emotional blockages’ can have a huge impact on labour. So with the help of my doula friend, I worked through any deep seated emotions I was having that could have been blocking my labour from starting. That was EXTREMELY helpful because after I realized a huge emotional block I was holding, and then let it go, my labour started soon after.

Thirdly, of course, is all the pain coping strategies I teach. Once labour started, the first half was the easy part. The key for that is to keep focussing on staying completely relaxed. Holding on to any tension or resistance will cause pain. I was able to feel no pain at all for the first half of the labour by breathing out all the pressure waves and making a low toning sound. You can try it now, just let yourself sigh with a deep sound. You naturally let all your tension go and you feel more grounded. Remember fear in labour = adrenaline = pain = more fear = more pain. You have to keep the adrenaline out of the equation in labour and keep deep breathing away any tension or pressure you feel building up. Pay attention to your body.

homebirth labouring mom As contractions intensified, I moved around, feeling for whatever positions felt more comfortable. Sitting, squating, standing, lunging, leaning forward on furniture, sitting backwards on the couch, swaying my hips etc. I was chatting with my doula, friend, mom, and midwives in between contractions. Eventually, I felt like leaving the living room and going up to my bedroom. In labour, women naturally experience a going within. They feel like they are going deeper and deeper inside themselves as labour progresses. A woman starts using more of her primitive, instinctual brain and less of the cerebral cortex. It is the instinctual part of the brain which controls the natural process of labour. Labour flows more smoothly when a woman is undisturbed so she can smoothly go deep within herself. Any distractions that pull a woman out of this state of mind will slow down the labour and also create unnecessary pain sensations. Bright lights, too much talking, asking questions, talking about time (which is a cerebral concept), telling a woman what to do so she can’t listen to her own body’s instincts, disturbances like frequent blood pressure checks, vaginal exams etc. will all take a woman away from her “labour land” state of mind. And to the labouring woman, this feels quite irritating.

I told my midwives that I wanted a very hands off approach to my birth. I didn’t want any unnecessary disturbances such as internal dilation checks or them telling me what to do. But having them there in the background helped me feel safe in the rare situation where medical help might be needed. It is important for birthing moms to feel safe and supported. That will lead to a smooth labour process. Anything that makes them feel worry, fear or anxiety will cause a slowing down of the labour process, or even complications.

homebirth labouring momOnce I got to my bedroom, the lights were off with just a dim light on in the bathroom. My older daughter had woken up by this point and she lit some candles to add to the mood of the room. My mom made sure the music playlist I had put together for the birth was still playing. I had complied a series of songs that I found both inspiring and relaxing. I love music and I find it helps me set the tone for focusing on feeling good. In labour, you want to take your attention off the pain sensations and replace them with anything that makes you feel good. My doula was massaging my sacrum while holding a hot pack on my lower back. My husband rubbed my back and shoulders. That all felt really good. By this point, I was not feeling zero pain, like in the earlier part of the labour, but all these things helped take the edge off the intensity of contractions so they were completely manageable.

People often tell me that I’m brave to have a homebirth. Nothing could be further from the truth. The truth is, in terms of pain management, homebirth is often easier to manage because I feel more comfortable at home and there are so much fewer disturbances to my instinctual state of being. In terms of safety, solid evidence shows that homebirth is as safe, if not safer, than hospital birth, as long as it’s a healthy pregnancy, there are trained care providers in attendance, and a hospital is less than an hour’s drive away if there is a need to transfer. Here in the lower mainland, BC, Canada, we are so lucky to have a fantastic midwifery system that functions relatively smoothly at home or hospital. If you feel more comfortable having a homebirth, definitely go for it, or at least look into it. If you feel safer and more comfortable in a hospital, then hospital is the place for you. Birthing moms should be in the place that is more conducive to them feeling safe and supported. You have to know yourself, and know what you prefer. It doesn’t matter what anybody else does. It only matters what kind of experience you want and how you’re going to get it.

waterbirth home birthEventually, my contractions got pretty strong and I wondered if getting in the bathtub with warm water would help. I wasn’t particularly planning a waterbirth, but I always keep my options open. The warm water does take the edge of, but of course, labour is still a pretty intense and powerful process. At one point I joked with my midwife, “So you brought an epidural with you, didn’t you?”

“Yeah, it’s just in my back pocket,” she smiled.

“Oh good. I wouldn’t want to be crazy enough to have a natural birth.” ūüôā

(Just in case you didn’t know, you can’t have an epidural or any other drugs at a homebirth because of the risk those things entail.)

I remember, through one contraction I just swore the whole way. Then for the next one I struggled to remember what the purpose of all the pain was. Oh yeah, to open the cervix and let the baby out. So I started chanting “Open, open…” through the whole contraction, while visualizing my cervix opening fully, quickly and easily. Soon after that I started to feel worried. I had the presence of mind to remind myself that this was a normal emotion during transition (the last bit of the dilation phase before the pushing phase). I was worried that this would go on forever and the baby would never come out. It’s common to have this rush of irrational feelings in transition, and a doula often reassures a labouring mom that this is a natural part of the process and it’s good sign that means things are progressing. It is important for the mom to go back to her state of feeling safe and relaxed instead of letting the worry and the adrenaline intensify. Again, smooth, fast and instinctual pushing phase vs. prolonged and worried pushing.

homebirth, waterbirthI soon began to feel “pushy”, meaning I felt like pushing a little at the peak of each contraction. I let the midwives know so they could get ready and everyone else too. My younger two kids were woken up so they could be present for the birth. I tried different positions in the tub – on my back, side, hands and knees, until I found the most comfortable position for myself, which just happened to be squatting facing the width of the tub instead of lengthwise so my feet could push against the side while my back rested on the other side.

Pushing contractions feel different than dilation contractions because you’re not just trying to relax through each one. You’re actually actively pushing with each one. And in a drug free birth, you can feel the powerful force of your body pushing instinctively. It’s not something you can stop. It’s like one mom said, it feels like you’re body is just vomiting the baby out. It’s so strong and so involuntary. In a drug free birth, no one has to tell the mom how to push. Her body just does it. Pushing feels way more fun than the dilation phase before it. I felt very powerful.

Once the baby’s head was low enough in my pelvis, I could feel it. It was definitely a strange sensation and I exclaimed to all the 10 people who, by now had piled into my bathroom, “It feels like a bowling ball.” I put my finger in and felt the top of the baby’s head less than an inch away. A couple more pushes later and I could feel her head crowning. This feels like a burning sensation as the perineum stretches around the baby’s head. I expected this part to take a while, as it can take several pushes to slowly push the head out. But my body just kept going and in one push she went from completely inside to completely out. I had planned to catch her myself if possible, but she came so fast. No one was quite ready for that. Luckily my husband was speedy quick in catching her and lifting her out of the water and onto my tummy. She was happy and content sitting on my tummy, looking around.

homebirth, waterbirthWe hadn’t found out the gender, so it was very exciting to look down and see it was a girl. My daughter finally got the sister she had been hoping for for so long. Here’s the picture that captures the sheer intensity of emotions of that moment right after birth – relief that it’s over, exuberance over the new person you are meeting, and for me the shock of how fast she came out and surprise that I got the girl I wanted.

It was a lovely family experience to have all my kids there, my mom, sister-in-law and friend. My husband caught the baby, my daughter took the photos, my older son cut the cord and my younger son helped the midwife weigh the baby. My kids will all grow up knowing that birth is just a normal, natural and safe part of life. Not something to fear. By the way, I wanted to wait till after the placenta was out to cut the cord, or at least until the blood in the placenta had finished pumping to the baby, instead of cutting the cord immediately. This is so that she can get her full blood volume and have a gentle transition to life on the outside.

Once I got out of the tub and walked back to my bed, I birthed the placenta and breastfed my baby before letting everyone else have her for some cuddles. My mom made me a nutritious, yummy smoothie with a tiny piece of placenta blended in. Having a bit of placenta reduces the risk of postpartum hemorrhage.

It was a lovely morning. I stayed in bed all day snuggling my new sweetheart. And the other kids were just over the moon excited with their tiny sister. Plus they got to take a day off school. ūüôā

newborn baby holding mom's finger

 

 

 


 

Community Birth Program in Surrey Memorial opens its doors

Community Birth Program in Surrey

A fantastic new program has opened in the Jim Pattison outpatient clinic at Surrey Memorial Hospital for expecting mothers in Surrey, Delta, White Rock and Langley. The Community Birth Program is modelled after the South Community Birth Program in Vancouver, BC.

Both the Vancouver and Surrey programs are based on the groundbreaking and innovative Collaborative Care¬†model where Physicians, Midwives, Nurses and Doulas work together as a team. Doulas are provided to clients at no charge because of funding from Fraser Health Authority. That means that even low-income women, immigrant women or women who have never even heard of Doulas can have one to support them through pregnancy, labour and post-partum. The women are thrilled to bits to have someone give them personalized attention, in their own homes, and help them navigate the new territory of parenthood, especially if it’s also in a new country. (If you’re not sure what a doula does, read my page¬†What is a Doula?)

Fraser Health decided to provide funding for this program because of the immense success the Vancouver program is having. Significantly lower c-section rates, shorter hospital stays and higher breastfeeding rates. These is all great news for mothers and babies, but also for the budget of the Medical Services Plan so it makes sense to fund doulas and midwifery/physician collaborative care if it’s going to save on the other end with reducing unnecessary medical ¬†procedures.

Normally, reducing the medical budget compromises patient safety, but for maternity care in particular, there’s lots of room for reducing unnecessary medical procedures while not compromising necessary ones. For example, the World Health Organization suggests that the optimal C-section rate is probably around 15%. Less than that and women who really need it, may not be getting it, which is often the case in impoverished countries. But more than 15% and probably too many women are having cesareans that may not always be necessary.

To find out what the cesarean rate is in the hospitals near you in BC, go to¬†British Columbia Cesarean Rates. For example, Surrey Memorial Hospital has a cesarean rate of ¬†28.65%. So there’s room for reduction. While a small number of mother’s would rather have a cesarean, the vast majority would rather avoid one. So reducing rates would benefit moms as well as reduce costs. Pioneering programs, such as the Community Birth Program and many others that are effective at reducing intervention rates without compromising safety are important for helping maternity care providers as a whole understand how to effectively reduce rates.¬†

I’m really glad the Surrey Community Birth program has finally opened after years of preparation. It’s going to be a really positive direction for expecting moms in Surrey and the Fraser Valley. While maternity services in BC are already so good, ¬†and has continued to improve over the past years, there is always room for improvement.¬†

What I would like to see is good quality prenatal education that is available to ALL first-time moms – that effectively teaches pregnancy nutrition, making informed choices and real labour coping strategies. (I say “effective” and “real” because obviously, I have my opinions about how ineffective and unrealistic some prenatal classes are in regards to those topics)

Choosing an appropriate caregiver for pregnancy is one of the most important decisions women make that effects the path their birth will take. I always teach in my prenatal classes how to figure out if your caregiver matches the kind of birth you want. But by the time they come to my classes, their already in their third trimester. It would be great if women got more information about caregiver choices early on (like before they even get pregnant, or at least in early pregnancy). When women go to their doctors for the first pregnancy test, what I would really like is for those doctors to provide a handout about the three kinds of maternity care providers in BC РFamily Physicians and Midwives for low-risk pregnancies and Obstetricians for high-risk pregnancies. 

I would also like every pregnant woman to be informed by her initial doctor about what a doula is and how a doula can help her in labour and delivery. It is up to the woman to choose if she wants one or not, but I believe every woman should at least get the information that such support exists and is proven to be helpful. There have been numerous scientific studies which prove the effectiveness of doula support at reducing unnecessary medical procedures while increasing maternal satisfaction and breastfeeding rates. If a doula were a drug, it would be unethical for doctors to not recommend them. But doulas are not a drug, and are not at the moment funded by the Medical Services Plan, so expecting families hire a doula privately. Maybe someday there will be MSP funded doulas available to all women. But for now, there are three options:

1. Find a volunteer doula. The BC Doulas Association has a list of newer doulas willing to volunteer their services. Give them a call. In Surrey, you may also be able to find a volunteer doula through the Healthiest Babies Possible Program.

2. Interview a few doulas in your area and ask if they are flexible with their rates or if they have payment plans. I am very flexible with my rates because I know not everyone can afford them but I am passionate about providing support to women who want it, and lots of doulas feel the same way.

3. Register with the South Community Birth Program if you live in Vancouver or the Community Birth Program if you live in Delta, Surrey or Langley to get access to midwifery care, physician care and doula support.

If you are expecting and would like to register with the Community Birth Program go to Fraser Health РCommunity Birth Program for more information. If you would like to BECOME  a doula with them, also contact them.

 

 

How to know when Vaginal Exams in Pregnancy and Labour are useful and when they are harmful?

Vaginal Exams ¬†are commonly done in labour by nurses, doctors and midwives to find out how dilated the labouring mom’s cervix is. Other terms that refer to the same procedure are¬†VE’s,¬†Internal Exams or¬†Pelvic Exams.¬†It is basically putting two fingers in the vagina all the way up to the cervix to feel :

1. How DILATED (open) the cervix is

2. How soft and short the cervix is (EFFACED)

3. Which direction the cervix is facing – POSTERIOR (to the back) or ANTERIOR (to the front, when labour progresses)

4. Where the baby’s head is in relation tot he pelvic bones (STATION)

5. And what position the baby’s head is facing.

While this can be a very useful procedure to find out very useful information, women also need to understand the full picture.

First of all, the damn thing hurts. It ranges from slightly uncomfortable to downright excruciating. Now remember, in nature female animals and humans don’t regularly go around sticking things up their cervix to cause even more pain and irritation when doing one of the most difficult and intense jobs in their lives – giving birth.

Secondly, it is not an exact science. It is not as if they are putting a ruler in down there. They’re just feeling around and making an estimate with their fingers and their experience.

Thirdly, having too many done can introduce germs and cause an infection, especially if several are done after the water has broken. In general, VE’s should be kept to a minimum and used wisely, but after the water has broken, this guideline should be followed even more strictly. I have seen some births where The rupture of membranes happened days before birth (called premature rupture of membranes), but there was no infection because they were extremely careful to avoid internal exams and instead assess progress by external signs. And I have seen births where the rupture of membranes happened normally at the start of labour * but an unnecessary number of pelvic exams were done, only to cause infections in the mom so that they had to have cesareans.

* Note¬†: Most labours start with contractions and the water breaks towards the end of labour (around transition which is between 8 – 10cm dilation). Only 20% of labour start with the water breaking and then contractions follow soon after. If contractions don’t start within 12 hours of the water breaking, it is called Premature Rupture of Membranes (PROM).¬†

Be wary of having students nurses, doctors or midwives at your labour. They need to learn how to do VE’s effectively, so they do one, then the mentor does one to make sure they’re estimate is right. Then when there is a shift change, the new person might want to do another one. All of this is unnecessary and simply risky once the water has broken.

Some caregivers do internal exams towards the end of pregnancy because they want to guestimate how soon you’re labour will start. Some caregivers don’t do any internals before labour because they¬†don’t see any point in it. They figure labour will start when it starts. There are some changes that take place before labour. The thing is, there is no way of knowing when labour will start because the changes can take place, but then no action may happen for weeks, or no changes may happen and then in a very short time, everything can happen and labour can be quick.

About.com provides a brilliant article in their Pregnancy and Childbirth called The Myth of Vaginal Exams. 

Labor is not simply about a cervix that has¬†dilated, softened or anything else. A woman can be very dilated and¬†not¬†have her baby before herdue date¬†or even near her¬†due date. I’ve personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she’s been told that this baby isn’t coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.

Some practitioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks.

So another reason some caregivers do weekly pelvic exams from about 37 weeks onwards is, if the cervix is slightly dilated enough to fit a finger in, they might try separating the amniotic sac from the uterus to try to hasten the start of labour. Some caregivers ask for permission before doing this, but some don’t even inform the women about what they are doing. So if you do not want his done, make sure you discuss it before allowing a pelvic exam in pregnancy. A lot of women get fed up with being pregnant and want this procedure done in hopes of speeding up the start of labour. But not all women want to do that. Know what you want and let your caregiver know what you want.

Fourthly, the results of a VE can be very discouraging if they aren’t what you expect. A woman who is in intense labour with contractions coming one on top of the other may be feeling that she’s in transition, yet have a VE say she’s only 6cm. This can be discouraging. The thing is, she may actually progress very quickly to 10. Where you are now has no relationship whatsoever with how fast you are going.

The fifth thing to consider will¬†help you determine when a pelvic exam might be useful and when it might be useless or harmful –¬†Will the information from the exam help us make a decision about the course of action ?

A lot of vaginal exams are done just for the heck of it to “assess progress”. Most of the time this is unnecessary and leads to unnecessary cesareans. Sometimes there may be no dilation for hours. There can be several reasons for this :

  • The baby might be rotating into a better position to fit through the pelvis. To understand how the baby’s rotation can help it fit, watch my video at¬†Understanding Optimal Fetal Positioning.
  • The mom might be feeling anxious or stressed, which can inhibit labour from progressing. To understand how emotions can effect labour,¬†Read my article.
  • Or there may be a genuine problem that cannot be solved except with medical intervention.
So the question to ask your caregiver if they are suggesting an exam that you are unsure about is, “What will you find out from the exam and what might you do based on what you find out?”

Usually two basic VE’s are done in labour, although sometimes even these are not necessary. One is when you get to the hospital, or if you are having a homebirth, when the midwife gets to your house. They usually do a VE to check if you are in active labour (4cm or more). Before active labour, the hospital will send you home, and the midwife will go home. Early labour can take hours and there is no point of being in the hospital before then unless there is some medical problem. If you are past 4cm, they will get you a room in the hospital, or the homebirth midwife might call the second midwife to get ready to come.

The second VE may be done when you feel an overwhelming urge to push. They may want to make sure there is no cervical lip left before you start pushing. In both these cases, action will be taken based on the results of the VE.

Other times that a VE may be useful are when a mom is really asking for medical pain relief. The amount of dilation will determine what kind of pain relief (epidural or morphine) may be appropriate or whether labour is close to the end and maybe no pain relief is necessary.

The thing is, some VE’s are done just for the sake of charting purposes. There is a ridiculous theory that dilation ought to be at least one cm every 2 hours. It doesn’t take a rocket scientist to figure out that different people do things at different rates and that’s ok. It doesn’t mean anything is wrong.

The important thing is to limit the number of VE’s done by figuring out if the information they provide will help you and your caregiver make decisions about what to do next. Don’t take the results of VE’s to seriously. Don’t get discouraged if it’s not what you expect. (I know that’s easier said than done.) And try to have only one person do the VE’s in labour instead of different people and different opinions.

 

To find out more about prenatal education, natural birth information or doula support in labour in Surrey or Langley BC email kaurina @ prenataljourney.ca or call 604 809 3288.

 

Great article called “What is the evidence for doulas?”

Ok, this is probably the most comprehensive explanation of why someone might want to hire a doula I have ever read, and it comes complete with a concept diagram of the whole thing!

Rebecca Dekker starts out by saying,

When I was pregnant with my first child, I briefly considered hiring a doula. I saw the doula flyers at Baby Moon, where I did prenatal yoga, and I thought it sounded kind of cool. But when I talked to my husband about it, he felt a little squeamish about the idea. We are both pretty private people (although you wouldn’t think it now that I blog about birth), and he didn’t want anybody else there. He just wanted it to be him and me. And he felt like he would do a good job of supporting me. At the time, it made sense. But hindsight, as they say, is 20-20.

Now all I can say is what were we thinking? How could it possibly be just him and me at the birth, anyways? We were planning to birth in a hospital! A teaching hospital, no less! Where there would be strange residents and students coming and going, and where we had no control over who we got as a labor and delivery nurse. And this was my first birth! It is so important to avoid a C-section in your first birth, because that sets the tone and risk level for all of the rest of your births (and we wanted to have at least 4 children, too). I knew on some mental level that doulas lower the risk of C-section, but I guess I just didn’t realize how important doulas are. Well, I do now. So today, I am going to talk to you about the evidence for having a doula present at your birth.

So true! I can relate because during my first pregnancy, I couldn’t imagine what I would need a doula for too. All that changed once I was in labour. To read my story you can go to¬†Birth Stories.

Rebecca goes on to explain the randomized controlled trials that prove how effective doulas can be for improving labour and baby outcomes. To read the rest of the article, click read the article here.

The absolute craziest thing is how after so much research, the medical profession isn’t like totally promoting doulas to every pregnant woman. The fact is, if doulas were a drug, it would be unethical not to recommend them. But they’re not a drug. They’re people. And so, right now, only the people who already get it, are choosing to have a doula. I hope by the time my daughter is having kids, every pregnant woman is informed about doulas and exactly how they can help, so she can make an informed choice, instead of of what I usually hear, which is, “I wish I had known about doulas BEFORE I gave birth!”