Postpartum Adjustment: My Plan of Attack

In my last post, I talked a bit about our plan to keep A in preschool/daycare while I'm on maternity leave.

This may seem like a crazy decision for a couple as cash-strapped as we are, but both my husband and I agree that it may save our collective sanity.

When you are pregnant, levels of the female hormone estrogen and progesterone increase greatly. For some of you, this may lead to shiny hair, clear skin and that pregnant "glow" everyone talks about (unfortunately for me, the clear skin is nowhere to be found). But in the days following the birth of your child, your hormones take a bit of a nosedive:

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That's right - they go back to their pre-pregnancy state in a jiffy, even though you had a good 10 months to adjust to their increased levels. Nature likes to play cruel tricks on us women.


It is thought that these drastic hormonal changes are what cause women to experience the baby blues; and, if you happen to be extra sensitive to all this bodily chaos, you may go on to develop postpartum depression or anxiety.

I knew all of this in theory when I was pregnant with my first child, but unrealistic expectations and lack of experience set me up for some serious postpartum adjustment in the days following A’s birth. So for this pregnancy, we’ve thought a lot about how to avoid some of the issues we (and I say “we” because my partner had to go through this change with me) faced the first time around. I like to call this my postpartum plan of attack or Plan Red. Because truly, I do sometimes feel that I’m going to battle with my emotions:

Zones of Operation
We will be planning for a home birth again. We toyed with idea of going to the hospital this time (just to avoid having A wake up in the night or be disturbed by the birth), but when I brought up the idea, my husband looked at me, aghast, and said “don’t make me go there” in a little boy voice.

So we are staying home, because apparently my husband needs it more than I do.

Allies
It is imperative to have decent help on hand following the birth of a baby, even more so when there are other children that need taking care of.

These have to be helpful people, though. Don’t invite anyone you feel slightly uncomfortable around (as they will be seeing you in your most vulnerable state), and make sure they’re there to cook and clean. Holding the baby is only an option when I am tired and would like a break to take a shower or a snooze. I will be calling in the troops, in the form of my mother, mother-in-law, and sisters-in-law (if they can spare the time). The hope is to have someone staying with us for the entire first month.

I am also hiring a postpartum doula, who will be there as an objective support person. She will support me with breastfeeding, suggest resources/tips I might need, and basically be a good listener (someone that is not scared of listening to me cry or blubber).

Supplies
Yep, I’m taking the plunge, and doing something that even the crunchiest of crunchy finds slightly repulsive. I am going to eat my placenta. I have a doula friend who will be taking my baby's hunka meat, drying it in a dehydrator, grinding it down, and then putting it into capsules for me to consume. I’ve written about this before, but never thought I’d actually do it. I’m desperate enough to see if it makes any difference in my emotions/mood following the birth – I would probably eat fried monkey if someone told me it could help.

Contingency
It’s always best to have a contingency plan in place in case something unexpected comes up. Although we’re hoping that this little baby does not have reflux, we’re open to the idea that it may happen. Which is where preschool comes in – taking care of a child who cries all day (and night) and does not sleep is difficult in the best of times. We want our older daughter to have some sense of structure and routine, just in case we are hit once again with the “reflux blues.”

We’ve also thought about what might happen if I have to transfer to hospital or have a baby who is sick. Again, we’re counting on our “allies” to pitch in and help. The past three years in Ottawa has given me time to meet many wonderful parents, some of whom have become great friends. So although we’re planning for the worst, we’re also hoping for the best – this time, we have reinforcements!

{Ottawa Doula} Fat Chance: Being Pregnant and "Overweight"

I wrote this post a long time ago - like, 8 months ago. This was inspired by a client of mine, but I've used no identifying information and have the ultimate respect for confidentiality. This is a rant/story about an issue more of us need to be talking about - and not just for pregnant women, but for all women who dare to surpass the dreaded BMI cutoff point.

I'm angry over a policy (or perhaps a subtle tactic) by which overweight and/or obese women are routinely treated in a disrespectful and unfair way by the birthing community - I say "community" because I don't know how far this form of treatment extends. Suffice it to say, I've only heard bad experiences with OBs. But I'm sure there are nurses, midwives and even doulas out there who have crossed the line of ethical behaviour.


Picture this: you are excited for your 20 week ultrasound appointment, at which point most women will meet their obstetrician for the first time (prior to this, you have been cared for by your family doctor, who may also exhibit similar biases, but with whom you most likely have a good working relationship).

The doc walks in, sits down, and begins rattling off alarming statistics about weight and pregnancy. They advise you not only to "gain 0 pounds," but say it may be beneficial for you to lose weight over the next several months. "Don't worry, they say, "your baby will just eat you." They begin to lecture you on diet and exercise, all the while strapping the blood pressure cuff to your arm. Your blood pressure reads high (no surprise, given Dr. Destructor has just crushed you like you were an annoying bug flying around the room).


At no point in this discussion are you:

a) congratulated on your pregnancy

b) asked how you are feeling

c) probed further for evidence of your lifestyle (do you exercise, eat well, and try to lower stress?)

d) asked about your preferences, knowledge or opinions

Based on your (false) blood pressure reading and BMI, you are automatically referred to a high-risk obstetrician, who treats other women with dangerous medical conditions which can potentially put the lives of their babies and themselves at risk. Your baby, on the other hand, is thriving and by all accounts growing well.

You're out the door in 15 minutes.

The following appointments are all the same - they always begin with, "because your BMI is high, you are at a much greater risk for stillbirth. You will most likely have a c-section. You will need to speak to the anesthesiologist prior to labour so that he can tell you all about the epidural you'll be getting."


This is the part of the post where all the swearing came in, but I've done some rewriting and tried to tone it down. Hubby wants me to keep my positive outlook on life intact. I'm also reiterating here that this is all my opinion, based on anecdotal evidence. Maybe you've had a different experience - I'm happy for you. But at a hospital not-to-be-named here in Ottawa, lots of women with higher BMI's are having a shitty experience. Oops, I swore - sorry.

At NO point in anyone's care should they ever be treated as a patient without a right to respect and evidence-based information. And yes, I realize there is evidence out there that more weight on a woman can complicate a pregnancy. But is this the case for every woman? And should that evidence cloud our vision enough to lose sight of the fact that individuals deserve a shared decision-making model of care? (where a patients' values and preferences are of utmost importance - read more here)

We as a society have some serious work to do in our treatment of the "epidemic" of overweight/obese individuals. Every strategy our government and health care providers have adopted treat weight as some form of disease that needs to be eradicated. In all my work I have done with eating disorders, I know three things to be true: Weight is NOT the problem. Willpower is NOT the problem. Fat people are NOT lazy.

The problem is how we function as a community; how we market food to individuals; how the food industry prepares the crap we can buy anywhere, anytime; how our fast-paced world allows for little or no time to reconnect with our bodies and our minds. I could go on and on (and perhaps I will in another post!) about the TRUE reason for weight issues, and none of the "solutions" we have implemented come even close to dealing with the root cause.

News flash: fat women can be healthy. I will be the first to admit that I'm skinny and slightly unhealthy. I don't exercise enough, I eat a lot of junk (at least lately!), and I fail miserably at coping with stress. And yet I have met women 50 lbs (or more) heavier than me who regularly participate in activites, have ample reserves for coping with day-to-day life, and eat as well as anyone can in an environment where industrial food is available at every corner.

If you are overweight and thinking about getting pregnant, be prepared to get stuck with a care provider who will treat you for your weight, and not for who you are as a whole person. Be prepared to meet with resistance at every corner. Every decision you make will be assessed against your BMI, and you may not be "allowed" to do some of the things you want to do.

Does this mean that you are stuck in your situation? Absolutely not! Despite the fact that we live in a country with universal health care, you still have the right to shop around. You are paying for this out of your taxes, and in no way do you need to settle for prejudiced care. Make sure to find a doctor that seems to be about the "whole package" rather than the number on the scale. The last thing you need during labour and birth is to be at the whim of a doctor who is blinded by your fat. I advocate midwifery care whenever I can, but especially in these cases - you will have a much greater chance of receiving positive direction rather than negative attention. Midwives can do a "shared-care" approach in these cases, where you continue to see your high-risk team at the same time.

Listen Up: This is not just an issue for overweight individuals to deal with on their own. This is an issue we all need to face.

Women are not numbers, and many doctors have a hard time remembering that fact. Our healthcare is suffering in this country because we put all of our faith in the numbers, with little regard for individual's feelings and preferences. Doctors (and other care providers) seem bewildered by any pregnant woman who doesn't heed their unwelcome advice - they label them "problem" patients, and throw up their hands in frustration. If you think practicing obstetrics is about "saving" someone, you need to find yourself another job. Women having babies don't need to be saved - they need to be heard.

As with any prejudice, fat bias hides away in the closet, peeking its nasty head out from time-to-time. Well, it's peaked out one too many times...

Enough is enough! Open your closet doors, air out your dirty laundry and give fat a chance.

A Correction! (and My Experience with Prenatal Classes)

First Off, I missed some important classes offered in Ottawa in my last post and also wanted to make a correction - Mothercraft offers a fee-based class tailored to all expectant couples in Ottawa. According to Mothercraft staff, their content is similar to that which is offered through the Ottawa Childbirth Education Association. My apologies for confusing this with their Birth and Parent Companion Program, which is designed for families with little or no support. I blame my pregnancy brain for this mistake :)

And thanks to all my readers for pointing out other great classes in the city - how lucky we are to have so many choices!

Birth to Breastfeeding
Healthy Beginnings (the Bradley method)
Journey Into Life (Hypnobirthing)
Mother Nurture Childbirth Services (Ottawa Valley)
Ottawa Prenatal Services (Riverside South)

The Ottawa Hospital Cancels Prenatal Classes

So as you may have already heard from Facebook and other social media, The Ottawa Hospital (TOH) has announced plans to cancel their entire prenatal education program:

The Ottawa Citizen
CTV
CBC Ottawa


For months, rumours have been circulating throughout the community that the classes would be cancelled by September 2012. A group of community organizations with a keen interest in childbirth education got together, with the intent to draft a letter of inquiry to TOH.

Before we could send our letter, prenatal instructors at TOH received a curt letter from hospital staff, informing them that classes were indeed to be cancelled, and that their services were no longer required. Our group quickly realized we needed to do something other than just a letter, and we sent out a press release first thing Monday morning. Which resulted in my phone ringing off the hook for about 5 hours.

But this was good! We now had people's attention, and would hopefully get an official response out of TOH.

Despite the helpfulness of the media, there are still a number of issues that need to be addressed and things that the community needs to understand. Please keep in mind, any opinions I give here are my own. I'm not writing this on behalf of any community partners. So don't blame them if I say something stupid.


1) Get Your Stats Right: several of our (extremely smart, talented) doulas/educators have pointed out that TOH's stats are flawed (or rather, they have been reported in a way to sway the public to see their side of the argument). They claim that about 10% of couples - 600 or so - take prenatal classes. However, they didn't point out that over 40% of birthing women at the hospital are first-time mothers, and that the classes are geared to these women - about 2560 or so. Therefore, 600/2560 is actually 23% - this is close to the Ontario average of 28% of couples who partake in prenatal classes.

2) Duplication: Ann Mitchell claims they are cancelling classes because they "did not want to duplicate a service that was already being provided in the community." How, exactly, are our classes a duplication? We offer education from a wide variety of perspectives. Yes, some of our classes are very similar in content to those at TOH, but not all. And many women want to take classes at the hospital - where they will be giving birth, and where they feel safest. 


3) Books and YouTube are acceptable forms of education: um, NO!! If you think reading some books and watching a few videos on youtube will prepare you for birth, you are in a sad state. I would love to be the fly on the wall at the hospital when you show up at triage - chances are, you will be sent home multiple times (because you don't recognize the signs of active labour), you will receive more interventions (because you don't know about the alternatives or the risks/benefits of these procedures), you will have trouble breastfeeding (because, ya know, apparently this just comes naturally to us), and you may have a higher risk of postpartum depression (because your expectations of parenthood are being shaped by popular movies and television)

4) The City of Ottawa provides great classes (ahem): I almost choked on my coffee this morning when I saw a comment from someone describing these classes as "great." First of all, the City classes are run by Ottawa Public Health. Their primary goal is to spout all the health and safety information they live and breathe by - don't smoke, don't drink, don't do drugs, don't sleep with multiple partners during pregnancy (what???), and don't, UNDER ANY CIRCUMSTANCES, sleep in the same bed with your baby. You might as well just throw your bundle of joy out the window if you plan to do that!! [My apologies to Public Health Nurses - you truly did help me out by doing home visits after I had my daughter. But in terms of preparing couples for labour and birth? I think they'd be best to stick to public health issues].

5) People are losing their jobs: In the Ottawa Citizen article, Mitchell claimed that "the program...[is] taught by nurses and social workers outside of their regular hospital duties. For that reason, no staff would lose their jobs once the program ended..." This is false information. Most of the prenatal educators at TOH are private instructors, and WILL be losing their jobs. The coordinator of the program, who has been there for 20 years, is also losing her job.

I'm sure there were other claims made that require clarification, but these are the few that have been brought to my attention.

My wish is for ALL expectant parents in the Ottawa area to have access to classes they want and need. The City of Ottawa classes may be beneficial to you if you are looking for more of a "prenatal health" program.

For couples hoping to get a comprehensive class that encourages women/partners to learn about all the options and make informed choices, check out the Ottawa Childbirth Education Association or Mothercraft Ottawa. Strapped for time? No worries, Birthcare offers a 1-day condensed course! Need all the help you can get because you're hoping for a natural or home birth? Try some of the alternatives, such as Birthing from Within, Nesting in Ottawa or Lamaze.


Have I missed any? Who did you take your classes with, and what was your experience?

Why The Office is Bad for Pregnancy

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Everyone  knows that our sedentary lifestyle is slowly killing us. When we work 8-9 hours a day sitting at a desk, come home, and plop ourselves down in front of the TV, we know we're doing our body a disservice. But what choice do we have? Money needs to be made, and our jobs are sometimes stressful (hence why we zone out in front of the TV every night).

But all the risks associated with our choices seem so far off in the distance. It's hard to take cardiovascular disease seriously when there's a "chance" that we'll develop problems. The payoffs we get now (money, power, job satisfaction) outweigh the negative impacts we may experience years down the road. That's why it's so hard to change - getting more exercise, eating better, and lowering stress have long-term benefits. Our brains are hard-wired to want what we want RIGHT NOW.

However, pregnancy is a short time in our lives. Long enough that we can appreciate what our bodies are putting us through, but short enough that we can see the outcome. And office life can have some detrimental effects on pregnancy and birth. But the good news is that short-term positive changes can be made to facilitate a healthier and less stressful pregnancy. And when we can see the benefits (i.e. a healthier mommy and a healthier baby), then we're much more motivated to make changes.

I've worked in an office for many years, and have never had an issue with sitting for long periods of time, typing all day long, and working under fluorescent lighting. Never, that is, until I got pregnant. Pregnancy changed my body, and made it hard to handle the demands of office life.

So here are some tips/tricks I have learned along the way, in both my first pregnancy and this pregnancy:

1) If possible, try to work from home or negotiate "flex hours" with your manager. Even 2-3 days a week at home can give you a much needed break from the fake lighting and lack of fresh air. Plus, you'll save time on your commute, which will give you the opportunity to get a bit of housework done or go for a walk.

2) Drink lots and lots of water. Office buildings have recirculated air, which can make them stuffy and dry. Keeping yourself well hydrated is a must.

3) Get up frequently - every 10 minutes. Go to the bathroom (not hard when your bladder is getting squished); take a quick trip to the water cooler; go for a walk around the building; or just do some stretching by your chair.

4) Sitting - we have an epidemic of malpositioned babies here in Ottawa. Some suspect it's because most of us are government/office workers, and we spent a lot of time reclined back in our chairs. This encourages our babies to take the "sunny side up" position, which can make labour and birth long and difficult (usually resulting in more interventions). One way to fix this is to buy an exercise ball to sit on instead of your office chair. This encourages you to arch your back, open your legs up wide and strengthens your core muscles.

5) Activate your commute. I park my car a 15 minute walk from work, which forces me to get 30 minutes of physical activity each day (I try to do a power walk). On the days I take the bus, I get off at a stop further away from the office, which again helps me to get short bursts of activity.

6) TV at night is still OK - just remember what I said above about posture and positioning. If you're watching TV at night with your hubby, bust out your yoga mat, and do some stretches. Or sit on your exercise ball instead of the couch. Even better? Turn off the TV and sign up for a yoga class!


Have you learned any special tricks/tips for being pregnant in the office?

Pregnancy: 17 Weeks

I am now 17 weeks pregnant, which I'm trying to wrap my head around. The first 12 weeks seemed to drag on and on, as I dealt with nausea/vomiting, exhaustion, and horrible headaches.

But all of a sudden, time seems to be picking up speed, and I can't believe I'll soon be going to my first (and hopefully only) ultrasound this pregnancy! Despite my misgivings about ultrasound technology, it's amazing how much I'm looking forward to "seeing" inside. I know I'm supposed to be trusting my body, but there's always a niggling little worry in the back of my mind that something might be wrong.

I know a lot of pregnant bloggers who do a weekly pregnancy post, with regular updates on cravings, belly size and weight, but that's not really my thing. I haven't even taken a belly shot yet! (it's there, although small. Same as last time!) However, it's always fun to chat about certain pregnancy-related decisions and milestones, so here's a little update:

Sex?
Yes, we will be finding out the sex of the baby this time around. I really wanted it to be a surprise again, but frankly, I'm just too excited to know whether I can, a) use all the baby clothes we already have; or b) get rid of most of the baby clothes we have, and start soliciting donations for "boys" clothes. As interesting as the whole gender-neutral debate has been recently, I'm still not willing to dress a little boy in bright pink sleepers. Why? Because frankly, I just don't like pink very much!! And we seem to have ended up with A LOT of pink being given/donated to us.

Movement?
Yep, feeling a lot of kicks and bumps. Last time I didn't feel a thing until around 21-22 weeks, so it's surprising to feel movement this time. I think in my first pregnancy, I was confusing kicks with gas. I also had an anterior placenta last time, which provided added cushioning in the front and may have prevented me from feeling a lot - no idea where my placenta is this time!

Doula work?
Still attending births! The universe seems to have blessed me with short, daytime births lately, so I'm expecting to be hit over the head by a few marathoners soon. I'm waiting on one mama/baby right now, and then won't see my next client until late June/early July. Beginning in August, I will be providing some backup for one week, but have no further primary clients.

Other pregnant doulas can probably attest to the fact that doula work is certainly harder when carrying a baby. There is nausea, but also a lot of extreme tiredness and lack of energy. It's been a challenge, but not impossible! Having great backups in place is key, as I feel confident I could call someone in my place if need be. And so far, all my clients have been very supportive and understanding - given the fact that I munch away on snacks pretty much every hour, this has been great.

Renos?
Yes, we will be working on a nursery, but I have no great expectations that this little babe will sleep in there. After our experience with A, I'm fully prepared to bed-share again if need be. But if this baby decides to be a decent sleeper, then at least the room and crib will be available. This is going to involve moving A into another room (the colder room in the house, as she's always been a hot kid!), and moving our office into the basement downstairs. I'm sad to be losing a proper office space, but we're not willing to give up our guest bedroom, as we have family and friends visiting quite often.

Exercise and Overall Wellness?
Given that I'm finally feeling better, I'm getting back into a regular exercise routine. It's not much, but I'm aiming to get regular walks in almost every day of the week. Some of these are longer hikes in the ravine behind our house, but often I'm just getting out of the office at lunch time and hoofing it around the hospital. Walking the perimeter of the General Hospital takes about 25 minutes! I'm also participating in some great prenatal yoga classes once per week.

Goals? Hopes? Dreams?
In an ideal world, I'd love to be adding some additional yoga practice into my week, as well as some occasional weight bearing exercises. So far, I'm happy with just getting my walking and one-day yoga class completed, but maybe I will find the motivation to improve.

My big focus now is on better nutrition. The first 3 months were a write-off, as my main diet consisted of cheese, crackers and cereal (oh, and occasional fried foods). But now I'm adding in greens, lots of legumes and fruit. I'm still eating quite a lot of meat (for me), but I'm trusting my body that this is what I need right now. I would love to have a vegetarian pregnancy, but know that this is not realistic for me.

So far, the pregnancy seems to be chugging along well, and I look forward to sharing some ultrasound pics on here in a couple of weeks!

Happy Monday!

GERD

I talk a lot about my daughter having had GERD (Gastroesophageal Reflux Disease), but I've never done a post explaining what this term is all about.

Simply put, reflux is when our stomach contents backwash into our esophagus. This happens to many people, child or adult, and can either be symptom-free or associated with a host of problems (pain, burning, breathing difficulties, weight loss etc) Reflux becomes a disease when the episodes cause some sort of problem or condition.

Most babies have reflux, given that their digestive system is still developing. Spit-up can be occasional, or quite frequent. Parents of children who frequently spit-up know that it's an inconvenience and can result in a lot of laundry! But beyond this, the lives of the child and/or parents are not negatively affected.

Reflux can become an illness or condition when it is excessive, and linked to some symptoms. It becomes a disease when the symptoms are severe, and sometimes in very young children, life-threatening.

No one can really say whether my daughter had an "illness" or "disease," but labeling it GERD just helped me to put things into context. Suffice it to say, our lives were thrown for a loop for many months, as we struggled to figure out what was wrong with our little baby.

The symptoms of GERD vary from baby to baby, so I can only speak from personal experience. Before we got a true diagnosis (although it was still a bit of a guessing game), some of the things we noticed were:

• Constant crying, especially after breastfeeding and at night
• Fussiness at the breast
• Coughing or choking when lying on her back
• Excessive spit-up 
• Inability to sleep, unless in an upright position

These symptoms began slowly, and we started noticing them around 3 weeks of age. At first we assumed we just had a colicky baby, but everything came to a head around 4 months of age (when colic has normally already disappeared). 

We made several trips to our family doctor, who at first, just waved it off as colic or "normal" baby behaviour. However, most people who spent the night with us knew that A was not "normal." The crying was intense and high-pitched, and I instinctively knew that she was in pain.

After my own Googling and searching around, I began to suspect that A was suffering from a mild form of GERD. She was still gaining weight (phew), but we could no longer cope with the crying and night-waking (which occurred every 30-45min). Once I became more specific in describing the symptoms A seemed to be experiencing, my doctor agreed with my suspicions. She prescribed Ranitidine (Zantac), a strong medication used by adults to help with the painful symptoms of reflux.

Immediately after the first dose, we suddenly had a smiling and giggling 4 month old on our hands. The transformation was a 180, and we knew for certain that she had been in a lot of pain.

Unfortunately, the medications used for reflux are not long-lasting, and come with a host of side effects. The Ranitidine worked on occasion, but A's body seemed to get used to it after a while, and it no longer had any effect. As well, it caused rashes, dry skin and constipation. After a trip to CHEO and a visit with a pediatrician, we switched to an even stronger medication (Prevacid). I was extremely nervous using this medication, as it had not been approved for use in infants. We continued to use it occasionally when things were really bad, but again, the side effects seemed worse that just dealing with the symptoms, so we eventually stopped.

Around 8 months of age, we did begin to see some improvement, and by 1 year, the reflux was gone (at least visibly). A continued to have digestive problems for another 6 months or so, until finally, we were able to say we were GERD-free.

The toll that this took on our family life was significant, and for a long time, we didn't want to have any more children, for fear that we would breed another GERD-ling. However, here we are again, praying that this little girl/guy may be blessed with a stronger digestive system. We feel confident that if this happened again, we at least have the tools and knowledge to deal with it. 

To help other parents out there who are struggling with this problem, here are some tips and other pieces of information I learned along the way:

1) If you suspect something is wrong with your child (even if it's just colic), keep a very detailed record of symptoms. Record exactly when crying starts and stops, and whether it's associated with feeds or not. Also mark down any other things you notice to be "off." This can be very useful for family doctors, who otherwise might discount things as run-of-the-mill.

2) Seek help and support. I found this forum to be really helpful, and purchased this book to read. I also poured over all of Dr. Sears' books, especially the one on "fussy babies." You may also need extra help around the house from in-laws, friends or even hired help.

3) Cry-it-out techniques and sleep training do not work for babies with reflux, and your child's pain should never be ignored. If you feel in danger of harming your baby because of excessive crying, lay her down in her crib, leave the room and call for some help. Scream, yell, kick things - do whatever you need to do to get your frustration out. Just don't take it out on your baby.

4) Some babies with reflux disease sleep fine. The majority do not, because lying on one's back can exacerbate the symptoms. You may need to consider alternatives, such as wedges or even propped up mattresses. Although safety should be foremost in your mind, if you listened to all the "experts" out there on "back-to-sleep", you would be dealing with a screaming infant all night long. I broke every rule in the book, and I'm proud to say that it worked for me. I even learned how to sleep upright, with my baby on my chest, propped up with a million pillows. Desperate times call for desperate measures.

5) Most doctors will tell you that breastfeeding is the problem - whether it's just the myth of breast milk as "bad" or because your child may have genuine allergies (which you are passing through the milk). If you hope to breastfeed, I strongly, strongly advise you to seek help from a Certified Lactation Consultant. It would be extremely rare that formula would ever be better than breast milk. Out of desperation, we tried formula twice, and endured the worst crying episodes we had ever seen in our child. I quickly went back to breastfeeding, and tried to eliminate some of the major culprits out of my diet (dairy and soy).

6) Listen to your gut (no pun intended!). I can't say this one enough. You know your baby the best, and you know what is best for them.

The High Needs Toddler

As first time parents, we're constantly questioning our skills, our judgement, and our ability to steer our child in the right direction. When A was a baby, I found myself consulting books and websites almost daily. I would type questions in Google, such as "why does my baby cry all day long" or "how do I get my baby to sleep longer than 45 minutes."

We thought we were just crappy parents. We couldn't understand why we were more tired, on edge and struggling more than our fellow new parents. We soon discovered it had nothing to do with our parenting abilities, and everything to do with the little person we had been blessed with. A was not only a high needs baby, but she also suffered from GERD, or gastroesophageal reflux disease. Medication and time were our saviours, and by one year of age, we felt we were finally exiting the fog of gloom we had been living in for so long. I've heard of parents of GERDlings opting for vasectomies after their experience, and I fully understand this decision.

Our little baby grew, and turned into an engaging and extremely verbal two year old. She speaks in full sentences, and says things like "Mommy and I had an argument, and I was so frustrated" (honestly!) We thought that when she was able to tell us precisely how she felt, that her tantrums and frustrations would subside.

Not so. Clearly, the books are not always correct. Having a child with good communication skills does not  equal a life of ease in the toddler world. Our high needs baby has grown up into a high needs toddler, and as of late, the household dynamic has not been good. There has been screaming (A), tantrums (A), yelling (Mommy) and more tantrums (Mommy).

And maybe I'm just making things sound worse than they are. As with all moms, I get to see the full spectrum of emotions from my child - when we're out (especially in the outdoors) she's a perfect little angel.

Being pregnant and sick has not helped the situation, and every morning that I'm working has turned into a battleground between myself and my daughter. Husband has started early mornings at the golf course, and misses most of the commotion.

Part of the problem seems to be A's "sensitivities"....to pretty much everything. She can't stand socks on her feet (she says they hurt, and the seam bothers her); any pants that are touching her feet are immediately taken off and thrown on the floor (and if they're tight in the waist, watch out!); brushing her hair is almost impossible given her curly knots; brushing teeth is a hit and miss; her coat bothers her when it pulls her sleeves up; and the car seat buckle is always too tight. And rather than just dealing with these issues by whining, A launches herself into full-blown tantrums over the smallest annoyance.

So far, my answer to the problem is three-fold:

1) Stay calm. Talk in a quiet voice. Reassure her that socks are not her enemy

2) Ignore the tantrums. This is hard when there are no rooms to lock myself away in my house.

3) Lose my cool, and begin yelling in return. Not a good strategy, I know.

The morning ends with me hauling a screaming A over my shoulder, no socks, no shoes, no coat, and hair not brushed. The neighbours must think we've lost it.

I need a change, because I have to deal with this by myself for at least 5 more months while husband works at the golf course. And starting my day in a terrible mood is not an option.

So far, my only solution has been to research products that might make dressing a little easier. Luvmum*** is a local Canadian business that carries brands of clothing for children with sensitivities. I plan on purchasing some seamless socks, and maybe some comfortable pants. As for the rest of the morning routine, I'm searching around for a fun/magnetic calendar we can use to teach A about the benefits of grooming :)

Any ideas for this tired mama?

***Luvmum is no longer operational. If you have any suggestions for other companies selling clothing for kids with sensitivities, leave a comment below!

{Ottawa Doula} Hospital Cesarean Rates

Hospitals are required to disclose their cesarean section rates, but the information is hard to come by without a lot of searching. Most women are admitted to hospital without any prior knowledge of their c-section risk, and will often be surprised when the birth ends up in the operating room.

Each hospital in Canada has a different cesarean section rate because policies and procedures differ from institution to institution. These are policies related to how women are "allowed" to labour and give birth. Things like timing of induction (how long you can go past your due date), electronic fetal heart rate monitoring (EFM), use of Pitocin and IV fluids, and length of pushing time are all regulated by hospital protocol.

Recently, we've seen a number of stories in the media sounding the alarm bell on the rising c-section rates in our Canadian cities. I came across this handy website today, and thought it would be interesting to share the c-section rates at various hospitals here in Ottawa.

Montfort Hospital: 25.8%

The Ottawa Hospital: 29.17%

Queensway Carleton Hospital: 33.18%

Almonte General Hospital: 25.91% 


Winchester District Memorial Hospital: 21.63%


The website also publishes each hospital's VBAC (Vaginal Birth After Cesarean) rate. Scraping the bottom of the barrel is the Queensway-Carleton Hospital, at a dismal 7.63%

Does this mean that women in Ottawa who want to avoid a cesarean section should plan to give birth where their chance of c-section is lowest? This, of course, is a personal choice, but I believe a wiser strategy would start with demanding more evidence-based care from our hospitals. In my opinion, policies and procedures are governed first by consumer demand, and second by evidence-based information (which is ridiculous, I know). The more you are complacent about what is being done to you, the more you pave the way for other women to have the same done to them. [and of course, some c-sections are necessary and medically indicated. Clearly this conversation does not apply to those women, although they still have a right to respectful and informed care]

So if you're under the care of a doctor or OB at one of these Ottawa hospitals, and you hope to avoid a c-section, what should you be asking about?

1) How will you monitor my baby's heart rate? (there is no evidence showing that continuous EFM is beneficial, and there is an increased risk of cesarean section when it is used)

2) If I go post-dates, when will I be induced? (Most OBs are following the 40+10 rule - when you are 41 weeks and 3 days, you will be induced. Again, there is evidence showing that healthy, low-risk pregnancies can extend to 42 weeks without increased risk to mom or baby)

3) When do you feel the need to use Pitocin during labour? What are my other options if you feel that my labour has stalled? (psssst...hire a doula. They have some neat tricks for getting labour to progress!)

4) Do you use routine IV fluids during labour, or can I eat and drink whenever I want?

5) If my baby is doing well, will I be able to push past the allotted time given for second stage?

Also keep in mind that the whole team of OBs needs to be on board with the terms/conditions you have in place. If you decide you absolutely do not want to be induced at 40+10 days, then you will need to be prepared to meet with resistance if your OB of choice is not on call around that time.

Pregnancy shouldn't be a time that women need to do battle to get the care they want. But as you can see above, the reality is, 1 in 4 women will have a c-section in Ottawa (and sometimes that number reaches close to 1 in 3). So it's up to you and your partner to fight for the care you need - doctors are often prepared to listen, but it's our responsibility to make sure we're heard.

And of course, you've heard the same old from me time and time again....hire a doula and that percentage goes down...blah blah blah....get a midwife and that percentage goes down...blah blah blah....have a home birth if you're healthy and comfortable with the idea...blah blah blah.

You get the picture!

What do you think? Are my local Ottawans surprised by these rates?

{Ottawa Doula} Sabbatical

As this pregnancy moves along, I am reminded daily that I will soon be taking a sabbatical from birth doula work. Every visit that I make to my client's homes and every baby that I witness coming into the world is bittersweet. I know that soon I will be the one on the birthing stool, and although I anticipate the joy of this, I know that my days of jumping out of bed to attend a birth at 1 a.m. are numbered.

Turning away clients has so far been the hardest part. I will not be taking on primary clients after August 1st (although may provide occasional backup for my doula friends). With each email I send out, I don't mourn so much the loss of income or "business," but more the loss of an intimate connection with people on the path to parenthood.

In this job, there needs to be boundaries (of course), but these boundaries are loose and sometimes transparent. I witness what we normally deem to be human frailty, or perhaps loss of control. As we go about our daily lives, meeting and working with other people, it's unlikely we have the opportunity to see the nakedness of our humanity - to see ourselves as we have always been. Animalistic, primal, and grounded.

Palliative care nurses may say the same - in our jobs, we see the essence of this life. We witness the comings and goings; the circle as it begins and completes. It is whole, it is real, and it never ceases to amaze me.

But doula work is hard with little ones around. You must have someone who is willing to take your kids at the last minute, and sometimes at unpredictable hours (depending on what your husband does - mine does not have a 9-5 job, and so we sometimes need childcare before 7 a.m. or after 5 p.m.). As well, you become that person. The one that cancels last minute, or just never shows up to events or appointments. The one that can only make plans by saying "however, I'm on-call for a birth at that time..." The one who can only travel if she takes 4 weeks off, and doesn't get paid for vacation.

As well, doula work does not pay a lot. Most people balk at the cost ("what!! You charge $550 to attend a birth?!"), but depending on the length of the birth and the hours I have dedicated to pre and postnatal care, I'm sometimes getting paid $15 per hour. For our family, full-time doula work (4 births per month) would not pay the bills. I've also come to the conclusion that my current life, with 3 days per week of work at the hospital and 2 births per month, while caring for a preschooler and a small baby, would be madness.

So despite the fact that I think I've found my calling; the thing I've always wanted to do with my life, I may need to step away for a while. Or at least until I can find a way to manage my home, love my children, give my hubby the attention he deserves, be a good friend/daughter/sister, AND attend births...all at the same time, and with a smile!

But stepping away doesn't mean saying goodbye. I'm happy to say I will soon be teaching prenatal classes with Birthcare. And with that comes the occasional backup I can do for other instructors, who are all doulas themselves. It may also be possible for me to do extra training in breastfeeding and postpartum doula care, which although the market is highly saturated, may offer some better daytime hours. And I will certainly never turn away a repeat client - the joy of following someone through to their second (or third!) pregnancy is too much to give up.

So, my hope is to have the best of both worlds. To keep my foot in the door, for when I feel like life will allow me to return. Giving up on my dream job is not an option. Allowing my dream to work alongside reality, is.

Are you a small business owner or doula? How do you manage to balance work life with small children?

For the joy of it

Remember this post? I had Feist's song stuck in my head at the time...

The decision to have a second (or third, or fourth, or...) baby is a deeply personal and highly charged decision. Or maybe not. Maybe your decision was quite simple - at the age of 16, for instance, you decided that you would have exactly 2 children. One boy, and one girl, for good measure.

For me, the decision was deeply personal and convoluted. There were moments where my husband felt ready for another baby, and I felt ready for my next glass of wine. Then there were moments where I felt the tug of baby as an ancient and powerful female desire. My uterus was literally calling out to me. And at these moments, hubby was quite content to head to the fridge for his next beer.

All of a sudden, though, we seemed to click. We began tentatively discussing "if," and then soon we were discussing "when." It came down to this: we ultimately could not see ourselves moving on in life without inviting another little person join our clan.

Maybe this little person would decline our invitation. Maybe once they showed up, they would be the unwelcome house guest (or that douche bag roommate you lived with in college) - getting drunk and rowdy, staying up too late into the night, waking us up at ungodly hours. Maybe they would even cry a lot and be emotionally dependent.

But we felt compelled to write the invitation.

Because buried within the chaos of The World of Newborn, there are hidden gems, worth ten times the frustration, sleep deprivation, guilt and sadness that may come along with parenthood. And with each "phase" there comes more joy and laughter  - when you meet your partner's eyes over the top of your child's head, and mutually bask in the question "did we actually make this little character?"

In the words of Peggy Vincent, we took a leap of faith, "just for the joy of it."

I may question my parenting techniques, my ability to be a good mother, and, let's be honest, my sanity. But what I will never question is whether I have the capacity to love. I will never wonder whether there will be joy. I will never wonder whether I made a mistake, because there are no mistakes in motherhood - there are only solid stepping stones of success and personal growth (and yes, these come with heartache and occasional exhaustion!)

And although I must sound as though I'm walking through the valley of the blissful-pregnant-lady, I'm also highly realistic of what's in store for us. Which is why I realize that my birth doula work may need to be on hold for a couple of years; and why I might need to be resourceful in finding ways to make money AND be a good mom; and why I need to stock away every last penny right now, in order to survive the bare-bones EI benefits I will receive; and why I might need to swallow my pride and just reach out for help.

So with eyes wide open, we moved forward, and extended the invitation. And a miniature someone received, and accepted.

Continuous Fetal Heart Rate Monitoring: Hospital Admissions

I've been posting a lot of research lately, but it is because research is just so great :) Really, can you think of a better way to grow and develop as a society? Research teaches us what has been, and maybe what should be. At its best, research results in positive change (there is also research at its worst, but that is a story for another day...)

I came across this recent systematic review from The Cochrane Library. [Side Note: If you don't know what The Cochrane Library is, and you are interested in health care (either personally or professionally), then you should be finding out! The Cochrane Library is an independent organization that conducts high-quality reviews, which provide evidence for health care decision making. Ever wonder why a doctor will prescribe a specific drug for your ailment? It's because of reviews that the doctor is able to read, in one paper, a summary of all existing evidence on a particular drug. If the evidence overwhelmingly shows in favour of the drug for treatment, then bingo! You get a prescription.]

The paper I linked to above is about cardiotocograph (CTG). When you go into labour and believe that it's time to head to the hospital, you will be assessed in triage. You're led to a little room, where the nurse will strap you to monitors which will record your baby's heart rate. This is normally done for about 20 minutes, during which time you will receive a cervical exam, and either be sent home or admitted to a room.

Granted, this is not done at all hospitals. Some will just listen to the fetal heart rate intermittently, quickly check you, and then determine whether it's time to be admitted. But generally, CTG is the way that things are done if you are under the care of a doctor or obstetrician (this blog post states that 76% of Canadian hospitals use CTG upon admission)

Why is this important? The Cochrane review that I linked to above found that c-section rates increase by 20% for women who undergo CTG compared to intermittent monitoring. Interesting, isn't it?

Science clearly shows that low-risk pregnant women should not be monitored continuously. In fact, this is an intervention that Lamaze International recommends you try and avoid, because continuous monitoring shows no benefits - only harm. Harm in the form of abdominal surgery, apparently.

In my experience, women that are strapped to monitors upon admission to hospital generally become agitated and no longer cope very well with their contractions. Not surprising, given that they are forced to lie in a bed, in a tiny clausterphobic room, and listen to the clippidy-clop of their baby's heart.

And yet, despite all the overwhelming evidence that shows that this type of monitoring can be harmful, we're still doing it! As I wrote in a previous post, it's all about the lag time between research findings and shift in practice.

But you know what does change policy? That's right - you dear readers! The women out there giving birth have the right to ask for good evidence-based care. When more women request a procedure (or decline a procedure), policies change over time to accommodate patients' wishes.

What has been your experience with hospital admission? What do you think of this 20% increased risk in c-section?

{Ottawa Doula} Another home birth "nightmare"

Sorry folks, you'll notice I'm unabashedly just linking to other great articles lately - I promise to have new (original!) material posted soon.

I had to share this blog post with you, by one of my favourite bloggers The Feminist Breeder. Her use of the word "douchecanoe" (which supposedly comes from another blogger) had me laughing out loud.

To help you with the context, you need to read this article first.

Regardless of your personal decisions/choices, society as a whole needs to understand that home birth is not only safe but also an essential option for some women. If this option were taken away from us (which it wouldn't be, because frankly, you can't control my vagina or how my baby comes out of it), this would be a violation of our reproductive rights as women.

{Ottawa Doula} Reduction: Deciding to terminate one baby in multiples

I work in the childbirth field, and yet I feel like I'm learning new things every minute:

READ THIS

Although I'd heard women of multiples getting one "sucked out" (which, by the way, is not how it works at all), I had never read about the procedure or how controversial it is.

Actually, it's not all that controversial when women are found to be carrying triplets (or more) and opt for a reduction. It becomes controversial when a women with twins wants a reduction to just one baby.

Instead of writing a big long post about this, I thought I'd get your opinion.

Would you reduce a pregnancy if you found out you were having twins?