PerinatalServicesBC



Connecting Pregnancy

Connecting Pregnancy Notebook

Acknowledgments

We would like to acknowledge the South Community

Birth Program, for sharing their

material to develop our manual.

Table of Contents

WELCOME 3

WHAT TO DO FOR LABOUR, BIRTH AND EMERGENCIES 3

USEFUL PHONE NUMBERS 3

COMMUNITY RESOURCES 3

USEFUL WEB SITES 3

CONNECTING GROUP GUIDELINES 3

CONFIDENTIALITY AGREEMENT 3

CONNECTING PREGNANCY: PROGRAM SESSION # 1 3

NUTRITION DURING PREGNANCY QUIZ 3

CONNECTING PREGNANCY: PROGRAM SESSION # 2 3

SAS – RELAXATION MEASURES 3

SAS - COMMON DISCOMFORTS 3

PRENATAL BACK CARE 3

CONNECTING PREGNANCY: PROGRAM SESSION # 3 3

GROUP ACTIVITY OR SAS – THINKING ABOUT BREASTFEEDING 3

GROUP ACTIVITY OR SAS – FAMILY & PARENTING ISSUES 3

CONNECTING PREGNANCY: PROGRAM SESSION # 4 3

RECOMMENDED FOOD and DRINK for LABOUR 3

CONNECTING PREGNANCY: PROGRAM SESSION # 5 3

GROUP ACTIVITY OR SAS – DECISIONS OF PREGNANCY 3

CONNECTING PREGNANCY: PROGRAM SESSION # 6 3

SAS - COMFORT MEASURES FOR LABOUR 3

ABOUT THE CBP DOULA PROGRAM. 3

CONNECTING PREGNANCY: PROGRAM SESSION # 7 3

SAS - SELF-INVENTORY 3

CONNECTING PREGNANCY: PROGRAM SESSION # 8 3

SAS - PERSONAL ASSESSMENT 3

COMMON NEWBORN PROCEDURES 3

BABY SKIN CARE AND RASHES 3

INFANT MASSAGE 3

CONNECTING PREGNANCY: PROGRAM SESSION # 9 3

SAS - CONTRACEPTIVE USE 3

CONNECTING PREGNANCY: PROGRAM SESSION # 10 3

ALL ABOUT MY BABY 3

WELCOME

CONNECTING PREGNANCY: GROUP PRENATAL CARE

“A fun and educational way to get prenatal care”

Please tailor highlighted to suit your program.

The Community Birth Program at the Jim Pattison Outpatient Care and Surgery Center offers group support, a place for women to air their concerns about their pregnancies, and an opportunity for women to be active in their own care. The over-all goal is to help women feel a greater sense of empowerment and confidence in themselves and their ability to care for their new baby and their family.

Every session includes:

• A “baby and mom check”. Blood pressure, weight and private time with your health care provider

• Time to socialize with other members of the group

• Snacks

• Time for discussion about pregnancy with other parents-to-be

There are 9-10 sessions meeting throughout your pregnancy. The sessions start and end on time. The calendar will help you keep track of each group session. Since you know well ahead of time when your group will meet you will be able to plan your work/school schedule and child care needs around these times. The Connecting Pregnancy group sessions provide your prenatal care. Childbirth education content is included within the sessions. If you have a problem between the group sessions you may call for an appointment at

XXX- XXXX local XXXX

Our best wishes for a special, enriching time throughout your childbearing year.

WHAT TO DO FOR LABOUR, BIRTH AND EMERGENCIES

For labour, birth and emergencies related to the pregnancy, a doctor or midwife is always available 24-hours a day at: xxx- xxx-xxxx local xxxxx

Ask for the Community Birth Program. If it is after hours, you will listen for the doctor or midwife on call and their pager or cell number. You will then call this number. Once you have called, please stay by the phone and keep the line clear so that the care provider can get in touch with you.

The ON-CALL doctor or midwife is available 24-hours a day, 7 days a week. The doulas assigned to your care are also on call 7 days a week, 24 hours a day once you go into labour.

For appointments or non-urgent questions/concerns, please call the Birth Program receptionist at:

xxx- xxx-xxxx local xxxxx

Do not hesitate to page your midwife or doctor if you experience any of the following;

• Any concerns related to your pregnancy

• Regular contractions 5 minutes apart or contractions that are very painful

• A change in the baby’s movement, especially if the baby is unusually quiet

• Fluid gushes from your vagina that you think isn’t either urine or normal discharge

• Vomiting and/or diarrhea for more than 24 hours

• Fever of more than 100.6° F(>38° C) that doesn’t go away within a few hours of taking acetaminophen (Tylenol)

• Painful, burning urination

• Bad headaches, vision problems (seeing spots, double vision)

• Sudden swelling in your face, eyes, hands & feet

• A desire to bear down or push the baby out

• Severe cramps or regular contractions more than 3 weeks before your due date

• Unusual environment exposure: chemical, toxic, fumes, smoke from fires

• Domestic violence or sexual assault

• Minor or severe motor vehicle accident

• Following a fall...especially if you hit your abdomen

• Breathing problems if you are asthmatic

• Shortness of breath with chest pain

• Heavy red vaginal bleeding that soaks through a large pad in 10 minutes time

• Fainting or extreme dizziness

USEFUL PHONE NUMBERS

|xx 24 HOUR ON-CALL NUMBER | xxx- xxx-xxxx local xxxxx |

|********ask for the XX provider on call, if you reach the message, listen for the | |

|doctor/midwife on call and their number for after hours emergency/labour ************ | |

|BC Nurse Line |8-1-1 |

| | |

|BCAA/ICBC Car Seat Info Line* |1-877-247-5551 |

|(Traffic Safety foundation) | |

|Breastfeeding Support (La Leche League)* |604-520-4623 |

|Car Seat Safety Check (Safe Start)* |604-875-3273 |

| | |

|Community Health Centers: |XXXXX |

|Next page | |

| | |

|Healthiest Babies Possible |604-877-4673 |

|Mother Risk (drugs, chemicals & infection in pregnancy)* |1-416-813-6780 |

|Nausea & Vomiting in Pregnancy Helpline |1-800-436-8477 |

|Newborn Hotline |604-737-3737 |

|Options for Sexual Health* |604-731-7803 |

|Pacific Post-Partum Support Society |604-255-7999 |

|Poison Control |604-682-5050 |

|Program for Victims of Domestic Violence |604-875-4924 |

* see website list

COMMUNITY RESOURCES

|Emergency (Ambulance/Fire/Police) 911 |Poison Control 604-682-5050 |

|LOCAL HEALTH UNITS |HOSPITALS |

|Public Health Nursing |Delta 604-946-1121 |

| |Langley Memorial 604-534-4121 |

|Cloverdale 604-575-5100 |Peace Arch 604-531-5512 |

|#205 – 17700 56 Ave |Surrey Memorial 604-581-2211 |

|Cloverdale Audiology | |

|#103A 17790 56 Ave | |

|Guilford 604-587-4750 | |

|#100 – 10233 153 St | |

|Langley 604-539-2900 | |

|20389 Fraser Hwy | |

|Newton 604-592-2000 | |

|#200 – 7337 137 St | |

|North Delta 604-507-5400 | |

|11245-84 Ave | |

|North Surrey 604-587-7900 | |

|#220 – 10362 King George Hwy | |

|South Delta 604-952-3550 | |

|4470 Clarence Taylor Cr | |

|White Rock/South Surrey 604-542-4000 | |

|15476 Vine Ave | |

|BABYLINE 604-592-2229 | |

|(newborn only – Weekends & Holidays 9:00am – 4:00 pm) | |

| |24 HOUR SUPPORT |

| |Crisis Line 604-951-8855 |

| |-Support and resource services for emotional crisis, alcohol and drug abuse, |

| |violence in the home, assault, and depression counselling. |

| | |

| |Health Link BC 811 |

| | |

| |BREASTFEEDING |

| |Fraser South Health Units 27 |6 — 8 kg (15 — 20 lb.) |See your doctor or dietitian |

*Does not apply to women expecting twins or triplets. These women should ask their doctor regarding how much to gain to reduce the risk of having preterm or low-birthweight babies.

36. True

[pic]

CONNECTING PREGNANCY: PROGRAM SESSION # 2

Dealing with the Discomforts of Pregnancy

Self-Assessment Sheets Relaxation Measures (SAS) Common Discomforts

Review SAS from Session #1 (Personal Goals)

Today’s Discussion Common Problems of Pregnancy, Why they

Occur, What Might Help

Body Mechanics and Exercise

Baby’s Best Chance

▪ Common Discomforts pg 20-25

▪ Physiotherapy pg 44-47

________________________________________________________________

NOTES:

Connecting Pregnancy Program

SAS – RELAXATION MEASURES

The following are different ways that people help themselves to relax when they are stressed. Check the ones that you have used and then put a 1 by the one that you find is most helpful to you.

sleep

exercise (workout)

exercise (light)

bath/ shower

backrub / massage

reading /TV

privacy /closed door

music

shout /make noise

talk /phone

laugh /funny stories

meditate/pray

eat

have sex

go shopping

go for a ride

journaling /writing

drink tea, coffee

other method

Connecting Pregnancy Program

SAS - COMMON DISCOMFORTS

Please check how each of these common pregnancy discomforts affects you.

|Discomfort |Often |Sometimes |Never |

|Low belly pain | | | |

|Leg cramps | | | |

|Varicose veins | | | |

|Sore breasts/nipples | | | |

|Frequent urination | | | |

|Bowel changes | | | |

|Heartburn | | | |

|Shortness of breath | | | |

|Bad dreams | | | |

|Moodiness | | | |

|Headaches | | | |

|Fatigue | | | |

|Low back pain | | | |

|Vaginal discharge | | | |

|Dizziness | | | |

|Swelling of hands/ feet | | | |

|Uterine cramping | | | |

|Itchy skin | | | |

PRENATAL BACK CARE

Posture During Pregnancy

Your posture changes as your baby grows and your weight increases.

Proper positioning during your daily activities helps prevent backache

and other discomforts associated with pregnancy.

Standing

• stand tall

• keep feet hip width apart

• keep knees soft, not locked

• tighten core muscles

Sitting

• sit well back in a firm chair

• avoid crossing legs

• hips and knees at 90°, use a footstool if needed

• support the small of your back with a pillow

[pic]

Incorrect Correct

CORE MUSCLES include

transverse abdominus (lower abs)

and the pelvic floor muscles

Pelvic Floor Muscles

Where is your Pelvic Floor?

Your pelvic floor muscles are a group of muscles which attach to the bottom of the pelvis. They provide support for your bladder, uterus and rectum.

|bladder |[pic] |

How is your Pelvic Floor Affected by Pregnancy?

During pregnancy, your pelvic floor muscles may become stretched due to the changes in hormones and the weight of your growing baby.

Why Train your Pelvic Floor?

• improves bladder and bowel control

• improves support for your pelvic organs

• helps your core muscle strength

How to Find Your Pelvic Floor Muscles

Your pelvic floor muscles help stop the flow of urine. Imagine that you are trying to stop yourself from urinating and hold for 1-2 seconds. Then relax. The tightening you feel is the contraction of the pelvic floor muscles.

If you are having difficulty finding these muscles, try this while sitting on the toilet. Try to stop the flow of urine for 1-2 seconds. Then let go and allow the bladder to empty completely. Use this as a test only, not an exercise.

Pelvic Floor Muscle Exercises

(Kegel's)

The following are two exercises to strengthen your pelvic floor:

1. Hold'ems:

Tighten your pelvic floor muscles. Hold them tight for a slow count of 5. Let go and rest completely. To progress this exercise, hold up to a count of 10

tighten

relax

2. Speed'ems:

Tighten your pelvic floor muscles for 1 to 2 seconds and then let go. Work on increasing repetitions without losing coordination. Build up to 5-10 in a row. This exercise helps stop leakage when you cough, sneeze or lift.

tighten

[pic]

relax

|Remember: |

|do Kegel exercises 3 times a day |

|start with 3-5 repetitions and do more when the exercises feel easy|

|breathe normally |

|Kegel's are easier to do sitting or lying down |

|do a Kegel whenever you cough, sneeze, laugh or lift |

|General Guidelines for Exercise |

|Avoid jumping and jarring activities and rapid changes in direction. |

|Avoid overstretching. |

|Avoid holding your breath when you exercise. |

|Begin exercise at a low intensity and gradually progress/maintain activity |

|levels. |

|Rise up from the floor slowly to avoid dizziness. |

|Be aware of symptoms if exercising on your back. If you feel short of |

|breath, nauseated, dizzy or unwell change position. |

|Drink plenty of fluids before, during and after exercise to prevent |

|dehydration. |

|Extra energy is needed during exercise and pregnancy. Make sure you are |

|getting enough calories. |

|Listen to your own body. Stop exercising and seek medical attention if you |

|experience any of the following or if you are unsure if you should continue|

|exercising. |

|increased pain |

|uterine contractions |

|vaginal bleeding |

|leaking fluid |

|dizziness/faintness |

|shortness of breath |

|chest pain |

|Be sure to contact your physician/healthcare provider if you have questions|

|about any of the above. |

|Source: Joint SOGC/CSEP Clinical Practice Guideline "Exercise in Pregnancy |

|and the Postpartum Period" |

Mid-back 1

• move on to your heels pushing your chest toward the floor

• stretch should be felt in your mid-back region

Mid-back 2

• with feet hip width apart, bend knees and shift weight backwards, push your chest towards the floor

• stretch should be felt in your mid-back region

• to feel a greater stretch on your side, cross one arm over the other

Buttock

• cross ankle over opposite knee with your back straight

• lean forward through your hips

• stretch should be felt in your buttock

[pic]

Strengthening

Pelvic Tilt

• Pull in your abdominal muscles, tuck buttock under and flatten your back. Hold for 3-5 seconds and then relax. Let the curve of your spine return.

• Try this exercise in side lying, sitting, on your hands and knees or standing against a wall.

[pic]

Transverse Abdominus (TA) Activation

• Try this exercise on your back with your knees bent (1st trimester), side lying (2nd & 3rd trimesters) or on your hands and knees.

• To find the muscle:

- Place fingers on lower abdominal muscles (find your hip bones and move fingers one inch in towards your belly button).

- Draw in the muscles below your belly button while breathing out.

- You should feel a small to moderate amount of tension develop under your finger tips as you contract your TA (you should not feel it push up against your fingers).

• Keep breathing.

• Think light and gentle.

• Hold for 5-10 seconds, repeat 5 times.

[pic]

[pic]

[pic]

|Everyday Tips |

|(and other things to think about) |

|Include relaxation as part of your daily routine. Take 10-20 minutes for |

|yourself to rest and refresh. |

|You can use heat (e.g. hot pack or gel pack) or ice to help relieve lower |

|back discomfort. Ensure that the heat or ice source is not in direct |

|contact with your skin (e.g. wrap in a towel). |

|When lifting or carrying, tighten your core muscles, hold load close to you|

|and use your legs not your back to lift the object. Avoid twisting |

|movements and get help with carrying heavy loads. |

|Pace yourself. Start activities slowly. Progress difficulty or duration of |

|the activity if you are pain free. |

|Wear a supportive bra to help prevent upper back pain. |

|Daily activities: |

|working surfaces should be at hip height when standing |

|if standing for a prolonged period of time, rest one foot up on a stool |

|(e.g. when washing dishes) |

|stand and walk 'tall' |

|getting in and out of a car: sit down on the car seat by backing in and |

|facing out, pivot and bring both knees in to the car together |

|change positions frequently |

|7. What to look for in baby equipment: |

|strollers: think about adjustable handles, how you are using it (walking, |

|running), weight, does it fold |

|change tables: hip height working surfaces are ideal |

|baby carriers; look for supportive and adjustable straps |

Activity Ideas

[pic]

• brisk walking • stairs • stationary bike

Activity Calendar

*Remember to do your Kegel's every day.

| |Monday |Tuesday |Wednesday |Thursday |Friday |Saturday |Sunday |

|Example Schedule|Walk 2x20 minutes | |Swim or Aquafit Class |Prenatal, yoga or | |Walk 2x20 minutes | |

| | | | |pilates class | | | |

|Your 1st | | | | | | | |

|Trimester | | | | | | | |

| | | | | | | | |

|Your 2nd | | | | | | | |

|Trimester | | | | | | | |

| | | | | | | | |

|Your 3rd | | | | | | | |

|Trimester | | | | | | | |

Adapted from BCW Physiotherapy Prenatal Back Care Pamphlet BCW#813

BCW# 814 ©2007 BC Women's Hospital-&Health Centre January 2012

CONNECTING PREGNANCY: PROGRAM SESSION # 3

Relaxation and Stress Reduction

Thinking about Infant Feeding

Self-Assessment Sheets Thinking About Breast Feeding

(SAS)

Today’s Discussion Family and Parenting Issues

Stress Reduction and Ways to Relax

The Relationship of Relaxation to Labour

Is there anything you need to do to get ready for breastfeeding?

Sexuality/Intimacy in pregnancy & post-partum

Depression in Pregnancy

Baby’s Best Chance

▪ Relaxation related to labour pg 59-64

▪ Stages of Labour pg 66-74

▪ Sexuality in Pregnancy pg 49-50

▪ Depression

▪ Perineal Massage

▪ So you’re going to be a parent pg 9-18, 85 & 88

    

________________________________________________________________

NOTES:

CONNECTING PREGNANCY PROGRAM

GROUP ACTIVITY OR SAS – THINKING ABOUT BREASTFEEDING

| |YES |NO |

|I have experience breastfeeding a baby | | |

|I know women who have experience breastfeeding a baby | | |

|My partner/family wants me to breastfeed | | |

What I Have Heard About Breastfeeding

Circle the reasons you may choose to breastfeed:

Baby is healthier Fewer allergies

Baby is more content Less expensive

Makes night feeding easier More convenient

Closer mother/baby relationship Baby is smarter

Might help me lose weight My family tells me it is what I should do

Other

Circle the reasons you may find it hard to breastfeed:

I plan to go back to work/school I don’t eat the right foods

My family/partner is against it I think breast babies are spoiled

I don’t think I can make enough milk I don’t know how to breastfeed

I want to smoke/drink My breasts will sag

I take medication I will be embarrassed

Other It may hurt me

CONNECTING PREGNANCY PROGRAM

GROUP ACTIVITY OR SAS – FAMILY & PARENTING ISSUES

Think about the following questions specifically for you and the family in which you grew up. Encourage your partner (or family member who will most help take care of your baby) to complete one too, and then share your thoughts with each other.

The best thing(s) we did together as a family are (were):

The relationship between my parents was (is):

The most common form of discipline used by my parents was:

The rewards most often used in my family were (are):

The person in charge in my family was:

My experience with caring for young babies and children is:

These are the parts about my own family that I want to keep as I raise my children:

These are the parts about my own family that I want to change as I raise my own children:

GROUP ACTIVITY OR SAS - FAMILY & PARENTING ISSUES

Put a check in the box to show who you think will do each of the following household tasks:

|WHO WILL ... |You |Partner or Family |Both |Unsure |

| | |Member | | |

|Feed the baby? | | | | |

|Give the baby baths? | | | | |

|Change the baby's diapers? | | | | |

|Comfort the baby when he/she cries in the middle of the night? | | | | |

|Take care of the baby when he/she is sick? | | | | |

|Decide how to discipline the children? | | | | |

|Work outside the home? | | | | |

|Decide how to spend money? | | | | |

|Decide how to spend time as a family? | | | | |

|Decide what foods we should eat? | | | | |

|Decide how many children to have? | | | | |

|Decide on birth control methods? | | | | |

|Decide on issues about safety for the baby; for example, will you | | | | |

|allow smoking, alcohol, and drug use around the baby? | | | | |

|Do the meal preparation? | | | | |

CONNECTING PREGNANCY: PROGRAM SESSION # 4

Labour

Doula Form

Preterm Labour

Today’s Discussion Coping in Labour

Stages of Labour (video)

Positions for Pushing

Baby’s Best Chance

▪ Stages of Labour pg 67-74

▪ Preterm Labour pg 80

▪ Hints to Help with

Labour and Birth pg 59, 74

▪ Supplies for Hospital

Birth and After pg 57

▪ The Tough Times of

Labour – how to help

a women through them pg 74

________________________________________________________________

NOTES:

Doula: A woman who gives continuous physical, emotional and informational support during labor and birth

Name:

What are the cross streets closest to your home:

Age:

Other children:

Your first language:

Other languages spoken:

Is it important that your doula speaks your first language: Yes □ Not Important □

Do you have specific requests or preferences you would like the doula coordinator to consider when assigning your doula (the doulas background, age, belief system):

Are there any special considerations (not medically related) you would like the doula coordinator to know about:

The doula coordinator may contact you when assigning your doula; what is your preferred telephone number? Home: Cellular:

*Due to the nature of the program, doulas are assigned to clients by the Doula Coordinator; however the Coordinator will do her best to consider your requests.

Please fax completed form to XXX Doula Coordinator at fax number: XXXXXX

Thank you!

RECOMMENDED FOOD and DRINK for LABOUR

PRE-LABOUR – LATENT PHASE

Cereal with milk and sugar

Hot milk with honey to aid sleep

Toast with honey or jam

Yogurt with fruit, honey, or jam

Light, nourishing soup with bread

You may feel nervous, and not be inclined to eat. SLOW DOWN. For most women, labour is a marathon, not a sprint. EAT SLOW.

EARLY ACTIVE LABOUR

Popsicles

Jello

And pre-labour foods or drinks listed above.

Eat and drink small amounts but regularly.

ACTIVE LABOUR

Drink 6-8 oz. per hour

You may not feel like eating, though you may if you want to. You do need to drink.

IMMEDIATE POSTPARTUM

Warm fluids

Anything you feel like and possibly a rehydration drink’ to help prevent shaking sensation

All of these foods and beverages should be stocked in your refrigerator from 37 weeks gestation onwards. Also include any foods which you especially enjoy. Remember that during pre-labour and active labour your body is temporarily unable to digest fats and proteins. Your uterus needs a large and steady supply of simple carbohydrates in order to function effectively in labour. Your midwives or doctors may encourage the use of certain foods and drinks to prevent or correct dehydration or ketosis, and/or to augment uterine contractions. (I.e. coffee with sugar)

Prior to labour be sure you have on hand food for a nourishing postpartum meal for yourself and possibly your birth attendants.

Since our clients leave the hospital early, if you are having a hospital birth be sure to pack sandwiches and tea or coffee or cocoa for the first 6 hours post-partum, for you and your partner.

CONNECTING PREGNANCY: PROGRAM SESSION # 5

The Experience of Birth

Self-Assessment Sheets Decisions of Pregnancy

(SAS)

Today’s Discussion Group B Streptococcus

PIH

Monitoring in Labour

Complications of Labour and Delivery

VBAC

Precipitous Birth

Assignment Continue to Practice Relaxation Measures

Baby’s Best Chance

▪ Experience of Labour pg 66-74

▪ C-Section pg 78-79

▪ Group B Strept pg 33 &158

▪ Hypertension pg 52

▪ Vaginal Birth after

Cesarean pg 79

________________________________________________________________

NOTES:

CONNECTING PREGNANCY PROGRAM

GROUP ACTIVITY OR SAS – DECISIONS OF PREGNANCY

You have gathered lots of information during your pregnancy. As you get closer to your baby’s birth day, you will need to use this information to make many decisions: use this list to document any decisions you have made or to help you think about the decisions that you need to make. If you need more information or advice about these decisions, let us know.

Labour Decisions

1. How will I take care of myself in early labour at home, before I go to the birth place?

1. When will I call my care provider (ex. Rupture of membranes, when contractions are how far apart)? When will I go to the birth place?

2. How will I get to the birth unit or how will extra support get to my home if I am having a homebirth?

3. What is our plan for older siblings when I go into birth?

2. What are my plans for coping in labour?

GROUP ACTIVITY OR SAS - DECISIONS OF PREGNANCY

After The Baby Arrives

6. If I have a boy, will he be circumcised?

7. What concerns do I have about feeding my baby?

8. Who will help me when I get home? What kind of help will I need with baby care, cooking and household help?

9. Who will be our family doctor?

10. Where and when will I go for my postpartum follow-up visits?

11. What will I use for birth control?

CONNECTING PREGNANCY: PROGRAM SESSION # 6

More on the Experience of Birth

Self-Assessment Sheets Comfort Measures for Labour

(SAS)

Today’s Discussion Doula Information

Video: the 3 R’s

More about the Birth Process

Comfort Measures

Medical Pain Management

Baby’s Best Chance

▪ TENS pg 74

▪ Medical Pain Management pg 75-77

▪ Movement and Positions

For Labour

________________________________________________________________

NOTES:

Connecting Pregnancy Program

SAS - COMFORT MEASURES FOR LABOUR

Place checks by the measures that you are planning to use to help you with your labour.

1. Movement

Walking

Rocking

2. Touch

Massage

Effleurage

Back pressure

3. Heat

Shower

Bath

Hot towels

4. Music

Tapes

Head phones

5. Relaxation

Breathing methods Imagery

Self-hypnosis

6. Medication

Relaxants

Narcotics

Regional anesthesia (epidural)

WHAT IS A DOULA?

Whether it is a hand to hold, someone to lean on, or words of comfort during the pains of labor, women have been helping women through childbirth for centuries. The Community Birth Program (CBP) is incorporating this age old tradition into its services by offering pregnant women the assistance of a doula. Doulas are trained childbirth professionals who provide women with continuous physical and emotional comfort and support throughout childbirth. Doula (pronounced “doola”) is a Greek word meaning “women-servant” or “caregiver”.

Continuous support from a doula has been demonstrated to have impressive benefits for expectant mothers, including shorter labours, less need for pain medication, a reduced likelihood of having a cesarean delivery and healthier babies. A comprehensive review published recently by the Cochrane Library, the biggest source of evidence-base healthcare in the world, concluded that having a doula (or other non-medically trained woman present at the birth) is the best guarantee you can have these days of a normal, satisfying childbirth experience.

ABOUT THE CBP DOULA PROGRAM.

Doulas are an integral part of our maternity care time. A CBP doula meets the woman and her family before the birth, provides continuous support during labor and birth, and visits them after the baby is born. Every woman in CBP is matched with a doula caregiver (who often speaks her first language). CBP doulas are a very special group of caring women who are committed volunteers in our program. Each doula receives an honorarium from CBP for their wonderful support.

About the CBP Doula Training

CBP doulas have attended a DONA (Doulas of North America) approved birth doula training and have participated in a mentorship program with experienced DONA certified doulas. DONA is recognized internationally as the oldest and largest doula association whose founders are responsible for the first doula studies. Information about doulas and the results of the studies can be found in DONA Birth Doula Position Paper.

Information about locating a DONA Approved Birth Doula Training or about Douglas College doula trainings can also be found at the DONA Website at

CONNECTING PREGNANCY: PROGRAM SESSION # 7

Thinking About Birth and the Baby

Self-Assessment Sheets Self-Inventory

(SAS)

Today’s Discussion Breastfeeding

Follow Me Mum (video)

Homework Talk with your Support Person about the

“Decisions of Pregnancy” (SAS)

Baby’s Best Chance

▪ Breastfeeding pg 98-102

▪ Vitamin D pg 109

▪ Introduction of Solid

Food to Infants pg 109

________________________________________________________________

NOTES:

Breastfeeding Resources:

▪

▪

▪

▪ (animated latch)

▪ (search for “breastfeeding”)

Connecting Pregnancy Program

SAS - SELF-INVENTORY

Check the column that most closely corresponds to how you feel now.

| |Often |Sometimes |Never |

|I make sure that I get regular exercise every day. | | | |

|I am careful to eat foods that are | | | |

|good for me and my baby. | | | |

|I have people I can count on to help me if I need them. | | | |

|I have a good relationship with the baby's father. . | | | |

|I feel that I have something meaningful to do with my time. | | | |

|I have a good understanding of how my body functions. | | | |

|I feel good about the health care that is available to me. | | | |

|I know if I have a medical problem I | | | |

|can get someone to help me. | | | |

|I am happy that I am having (or have had) a baby. | | | |

The area that I need to work on the most is

CONNECTING PREGNANCY: PROGRAM SESSION # 8

After the Baby Arrives

Self-Assessment Sheets Personal Assessment

(SAS) Delivery

Today’s Discussion Common Newborn Procedures After Delivery

Baby Care

Sharing a Bed with your Baby

Discussion on Feelings about Ourselves and Our Support Systems

Siblings

The Postpartum Period and the Need for Help and Support

Soothing the Newborn

Circumcision

Infant Massage

Baby’s Best Chance

▪ Newborn pg 110-118    

▪ Cord Care pg 115

▪ Crying pg 121-123

▪ Eye Care pg 115

▪ Bathing pg 115

▪ Safety/Jaundice pg 116-117

▪ Talents of the Newborn pg 134-138

▪ Early postpartum pg 83-84

▪ Adjustment to Life with your

Baby pg 82-88

➢ Coping strategies

➢ Sibling preparation 

➢ Coming Home  

________________________________________________________________

NOTES:

Tummy Time Website: ?q=whatcanido/276

Connecting Pregnancy Program

SAS - PERSONAL ASSESSMENT

Under each question, circle all words that describe your feelings about the statement

When I think about being in labor I feel:

excited worried scared anxious

relieved unprepared happy thrilled

When think about caring for my new baby I feel:

warm loving anxious uneasy

confident uncertain tired excited

When I think about my relationship with the baby's father I feel:

comfortable anxious uncertain angry

loving secure upset relaxed

When I think about myself I feel:

content unhappy unattractive secure

satisfied unsettled alone proud

When I think about my family and friends I feel:

loved abandoned secure happy

hurt uncertain on my own supported

WHAT HAPPENS TO BABY AFTER BIRTH?

COMMON NEWBORN PROCEDURES

Skin to Skin

The best way to greet your new baby at birth is by putting the baby on your tummy or chest, skin-to-skin, immediately after birth. When a newborn is put skin-to-skin it has an easier transition to life outside the womb! Skin-to-skin:

o Helps keep a normal body temperature

o Exposes baby the healthy bacteria on mother’s (or father’s) skin providing immune protection

o Baby smells the breast and show interest in feeing within an hour of birth!

For more information on the benefits of skin-to-skin and early feeding:





Newborn Exam

All newborns get a careful head-to-toe examination within a couple of hours of birth. Sometimes this exam is done before you breastfeed for the first time, especially if we have called a pediatrician to attend your delivery. Often we can delay the exam until after you have had skin-to-skin time and your first breastfeed.

While we examine your newborn, we encourage you to watch and also participate. Please feel free to ask any questions you have about your baby. Your newborn will recognize your voice, so talking or singing to your baby, as well and gentle touches, will provide comfort.

During this newborn exam we: listen to the heart and lungs, measure length and head circumference, examine each part of the baby and check the baby’s reflexes.

For more information on the normal newborn:





Eye Ointment

Within one hour of birth, newborns routinely have a small amount of 0.5% erythromycin antibiotic ointment placed in each for the purpose of preventing serious eye infections that can lead to permanent eye damage. Chlamydia and gonorrhea are the two most serious infections the eye ointment is meant to prevent; both of these infections can pass from mother to baby at delivery. If you have been screened for Chlamydia and gonorrhea in pregnancy and are in a monogamous relationship, the chance of serious infection is very low. Other bacteria may cause eye infections, but they are not as serious. The ointment is not painful, but does cause short term blurring of vision.

Although there is a law in BC requiring health workers to apply the erythromycin ointment, as parents, this is always your choice. Some parents do not want to give their newborn baby antibiotics. You may sign a waiver of treatment at the hospital.

For more information on newborn eye treatment:





Vitamin K

Vitamin K is essential to blood clotting. It is produced in our intestines by the normal, healthy bacteria that live there. Because newborn babies do not yet have this bacteria living in their intestines (babies are sterile when they are born), they are susceptible to a disorder called Vitamin K Deficiency Bleeding (VKDB), sometimes called Hemorrhagic Disease of the Newborn (HDN). VKDB may cause serious bleeding into the brain or rarely, fatal hemorrhage. The number of babies who have VKDB is very small, ranging from 1.5% to 0.001%, and is higher in breastfed babies, as formula is enriched with Vitamin K.

Skin-to-skin immediately after birth and early and frequent breastfeeding help to lower the incidence of VKDB, however, the most effective means of prevention is a single injection of Vitamin K into newborn’s thigh. For over 50 years health care providers have been giving babies intramuscular injections of Vitamin K as an effective means of decreasing VKDB. The risk of a Vitamin K injection is a minor amount of short-term discomfort in the newborn. No long term consequences have been recorded in the medical literature. Some parents may choose to give oral Vitamin K, but this is not as effective in reducing VKDB, It is also an option to decline Vitamin K treatment for your newborn, as long as you understand the information available. In certain situations, such as a preterm birth or forceps delivery, Vitamin K would be very strongly recommended.

For more information on Vitamin K for the newborn:





Neonatal Metabolic Screen

Often referred to as the ‘PKU’ test, or ‘heel prick’ test, this simple blood test is offered to all newborns in BC for the early detection of 4 potentially very serious disorders that affect the newborn metabolism. If not detected, these 4 disorders may cause irreversible damage in a newborn, but if picked up early, diet changes and medications can greatly reduce this risk.

The test is done after a baby is at least one day old. A very small prick is made in the baby’s heel and four drops of blood are collected on a special card, and then sent to the laboratory for results. We can do this in your home if you go home early from the hospital. The PKU test may now be screening for many more rare metabolic problems.

The four metabolic disorders are:

Phenylketonuria (PJU): An inability to metabolize one of the components of protein. This occurs in 1/18,000 babies in BC. Dietary changes can prevent damage.

Galactosemia: Lack of an enzyme necessary to use galactose (milk sugar) for energy. This occurs in 1/25,000 babies in BC. Lactose-free diet helps prevent serious problems for the baby.

Congenital Hypothyroidism: Low or absent thyroid hormones important for mental and physical development. This occurs in 1/35,000 babies in BC. Hormones are replaced to prevent problems.

Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD): Babies with MCAD can’t use fat stores for energy. This occurs in 1/20,000 babies in BC. Eating well on a schedule prevents serious problems for these babies.

For more information on the newborn screening test:





Adapted from South Community Birth Program January 2012

BABY SKIN CARE AND RASHES

SKIN CARE:

How often do babies need a bath? 2-3 times/week. Daily cleansing of skin folds (neck, armpits, between fingers, groin) with water. Gentle baby soap. Water only for face.

Dry skin – very common, especially on hands and feet. Can use vegetable oil (olive oil) or non-fragrance, gentle products as below.

Natural skin products: this is only a partial list; the important thing to look for is something that is non-medicated and unscented. (some babies will do fine with regular scented products, watch your baby for sensitivity)

• Aveeno Baby – line of bath soap, moisturizers

• Glaxal Base – hypoallergenic moisturizing cream

• Eucerin – moisturizing cream

• Laundry detergent – wash clothes prior to baby wearing them. Avoid fragrances or dyes.

• 38-40% Zinc oxide barrier cream for diaper rash

• Wipes- most standard diaper wipes have chemicals, fragrances and can make diaper rash worse. Clean diaper area with soft wet cloth or wet cotton balls. Save wipes for when you’re out of the house, or use more expensive natural wipes. You can also rinse the standard wipes with warm water.

RASHES:

Common in many newborns. Description and treatment:

• Newborn rash – erythema toxicum. Red with raised small white center. Moves around. No treatment needed.

• Milia – tiny white bumps on nose, chin and plugged oil glands. No treatment needed.

• Newborn acne – small red or white bumps on forehead or cheeks. Often develops within 4 weeks due to maternal hormones during pregnancy. Can clear up or linger for months. Wash with warm water several times a day and pat dry.

• Heat rash – fine, clear or red spots, often on cheeks, neck, skin folds. Disappears on own, no lotions or oils. Dress baby in layers-typically they need one extra layer than you have. OK for hands and feet to be slightly cool as long as core is warm.

• Cradle cap – Usually clears up on own in a few months. Thick, yellow patches of dried skin. Can use baby oil, gently loosen and comb out flakes, then shampoo off.

• Thrush – bright red, defined, raised rash that doesn’t go away with diaper rash cream. Caused by candida (yeast). Treatment is antifungal cream (Nystatin, over-the-counter). Baby’s mouth and mom’s nipples (if breastfeeding) may be affected and need treatment. If nipples are suddenly painful, or you notice white spots on baby’s gums, cheeks, contact CBP for an appointment.

To view a slideshow of common newborn rashes, see:

health/baby-rashes/F10090

Courtesy of Vancouver Coastal Health- 2012

Connecting Pregnancy Program

INFANT MASSAGE

What is Infant Massage?

Gently massaging your baby has many benefits for both you and your baby.

• Relaxation. Loving touch lessens tension, fussiness, and irritability that your baby may have. It aids digestion and can provide relief from gas and colic. Providing this massage may also lessen the stress that you have been feeling from your baby's behavior.

• Enhances bonding. Having this special, intimate time with your baby can contribute to the closeness that you feel. Touch conveys nurturing and love which are essential ingredients for emotional and physical growth and well-being.

• Aids growth and development. Studies have shown increased weight gain and immune function. Even the nerves show strengthening which, in turn, aids the functioning of muscles and the brain.

• Promotes communication. The better you know your baby the more aware you will become of the baby's non-verbal cues. This communication instills a message of love and security.

• Improves the baby's sleep. As your infant learns to relax and release stress, sounder and longer sleep often is the end result.

How do I get started?

There are a number of basic points and steps to learn when massaging your baby. There is no one best time to massage a baby but many parents find a good time to massage is after the baby's bath.

To enjoy the benefits of infant massage, create a pleasant environment for you and your baby. Make sure the room is warm and the baby is lying on a towel or mat. Have some relaxing music on in the background and a vegetable based oil ready to massage your baby.

Don't worry if you cannot fully massage your baby the first time. Massage may be something new and different. It may take some time for your baby to relax and enjoy the new sensation.

Start by massaging the legs and feet of your baby using long soft strokes and keeping contact with your baby. Progress on to the abdomen and then the upper body doing as much as your baby seems to like and that you enjoy.

The first learning experiences of a baby come from contact with parents and caregivers.

What a wonderful way this is to strengthen the bond between you and your baby.

Courtesy of Vancouver Coastal Health- 2012

CONNECTING PREGNANCY: PROGRAM SESSION # 9

Putting It All Together

Self-Assessment Sheets Contraception

(SAS)

Today’s Discussion Sharing of Birth Stories

Exercises after Birth

Contraception

▪

▪ sexualityandu.ca

Sharing Together: Thoughts and Concerns about the Birth Process and the Early Post-Partum Weeks

Mood Changes after Childbirth

Soothing a Fussy Baby

Community Resources

Baby’s Best Chance

▪ Immunizations/

Health Passport pg 119-120

▪ Contraception Options pg 92-95

▪ Sharing a Bed with your

Baby pg 11-112

▪ Self-Care: The first Week

after Baby is Born pg 86, 103, 105

▪ Taking Care of Baby pg 110-112

▪ Thoughts about Siblings pg 82

▪ Mood Changes after

Childbirth pg 85 & 86

▪ Postpartum Depression pg 86

▪ Postnatal Exercise pg 47

_______________________________________________________________

NOTES:

Reproductive Mental Health Self-Care Guide:

bcwomens.ca/NR/rdonlyres/483927DE-698E-42A7-89E5-6E7080D6ABA9/12518/ReproductiveMentalHealthSelfCareGuide.pdf

Birth Control by Breastfeeding:

reading_room/lam.html

Connecting Pregnancy Program

SAS - CONTRACEPTIVE USE

Below is a list of various contraceptives. Respond to them in terms of whether you have ever used them, are planning to use them, and/or want more information

Have Used Method Plan to Use More info

condoms, male

condoms, female

vaginal preparations

diaphragm

intrauterine device (IUD)

birth control pills

birth control patch

depo provera shot

norplant

natural family planning

pulling out (withdrawal)

abstinence

vasectomy

tubal ligation (sterilization)

CONNECTING PREGNANCY: PROGRAM SESSION # 10

Now What Happens?

Self-Assessment Sheets All about my Baby

(SAS)

Today’s Discussion Continued Sharing of Birth Stories

Reviewing Plans for Taking Care of Myself, My Baby, and My Family

Amazing Talents of the Newborn (video)

Contraception

________________________________________________________________

NOTES:

Sexuality and U: sexualityandu.ca

Connecting Pregnancy Program

ALL ABOUT MY BABY

My baby's name

My baby was due on but …

My baby actually delivered on at AM/PM

My baby weighed lbs and oz

My baby was inches tall

helped deliver my baby

I gained lbs carrying my baby

My thoughts during labor were:

When I first saw my baby I felt:

We hope you have felt supported in this journey,

your Care Providers at Community Birth Program.

Sacred Space

Birth in Progress

-----------------------

Having a new baby is a real adventure for you and your family. We wish you well in the journey and hope that your experience in this Connecting group will give you increased support and confidence.

For more information about eating during pregnancy, read Baby’s Best Chance, pp. 36-43

Lying

• rest on your side with knees bent

• use pillows for support; between knees and under belly

• when moving in bed, tighten core muscles to turn

• get in and out of bed from side lying

|[pic] |[pic] |

|Incorrect |Correct |

Walking

stand tall

take small steps

keep feet hip width apart

tighten core muscles

• wear comfortable, and supportive shoes

d)

[pic]

[pic]

•

[pic]

▪

Ribcage/back

• extend arm over head and reach towards one side

• stretch should be felt along the ribcage of your extended arm

•

Stretching & Strengthening

During pregnancy, muscle imbalances can occur. Certain groups of muscles tend to shorten and tighten while others lengthen and weaken. Stretching and strengthening can restore muscle balance and prevent discomfort.

Stretching

• gently warm up prior to stretching

(e.g. walk 5-10 minutes prior to stretching)

• hold each stretch 20-30 seconds, repeat 2-3 times

• you should feel a stretch without pain

• ensure proper posture

• do not overstretch

• breathe!

Ideas for stretches

during your

pregnancy

Triceps

• hold elbow with opposite

hand

• gently pull behind your

head

• stretch should be felt at the

back of your upper arm

•

©2007 BC Women's Hospital &Health Centre

[pic]

[pic]

Calf (soleus)

• bend back knee with heel down

• stretch should be felt in the calf of your back leg

Calf (gastroc)

• keep back leg straight with heel down, shift weight forward

• stretch should be felt in the calf of your back leg

Buttock

• in side lying, bring your knee towards your chest and hold

• stretch should be felt in your buttock and lower back

•

Hamstrings

with back straight, lean forward through your hips

• stretch should be felt through the back of your leg and/ or calf

•

[pic]

Hip

with back straight, shift weight forward

• stretch should be felt in the front of the hip of the back leg

e)

[pic]

4-1

-----------------------

Vancouver Coastal Health - South Community Birth Program

October 2007

Vancouver Coastal Health - South Community Birth Program

October 2007

Vancouver Coastal Health - South Community Birth Program

October 2007

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October 2007

Vancouver Coastal Health - South Community Birth Program

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Vancouver Coastal Health - South Community Birth Program

October 2007

Vancouver Coastal Health - South Community Birth Program

October 2007

2-12

©2007 BC Women's Hospital &Health Centre

©2007 BC Women's Hospital &Health Centre

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