2018
My water broke!
just b -r-e-a-t-h-e Help during labour
Step-by-step
your body bo dy After birth
What to expect
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in this issue
4
editor’s Note
8
Labour + Birth Stages We explain how labour progresses, step-by-step.
p. 16
14
6 Questions About epidurals A common pain relief option for labour and birth.
16
B-R-e-A-T-H-e Ways breathing techniques can help you labour.
27
Your Body After Birth Some things you can expect.
30
Survey Says! Our readers dish about body pillows, nesting and more.
Shutterstock.com
p. 14
p. 30
parentscanada.com 3
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SUMMER 2018
EDITOR-IN-CHIEF Katie Dupuis ART DIRECTOR S. Dale Vokey
editor’s message If you’re anything like me, the positive pregnancy test will turn you into a research maniac—especially where labour and delivery are concerned. I know, with my first daughter, I researched the heck out of my options, to be sure I was as well-informed as possible when the time came. But here’s the thing: When Sophie finally decided to make an appearance (a week late!), all of my careful planning—while useful, to prepare me—went out the window. It became about bringing my girl into the world as safely as possible. After a few minor hiccups, I was holding her in my arms, and to me, that was really all that mattered. In hindsight, I’m so glad I’d educated myself as much as I did. And when I found reliable websites and magazines, I went back to them often to seek out answers for my many, many questions. (Even six years after Sophie was born, I still go back to the same parenting resources!) That’s what we aim for at ParentsCanada, and with this Labour & Birth Guide. We want to be there for you, when you’re unsure, when you’re worried, when you need a friend. We’ll try to be the (sassy, well-informed) pal you need as the weeks and months tick by, and we’ll be there for you long after you welcome your wee bundle of joy. Looking forward to getting to know you, and your new addition. Congratulations! — Katie Dupuis, EDITOR-IN-CHIEF
NATIONAL ACCOUNT MANAGERS Lori Dickson Meghan Bradley V.P., DIRECTOR OF MARKETING AND INTERNET DEVELOPMENT David Baker OPERATIONS DIRECTOR Bonnie Young
PUBLISHED BY:
PRESIDENT/PUBLISHER Jane Bradley 2010 Winston Park Drive, Suite 200, Oakville, ON L6H 5R7 Telephone: 289.291.7723 No part of this publication may be reproduced without permission of the publisher. ©2018
COVER SUPPLIED BY:
E DITOR IAL BOAR D O F A DV I SO R S Donna Brown Wilson Clinical Nurse Specialist Perinatal Program, Sunnybrook and Women’s College Health Sciences Centre, Toronto Eric Goldszmidt, MD, FRCPC Deputy Anesthesiologist-in-chief, Mount Sinai Hospital, Toronto Andrea Skorenki, MD University of Alberta Department of Obstetrics and Gynecology Allison Tannis, BSc, MSc, RHN Nutritional Consultant, Halifax The information in Labour & Birth Guide is not a substitute for the care of a doctor or midwife.
4
Meet Brittany – nearly 7 months pregnant at the time of our shoot, carrying her second child & exuding confidence and style from head to toe in a fit & flare, crochet dress (#407567) from Thyme Maternity’s May collection. Available at Thyme Maternity in stores and online in sizes S-XL. Visit thymematernity.com for more go-to maternity looks .
’s LABOUR & BIRTH GUIDE
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24604026
OF LABOUR BY NANCY LEV Y, RN
You’ve been waiting for this day for 40 weeks. You’re finally in labour.
HERE’S WHAT TO EXPECT AT EVERY DISTINCT STAGE OF THE PROCESS.
FIRST 7 to 8 hours
During early or first-stage labour, the cervix dilates three to four centimetres.
Your contractions: • Usually result in cervical dilation to three to four centimetres and partial effacement (the process by which the cervix prepares for delivery). • Build to a peak and recede. • Are mildly to moderately painful and can begin in the lower back. (May feel like menstrual cramps.) • May be light enough that you can breathe normally. • May become strong enough that you pay attention to your breathing and/or begin relaxation exercises. • May be five to 20 minutes apart, becoming more and more intense, longer and closer together. • May be 30 to 45 seconds long (but not lasting more than 60 seconds). 8
• May result in baby beginning to bring chin to chest so the smallest diametre of the head can start to pass through the pelvis. Your doctor or midwife may: • Suggest going to the hospital if the membranes rupture (the water breaks) or contractions are five minutes apart.
Shutterstock © Hong Vo / © Iryna Prokofieva/© Zdenek Fiamoli
You may: • Be excited, anxious, energetic, confident. • Be more comfortable at home until labour becomes active. • Eat lightly. • Wonder if ‘this is it’. • Go back to sleep if it’s nighttime.
’s LABOUR & BIRTH GUIDE
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• Hands and knees. (Excellent for back pain – and this may help a baby in the posterior position to turn.) • Squatting – this increases the diameter of the pelvis (especially helpful when there has been little or no progress.) • Sitting on toilet; useful because of the association with ‘letting go’.
SECOND
During the second stage of labour, the cervix dilates fully and the baby is born!
30 minutes or two or more hours You may: • Have a renewed sense of energy and excitement. • Need to regroup after intense transitional labour. • Not feel the urge to push right away. • Hold your breath when pushing or allow some breath to release, letting out a sound as you push. • Be surprised by the overwhelming urge to push (bear down) with contractions. • Find it satisfying to bear down – or find it painful. • Be tired, especially as this stage progresses, and even sleep in between contractions. • Want to resist bearing down because of the intense rectal pressure of fullness. • Continue to have lower back pain. • Be embarrassed about passing some stool. As long as the fetal heartbeat is stable, there’s no rush. It may take a while before you get the hang of bearing down, but you will. You might find the following positions comfortable/effective: • Semi-sitting at a five-degree angle or more. • Side-lying. This position is useful for severe hemorrhoids, or for when delivery is moving unusually quickly. A bonus is that this position lets you watch your baby’s birth.
The delivery: • Baby’s head slips out of the fully dilated cervix, leaving room at the top of the uterus. It may take a few minutes for the uterus to become taut again around the rest of the baby’s body – this is why there is sometimes a lack of urge to push upon full dilation. • Baby’s oxygen level is affected if you hold your breath during pushing. Safe level is maintained when a new breath is taken at least every six to eight seconds. • Eventually, the baby’s nearly born head causes the perineum to bulge and the vaginal lips to part when the mother pushes. The head becomes visible when it is low enough. • The baby’s head recedes out of sight in between pushing efforts. • Eventually, baby’s head fully opens the vaginal lips and does not recede. This ‘crowning’ is characterized by an intense stretching and burning sensation known as the ‘rim of fire’. • Perineal tissue is vulnerable to tearing at crowning. ‘Rim of fire’ sensation can be seen as nature’s way of discouraging the mother from pushing at this time, decreasing the likelihood of tearing. • Baby’s shoulders follow, and then the rest of the body is born! The medical staff or midwife may: • Put a hand on your abdomen to feel when contractions occur. • Encourage you to push during contractions and offer guidance and instructions. • Examine you vaginally while you are pushing to feel the baby’s head. • Stretch perineal tissue with U-shaped massaging motions and warm compresses; this helps avoid tearing and is sometimes done instead of an episiotomy. • Perform an episiotomy. Regional anesthetic is given if needed, unless you’ve had an epidural. • Check fetal heart rate more frequently. parentscanada.com 9
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THIRD
During the third stage oflabour, the placenta is born.
5 to 30 minutes You may: • Need a few minutes to collect yourself before focussing on your baby. Don’t feel guilty about this; it’s an emotional and stressful event! • Be surprised by the baby’s appearance. The body may be a bloody, greyish-purple colour, and covered with a white substance (vernix). The head may appear misshapen from being in the vaginal canal. Babies aren’t super cute right away! • Be engrossed with your baby, be emotional, overwhelmed and cry. • Not even notice the birth of the placenta.
Shutterstock/© happybas
In your body: • The uterus contracts so the placenta detaches from the uterine wall; it usually slips out in one or two pushes. • Continuing contractions may be mildly painful. • The uterus contracts against the exposed blood vessels from the former site of the placenta to control bleeding. The medical staff/midwife may: • Ask you to push for birthing the placenta at the appropriate time. • Invite your birthing partner to cut the umbilical cord. The cord may be cut immediately or the doctor or midwife might want to wait a few minutes. • Check baby’s condition immediately, then again at one to five minutes after birth to determine the baby’s Apgar score. • Give the baby a Vitamin K injection to facilitate blood clotting. • Dry and wrap your baby for warmth. • Give you a pitocin injection in your thigh or through IV. This is a precautionary measure that’s used to help the uterus contract. • Examine the placenta and umbilical cord to make sure they appear normal. • Take routine blood samples from the umbilical cord. • Repair the episiotomy incision, if necessary. 10
AFTER
Congratulations! The hardest part is over.
The first few hours You may: • Be hungry, and feel tired, elated and satisfied. • Be mildly uncomfortable if you had an episiotomy. Your baby may: • Open her eyes and be alert and attentive to his or her parents (the ‘first period of reactivity’). The medical staff/midwife may: • Encourage the baby to breastfeed – this helps control uterine bleeding. Also, if the baby is breastfed within two hours after birth, it is more likely to breastfeed successfully in the coming weeks. • Check the height and tightness of the uterus, vaginal bleeding and blood pressure. • Put antibiotic ointment in baby’s eyes. (This can be delayed for an hour to allow the baby’s first glimpse of her parents.) • Leave the new family alone to bond. Every labour and birth is different, and timing may not be exactly as described here. However your labour progresses, congratulate yourself for your hard work – and the miraculous result.
’s LABOUR & BIRTH GUIDE
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Here’s what you need to know about epidurals BY ERIC GOLDSZMIDT, MD, FRCPC
Shutterstock/© PhotoMediaGroup
What exactly is an epidural? An epidural is a needle placed between the bones of the spine of the lower back. The needle is used to locate a space just outside the sac where the spinal cord and its fluid are located. A fine plastic tube is threaded into the space and the needle is removed (like an intravenous). Once the tube is in place, the anesthesiologist delivers numbing medicine and pain-relievers into the epidural space, freezing the nerves to the uterus the way a dentist freezes the nerves to a tooth. Once the tube is in place, it will be connected to a pump that delivers a constant flow of the medication to keep you comfortable. As long as the epidural does not fall out, it can be used as long as labour lasts. It will not wear off. If the epidural falls out or does stop working for some reason, it can always be redone.
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’s LABOUR & BIRTH GUIDE
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What are the risks and side effects involved? The major risks include very rare complications such as nerve damage, paralysis and toxic drug reactions, which may lead to a loss of consciousness or seizures. These are exceptionally rare cases. Minor risks include itchiness from the epidural pain relief medication, weak or heavy legs, and bruising from the needle (which may cause a sore back). There is a small risk of getting a spinal headache a day or two later, but it goes away. Will I be able to feel any pain at all? Pain is very subjective and no two labours are alike. Most women with an epidural are very comfortable for most of their labour. They may have breakthrough contraction pains that are treated with additional epidural medication. As labour progresses, some women experience a lot of vaginal, rectal and perineal pressure. Again, this is usually treatable. When it is time to deliver, some pressure sensation is required to give you an urge to push. Some women find this uncomfortable.
I
How and when is an epidural administered?
An epidural can be administered at any time after your obstetrician has determined that you are in fact in labour. You cannot get it too early in labour and you can receive one up until it is time to actually deliver the baby. Once you have requested an epidural, an anesthesiologist will see you as soon as he or she is able. The doctor will take a medical and obstetric history, review your medical chart and discuss the epidural, risks, and complications with you. Once you have consented to have the epidural, the doctor will position you in either the sitting position or lying on your side. The doctor will show you how to arch your lower back to make it easier to perform the procedure. Your lower back will be cleaned with a cold solution and a plastic drape placed over the area to keep it clean. The doctor will feel your back, looking for the best spot to place the epidural, then freeze the skin at that spot. You will feel a little prick (like a bee sting) followed by some burning (the freezing medicine burns a bit when it is first injected). After that, the epidural needle will be inserted. This will feel like a dull pressure in your lower back but should not be overly uncomfortable. When the plastic tube is placed, people occasionally feel an electric shock in one of their legs (like hitting your funny bone). This is brief and of no significance. Once the tube is taped in place, you will not feel it and can move into a comfortable position.
People say you can’t have an epidural if you have a tattoo on your lower back. Is this true? This is not true. The theoretical risk is the introduction of tattoo dye into the spinal canal. To date, there are no known reports of complications related to placement of an epidural through a tattoo. It is not usually an issue because most of the time, an epidural can be placed without puncturing the tattoo at all. If this is not possible, a small needle can be used to make a hole prior to inserting the epidural needle to decrease the risk of picking up some ink. In spite of this, some anesthesiologists may still refuse to do an epidural through a tattoo. Can you still urinate if you have an epidural? Ideally, women would still be able to sense when their bladder is full and pass urine themselves. They should even be able to walk to the bathroom with some assistance. Some cannot and require a catheter (a small tube inserted through the urethra into the bladder) to empty it. This is not painful because of the epidural. Some hospitals still routinely catheterize patients with epidurals. Can all women have an epidural for labour? Nearly all women can receive an epidural for labour. Some medical conditions that may contraindicate epidurals are active infections, bleeding disorders, blood thinning meications, spinal malformations (spina bifida), and previous major spinal surgeries. Prenatal consultation with an anesthesiologist is recommended. LBG
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b reathe in
To prepare for birth, familiarize yourself with breathing and relaxation techniques that help you stay in touch with your body and your needs. by Katarina EhlEr, rn, b Sc n
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Shutterstock/Š fizkes
breathe out
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Each day, try spending quiet time with your partner or by yourself, relaxing and getting in tune with your breathing. The ultimate goal of relaxation when giving birth is maximizing oxygen supply to the uterus and improving uterine efficiency. If you are stressed, the uterus tenses up, causing more pain. PREPARATION Get into a comfortable position, side-lying or semi-sitting, supported by pillows. › Don’t let your hands and feet dangle; this makes your muscles work, increasing tension. › Ensure all body joints are slightly flexed. › Have a blanket ready in case you get chilly. › Create a distraction-free environment (dim the lights, play quiet music). You can bring your playlist to the hospital. When you have mastered relaxation in this quiet, controlled environment, progress to a ‘busy’ environment, since the hospital is a frenetic place, with many distractions. METHODS OF RELAXING ProgrEssivE rElaxation
this is focussing on one or more muscle group at a time in order to relax your entire body. tense each body part for about six seconds and release (don’t hold your breath). slowly focus on each part of your body, consciously tensing and releasing individual muscle groups, and working down
from your face to your toes. Your partner or a recorded voice can also help guide you. touCH rElaxation
Your partner can apply the following techniques: › a gentle, still touch over a tense area until that area relaxes completely. › Firm pressure to tense areas with fingertips and/or palm of hand. slowly release tense area. › gently stroking tense area away from centre of body, massaging tense muscles. as you become familiar with your body, your partner will be able to recognize tense areas and go directly to them. ‘PuPPEt string’ rElaxation
imagine you are a puppet with strings attached to your body. imagine lifting one ‘string’ up, then relaxing it. once you have mastered this technique, lift multiple strings simultaneously (for example, an elbow and a foot) and relax them. guiDED imagErY
this form of relaxation uses the body and mind. Form a mental picture of a pleasant
scene, such as a warm bath or lying in the sun on a beach, and escape into that scene. remember that relaxing involves controlled breathing. BREATHING our pace and rate of breathing changes constantly depending on our emotional and medical status. Pain or panic can cause rapid breathing or forceful exhaling, resulting in the flushing of carbon dioxide out of our system (hyperventilation). Hyperventilating causes a sense of dryness, dizziness and lightheadedness. grEEting brEatH
recommended for any type of contraction, greeting breath is also known as cleansing breath, relaxing breath, in/out breath, refuelling breath, and complete breath. Perform this type of breathing at the beginning and end of a contraction. › take a deep breath through your nose and out through your mouth. (if you are congested, breathe through mouth only.) › imagine breathing in energy and releasing tension.
Focus on one muscle group at a time to gradually relax your entire body. parentscanada.com 17
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› Stretching your body as you breathe in, returning to your starting position as you breathe out. This type of breathing allows maximum expansion of lungs and a complete exchange of gases. Breathing should be effortless.
BENEFITS OF APPLYING GOOD BREATHING TECHNIQUES
SLOW-PACED, RHYTHMIC, FULL-CHEST BREATHING
This is for tolerable contractions (usually in the early stages of labour). › Breathe in and out slowly and effortlessly, at about half the pace of your regular breathing pattern – or at a rate of 6 to10 breaths per minute. › As you breathe in through your nose, you or your partner can place your hands under your rib cage and watch your chest rise and swell as air enters your lungs. When you breathe out through your mouth, observe how the chest falls and you feel relaxed. › While your partner is timing the contractions, concentrate on a focal point – an object or person in the room. (Or keep your eyes closed and use your imagination to create a focal point).
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bottom teeth and relax your mouth in a gentle smile on the out breath. This will help keep your mouth moist. › Maintain equal breaths in and out; this will avoid hyperventilation (a condition in which you breathe too fast, causing a low level of carbon dioxide in the blood). TRANSITION BREATHING
2. Decreasing or avoiding breathlessness, which is common in prenatal and labouring women. 3. Heart and lungs will be better prepared for oncoming labour. Your partner/coach needs to learn and follow your breathing pattern so that you can be guided during labour. (Your breathing patterns may differ if your contractions are artificially augmented.) UPPER CHEST OR LIGHT BREATHING
Used during more intense labour, when slow breathing no longer helps, and you can no longer perform any activity during contractions, such as walking. › Breathe between your mouth and bra line, faster than the light breathing rate, 30 to 60 breaths/ minute. › Your coach can place hands on your upper back below your shoulder blades. You can feel the pressure in his hands when you breathe.
This technique is used when deep or shallow breathing is no longer helpful. This form of breathing is at the centre of the mouth › Sit or stand up. › Part your lips gently into a smile and breathe in and out through parted lips. BREATHING DURING SECONDSTAGE LABOUR (DURING SPONTANEOUS OR SELFDIRECTED PUSHING)
You are the best judge of how to push. › Relax your pelvic floor by breathing in a pattern that works for you. › Avoid straining. Push as your body conveys. › Avoid prolonged breathholding, which results in gasping for air. You may feel more than one urge to push during a contraction. This lasts a few seconds. › Exhale during pushing; make as many groans, grunts and moans as you want. › Pant or blow during crowning to prevent tissue damage or trauma. As you concentrate on breathing, your body begins to relax, and your breathing follows a natural rhythm that best suits you. The two of you work together – just like you and your baby.
Shutterstock/© VGstockstudio
1. Air circulation will improve and will supply baby and uterus with much-needed oxygen and nutrients, while excreting carbon dioxide.
ROVING BODY CHECK WITH SLOW BREATHING
This technique combines breathing and relaxation. › Slowly breathe in through your nose and out through your mouth, releasing tension in one part of the body. › Breathe in as your partner massages the tense area of your body. As you exhale, your partner can gently release that part of your body, telling you when to let go and relax. › Move slowly in this way, at your own pace, moving throughout your whole body. Give regular feedback to your coach so he or she can stay in tune with you.
› Make quiet ‘hee-ha’ sounds. › Place your tongue behind your
’s LABOUR & BIRTH GUIDE
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UP TO 3X
After
Birth
Here’s what you can expect from your body postpartum
shutterstock/© iryna inshyna
by Dr . Dar a Make r , FaMily Phys ic ian
After you’ve given birth, you can expect to experience a myriad of mental and physical changes, from bleeding to mood changes. How do you know which changes are normal and when you should call your doctor? Dr. Dara Maker, a family physician at Women’s College Hospital in Toronto, advises women to pay attention to their bodies. parentscanada.com 27
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Bleeding What’S normal: It’s normal to
have some bleeding, similar to a period, that may last up to three weeks postpartum. the lining of the uterus is shedding, so it’s normal to experience a heavier flow early on. this should lighten over a few weeks. What’S not normal: Contact
your doctor if you are soaking through a pad every hour, if you are passing clots greater than the size of a loonie, or if you have foul smelling discharge or a fever. these symptoms could indicate an infection or retained placenta. Vaginal soreness What’S normal: many women
have an episiotomy, or small tears, during delivery, so it’s common for the area to be sore and uncomfortable for up to a few weeks. Keep the area clean and use a squirt bottle filled with water after urination or a bowel movement. Some women use an ice pack, especially 24 to 72 hours after delivery, to help bring down the swelling. You can sit on a doughnut pillow and use stool softener to ease the pain. What’S not normal: If you’ve
taken acetaminophen (tylenol) or ibuprofen (advil) but still have substantial pain – or if the pain gets worse – talk to your doctor. Hemorrhoids
Shutterstock/© optimarc
What’S normal: It is very
common for women to develop hemorrhoids during pregnancy or during the delivery. Basically, intra-abdominal pressure forces veins to swell and stretch around the anal area. You can treat the symptoms of pain, itching and discomfort by taking a warm sitz bath (a shallow bath with warm water) for 10 minutes. also be sure to drink lots of water and 28
eat a high-fibre diet to avoid straining. You can also apply witch hazel, which is soothing, or use an over-the-counter product containing hydrocortisone and zinc oxide. What’S not normal: For many women, the hemorrhoids will eventually go away, but others will have them long term. Consult with your doctor if you’re bleeding or in a lot of pain. Surgery is a last resort option.
Mood changes What’S normal: Forty to 80 per cent of women will develop the baby blues. this is normal. It usually starts during the first week postpartum, and can last for two weeks. relying on support from friends and family helps a lot. What’S not normal: Up to 10
per cent of women may develop postpartum depression, which can appear anytime within 12 months of delivery. If you have substantial sadness, anxiety or are having trouble caring for your baby or getting things done,
see your doctor. anxiety can be common, but if it interferes with eating and sleeping and you are agitated all the time, take it as a warning sign. It can be treated with a range of therapies including individual therapy, group therapy or medication. Women who have had it before are more likely to get it again. C-section scar What’S normal: Follow your
doctor’s direction upon discharge to care for your C-section scar. once the staples come out, you will likely get steri-strip bandages, which you should leave on for as long as your doctor advises. When you remove them, keep the area clean by gently cleaning with soap and water. What’S not normal: If your scar is red, oozing or smelling, contact your doctor. You could have a postpartum wound infection, which affects up to 10 per cent of women. It can be treated with antibiotics.
Breast pain What’S normal: after delivery, your breasts will fill with milk and become engorged. often, it is difficult for newborns to help relieve the engorgement because they can’t yet suck hard enough to empty the breasts. Some babies also have problems latching, which can cause mothers to have bleeding or cracked nipples. Both conditions are painful. For engorgement, use tylenol or advil. You can also use cool cloths or even cool cabbage leaves to relieve the pain. try expressing milk by hand or pump and you should see an improvement fairly quickly. If you have cracked or sore nipples, see a lactation consultant or go to a breastfeeding clinic to make sure you are breastfeeding properly. otherwise, the pain will worsen. What’S not normal: Call your doctor if your breast is sore, hard and red or if you have a fever. this could be an infection called mastitis, for which you might need antibiotics.
’s Labour & birth Guide
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HERE’S WHAT OUR READERS SAID ABOUT THEIR LATE PREGNANCY EXPERIENCES.
Says! Netflix & chill?
2%
HAD TO STOP WORK
70% LIKE A BIRD 48% of women experienced the legendary ‘nesting instinct’ – a burst of energy and strong drive to have everything ready before the birth. “I wanted to clean floors with a brush!” –MONICA, EDMONTON, ALTA.
“I have the feeling I need to purge.” – JACQUELINE, TORONTO, ONT.
because of doctor’s orders 2% were stay-at-home mothers 30
“I was laying flooring the day my water broke!”– REBECCA, GORES LANDING, ONT. “There was a lot of vinegar and baking soda happening.” – FIONA, MISSISSAUGA, ONT.
of survey takers said they had taken a childbirth/prenatal class or that they planned to.
Thank you,
OH BODY PILLOW There’s nothing like a body pillow to prop up a swelling third-trimester belly. Indeed, 2/3 of respondents used one.
Shutterstock/© Halfpoint/ © krisArt
55% of respondents said they planned to take time off from work before their due dates. 33% said they’d work throughout the pregnancy
’s LABOUR & BIRTH GUIDE
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