A Father’s Day Gift – Skin to Skin from Birth: A Guide

I once took a workshop with the amazing Gena Kirby about the natural mammalian instincts that occur during the birth of a child. Given the freedom and absence of intervention, a woman most often will stand, squat or kneel to give birth to her baby. She will gently guide her baby’s entry into the world and slowly lower her baby to the ground. She will take her time to catch her breath, reconnect with her surroundings and those with her, and then lastly will acknowledge her baby. 

pregnant couple

We have done an amazing job in our community of educating, encouraging and providing the opportunity for women to do skin to skin with their babies right after birth, but what if a woman isn’t ready to receive her baby? It’s so much more common than we acknowledge. And unfortunately, without knowing this, women often feel like there is something wrong with them if they don’t have that ecstatic moment of utter connection to their little being right away. Giving women time to absorb their reality and giving partners the opportunity to be a part of the beginning of a brand new life is a win-win for all.

So the baby is just born and automatically the midwife or doctor will bring the baby up onto the mother’s belly (except in special circumstances). The umbilical cord continues to pulsate (pumping red blood cells and other great stuff into baby) and everyone oohs and aahs. Maybe everything seems frantic, maybe mom’s eyes are still closed and she is catching her breath, maybe the parents have no idea what to do next. It’s all good. Now imagine it’s you. Stay where you are and listen to what you and your body need right now. Maybe it’s connection, maybe it’s to be left alone. Maybe both your partner and the baby need connection - and you don’t have it in you right now to provide that. There’s many great reasons why that’s okay to let your partner do the parenting right now. Your doula will know that now is the time for your baby to be skin to skin with dad or partner but it may be a great idea for your birthing team (including your partner) to know that you are okay with your partner having that privilege to start. 

Skin to skin means having your baby naked (not wrapped in a blanket) and placed directly skin to skin on either your chest or your partner’s chest immediately after birth, for as long as possible.

So dads and partners, don’t worry about hairy chests, thin chests or big chests. The baby is happier just having its temperature more stable, its heart and breathing rates more stable, and hearing the familiar thump-thump of a heart beat. Skin to skin with both parents allows the baby to be colonized to the parents’ bacteria which strengthens its immune system. This, plus breastfeeding, are thought to be important in the prevention of diseases. Some other great facts about skin to skin include:

Dad preemie skintoskin

  • Even babies on oxygen can be cared for skin to skin. This helps reduce their need for oxygen, and supports good breathing.
  • The baby is more likely to latch on well to the breast.
  • The baby is less likely to cry.
  • The baby is more likely to breastfeed exclusively longer

And for those who give birth by caesarean, your partner will be invaluable to you and your baby in the operating room. Although mothers are sometimes now given the opportunity to provide this kind of skin to skin support to their babies on the table, it’s still an unfortunate rarity. So dads and partners, take this opportunity to get a stable chair to sit in and place the baby right skin to skin in the operating room. Dads and partners can prep for the baby’s caesarean birth by wearing a button down shirt and putting the hospital gown on with the ties in the front.

IMG 9984sm

Interestingly enough, studies also show that a father’s involvement from birth leads to

  • fewer behavioural problems
  • higher educational achievement 
  • higher self esteem and satisfaction
  • More satisfying sexual relationships
  • Lower criminality and substance abuse
  • Better friendships with better adjusted children

So here's the "how to do it" part: 

1. Place your naked baby’s chest directly on your naked chest in a vertical position. Don’t worry about hairiness – it’s soft and better than stubble. 

2. Allow your baby to turn its face to one side or the other, keeping its chin slightly lifted and airway open.

3. Allow your baby to stay in this position as long as it would like (preferably for at least the first 1000 minutes). Newborn procedures like checking temperature, heart rate, breathing, giving the Vitamin K injection and others can be done while skin to skin. At some point you may want to weigh the baby, but that can wait until after the baby has breastfed and then the baby can go back onto one of the parents’ skin again.

dad skintoskin

Preparing for Parenthood When You Have a Disability

From our guest blogger Ashley Taylor, disabledparents.org

disabilityWhen the blue line appears or the agency calls to announce the good news, your first thought is probably exultation — your family’s about to get bigger! But then… the doubt, anxiety and fear creep in. After all, you want to be the best parent possible, but. oh. my. goodness! You’re about to be responsible for the care of a helpless newborn. Yikes!

All new parents experience these crazy emotions—and when you have a disability to compound the changes, your stress may double or triple. But it doesn’t have to. The first few weeks after your baby’s arrival are the most challenging, but planning your new life, adapting your home, and setting up a dependable support system, should facilitate a smooth transition to parenthood.

Mental preparations

Not much trumps snuggling with a newborn. A newborn brings powerful joy—and sleepless nights, complete chaos, feelings of inadequacy, and worry that you’re doing it wrong.

Make a plan to take care of yourself during those early weeks—self-care is critical to maintaining your sanity. Whether it’s a cup of tea or an hour out while she hangs with the sitter, make time to rejuvenate your spirit. Know what helps you relax before your baby arrives, so that it’s easy to request assistance, plan a weekly lunch date, or schedule that house cleaning.

If you’ve got very little experience with brand, new tiny humans, educate yourself. Learn how to establish routines. You’ll quickly discover that just when you get the hang of things something changes. But, a plan and a healthy sense of humor go a long way to helping you feel prepared.

Acknowledge your limits. With a physical disability, it’s best to determine ahead of time what you can and can’t do, where you’ll need the most help, and how to adjust for everyone’s safety.

Home adaptations that make childcare easier

While your specific disability will dictate the changes you’ll need before the peanut arrives, here are some suggestions:

  • Replace steps with a ramp with railings on both sides; or add a ramp and keep the steps.
  • Use expandable hinges for doorways — a much more cost-effective way to increasing the width by 2-inches.
  • Installing skid-resistant flooring to prevent slips in the bathroom, kitchen, stairs and other uncarpeted rooms.
  • Replace door knobs with lever handles.

If you find that your home requires more extensive modifications, there’s a wealth of information and resources available. This article on home remodeling for parents with disabilities from Redfin.com is a great place to start.

Get the right equipment

Babies require an insane amount of stuff. From high chairs to changing tables and monitors to diaper genies, it won’t be long before your home resembles a baby supply store. This equipment does make child care easier, and more companies are recognizing the importance of designing equipment that works for people with or without disabilities.

Parents, who are hearing-impaired, can purchase baby monitors and alarms with flashing lights. High chairs have a variety of options, many of which are adjustable and include easily removable and cleanable lightweight parts.

Adjustable cribs are a boon for parents who use wheelchairs. These cribs also work great for changing your baby’s diaper or clothing.

Other equipment that you might consider includes:

  • Chest harness baby carriers
  • Accessible baby bathtubs
  • Accessible strollers that snap to wheelchairs
  • Breastfeeding slings
  • Boppy baby chairs and two-sided nursing pillows
  • Swivel base baby car seats

In one study, disabled parents named night care, bathing, and carrying babies as their biggest challenges. The study also concluded that furniture adaptations, assistance from caregivers and other supports make infant care absolutely doable.

Resources are out there. Don’t be afraid to reach out. Talk to your doctor, find a support group, and take classes to help you learn skills and tricks from others with similar experiences. And as your new life unfolds, embrace and enjoy the wonder and new memories you’ll make.

Photo Credit: pexels.com

Guest Blogger Ashley Taylor is a disabled mother of two wonderful, amazing, energetic children. She met her husband, Tom, while doing physical therapy. Tom had suffered a spinal cord injury due to a car accident and uses a wheelchair for mobility. Ashley and Tom knew they wanted children and knew they would have to adapt their lives and home in order to make this dream come true. Ashley is happy to say that they are the proud parents of two healthy, wonderful children and their disabilities haven’t stopped them from leading a happy, fulfilling life.

Celiac Awareness

Notice how the definition doesn’t say anything about digestive symptoms?

Celiac disease is estimated to affect approximately 1% of the population but many people suffer for years without a proper diagnosis due to the wide variety of possible symptoms. Undiagnosed celiac disease can have a significant impact on your quality of life and long-term health so it’s important for us to spread awareness and ensure this doesn’t happen to you!

celiacribbon

What is celiac disease?
The Canadian Celiac Association defines celiac disease as “a multi-system autoimmune disorder that is triggered by ingestion of gluten (a protein in wheat, rye and barley) in genetically susceptible individuals.” Do you notice how the definition doesn’t say anything about digestive symptoms? In all individuals with celiac disease, gluten damages the absorptive surface of the small intestine leading to poor absorption of nutrients. However, patients can present with either intestinal symptoms or non-intestinal symptoms (or both!).

celiac diagram

What are the symptoms of celiac disease?
The most common symptoms associated with celiac disease are: chronic diarrhea, abdominal pain, weight loss, and malabsorption. It can be diagnosed at any point in your life and is not just a childhood disease. In children, it is essential to screen for celiac disease if they are experiencing failure to thrive (not following their expected growth curve). 

One of the most common misconceptions about celiac disease is that the above symptoms MUST be present for a diagnosis to occur. This is not the case. The theme for Celiac Awareness Month this year is #GoBeyondTheGut. We need to start recognizing that celiac disease can be present without the classic digestive symptoms. Here is a list of just a few of the non-classical symptoms of celiac disease: 

Chronic fatigue• Chronic constipation
Recurrent Vomiting 
Iron Deficiency Anemia
Osteoporosis 
Infertility
Dental enamel defects
Neurological problems, such as peripheral neuropathy 

What is the testing process for celiac disease?
Talk to one of our Naturopathic Doctors about doing the screening blood test. If the screening test comes back positive, you’ll need to see your medical doctor for a referral to a gastroenterologist so that you can have an intestinal biopsy done to confirm the diagnosis. Celiac disease cannot be definitively diagnosed based on the screening blood test alone! 

Can’t I just try eating gluten free and see if I feel better?
Unfortunately, the answer to this question is no. First of all, you must be eating gluten to be accurately tested for celiac disease. If you start on a gluten free diet and then notice symptom improvement, you would have to start eating gluten again (often for up to 3 month) to get an accurate test result for celiac disease. For this reason, it’s ideal to get screened for celiac disease before starting a gluten free diet.  

You might be wondering why it would be necessary to go back on gluten to get a proper diagnosis if you’re feeling better anyways. Couldn’t you continue on your gluten free diet without a confirmed celiac diagnosis? Although following a gluten free diet is becoming increasingly popular, a gluten free diet by choice is very different than the gluten free diet that must be followed for the treatment of celiac disease. When you are diagnosed with celiac disease, your gluten free diet must be strict, life-long, and avoid even small amounts of gluten cross-contamination. It is important to have the proper diagnosis so you can follow the correct diet. 

celiac GF
 
How does this compare to non-celiac gluten sensitivity?
If you’ve tested negative for celiac disease but still feel strongly that you react negatively to gluten, you might have non-celiac gluten sensitivity (NCGS). There seem to be a subset of people who test negative for celiac disease but still develop symptoms when they consume gluten. 

The difference between celiac and NCGS is that people with NCGS have no celiac antibodies and no intestinal damage. There are also no biomarkers for the diagnosis of NCGS. The only way to be diagnosed with NCGS is to rule out celiac disease and then follow a gluten-free diet. If your symptoms resolve on a gluten-free diet, there’s a good chance you suffer from non-celiac gluten sensitivity. 

Do you read this and wonder if you should be tested for celiac disease? Or if your child or another family member should be tested? Book an appointment with one of our naturopathic doctors to find out whether testing is right for you. Our naturopathic doctors can also support you in starting a gluten free diet in a safe and healthy way. Check out Dr. Emily’s blog post from last year’s Celiac Awareness Month to read more about the gluten free diet and how a naturopathic doctor can support you! 

References:

Canadian Celiac Association. Retrieved from: https://www.celiac.caRashid M, Lee J: Serologic testing in celiac disease: Practical guide for clinicians. Can Fam Physician. January 2016 62:38-43. Retrieved from: http://www.cfp.ca/content/62/1/38.full

DrEmilyCasey squareDr. Emily Casey is a Doctor of Naturopathic Medicine at The WOMB Burlington.Through her own health journey, Dr. Emily has learned the importance of individualized treatment and healing the whole person. She believes strongly that your overall health begins with a healthy digestive system. Dr. Emily enjoys living an active life, including swimming and running, drinking tea, and she is always on the lookout for new and delicious gluten-free food!

No more sniffling, sneezing, itchy kids!

Preventing and Treating Your Child’s Seasonal Allergies

When springtime comes around, we want your kids to be able to play outside and enjoy the beautiful warm weather! But when your child suffers from seasonal allergies, outdoor play becomes much less fun. Did you know that seasonal allergies can be prevented and treated naturally with the help of a Naturopathic Doctor?

Why seasonal allergies?

allergies child

Seasonal allergies are the immune symptoms that develop with exposure to an environmental allergen, such as grass, pollen, weed pollen, tree pollen, animal dander, dust mites, mould spores, and more. In Canada, allergy season usually starts in April and can continue all summer and even into the fall depending on the type of allergy and the severity. By avoiding triggers, supporting the immune and digestive systems, decreasing inflammation, and consuming natural anti-histamines, we can see great improvements in allergy symptoms in children (and adults too!). Let me lay them out for you:

Avoiding Triggers

This can be the most challenging strategy with environmental allergies but the more information you can gather, the better you’re able to understand and avoid these triggers. 

Talk to an allergist (this requires a referral from your medical doctor) to get proper testing for your child. Figuring out your child’s specific allergy helps you better understand how to minimize their exposure to the allergen. 

Consider food sensitivity testing. Eliminating your child’s food sensitivity from their diet will support their immune system function, digestion, and decrease excess inflammation. The fewer allergens the body has to deal with at one time, the better. A Naturopathic Doctor can support you with getting testing, interpreting the results and establishing a supportive and appropriate diet for your child.

Supporting the Immune and Digestive Systems

Seasonal allergies are associated with an overactive immune system. Luckily, we have great options for balancing your child’s immune system. We can start with supporting the foundations of health, including sleep, stress, diet, and activity level. Then, we can consider the addition of the following two nutritional supplements. 

Vitamin D. Low levels of Vitamin D are associated with seasonal allergies. Proper supplementation can help avoid a deficiency and support the immune system. 

Probiotics. A large part of the immune system is located in the gut. Probiotics are an effective treatment for improving digestion and decreasing symptoms of seasonal allergies. 

allergies child2

Decreasing Inflammation 

When the immune system becomes overly reactive, it can cause excess inflammation in the body. Focusing on your child’s diet with the following recommendations is a great way to manage inflammation and improve allergy symptoms. 

Omega 3 fatty acids. Aim for at least 3 servings of fish per week. It can also be beneficial to consider an additional fish oil supplement to get the therapeutic dose of omega 3 fatty aids.

Bioflavonoids. These are the colourful compounds in fruits and vegetables. Work on ensuring your kids get 5-8 servings of fruits and veggies daily.

Limit added sugar. Sugar decreases the immune system's ability to function and can be even more inflammatory. It is recommended that children get no more than the equivalent of 6 tsp or 25g of sugar daily. Check your food labels for sugar added - sugar comes in many different names and forms!

Consume Natural Anti-Histamines

Did you know that anti-histamines don’t only come in the form of a pharmaceutical medication? We can find them all around us! Three amazing natural anti-histamines are vitamin C, quercetin, and stinging nettle.  Vitamin C. Aim to give your child Vitamin C from whole fruits and vegetables or from an added supplement, as opposed to fruit juices (which are high in sugar). Fruits and vegetables that are high in vitamin C include bell peppers, citrus fruits, and strawberries. 

Quercetin. This is a bioflavonoid found in most red, green, and purple fruits and vegetables, including apples, berries, tomatoes, and leafy greens. It is also available in supplement form.

Stinging Nettle. Consume nettle leaf as a tea for its beneficial effects of decreasing allergy symptoms. It has a mild flavour and is often well tolerated by kids. If not, you can try making it as an iced tea and add some honey and lemon for added flavour. 

As you can see, there are lots of natural options to reduce seasonal allergy symptoms in your kids! Also, many of these ideas are safe and effective during pregnancy and while breastfeeding. Book an appointment with one of our naturopathic doctors for more information on how you can treat your allergy symptoms. We want to help you and your kids get outside and enjoy the sun this season!

DrEmilyCasey squareDr. Emily Casey is a Doctor of Naturopathic Medicine at The WOMB Burlington.Through her own health journey, Dr. Emily has learned the importance of individualized treatment and healing the whole person. She believes strongly that your overall health begins with a healthy digestive system. Dr. Emily enjoys living an active life, including swimming and running, drinking tea, and she is always on the lookout for new and delicious gluten-free food!

Our Roots: Who Are We?

Why WOMB?

I think there comes a time in every person’s life when the age-old question starts to lurk in the back of their mind, ‘Who Am I?’ That nagging feeling that asks, now that I’m a parent, now that I have my dream job, now that I’m coming off of maternity leave, what defines me? Who am I becoming? Where am I going? IS THIS MY LIFE? 

Some would call this a crisis of the soul. Some would call this an awakening. Some would call this just part of life’s journey. Well, this is where The WOMB is in its life – on a path that twists and turns and sees something beautiful around every corner. Sometimes that path is strewn with rocks and sometimes it is as smooth as baby’s bottom (I couldn’t resist). Either way, the journey has made us sit back and ponder, “Who is The WOMB?” and “Why WOMB?”. And here is what we came up with.

tree roots

At its ROOTS, The WOMB grounds us. Its roots provide our foundation and nourish our vision and mission. They are our cause, our source and our origin of being. Today, these are our 5 core ROOTS:

1. LOVE & CONNECTION:

007 DuforFamily HRM 1

Love and connection are expressed in our relationships with our family, our team, our community, our earth and most importantly with ourselves. Love and connection nourishes, nurtures, and supports these relationships through compassion, communication, kindness, respect, inclusivity, synergy, faith and trust. As Brené Brown says in her book The Gifts of Imperfection, “Love is not something we give or get; it is something that we nurture and grow, a connection that can only be cultivated between two people when it exists within each one of them – we can only love others as much as we love ourselves.” 

So find your connection at The WOMB, first with yourself through your yoga and meditation programs, counseling and healing services, then with your community in Emerging Mothers Groups, drop-in groups, fitness and workshops.

2. INSPIRATION, TRUTH & AUTHENTICITY: 

pregnant outdoors person 54634

Expressing and connecting to our individual nature and essence allows us to each grow, develop, learn and evolve into the people that INSPIRE our families, friends, community and especially our CHILDREN. With kindness and compassion, awareness, inclusivity, integrity and wisdom, we can inspire the next generations to be true to themselves too. This means being REAL. This means not only allowing ourselves to fail, but also accepting our failures as part of being human, and then evolving and learning from them. It means being courageous in times of transition (don’t we all know transition!), trying new things, being vulnerable and reaching out for support when needed. It means remembering that Facebook and Instagram are just “highlight reels” and that “sleeping through the night” often means different things to different people. It also means acknowledging that families come in different shapes, sizes and make ups, such as LGBTQ, surrogacy, adoption and mixed. So be courageous. Be your own kind of person, your own kind of parent, your own kind of beautiful. There’s lots of THEM but only one YOU. And what your family needs is YOU.

Connect to your own spirit in The WOMB’s yoga and meditation classes, understand your own individual expressions of being in Birthing from Within and HypnoBirthing® courses, gain wisdom in The WOMB Talks Pregnancy, Birth & Parenting workshops or just drop in for a tea. Oh! Maybe even a massage while The WOMB looks after your little one(s)!  

3. GRATITUDE & GIVING BACK: 

guatemala Woman and child

This one is big for us. The vision of The WOMB began with 2 women, but it has grown to encompass whole communities of love that have nourished us too! We are so grateful that you’ve not only given The WOMB your support, you have trusted us with the support of your families and referrals to your friends. You have also come together in times of need to support others in our community who are in of love and a helping hand. Because of your generosity and our desire to 'pay it forward', we’ve chosen to put together what we call our “Angel Fund”. It is a fund that sees the light in every darkness by supporting families with services that they couldn’t otherwise afford or access. It means being able to provide breastfeeding support to women in hospital ICUs, gathering resources for brave women in shelters who have left everything behind to escape an abusive situation, providing in-home counselling sessions through our Well-Mama Program with Counting Butterflies, and providing pelvic floor rehab to refugees without any means of payment. These are just a few examples of how The WOMB has helped in the past. But there is so much more we can do! Our founders are currently working with a group in Guatemala to open a home that would provide birth and postpartum support to women who have experienced rape and incest. Please contact us if you would like to support this WOMB initiative. More info is coming!

4. PRESERVING MOTHER EARTH: 

action adult adventure 701016

Since I became a mother, it was as if a lion took over my psyche and changed the fire within me. I suddenly was protective with all my being. My children are my roots, my legacy, my life-giving aspect of nature and I was their sustainer of life. It’s marvelous to me that this is exactly how our earth must feel about us. She protects us by providing life-supporting air, nourishes us with water to hydrate and land upon which to sow our crops. Thus, at The WOMB we believe it is our sacred and divine duty to respect our mother earth, preserve her legacy, conserve her resources and keep it as clean as possible. We use hand towels at The WOMB, organic products whenever possible, cold water in our washing machines to save energy, recycle waste products and never forget to thank her loving and giving spirit. She in return provides us with health and nourishment! 

5. LEARNING & EVOLVING:idea

This root very much ties into our deep belief that when you know more, you do better. We acknowledge that learning is a life long process. It means growing in awareness, taking the opportunities for education, developing intuition, living by our own core values, and listening to our inner wisdom. The opportunity to learn and evolve is everywhere. From moments of complete epic meltdowns in the arms of your doula, to laughter and hilarity in an Emerging Mothers Group. There may be moments of seeking your heart’s deepest questions in childbirth preparation classes or moments of pure evidence-based treatments with your health care practitioner. The WOMB believes in the evolution of the whole person, so find your learning opportunities in the physical, emotional, mental and spiritual support The WOMB lovingly provides to you and your family every day.

So WHY WOMB? Well because The WOMB believes in YOU and your full potential. The WOMB believes in your flaws and your strengths, and loves you for both. The WOMB believes that you can evolve, grow, develop and BE your own person – just as it continues to grow, develop, evolve and support its own roots. So I’ll see you soon, right? I’ll be the one with the tea in hand and the sign over our door that says, “Free Hugs”. Take me up on it. 😊

AngieStenback3Angie Stenback is Co-Founder of The WOMB, a Birth and Postnatal Doula, Childbirth Educator, Pre- & Postnatal Fitness Trainer, mother to 4 amazing kids and wife. When not at The WOMB, she can be found most often in the hockey rinks, her "taxi" or the dance studio. She heeds her heart's call by practicing yoga, meditating, dancing or spending time amongst the trees on a hiking trek.

Pregnancy-related Pelvic Girdle Pain:

Embrace the Evidence and Move beyond Biomechanics

Originally published in the Journal of Yoga and Physiotherapy
Volume 3 Issue 5 - January 2018

Sinéad Dufour, Assistant Clinical Professor, School of Rehabilitation Science, McMaster University, CanadaSubmission: January 17, 2018; Published: January 24, 2018*Corresponding author: Sinéad Dufour PT PhD, Assistant Clinical Professor, School of Rehabilitation Science, Director of Pelvic Health, The Worldof My Baby (WOMB), McMaster University, Canada, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

back pain pregnancy

Opinion:

Imagine you are 32 weeks pregnant with your first child and you start to have pain in the low back and pubic area when you change position, sit or stand for longer periods. The painmakes it very difficult for you to function and you worry about whether you can continue to work and manage your household.You are also concerned about the upcoming birth of your baby and whether you will be able to care for your baby, an often seemingly overwhelming task without having to deal with pain. Now imagine you have seen your health care provider and havebeen told that your pelvis is separating because of the “pregnancy hormones” and that you need to put up with this until after you have your baby, as “it will probably get better afterwards”. Imagine you are also told, to be careful because “your pelvis is unstable”. These are common words of advice or explanations pregnant women with pelvic girdle pain (PGP) receive from their healthcare providers, including physiotherapists. These words are not substantiated and do more harm than good.

Pelvic girdle pain (PGP) is defined as a specific type of low backpain that can occur with or without additional low back pain [1].Pregnancy-related PGP is a specific category of PGP impacting women in the perinatal period and differs in its etiology as it is related to pregnancy and associated biopsychosocial influences.It represents a prevalent condition with an incidence as high as 46-58% [2]. The cause of pregnancy-related PGP is complex and multifactorial [1,3]. Evidence has shown an alteration in motorcontrol in pregnant women [3] and more recently, central pain mechanisms have been considered and implicated [4-7]. As such,to appropriately address the complexity of pregnancy-related PGP, physiotherapists and others must both acknowledge and part with common yet unsubstantiated beliefs surrounding the concept of “pelvic instability” [8]. Instead, current advances in pain science support the notion that pregnancy-related PGP represents sensitization of the structures of the pelvis [4-7].Thus, attention must move away from biomechanics and engage the multiple underlying mechanisms such as the stress system (HPA axis) and associated coping, inflammatory load, status (HPA axis) and associated coping, inflammatory load, status of the gut microbiome and sleep quality to name a few [5-9]. Despite the evidence supporting the need for a biopsychosocialperspective, recent research demonstrates that when it comes to pregnancy-related PGP, physiotherapists continue to preferentially use a biomechanical approach [9,10]. Guidance for an evolved evidence-informed approach is available from the the most recent published CPGs for pregnancy related PGP [4]. From an assessment perspective, Clinton et al. [4] indicate the use patient reported outcomes as an important way to capture the various assessment domains relevant to pregnancy-related PGP[4]. Specifically, among other scales, the Pain Catastrophizing Scale (PCS) is recommended [4]. The PCS has three subscales:- rumination, magnification, and helplessness and has been utilized in various populations, including the antepartum population [11,12]. Using an outcome measure like the PCS is important to aid physiotherapists and others in assessing the mental processing that is associated with pregnancy-related PGP. The significance of patients’ beliefs and perceptions about their pain and their pain experience has been well demonstrated across a wide spectrum of orthopedic conditions including in the antepartum population [13]. Perception of pain has also been linked to the development of persistence [14-16], an important consideration for pregnancy-related PGP.

preg relaxation

From a management perspective, it has been shown that pregnant women’s expectations of care are not met and that their knowledge about how to manage the condition is lacking [17]. Further, a recent qualitative study elucidated women’s experience of care for pregnancy-related PGP highlighting the importance of perceived hope and self-efficacy [18]. Thus cognitive care strategies that focus on pain neurophysiologyand stress response education [4,6], mindfulness-based stress reduction [19], and tailored exercise [3,4,6] are advocated.

Science has evolved and to clearly guide practice well beyond a biomechanical approach where pregnancy-related PGP is concerned. Physiotherapists well-positioned to educate PGP is concerned. Physiotherapists well-positioned to educate and empower women so they understand how to interpret and respond to the pain they are experiencing. Knowledge translation efforts to support the provision of evidence-informed care herein are needed.

References

1. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B (2008)European guidelines for the diagnosis and Treatment of pelvic girdlepain. Eur Spine J 17(6): 794-819.
2. Rost CCM, Jacqueline J, Kaiser A, Verhagen AP, Koes BW (2004) Pelvicpain during pregnancy. a descriptive study of Signs and symptoms of 870 patients in primary care. Spine 29(22): 2567-2572.
3. Stuge B (2012) Pelvic girdle pain: examination, treatment, and thedevelopment and implementation of the European guidelines. Journal of the Association of Chartered Physiotherapists in Women’s Health111: 5-12.
4. Clinton S, Newell A, Downey P, Ferreira K (2016) Pelvic girdle painin the antepartum population: Physical therapy clinical practiceguidelines linked to the international classification of functioning,disability, and health. section on women’s health and the orthopaedicsection of the American physical therapy association.
5. Bergström C, Persson M, Mogren I (2016) Sick leave and healthcareutilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum. Chiro& Man Ther 24: 7.
6. Smith MC, Ramirez LO, Clarke G, John FC, Higgins MF, et al. (2017)Stress reduction therapy improves symptoms of pregnancy-relatedpelvic girdle pain and reduces salivary cortisol. Irish Pain SocietyAnnual Research Conference, Aug 26th, Galway, Ireland.
7. Felice VD, Moloney RD, Cryan JF, Dinan TG, O’Mahony SM (2015) Visceralpain and psychiatric disorders. Mod Trends Pharmacopsychiatry 30:103-119.
8. O’Sullivan PB, Beales DJ (2007) Diagnosis and classification of pelvic girdle pain disorders – Part 1: A mechanism based approach within a biopsychosocial framework. Man Ther12(2): 86-97.
9. Shoskes DA, Wang H, Polackwich AS, Tucky B, Altemus J, et al. (2016) Analysis of gut microbiome reveals significant differences between men with chronic prostatitis/chronic pelvic pain syndrome and controls. J Urol 196(2): 435-441.
10. Vandyken C, Hilton S (2012) The Puzzle of pelvic pain: a rehabilitation framework for balancing tissue dysfunction and central sensitization - a review of treatment considerations. J Wom Health Phys Ther 36(1): 44-54.
11. Dufour S, Daniel S (2018) Understanding clinical decisio making: pregnany-realted pelvic girdle pain. J Wom Health Phys Ther IP.
12. Bergbom S, Boersma K, Overmeer T, Linton SJ (2011) Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. Phys Ther 91(5): 754-764.
13. Grotle M, Garratt AM, Krogstad Jenssen H, Stuge B (2012) Reliability and construct validity of self- report questionnaires for patients with pelvic girdle pain. Phys Ther 92(1): 111-123.
14. Vøllestad NK, Stuge B (2009) Prognostic factors for recovery from postpartum pelvic girdle pain. Eur Spine J 18(5): 718-726.
15. Noren L, Ostgaard S, Johansson G, Ostgaard HC (2002) Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J 11(3): 267-271.
16. Ostgaard HC, Zentherstrong G, Roos Hansson E (1997) Back pain in relation to pregnancy: a six-year follow up. Spine 22(24): 2945-2950.
17. Crichton M, Wellock V (2008) Pain, disability and symphysis pubis dysfunction: women talking. Evidence Based Midwifery 6(1): 9-17.
18. Stuge B, BerglandA (2011) Evidence and individualization: Important elements in treatment for women with postpartum pelvic girdle pain. Physiother Theory Pract 27(8): 557-565.
19. Crisp CD, Hastings Tolsma M, Jonscher KR (2016) Midfulness-based stress reduction for military wome27: 557-565.n with chronic pelvic pain. Mil Med 181(9): 982-989.

Gratitude for the Gift of Life

A Blessingway Start

Kuepfer Tammy Maternity 2015 Apr 12 18 Edit WEB 2

Life is full of gifts. Receiving life in the form of a child, is one of the most beautiful of them. I have four of these gifts in my life and with each one, I’ve learned something along the way. And for each of these lessons, whether challenging or easy, I am grateful. 

My first son taught me about the unknown. Standing at the threshold of a new life I pondered: How do I give birth “the right way”? Is my relationship with my partner ready to be “ruffled” by a new soul in the house? When will my child arrive? Will I be a good mother? In the end, his gift to me was that of fulfillment – I was finally a parent. 

My second child, I will admit to you, was brought into the family so our first wouldn’t be an only child. I couldn’t help but worry that if something happened to us, our first would be left alone. We couldn’t do that to him. So, my second taught me “family”. He taught me that “special time” was time together – not time individually. We were a unit bigger than just me, my partner and a child. We were a pride, a gaggle, a herd. BUT I also learned that looking after two children is challenging (to say the least!) and can’t be done alone. You will sacrifice your whole being if you don’t have any supports or resources in place. You will need your circle of support to remind you that even in those moments when you believe with all your heart that “I wasn’t meant to be a mother”, they will be there to tell you, “Ya, I felt that way too!” 

michkeith

With the arrival of our third son, I relaxed finally into parenthood. My first two could play together and I could sit back with my newborn on my chest and just watch and spectate the beauty of their interactions and glory in different personalities and passions. I saw myself no longer as someone “trying” to be a mother, trying to meet someone else’s standards, to do it in a blogger, Baby Center kind of way. Instead I stopped caring what anyone else thought and listened to my own intuition and what was right for me. 

Having a fourth child just solidified that belief that intuition is the success to my parenthood. I know my children best (despite what google or someone in the grocery store says), I know their ins and outs and I know that I don’t need to force anything for them to grow, love and develop. I have said on many occasions that I wish everyone could have their 3rd or 4th baby first, to have the confidence in their heart to listen to their own wisdom and to relax into the process. So I’m writing this blog so that you can have a sample or starting point at which to begin to understand who you are as you become or grow into being a mother - a place to begin to listen to your own inner voice called intuition.

History has shown that in these beautiful times of planning, gestating and anticipating new life, people turn to things that have deeper, greater and more enduring meaning. As mothers and mothers-to-be, we stand at a threshold of unknown - searching books, sites and asking other mothers about “what to expect” physically, mentally and spiritually. Will I know how to do this? To birth, to be a good parent… Who will I be? What will the “new me” be like? 

prenatal yoga picture

What you need to know first is that allowing the spirit of “who you will become” after your child’s arrival, is a gift – probably one of the most important for yourself. Opening your heart to the unknown and allowing the process of life to unfold in front of you can be both challenging and rewarding. With a baby coming, there is so much to worry about, so much to prepare, so much to buy and have ready, so much to know! Have you ever sat back and considered what YOU need to be a mother? Write it down. Move toward it. Have you sat in a quiet room, by yourself and listened to your inner voice and just followed it? Try it. Practice it. It will be courageous of you to see what happens when you follow your own advice. 

While you await the gift of your child, another way to receive for yourself and open to your new self is by celebrating the woman-you-are-to-become through a Blessingway or Mother Blessing. Traditionally, a Blessingway (in the tradition of the Navajo) or Mother Blessing (a north American term) is a birth ritual or ceremony that celebrates a woman’s passage into motherhood. The ceremony acknowledges the changes a woman is going through in the months leading up to her baby’s arrival, and the greater impact of birth and early parenthood on her, as a person. In a close circle of women, the mother-to-be is nurtured in storytelling, adornment, gifts, blessings and food. Bead bracelets can be made, which the mother-to-be will carry with her into birth as a reminder of the strength and support her circle of women sends with her. The group can hold a red string ceremony to connect each with the other as women, and when the announcement arrives that baby is earth-side, the red string around the participant’s wrist or ankle is cut and released free. From all of this, the mother-to-be comes away with a strong sense of belonging, support and confidence that she will need as she nears the birth of her baby and after her baby is born. 

WOMBMoms

Chances are you have attended or have heard of a “baby shower”. This type of celebration is a wonderful chance to rain baby presents upon the family so they are prepared with the materials they may need for their child. A Mother Blessing can be another option or in addition to a Baby Shower. Celebrate and recognize the mother-to-be as she transforms and transitions. You don’t have to follow any set agenda or order. Mother Blessings can vary in proceedings and rituals, so choose what you would like to do in yours. You can make it as “North American” or “Granola” as you like. Receiving your gift of love, belonging and support will give you the confidence to listen to your inner voice and be the mother you were meant to be – one who can also teach your children to live the life of gratitude for their gifts and inner voice too.

AngieStenback3If you have any questions about blessingways or Mother Blessings, or would like to host one, The WOMB has space in Milton or Burlington for rent. This email address is being protected from spambots. You need JavaScript enabled to view it., cofounder of The WOMB and Doula can also help you facilitate the right ceremony for you.

5 myths to debunk that will help you go back to work and still breastfeed

It would be so nice if we could continue to stay home with our little ones, but for most of us, going back to work is a reality.

For many mothers in Canada, we are lucky to have one year of maternity leave before returning to work. But for some, they need to go back sooner and for those who do get the full year, they would like to continue their breastfeeding relationship. Many ask, “Do I need to wean just because I’m going back to work?” The answer is no. It is hard enough to be separated from your baby, so being able to breastfeed when you are together benefits both of you emotionally and physically. 

Here are my top 5 myths about breastfeeding and going back to work after the one-year maternity leave.

1. I need to stop breastfeeding when I go back to work.

Absolutely not! Yes, it may be a bit challenging at first to juggle getting back into the swing of things with working and continuing to breastfeed, but it is just an adjustment. Going back to work is an adjustment in itself anyway. The benefit of continuing to breastfeed, is that you can still renew that closeness and one-on-one time with your baby when you are home - which makes the adjustment of going back to work easier for both of you. 

A side bonus is that many children who will go to a daycare setting when mom returns back to work, will come in contact with new and unexpected viruses and germs. When you breastfeed, you pass on valuable antibodies to your baby through your breastmilk. So, although it is inevitable that your little one may get sick, they will most likely recover sooner or not get as ill if you continue to breastfeed. 

2. I will need to pump when you go back to work. 

Many women have a love-hate relationship with their pump and many haven’t pumped for months. They often wonder “When will I find time in my day to pump? Where will I pump and where will I store the milk?” Of course, this is always an option and you can speak with your employer about setting up a room for you to pump and for you to store your milk (it’s their legal obligation to do so) but you don’t need to pump. Many mothers will simply hand express a bit while away if they feel too full and just breastfeed when they are with their baby. Sure, the first few days when you go back to work may be tough and you may be a bit uncomfortable and leak a little. No problem, bring an extra shirt just in case, learn how to hand express and by the end of the week your body will adjust and you will be fine!

3. I need to start giving whole milk or formula when I’m away from my baby 

Many day cares are very accommodating with what you give decide to give your baby. If you have decided to introduce whole milk into your baby’s diet, then they can definitely provide that to your little one. But many families decide not to do whole milk or dairy and know that baby can get their fat and vitamins from food sources. There are many other options. Speak with your daycare provider about what will work. If you have decided to pump and provide that milk to your baby, you can do that. Working with a naturopathic doctor will also help you decide on alternative forms of milk such as almond, cashew, coconut, or rice milk to name a few. You can also just do water during the day and baby can just continue to breastfeed when you are together. 

4. My baby has never taken a bottle so I will need to introduce one.

This is not necessary at all. If you are going back after a year maternity leave, most one-year-olds will take a sippy or open cup. In fact, many day cares don’t want to have to deal with bottles and will encourage your little one to use a cup. Even if they never had, you’d be surprised how quickly our little ones pick things up when they are surrounded by their peers in daycare who are all doing the same thing.

5. I will need to wean breast feeds before I go back to work.

Not really. Just enjoy the time you have with your baby. By the time your baby is a year old, the number of feeds has usually decreased and on average, your baby may feed 4 times during a 24-hour period. Remember, when you go back to work you may feel full for a few days but your body will quickly adjust. And your baby will also quickly realize when they are without you that they cannot feed from you so they will find another option while you are away. 

Do keep in mind, when you and baby are together your feeding patterns may change. Many babies do what we call “reverse cycling” in which they tend to feed a lot overnight. This is usually temporary when you first return to work. Often its even your baby’s way of just staying close to you as they will miss you when you are gone. But again, your baby will quickly learn the routine. And on weekends, you can resume your regular feeding patterns. On Monday you may feel a bit full again, but your body will once again adjust! Our bodies are just so cool that way! 

Anita Arora is an International Board Certified Lactation Consultant at The WOMB. Anita’s aim is to help mothers reach their feeding goals in a non-judgmental, accepting and natural approach. Anita sees women both in clinic and in the comfort of their homes to assist them with any and all feeding issues. Anita runs a Breastfeeding Café Drop In Group every month, and leads workshops for parents-to-be and mothers returning to work on a regular basis. Her next Breastfeeding and Back to Work workshop is Thursday November 2, 2017 at 10:30am at The WOMB. 

 

Sex After Baby: What everyone wants to know, but sometimes is afraid to ask!

Nelia DeAmaral, Registered Psychotherapist and Coach for Women, & Jenny Telfer-Crum, Pelvic Health Physiotherapist

 

Six weeks after you give birth, you will visit with your care provider. Maybe your care provider gives you a thumbs up to resume “normal activities” (including sex). Maybe your care provider checked that everything was healed, or maybe not. Were you or are you ready? Do you feel an obligation to become ready because your partner wants to be intimate again? Most women aren’t and if you are still finding yourself “not ready” a few months later, you are not alone. Partners often are given the impression that once the body is mostly healed, that sex can resume. 

Let’s talk about what sex after baby is really like. This topic comes up over and over in our sessions with new moms, who are almost afraid to ask, but really want to know how to deal with this change in their relationship. Mostly everyone wants to know if they are normal, if things will be okay, and how to stay connected to their partner during this change. 

If you aren’t quite ready, that’s okay. If you are looking for ways to return to intimacy after baby, we’ve listed that too! There are good reasons for how you feel. Below are some factors that might influence when you return to sexual activity with your partner, and some strategies for when and how you return to these activities.

Let’s start by setting some normal expectations for sex after baby. Your first several times being intimate again, will likely require lots of talking, adjusting, and flexibility. It will be a time of “figuring out” and “experimenting” - not hanging from the chandeliers (but it’s okay if it is!). So NO PRESSURE! You will likely need to slow everything down. Your body will feel different and it will be your first time being sexual with this new body & your first time being sexual as a mother! It’s important to take the pressure away that this will be amazing sex, or the sex you had before (at least initially).Your body has been through a major change, and your first few times of being intimate can feel awkward and different. Most partners are very happy to be supportive as you explore these new sensations and experiences.

It is common if…..

1. You feel Pain or Fear of pain or Tension in the pelvic area: 

Your 6 week “go ahead” just means is that your tissues have the integrity needed to withstand the friction and stretching that occurs with intercourse. But vaginal tissues are sensitive after birth REGARDLESS of whether baby is born vaginally or by caesarean birth, whether you have stitches or not.

Imagine you pulled your bicep muscles in your arm lifting something – our first instinct is to bend the arm and hold it close to us. This is a guarding response to keep up safe and prevent further injury when our tissues are fragile and stretched. We rest the muscles for a couple of days, and without even thinking about it we will rub our arm where it hurts – this provides our tissues with normal sensory input (touch, friction, pressure) and helps us check in as to where any tenderness is and how it is changing. Then over the next week or two we will gradually start using our arm again to lift things, testing out how much we can lift. Within a couple of weeks you are pain free, doing your usual activities.

At the perineum and vagina, the same healing process occurs. First our muscles tighten in a guarding response to being stretched or torn (and in the case of caesarean births, tighten in response to neighbouring muscles being impacted). However, at the pelvic floor and perineum, we often don’t get the same normal input we do at other parts of our body. We aren’t often touching or rubbing this area apart from toileting, and women often don’t consciously relax the pelvic floor over time. So what we can have are tight and sensitive tissues around the entrance to the vagina.

Learning to relax your pelvic area again.

Fortunately, most women do very well with pelvic floor corrective exercises focusing on “reverse kegels”, which is teaching the pelvic floor how to RELAX appropriately. Gentle touch in this area can also help desensitize these tissues and bridge the gap between recovering from birth to returning to intercourse. Our Pelvic Health Physiotherapists can help identify where any tension or sensitivity is harboured in your muscles and how to work towards recovery. Research has shown that child birth, even with tissue trauma like an episiotomy, is not linked with long term impacts on sexual function.

How to talk to your partner: Talk to your partner about the worry, and keep talking even during sex. Notice when you tense up, practice relaxing with your breath, and ask for what you need (eg. slow down, pause, or stop for today). 

Remove the pressure for penetration right away. Many women find it helpful to use lubricant, or have touch without penetration for arousal or even orgasm. Try a different position such as a position of power (ie. woman on top) to control rate and depth of penetration.

Some women experience physical and emotional trauma during birth, and despite their efforts, their body doesn’t feel safe letting go. A couple of sessions with a counsellor can help you sort through feelings of self-blame & anxiety. The WOMB offers specialized support for healing from a difficult birth.

2. You feel too exhausted to have sex

This doesn’t mean you don’t love your partner or that your relationship is doomed.

It can be difficult to feel the desire to be intimate, when you are in the most exhausted state of your life! Early parenthood is a time of choosing between your various survival needs. Your frequency of sex will likely decrease because that’s what happens when we are exhausted! 

Give yourself time. It is normal for babies to have erratic schedules. Sometimes more sleep isn’t an option, but studies show that meditation and relaxation can have similar benefits to more sleep. Try these simple, and short meditations for moms and meditation for sleep. Many partners experience feeling loved through intimacy. What other ways do you and your partner feel loved? Maybe something you each already do without words or touch? 

3. You feel too stressed to have sex

The stress of being a new/new again mother is tremendous. You mind is busy and you might feel like you are constantly “on call” and ready to respond to your baby. Sexual arousal is governed by our parasympathetic nervous system, aka “rest and digest” system. When we are stressed, the increase in cortisol (stress hormone) decreases oxytocin (aka hormone of love). Stress also increases tension in the pelvic floor muscles - which can loop back up to tissue sensitivity. 

Focusing on bringing down your overall stress levels might make a little more space for feelings of intimacy. Either way, it will help you cope with the challenges of mothering with greater compassion and presence. Simple awareness practices can help you see yourself with more compassion, which is a proven way to calm down the fight or flight. Try this meditation for stress and anxiety. You can do it anytime. It’s quick and you can even do it while you feed baby. 

4. You feel touched out or too “called on” as an introverted mom

Being a mom, especially if you are an introvert, can leave you feeling like you have no time to be alone and recharge, which can be extremely draining. Some women don’t feel the need or desire to be touched especially because holding baby increases our oxytocin levels on it’s own, so you don’t feel you need to get that affection from your partner. 

It might sound counter intuitive to building intimacy, but sometimes you might just need some time alone. You’ll be surprised how much even 20 minutes can help you feel like yourself again. Time alone is especially helpful if you can step away and allow your partner to parent in their own way and you have specific and set times when you can expect a break. Read more about ways your partner can support you in the article A Mind-Reading Guide for New Fathers.

5. You don’t really like your partner right now or you feel like he’s a roommate

The demands of the early months of parenting can leave you both feeling a little disconnected or unusually irritated with each other. Virtually everyone goes through this. Know that you are not alone. Find small ways to connect that are doable for both of you. Many couples find that a couple of sessions with a counsellor or coach can help get them on track with communication and bonding. The WOMB offers sessions for couples. 


7. You don’t feel connected to your body, don’t love your body or wonder how your partner will love your body again: Who’s body is this anyway? 

Maybe you feel like your body has gone from being yours to providing a function for your baby, whether it’s feeding or caring for baby in other ways. It’s ok not to love your body. Try making friends with your body. Treat it as you would a tired, hardworking friend. Be compassionate with yourself. Many clients describe the relationship to this new body as an acquaintance or even a distant “facebook friend”. Talk to other women. It will help you realize that “bouncing back” is a myth.

Some women find themselves hiding their bodies from their partners for fear of judgement. Talk to your partner about this. Honesty is a true form of intimacy. What if this stage was a chance to be loved when you aren’t perfect? Imagine allowing your partner to love you, just as you are right now? Intimacy is more profound when we allow ourselves to be seen in our imperfection. For more on embracing imperfection look up the work of Brene Brown, a renowned researcher on whole-hearted living.

8. Mood Changes

This is a complex interplay of the physical, social and psychological factors listed above. You will feel good again! Medication given to help aid in post partum depression (SSRIs) can also dampen arousal and desire. It’s normal to feel sad, anxious and not like yourself. If you find that you are feeling this way more often than not, seeking support can make all the difference. Even just feeling normal and being understood goes a long way. 

Here are some quotes from fellow mothers in the Emerging Mothers Group in response to the question, “What would you tell your daughter at this stage of mothering if she felt as you do”?

“This experience makes you part of a community of women”

“Don’t be so hard on yourself”

“You are right where you need to be at this stage”

“You have done something amazing - a miracle. Give yourself time.”

“Let in your partner’s hugs. You don’t have to hide”

We hope this article was helpful. So much can be done to make this transition easier for women and families. Feel free to contact us to talk more or to book a time.

Sincerely, 

Nelia DeAmaral, RP

Registered Psychotherapist and Coach for Women

This email address is being protected from spambots. You need JavaScript enabled to view it.

647-456-2229

 

Jenny Telfer-Crum, PT

Pelvic Health Physiotherapist

This email address is being protected from spambots. You need JavaScript enabled to view it.

 


Get in touch! Give us a call at 905.842.2434, or click here to send us an email. 

Review our Cancellation Policy