Second Trimester

At all times, a midwife is on call for you. The central line is: (604) 901-7806

The central number leads to a message that will tell you who is on call and how that midwife can be reached.

FOR NON-URGENT Calls
Leave us a message. We strive to return calls in 24-48 hours. Texting and emailing is not always reliable. Please let us know what the best way to reach you is.

SERIOUS Calls
Leave a message for the midwife on call between 9am & 9pm.

• Please respect that after-hours calls are welcome if they are for urgent concerns only. 

URGENT Calls
Anytime: if you have an urgent call, call the midwife on call.

• If you don’t get a response within fifteen minutes, call again.
• If you still don’t get a response within another fifteen minutes, please try the off-call midwife.
• If you have no response from any of us, call Sechelt Hospital Maternity, inform them of your situation and ask for their help: (604) 989-6248.

LABOUR Calls

Daytime (between 9am & 9pm):

• If you suspect you may be in labour, phone the midwife on call. A heads-up call can help us to arrange our day so that we will be available when you need us later.

Nighttime (between 9pm & 9am):

• If you know you are in active labour and/or need a midwife now, please page us urgently!
• If you do not need a midwife immediately, please wait until morning.  We appreciate our chances to sleep through the night, and having a perky midwife when labour gets hard may be just what you need.

Lehe Spiegelman: (604) 603-0477
Jules Atkins: (778) 808-2959

Normalizing Blood Sugar

What are the benefits of maintaining stable blood sugar levels?

• Feel better and have more energy
• Minimize nausea
• Minimize strain on internal organs and body chemistry
• Minimize chances of hypertension
• Maintain stable internal body chemistry and prevent candida/yeast growth
• Maintain mineral stores. Sugar is associated with depleting minerals like calcium.
• Grow a smaller baby, have an easier labor, increase your chance of spontaneous vaginal delivery without the need for intervention
• Minimize weight gain without “dieting”
• Return to your pre-pregnancy/ healthy weight easier and more naturally

How can I promote normal blood sugars?

Focus on a variety of healthy foods

As always, eat a variety of wholesome foods: fresh vegetables, fruits, grains, beans, quality dairy and meat (unless you are vegan/vegetarian), as well and unrefined oils and fat.

Balance your meals

Foods should be partnered together for taste, enjoyment but also to reduce a glycemic rise.  For example, combining carbohydrates with protein (salad and fish, rice and chicken), and fruit with fat (pear with nuts, banana and yogurt).  These combinations allow sugars to be released slowly, instead of all at once.

Eat small frequent meals

Eat smaller portions more frequently.  Take the food you might normally eat in three meals and divide it into six, evenly spaced throughout the day. This can reduce digestive stress, and allow your meal to digest more easily, as well as keeping your blood sugar from having wide fluctuations throughout the day.

Be active every day

Developing a daily exercise program is as important as eating well. Being active helps in two ways. First, every time you exercise, you use up blood sugar and keep levels lower for several hours. Exercising for a few minutes after every meal (even just a ten minute walk around the block), when your blood sugar levels are elevated, is an excellent practice. Secondly, exercise that builds muscle will create more cells that use up blood sugar, even while you are sleeping.

Eat less processed, closer to whole and raw

Eat foods in their natural unprocessed form.  For example, whole fruit causes a lower blood sugar rise than fruit juice. Grains cooked until they are mushy cause a greater blood sugar rise than when they are al dente.  Processed foods are in a way pre-digested and breakdown much faster than their whole counterparts, thus quickly creating a sugar rise.  For example, white rice will digest quicker than brown rice.

Reduce stress

Reduce stress, which causes blood sugar to rise. Meditate, breathe, do yoga, get a massage, take a bath with lavender & Epsom salts, ask for support, or whatever it takes.

Take a good quality prenatal supplement

Taking a good quality prenatal supplement helps your body cope with the physiological stress of pregnancy. To help specifically with blood sugar control, choose a prenatal supplement that has about 20mg of zinc and 200 mg of chromium. Both can be toxic in large dosages, so more is not better. B-vitamins and vitamins C and E are also important.

At the same time, it is always better to get your nutrients from whole food, so do not count on your supplement to cover gaps if you are skipping meals or eating fast food.

Eat some Omega-3s every day

Make sure you get a source of Omega-3 fatty acids every day. These help the insulin in your body work to lower high blood sugar and minimize weight gain. Omega-3 fatty acids are also essential for healthy fetal and infant brain development and for preventing pre-eclampsia and premature births.

Good sources of Omega-3s include:

• a serving of cold water fatty fish such as salmon, halibut, mackerel, or sardines
• 3T of ground flax seeds
• 1T of flax oil
• fish oil supplements (DHA plus EPA)
• Grass fed meat & dairy

Choose healthy fats

Choose cold pressed olive oil, coconut oil, ghee or butter over refined vegetable oils.    Reduce the amount of harmful fats you eat, such as “vegetable oils” and fried foods. Also avoid trans-fatty acids and partially hydrogenated fatty acids, which are found in most margarines and commercial crackers, cookies, cereals, and many other processed foods.

Choose lower Glycemic Index carbs

Choose foods with a lower glycemic index [see below]. Only carbohydrate foods raise blood sugar. Protein and fats don’t. But please remember that a diet of all proteins and fats is not healthy; you need the fiber and nutrients of carbohydrate foods.

Avoid food binges

Be aware that binging – eating a lot of carbs at once, especially high GI foods like fruit, bread, and pasta – can cause sharp rises in blood sugar. Whenever you have a sugar craving or an urge to binge, think about whether you have eaten enough protein in the last day – maybe you are just hungry for more nutrients. Also consider whether you might be dehydrated, as sugar cravings can be disguising thirst.

What about low Glycemic Index foods?

Some carbohydrate foods cause a significantly higher rise in blood sugar than others do. Predicting which ones will do this is not easy, so you will need to look them up on tables of what is called glycemic index (GI).

High GI foods

Foods that cause an especially large rise in blood sugar include;

• Any bread, cracker, cookie or pastry made from wheat flour, whether that flour is white or whole wheat. Bread with rye flour as the first ingredient is better, as is bread with a significant proportion of unground grains (such as whole wheat berries or rye berries or cracked wheat), oatmeal, seeds, nuts or barley
• Most commercial breakfast cereals.
• Potatoes, especially the large baking kind. Small new potatoes, slightly undercooked, are much better
• Watermelon and tropical fruits, especially overripe ones such as bananas with brown spots on the skin. Many other fruits, including cherries, grapefruit, and dried apricots, especially if not overripe are much better. Greenish bananas are okay.

This doesn’t mean that you can never eat these foods again. It would probably be okay to eat small servings of them occasionally (like one slice of bread or one pancake, several times a week), especially when eaten with protein foods or with carbohydrates with a lower glycemic index.

Intermediate GI foods

Rice is an intermediate glycemic index food. Eating it slightly undercooked, rather than mushy, is better. Parboiled and basmati varieties are better than others. Sticky rice, puffed rice cereal, and rice cakes, however, raise blood sugar a lot. You might try substituting barley sometimes, which takes a long time to cook, but tastes great (even for breakfast), and has a very low GI. You can make enough for several days and then heat up portions in the microwave.

Low GI foods

All watery vegetables (as opposed to starchy ones like potatoes and parsnips) can be eaten in unlimited quantities. Beans are a carbohydrate food (also containing good protein) with a very low GI, and so a great food.

Adding fat or protein to your meal will lower the GI index of a higher rated food.  For example, a baked potato is a high GI food.  When eaten with butter, a salad as a side and a chicken breast, the meal becomes well balanced and wholesome.

After the Baby:  Coping with Anxiety, Depression and Intrusive Thoughts

 

Anxiety, depression and intrusive thoughts are common concerns for both women and men during pregnancy and after the baby is born.   Here are some resources that may be useful.

 

Pacific Post Partum Society

Telephone support and support groups for women suffering from depression after giving birth or adopting a baby/child.   Support is available in English, Punjabi, Spanish, and French.

Toll-free number:  1-855-255-7999  M-F  10-3

www.postpartum.org

 

BC Crisis Line

Free accessible resource – useful for parents in crisis

Toll-free number:  1-866-661-3311

http://crisiscentre.bc.ca/

 

Anxiety B.C.

http://www.anxietybc.com/

Excellent on-line resource with a special section for new mothers and parents.

 

Kelty Mental Health

Mental health resource center out of BC Children’s hospital

Toll-free number: 1-800-665-1822

http://keltymentalhealth.ca/

 

Canadian Mental Health Association

Information and resources about PostPartum Depression

http://www.cmha.ca/mental_health/postpartum-depression/#.U_qlZrad6Fw

 

Postpartum Men

Website for for men with concerns about depression, anxiety or other problems with mood after the birth of a child.

www.postpartummen.com

 

Information Children

Non-profit organization out of Simon Fraser University.  It provides information, support and referrals to parents and others on the care and well-being of children and families.

http://www.informationchildren.com/

 

Meet ups of Mums (search by city)

Find out about meet-up groups of mums happening in your community. LINKS TO COME for groups on the Sunshine Coast

 

Parent Support Services of B.C.

Parent support circles and lots of on-line information for parents.

http://www.parentsupportbc.ca/

Parent Help Line

An online resource with lots of good information and parenting tips.

http://www.parenthelpline.org/phl/home.aspx

How is your baby doing? Fetal Movement Counting is a good way for you to know!

When you are pregnant, paying attention to your baby’s movements is a very good way to tell how your baby is doing.  Most women will feel their babies move by around 20 weeks of pregnancy.  The first movements may be quite gentle, but as your baby grows, his or her movements will become stronger and easier to feel.  Women describe them as ‘kicks’, ‘punches’ and ‘rolls’.  All babies will also have times when they sleep, sometimes for long as 75 minutes, when they don’t move much.  This is normal.

By the last 3 months of your pregnancy you will know your baby’s pattern of movements very well.  You may have a very active baby, or a quieter baby.  Your baby may be most active in the morning, or at night when you are trying to sleep!  Starting at around 26-30 weeks, it’s good ‘check in’ with your baby every day to make sure he or she is doing well.  You can do this by taking some time to pay attention to his or her movements, but you don’t have to do daily movement counting unless you have concerns or your midwife has advised it.

Babies who are not doing well usually move less often, though in some cases women will report that movements are generally hard to fee and this may be due to the baby’s position or the position of the placenta. If the placenta is on the front of your uterus, you may have less noticeable movement sensations. Most importantly is a sense that the movement quality and quantity has changed. Mothers sense this change and feel that their baby is not moving as much as it was.  If you think your baby is moving less than normal, you should do a fetal movement count.  Women with risks in pregnancy such as high blood pressure, diabetes, or a history of pre-term birth may be advised to do daily fetal movement counts.  Here’s how to do a proper count:

How to a Fetal Movement Count

• Pick any time of the day that’s convenient for you.
• Lay down on your side or sit and recline.
• Count groups of movements as ONE movement: for example, two or more movements that happen together with no pause or a pause of less than half a minute are counted as ONE movement.
• Record your baby’s movements (if you are doing daily counts, you can use the record on the back of this form)
  • Make a note of the time you start counting
  • Count up to 6 movements or groups of movements
  • Make a note the time when you have counted to 6

Normal: Your baby’s movement is NORMAL if he or she moves 6 times in a very short period of time OR if he or she moves at least 6 times within two hours.

Not normal: Your baby’s movement is NOT NORMAL if the he or she does not move 6 times within 2 hours.

If your count is not normal:  If you have not felt 6 movements within 2 hours contact your midwife or the Maternity Unit at your hospital (Sechelt: 604-989-6248) or go to the hospital IMMEDIATELY.  Your baby’s movements and heartbeat will be monitored more closely to make sure your baby is healthy or to see if your baby has a problem.

Have you hired your doula yet?

Research has shown numerous benefits of having a doula, and as midwives we see these positive effects again and again. Because of this, at Suncoast we are strong advocates for doula care.

What’s a doula?

Doulas (also called Childbirth Assistants, Labor Support Professionals, Birth Assistants, or Birth Companions) provide emotional, physical and informational support during pregnancy, labor, birth and immediate postpartum.

• A Doula provides continuous, uninterrupted support throughout labor and birth. She offers information, massage, suggestions for position changes, relaxation techniques, reminders to stay hydrated and keep your bladder empty, etc.
• A Doula does not replace a partner. Instead she also helps support the partner in ways that help enhance the bond between the couple.

Why do I need a doula?

Even if you have a wonderful, caring partner, best friend, midwife/doctor, will he or she:

• Provide prenatal visits in your home?
• Bring a birth ball and other tools to make your labor easier?
• Provide massage appropriate to whatever stage of labor?
• Provide relaxation and focusing techniques?
• Suggest positions to help labor progress?
• Do the double-hip-squeeze or provide counter pressure in just the right place? Or even know what these are?
• Know how to appropriately use the Take Charge Routine?
• Suggest positions to ease back labor, aid relaxation, help with pushing, etc?
• Offer you cold/hot packs?
• Bring you drinks, snacks, ice chips?
• Stay by your side so that your partner can take a break when needed?
• Instinctually know when you would like someone to mop your brow with a cool cloth?
• Know when your request for drugs is a way of asking for more physical/emotional support?
• Stay by your head providing encouragement while you are in transition and when the baby is being born?
• Take notes during labor and provide you with a written record of the birth?
• Take photographs of you, your partner, your baby, and other members of the birth team before, during and after birth?
• Visit you at home afterwards to review the birth and see your beautiful new baby?
• Help you with breastfeeding?

What do doula services include?

• Pre-natal visits (usually two) in your home or other comfortable space
• On call guarantee 24/7 for two weeks prior to due date to two weeks after, or until baby is born (or similar variation) , with a back-up doula if needed
• Telephone support during early labor, before you need physical support
• Continuous presence once labor is established, until one or two hours postpartum
• If early labor is long, telephone support and/or home visits where appropriate to help create a coping plan
• Labor and birth positioning suggestions for comfort and labor progress
• Massage and other alternative pain relief measures
• Information on all aspects of labor for you and your partner
• Support of whatever choices you make during labor
• Photographs or videotape of birth, if desired
• Help with initiation of breastfeeding
• One or more postpartum visits, at your convenience

Additional Services may include:

• Telephone support throughout pregnancy and immediate postpartum
• Assistance with preparation of a Birth Plan that works
• Accompany mother to meet with midwife
• Private childbirth education classes in your home
• Personalized relaxation tapes for birth
• Pregnancy photography
• Belly cast
• A written record of the birth (“Birth Story”)
• Intensive postpartum breastfeeding support
• Postpartum Doula support, including overnights if desired

How do I find a doula?

Whether you just got pregnant or are already in labour, it’s never too early or too late to hire a doula

• Ask your friends and acquaintances – you’d be surprised how many people have now heard of or used a doula.
• Ask your midwives for referrals

Don’t be shy about interviewing as many doulas as you want. You want someone you are comfortable with, and who you feel will work well with you and your partner. You won’t necessarily “click:” with the first one you meet. Don’t worry, nobody will take it personally!

What about fees?

Fees range anywhere from $0 to $1000, usually depending on the experience of the doula. The average is around $600. Additional services, such as private prenatal classes, would be an added fee.

If cost is an issue, some doulas are able to offer a sliding scale to a small number of clients. Also, there are a number of doulas who are available for low or no cost. Call the Doula Services Association, who keeps a list of these doulas.

Myths about Doulas

We notice that when clients are first introduced to the idea of having a doula, there are a number of comments that come up frequently. Of course they are meant sincerely, but often come from a place of not understanding birth and/or the doula’s role. The following are grouped by theme.

I’m very private … OR … I want as few people as possible … OR … There are already going to be a lot of people (friends, family or staff) … OR … A doula will decrease the intimacy between my partner and myself

A good doula will actually make it feel like FEWER people in the room, thus enhancing the intimacy of the experience. She can do this in various subtle ways:

• Taking over the practical jobs that would otherwise take your partner away from you, fetching food, refilling your water, calling the midwife, heating hot packs, etc.
• Giving pointers as to how best provide support: back massage, cold clothes, double hip squeeze.
• Addressing the questions or fears of family/friends (whether present or on the phone) so that the laboring mom doesn’t have to

We frequently hear and see how having a doula takes the pressure off the partner to remember everything about every stage and variation of labor and birth, and then choose the appropriate types of physical, verbal and emotional support. This way your partner can relax and enjoy the beauty of the experience, as well as discover his/her own strengths. As a client once said, “It’s like having cheat notes!”

My friend who loved her birth experience didn’t have a doula … OR … I’ve already had a baby, I know what to expect

Yes, it is possible to have a birth without a doula, but even an “easy” birth can be enhanced by a doula. For this reason, even pregnant midwives and doulas hire doulas!

If I have a midwife, I won’t need a doula … OR … My midwife will bring her student

Midwives and doulas do have much overlap in styles and skills. There are also a number of key differences:

• Increased labor support: Because a midwife’s primary responsibilities are clinical – to make sure that you and baby are safe – certain situations will take her away from focusing on just labor support
• Early labour: Midwives do not attend you until you are in active labor – 4 cms dilated and having regular contractions. If you are like many other women, chances are you will have hours of early labour – ranging from 2-24 – when having a doula to reassure and support you could be very helpful for you and your partner. Rather than navigating this time alone, you and your partner could have the additional support offered by your doula. A doula will be there when your partner needs to eat or sleep, if you run out of coping strategies, or even just need a reminder this is still normal.
• Precipitous labour: If you have a very fast labour, your midwife will be occupied with getting ready for the birth. When things need to be done quickly, a doula can be an extra set of hands that frees your partner to stay with you during this intense experience. A doula can also be the person whose voice is constantly in both your ears reminding you this is normal, just fast, and will be over soon.
• Moment of birth: As mentioned, at the moment of birth the midwife is focusing on her many clinical duties, most which are below your belly button (including reducing your chance of tearing). A doula will still be available to do all other forms of physical and/or emotional support that you and your partner may need.
• Scary outcomes: When things are not going ideally, there may be a flurry of clinical activity. A doula can stay with you and your partner/family to “translate” what is happening and help facilitate information flow. Your doula will be a grounding presence for you and your partner while your health care providers work to ensure that you and your baby are safe.

My partner will be my doula … OR … My mother/sister/best friend will be my doula

Each labor is unique in its own way. Unless your partner/mother/sister/best friend has extensive birth experience, they may not have the creative resources necessary for the twists and turns of your labor. In addition, the added element of being emotionally involved can have moments of such depth that they need to step out of the doula role. This is especially true for grandmothers (your mother)! Doulas have much more of an ability to maintain neutrality when confronted with the intensity of a laboring woman; for example, if your birth plan is to avoid drugs but your sister had three epidurals, she may not know how to support you if you have moments of doubt about your ability to continue without drugs.

My friend who had a doula still had a long, difficult labour

Having a doula does not guarantee a fast, easy labour or a vaginal delivery. It can, however, enhance your experience no matter what that is.

I can’t afford a doula

Some doulas work for low or no cost in order to get more experience. Many of these women have a natural instinct or other skills that make them excellent despite their minimal experience. The only time a newer doula would not be recommended would be if you have special or complicated birth needs, such as planning a VBAC, breech, etc.

I’m too shy … OR … I don’t have time to interview doulas

Ask your midwife for a referral – we will try to choose someone we think you will connect with. We also have a list of doulas on our website. Or you can check out Pomegranate’s Doula Speed Dating night.

I’m planning on having an epidural, so I won’t need a doula

Usually you will not be able to have an epidural until you are five centimetres dilated, so a doula can help you cope until then. Once you have your epidural, you still have much work to do to have a baby. There will be a role for a doula no matter what type of birth you have.

Midwives and doulas have been working together for centuries. Historically, doulas were women from the neighborhood who attended births and helped out a friend in need. In the last century when birth became more medicalized, the labouring woman was expected to be alone. Partners have been invited into the labouring rooms only for the past several decades. For centuries, birth was an event where families, and experienced women, supported the natural birthing process. At Pomegranate, we are invested in you having a birth where you feel safe, informed and supported. Our intention is to offer you resources so that you can make decisions that suit you and your family best.