We Would Like to Acknowledge the South Community

Connecting Pregnancy

Connecting Pregnancy Notebook

1 Acknowledgments

We would like to acknowledge the South Community Birth Program, for sharing their material to develop our manual.

2 Table of Contents WELCOME...... 3 WHAT TO DO FOR LABOUR, BIRTH AND EMERGENCIES...... 3 USEFUL PHONE NUMBERS...... 3 COMMUNITY RESOURCES...... 3 USEFUL WEB SITES...... 3 CONNECTING GROUP GUIDELINES...... 3 CONFIDENTIALITY AGREEMENT...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 1...... 3 NUTRITION DURING PREGNANCY QUIZ...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 2...... 3 SAS – RELAXATION MEASURES...... 3 SAS - COMMON DISCOMFORTS...... 3 PRENATAL BACK CARE...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 3...... 3 GROUP ACTIVITY OR SAS – THINKING ABOUT BREASTFEEDING...... 3 GROUP ACTIVITY OR SAS – FAMILY & PARENTING ISSUES...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 4...... 3 RECOMMENDED FOOD and DRINK for LABOUR...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 5...... 3 GROUP ACTIVITY OR SAS – DECISIONS OF PREGNANCY...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 6...... 3 SAS - COMFORT MEASURES FOR LABOUR...... 3 ABOUT THE CBP DOULA PROGRAM...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 7...... 3 SAS - SELF-INVENTORY...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 8...... 3 SAS - PERSONAL ASSESSMENT...... 3 COMMON NEWBORN PROCEDURES...... 3 BABY SKIN CARE AND RASHES...... 3 INFANT MASSAGE...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 9...... 3 SAS - CONTRACEPTIVE USE...... 3 CONNECTING PREGNANCY: PROGRAM SESSION # 10...... 3 ALL ABOUT MY BABY...... 3

3 4 WELCOME

CONNECTING PREGNANCY: GROUP PRENATAL CARE

“A fun and educational way to get prenatal care”

Please tailor highlighted to suit your program.

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

Every session includes:  A “baby and mom check”. Blood pressure, weight and private time with your health care provider  Time to socialize with other members of the group  Snacks  Time for discussion about pregnancy with other parents-to-be

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

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

WHAT TO DO FOR LABOUR, BIRTH AND EMERGENCIES

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

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

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

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

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

 Any concerns related to your pregnancy  Regular contractions 5 minutes apart or contractions that are very painful  A change in the baby’s movement, especially if the baby is unusually quiet  Fluid gushes from your vagina that you think isn’t either urine or normal discharge  Vomiting and/or diarrhea for more than 24 hours  Fever of more than 100.6° F(>38° C) that doesn’t go away within a few hours of taking acetaminophen (Tylenol)  Painful, burning urination  Bad headaches, vision problems (seeing spots, double vision)  Sudden swelling in your face, eyes, hands & feet  A desire to bear down or push the baby out  Severe cramps or regular contractions more than 3 weeks before your due date  Unusual environment exposure: chemical, toxic, fumes, smoke from fires  Domestic violence or sexual assault  Minor or severe motor vehicle accident  Following a fall...especially if you hit your abdomen  Breathing problems if you are asthmatic  Shortness of breath with chest pain  Heavy red vaginal bleeding that soaks through a large pad in 10 minutes time  Fainting or extreme dizziness

6 USEFUL PHONE NUMBERS

xx 24 HOUR ON-CALL NUMBER xxxxxx-xxxx local xxxxx ********ask for the XX provider on call, if you reach the message, listen for the doctor/midwife on call and their number for after hours emergency/labour ************

BC Nurse Line 8-1-1

BCAA/ICBC Car Seat Info Line* 1-877-247-5551 (Traffic Safety foundation)

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

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

Community Health Centers: XXXXX Next page

Healthiest Babies Possible 604-877-4673

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

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

Newborn Hotline 604-737-3737

Options for Sexual Health* 604-731-7803

Pacific Post-Partum Support Society 604-255-7999

Poison Control 604-682-5050

Program for Victims of Domestic Violence 604-875-4924

* see website list

COMMUNITY RESOURCES

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

LOCAL HEALTH UNITS HOSPITALS Public Health Nursing Delta...... 604-946-1121 Langley Memorial...... 604-534-4121 Cloverdale...... 604-575-5100 Peace Arch...... 604-531-5512 #205 – 17700 56 Ave Surrey Memorial...... 604-581-2211 Cloverdale Audiology #103A 17790 56 Ave 24 HOUR SUPPORT Guilford...... 604-587-4750 Crisis Line...... 604-951-8855 #100 – 10233 153 St -Support and resource services for emotional crisis, alcohol and drug Langley...... 604-539-2900 abuse, violence in the home, assault, and depression counselling. 20389 Fraser Hwy Newton...... 604-592-2000 Health Link BC...... 811 #200 – 7337 137 St North Delta...... 604-507-5400 11245-84 Ave BREASTFEEDING North Surrey...... 604-587-7900 Fraser South Health Units...... <- see phone #’s #220 – 10362 King George Hwy -General breastfeeding information and support at all offices South Delta...... 604-952-3550 -Breastfeeding Clinics 4470 Clarence Taylor Cr -Short term equipment loan at some Health Units White Rock/South Surrey...... 604-542-4000 15476 Vine Ave La Leche League...... 604-520-4623 BABYLINE...... 604-592-2229 -support as well as information on rentals or purchase of equipment (newborn only – Weekends & Holidays 9:00am – 4:00 pm)

Baby’s Best Chance Website: ENQUIRY BC (for info on all BC Gov’t...... 604-660-2421 http://www.bestchance.gov.bc.ca/ programs and Services)

CAR SEAT INFORMATION...... 1-800-247-5551 DROP-INS BCAA/ICBC info line (Supervised play and parent support groups) Handouts and information available at Health Unit Offices Aldergrove Neighbourhood Services...... 604-857-4662 Suggested website: www.childseatinfo.ca 27032 Fraser highway

CHILD CARE RESOURCE & REFERRAL PROGRAM Clover valley Family Resource Place...... 604-671-9079 Surrey Options...... 604-596-4321 Langley...... 604-533-4425 Guildford Family Place...... 604-583-3844 Surrey...... 604-572-8032 10310 154 St White Rock...... 604-542-4357 Langley Family Place...... 604-534-7921 COMMUNITY SERVICES 5339 207 St (Information on day-care, drop-ins, toy libraries, job searching, counseling, volunteer programs etc.) Newton Family Resource Program...... 604-572-8032 #103 – 6844 King George Hwy (Early Years Centre) Aldergrove Neighbourhood Services...... 604-857-4662 North Delta Deltassist...... 604-594-3455 North Delta Youth Services...... 604-591-9262 Ladner Deltassist...... 604-946-9526 11861 88 Ave Langley Family Services...... 604-534-7921 Surrey community Services...... 604-584-5811 Boys & Girls Club of S. Delta...... 604-946-3933 Surrey OPTIONS Services...... 604-596-4321 Whalley Family Place – 3 locations...... 604-580-2344 Peace Arch Community Services...... 604-531-6226

8 FOOD BANK MINISTRY OF HOUSING & SOCIAL DEVELOPMENT

Cloverdale...... 604-581-5443 Inquiries regarding income assistance and employment th 5950 179 St. services All inquiries...... 604-586-2992 Langley...... 604-533-0671 5768 203 Ave SEXUAL HEALTH South Delta...... 604-946-4430 5545 Ladner Trunk Road (Wed’s – Ladner Christian OPTIONS (Formerly Planned Parenthood)...... 604-731-4252 Fellowship) PARKS AND RECREATION

Surrey...... 604-581-5443 Delta...... 604-946-3293 10732 135 St. Langley...... 604-533-6086 Surrey (Infoline)...... 604-501-5100 White Rock...... 604-531-8168 #5-15515 24 Ave White Rock...... 604-541-2161

HEALTH INSURANCE BC SUPPORT GROUP AND OTHERS

Medical Claims and Other Inquiries...... 1-800-663-7100 Alcohol and Drug Counseling (24hr resource)...... 604-660-9382 Registration and Premium Inquiries...... 604-683-7151 Boys & Girls Clubs of Delta...... 604-591-9262 Options to Community services...... 604-596-4321 MINISTRY OF CHILDREN AND FAMILIES DEVELOPMENT Parents of Multiple Births Association...... 604-822-7486 Family Services, Child/youth Mental Health, Child Parents Support Society...... 604-669-1616 Protection, Youth and Probation, Fostering Pacific Post-Partum Support Society...... 604-255-7999 and Adoption...... 604-951-5701 STI Clinic (Sexuality Transmitted Infection)...... 604-587-7900 Diversecity Community Resource (Immigrant Serv.)...... 604-597-0205 Delta...... 604-501-3237 N. Surrey Community Health Centre...... 604-583-5666 Langley...... 604-514-2711 Women’s Place...... 604-536-9611 North Surrey...... 604-951-5844 (counseling and referral organization) Newton...... 604-501-3122 White Rock...... 604-542-3900 MCFD Aboriginal...... 604-586-4200

9 USEFUL WEB SITES

Babies Best Chance http://www.health.gov.bc.ca/cpa/publications/ babybestchance.pdf www.gov.ns.ca/hpp/publichealth/content/pubs/ 05003_breastfeed Breastfeeding Basics ingbasicsbook_aug07_en.pdf Breastfeeding Video Clips www.drjacknewman.com

Breastfeeding and Parenting www.kellymom.com

BC Women’s Hospital & Health Centre www.bcwomens.ca

Canadian Institute of Child Health www.cich.ca

Canadian Pediatric Society www.cps.ca

Car Seat Information www.tsfbcaa.com

Doulas of North America www.dona.org

Fit to Deliver www.fittodeliver.com

HIV / AIDS in Pregnancy www.cdnaids.ca

La Leche League International www.lalecheleague.org

Lamaze International www.lamaze.org

Motherisk (morning sickness, drugs, chemicals www.motherisk.org and infections in pregnancy)

Options for Health www.optionsforsexualhealth.org www.bcwomens.ca/Services/HealthServices/ReproductiveMenta Post-Partum Depression Self-Care Guide lHealth/Resources then look for link to “self care guide” www.cpsbc.ca Find a Family Physician

BCWH Power to Push Campaign www.powertopush.ca

Safe Start (BC Children’s Hospital) www.bcchildrens.ca/KidsTeensFam/ChildSafety/SafeStart

Sexuality and U (contraception info and more) www.sexualityandu.ca

South Community Birth Program www.scbp.ca

Vaginal Birth After Cesarean (VBAC) www.vbac.com

Vancouver Sun Parenting http://www.canada.com/vancouversun/features/parenting/index.html

Vancouver Dad www.vancouverdad.com

10 2013

January February March S S Su M Tu W Th F Sa u M Tu W Th F Sa u M Tu W Th F Sa 1 2 3 4 5 1 2 1 2 6 7 8 9 10 11 12 3 4 5 6 7 8 9 3 4 5 6 7 8 9 13 14 15 16 17 18 19 10 11 12 13 14 15 16 10 11 12 13 14 15 16 20 21 22 23 24 25 26 17 18 19 20 21 22 23 17 18 19 20 21 22 23 27 28 29 30 31 24 25 26 27 28 24 25 26 27 28 29 30 31

April May June S S Su M Tu W Th F Sa u M Tu W Th F Sa u M Tu W Th F Sa 1 2 3 4 5 6 1 2 3 4 1 7 8 9 10 11 12 13 5 6 7 8 9 10 11 2 3 4 5 6 7 8 14 15 16 17 18 19 20 12 13 14 15 16 17 18 9 10 11 12 13 14 15 21 22 23 24 25 26 27 19 20 21 22 23 24 25 16 17 18 19 20 21 22 28 29 30 26 27 28 29 30 31 23 24 25 26 27 28 29 30

July August September S S Su M Tu W Th F Sa u M Tu W Th F Sa u M Tu W Th F Sa 1 2 3 4 5 6 1 2 3 1 2 3 4 5 6 7 7 8 9 10 11 12 13 4 5 6 7 8 9 10 8 9 10 11 12 13 14 14 15 16 17 18 19 20 11 12 13 14 15 16 17 15 16 17 18 19 20 21 21 22 23 24 25 26 27 18 19 20 21 22 23 24 22 23 24 25 26 27 28 28 29 30 31 25 26 27 28 29 30 31 29 30

October November December S S Su M Tu W Th F Sa u M Tu W Th F Sa u M Tu W Th F Sa 1 2 3 4 5 1 2 1 2 3 4 5 6 7 6 7 8 9 10 11 12 3 4 5 6 7 8 9 8 9 10 11 12 13 14 13 14 15 16 17 18 19 10 11 12 13 14 15 16 15 16 17 18 19 20 21 20 21 22 23 24 25 26 17 18 19 20 21 22 23 22 23 24 25 26 27 28 27 28 29 30 31 24 25 26 27 28 29 30 29 30 31

11 2014

January February March Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa 1 2 3 4 1 1 5 6 7 8 9 10 11 2 3 4 5 6 7 8 2 3 4 5 6 7 8 12 13 14 15 16 17 18 9 10 11 12 13 14 15 9 10 11 12 13 14 15 19 20 21 22 23 24 25 16 17 18 19 20 21 22 16 17 18 19 20 21 22 26 27 28 29 30 31 23 24 25 26 27 28 23 24 25 26 27 28 29 30 31 April May June Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa 1 2 3 4 5 1 2 3 1 2 3 4 5 6 7 6 7 8 9 10 11 12 4 5 6 7 8 9 10 8 9 10 11 12 13 14 13 14 15 16 17 18 19 11 12 13 14 15 16 17 15 16 17 18 19 20 21 20 21 22 23 24 25 26 18 19 20 21 22 23 24 22 23 24 25 26 27 28 27 28 29 30 25 26 27 28 29 30 31 29 30

July August September Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa 1 2 3 4 5 1 2 1 2 3 4 5 6 6 7 8 9 10 11 12 3 4 5 6 7 8 9 7 8 9 10 11 12 13 13 14 15 16 17 18 19 10 11 12 13 14 15 16 14 15 16 17 18 19 20 20 21 22 23 24 25 26 17 18 19 20 21 22 23 21 22 23 24 25 26 27 27 28 29 30 31 24 25 26 27 28 29 30 28 29 30 31 October November December Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa 1 2 3 4 1 1 2 3 4 5 6 5 6 7 8 9 10 11 2 3 4 5 6 7 8 7 8 9 10 11 12 13 12 13 14 15 16 17 18 9 10 11 12 13 14 15 14 15 16 17 18 19 20 19 20 21 22 23 24 25 16 17 18 19 20 21 22 21 22 23 24 25 26 27 26 27 28 29 30 31 23 24 25 26 27 28 29 28 29 30 31 30

12 CONNECTING GROUP GUIDELINES

Group is a place to:

. Ask questions . Give answers . Express your worries and fears . Share your joys . Learn more about yourself . Make new friends

Because people will be sharing some very personal issues – and to make group sessions fun and productive – we’d like you to follow these few guidelines:

. Whatever is said in this room – stays in this room. . Only one person talks at a time. Respect others and listen to what they are saying. Try not to interrupt. . Groups start and end on time. . Bring this Handbook to every session. We will use materials from the book each time. . Children are welcome to attend group with you, however, it is your responsibility to manage, or remove, them if they are disturbing the group. . In order to help maintain the group dynamic, please try to bring the same support person each time.

Group flow:

. Do your weight, blood pressure and urine. . Give the paper with the above values to the co-facilitator. . Then put your name on the board. . Belly checks are meant to be brief; please bring your general questions to the group.

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

13 CONNECTING PREGNANCY GROUP PRENATAL CARE

CONFIDENTIALITY AGREEMENT

Privacy is something everyone is concerned about when they come for group medical appointments. You have the right to expect that what is said here be private and confidential. Along with our commitment to maintain your privacy, you will also have a responsibility to respect and protect each other’s privacy.

Please share useful information outside the group, but what you hear and learn about individual group members should stay here.

Printed Name:______

Signature:______

Date:______

14 CONNECTING PREGNANCY: PROGRAM SESSION # 1

Getting Acquainted Eating Well for You and Your Growing Baby

Self-Assessment Sheets Personal Goals for a Healthy Pregnancy (SAS) Pregnancy Review Sheet

Today’s Discussion Learning about the Connecting Pregnancy group Self-Care: Weight, Blood Pressure & Gestational Age Good Nutrition for Pregnancy & for a Lifetime Lifestyle Choices Exercise Gestational Diabetes

Homework Self-Assessment Sheets

Baby’s Best Chance . Fetal Development...... pg 26-30 . Nutrition...... pg 36-43 . Fibre and your Health...... pg 38 . Iron...... pg 39 . Calcium and Vitamin D...... pg 39-40 . Pregnancy and Nutrition, Spina Bifida and Folic Acid...... pg 39 . Pregnancy and Dental Health.....pg 22 &158 . Prevention- Listeria...... pg 41-42 . Gestational diabetes: The exercise link...... pg 34 & 158

______

NOTES:

CONNECTING PREGNANCY PROGRAM 15 SAS – Personal Goals for A Healthy Pregnancy

Most women find that they have something(s) they would like to change in their life. Pregnancy is a special time when may women/couples find they are more open to making changes. Look at the items below, decide how happy you are with each of them and identify those you would like to change. Circle the number that shows whether you feel that you are doing well in that area or whether the area needs improvement/change.

Doing well Could be better Need help 1. I get regular exercise 1 2 3 4 5 2. I eat a healthy, balanced diet 1 2 3 4 5 3. I know how to decrease stress in my life 1 2 3 4 5 4. I don’t smoke and don’t breathe second- 1 2 3 4 5 hand smoke 5. I don’t drink or use street drugs 1 2 3 4 5 6. I have people around that I can count on 1 2 3 4 5 7. I have a good relationship the baby’s father 1 2 3 4 5 8. I have something meaningful to do with my 1 2 3 4 5 time 9. Other areas: 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

10. I think I am:  underweight  just right  overweight

My goal for my weight gain in pregnancy is:

11. The aspect(s) of my life that I want to work on the most of the items above it (are):

16 NUTRITION DURING PREGNANCY QUIZ

There may be more than one correct answer for every question.

1. As a rule, all pregnant women should eat 3 square meals per day. True False

2. Which of the following nutrients does a woman need more of during pregnancy? a) Iron d) calcium and vitamin D b) folic acid e) protein c) essential fatty acids f) all of the above

3. What key nutrients are provided by the Vegetables and Fruit group of Canada's Food Guide? a) folic acid c) fibre b) vitamin C d) calcium

4. Canada's Food Guide recommends that pregnant women eat at least 6-7 servings of grain products every day. How big is a serving? a) 1 slice of bread b) 1/2 cup rice, couscous, bulgur, quinoa or pasta c) 1 cup rice, couscous, bulgur, quinoa or pasta d) 2 cups rice, couscous, bulgur, quinoa or pasta

5. What key nutrients are provided by the Meat and Alternatives group of Canada's Food Guide? a) Iron c) vitamin C b) essential fats d) vitamin D

6. How many servings from the Milk and Alternatives group of Canada's Food Guide are recommended during pregnancy? a) 2 c) 5 b) 3-4 d) 6-10

7. Which of the following provides an excellent source of calcium? a) green beans d) liver b) sardines e) yogurt c) milk powder

8. While cheese and yogurt provide calcium, they lack _____which must be obtained from fluid milk or skim milk powder a) folate d) vitamin D b) iron e) zinc c) vitamin A

17 9. For pregnant women who do not tolerate dairy, which of the following provides good sources of calcium? a) lactaid products d) tofu made with calcium b) liver e) almonds c) eggs

10. Which of the following foods provide a rich source of folic acid? a) red meat d) oranges b) lentils and legumes e) milk c) broccoli 11. Which of the following foods are good sources of dietary fibre? a) lettuce d) black-eyed peas b) bran cereal e) raspberries c) bananas

12. Which of the following are excellent non-animal sources of iron? a) bran cereal d) cream of wheat b) broccoli e) spinach c) whole-grain cereal 13. Which of the following helps your body absorb iron from foods? a) meats d) tea b) dairy e) coffee c) fruits and vegetables 14. Which foods interfere with your body's ability to absorb iron? a) meats c) tea b) pop d) coffee 15. Which of the following are good sources of essential fatty acids? a) tofu d) butter b) canola oil e) soy milk c) fish

16. Pregnant women should avoid eating fish because of potential mercury contamination. True False

17. Which of the following foods provide a rich source of Vitamin C? a) canola oil d) orange juice b) baked potato e) tomatoes c) green pepper

18. Drinking plenty of juice is a great substitute for fresh fruits and vegetables. True False

18 19. Pregnant women need to restrict their salt intake. True False

20. For pregnant women, it is unsafe to eat fresh vegetables or fruits that have been sprayed with pesticides, even after they have been washed. True Fals e

21. Foods that cause food-borne illness can always be detected by changes in appearance, smell or taste. True Fals e

22. Keep perishable foods at room temperature for no longer than: a) 1 hour c) 3 hours b) 2 hours d) 4 hours

23. Pregnant women should avoid raw meat, fish and poultry, raw eggs and unpasteurized dairy products. True False

24. Prenatal supplements are a great substitute for poor food intake. True Fals e

25. All herbal teas are safe for consumption during pregnancy. True Fals e

26. All artificially sweetened foods and beverages are safe for consumption during pregnancy. True Fals e

27. Pregnant women should avoid peanuts and other high allergy foods during the last trimester. True Fals e

28. To help prevent nausea, you should: a) skip breakfast b) eat crackers before getting out of bed 19 c)drink clear tea or fluids throughout the day d) eat every 1-3 hours e) eat cold foods more often

20 29. Constipation (hard bowel movements) in pregnancy may be relieved by: a) switching from white to whole-grain breads b) consuming more water, diluted juices, herbal teas c) taking 1 tbsp mineral oil in the morning d) increasing daily physical activity e) eating plenty of fruits and vegetables

30. Fried, fatty foods cause heartburn during pregnancy. True False

31. Drugs acquired without a prescription are safe to take during pregnancy. True False

32. Drinking an occasional beer during pregnancy is not a problem. True False

33. Pregnant women should consume no more than 11/2 cups of coffee or 4 cups of tea per day. True False

34. Any exercise during pregnancy is really okay. True False

35. The recommended weight gain for a healthy pregnant adult woman is: a) <15 pounds d) 24-40 pounds b) 15-25 pounds e) different for every woman c) 25-35 pounds

36. The 'Eat Well Live Well' section of the Dietitians of Canada website at www.dietitians.ca has plenty of interactive tools for assessing diet and activity. True False

Courtesy of the Vancouver Coastal Health - South Community Birth Program 07 (January 2012)

21 Nutrition During Pregnancy Quiz

ANSWER KEY

1. False

One type of meal plan is not suitable for everyone. Pregnant women should eat when they are hungry, but should have at least 3 balanced meals per day. A balanced meal contains food from at least 3 of the 4 food groups.

2. f) all of the above You will eat more during pregnancy because your body requires extra nutrients and energy for the growth of new tissues for yourself and your baby. See Canada's Food Guide to find out how many servings of each food group to eat. Canada's Food Guide provides a range of servings for each food group because every pregnant woman has a different appetite, body size and activity level. Let your appetite guide how much you eat.

If you feel that you may not be able to achieve the recommended number of servings required for pregnancy, a supplement for certain nutrients may be considered. This should be discussed with your health care provider.

3. a, b, c Nutrient Folic Acid Vitamin C Fibre Why this Supports expanding Helps the body absorb the Helps prevent blood volume and iron from food. constipation. Nutrient is growth of maternal and Important fetal tissues.

Food Sources - asparagus - broccoli, cauliflower - dates - broccoli - cabbage, brussels sprouts - pear - oranges - green pepper, potatoes - berries - romaine lettuce - tomatoes and tomato - prunes - spinach products - dried fruit - brussels sprouts - citrus fruits: eg. grapefruit, - potatoes - corn orange - peas - kiwi - melons Tips Don't overcook vegetables as folic acid will be destroyed.

Enjoy 7-8 servings or more of Vegetables and Fruit per day. See Canada's Food Guide for examples of a serving size. Choose dark green and orange vegetables and orange fruit more often.

22 4. a,b A serving is ½ cup of a cooked grain, 1 slice of bread or ½ bagel, or ¾ cup cereal. Canada 's Food Guide recommends that women eat 6-7 servings of grain products throughout the day and that pregnant women include an extra 2-3 food guide servings from any food group each day.

Example of 7 servings of grain products: Breakfast: 1 ½ cups cereal + fruit + milk (2 servings); Snack: fruit and yogurt Lunch: chicken sandwich for lunch with salad (2 servings); Snack: cheese and crackers (1 serving) Dinner: Bbq halibut and steamed veggies and 1 cup of herbed rice (2 servings) Snack: 1 cup hot milk and blueberries

Courtesy of the Vancouver Coastal Health - South Community Birth Program 07 (January 2012)

23 5. a) and b) and many other nutrients: Nutrient Iron Protein Folic Acid* Essential fatty acids Calcium* Fibre* Why this Supports expanding blood Helps with maternal Supports Promotes proper fetal neural Maintains integrity of Helps with Nutrient is volume and growth of and fetal growth. expanding blood and visual development. mother's bones. constipation. Important maternal and fetal tissues. volume and growth Promotes fetal Builds fetal iron stores. of maternal and development of bones fetal tissues. and teeth. Meat and  Canned or cooked beans eg. ·Fish · Cooked dried · Fatty fish eg. mackerel, Sardines  Baked beans Alternative Lima, Kidney, Black, ·Seafood peas, beans and salmon and sardines  Tofu with calcium  Black-eyed peas Sources of Soybeans lentils ·Dried beans, peas,  Soybean oil  Almonds  Kidney beans this  Chick and Split Peas lentils · Peanuts  Canola oils  Sesame seeds,  Lima beans  Lentils Nutrient ·Eggs · Sunflower seeds  Non-hydrogenated whole  Refried beans · Clams  margarines  Baked beans ·Peanut butter  Great northern  Salad dressings made with · Oysters Meats  Salmon with bones beans · Red Meat non-hydrogenated oils  Soybeans · Pumpkins, Sesame and Squash Seeds Tips · Iron from meat sources (heme Eating protein in Folic acid can be iron) is more easily absorbed combination with destroyed by than iron from non-meat carbohydrates overcooking. sources (non-heme iron) (eg. fruits, · Vitamin C rich foods help vegetables, absorb non-heme iron grains) at meals · Do not eat iron-rich foods and snacks helps with tea or coffee as they balance energy interfere with iron absorption levels and blood sugars.

* The sources of these nutrients are found in the Alternates only.

24 Revised: January 24th, 2012 6.a) 2 servings per day of Milk and Alternatives (for teens: 3-4 servings per day). See Canada 's Food Guide for examples of a serving size.

6 . b ) , c ) , e ) Liver is not recommended for pregnant women because the Vitamin A level is too high.

7 . d) Only fluid milk, milk powder, and fortified soy/nut/rice beverages contain vitamin D (not cheese or yogurt). If you do not drink these products, take a vitamin D supplement. In Canada, our bodies cannot synthesize vitamin D from the sunlight from October to March.

6. a),d),e)

6. b), c), d)

7. b), c), d),e)

8. a), c), e)

8 . c ) , d )

9. a), b), c), e)

10. False

Canada's Food Guide recommends that Canadians eat at least two servings (of 75 grams each) of fish a week. Pregnant women should choose fish and shellfish that contain higher levels of beneficial fatty acids and lower levels of mercury such as: anchovy Atlantic salmon shrimp capel in mackerel smelt clam char mullet rainbow trout mussel hake pollock (Boston lake whitefish oyster herring bluefish) blue crab

Limit intake of predatory fish that tend to contain higher levels of mercury, such as fresh/frozen tuna, shark, swordfish, marlin, orange roughy and escolar to 150g per month. For those who consume large amounts of canned "albacore" or "white" tuna, there is some potential for exposure to higher levels of mercury. Limit to 300g per week (4 Canada Food Guide servings). "Light" canned tuna (especially of the skipjack variety) is lower in mercury and can be eaten in higher amounts.

6. b), c), d), e)

25 7. False

Juice is not a good substitute for fresh fruit or vegetables. Juice lacks the fibre that is beneficial for digestion and for preventing constipation. Juice is also high in sugar. Choose fresh fruits or vegetables instead of juice when possible. If you drink juice, choose 100% fruit or vegetable juice.

6. False

Salt does not have to be restricted because salt is needed to accommodate for the increase in blood volume during pregnancy. However, you do not need to add more salt to your food as we get more than we need from our regular diet.

11. False

Pregnant women are encouraged to eat as much fresh produce as possible due to the higher level of nutrients when compared to processed foods. The nutritional benefits of eating fresh produce more than outweigh the small risk of pesticide residues. However, you can minimize your exposure to pesticides by buying locally grown ("Buy BC") produce, by washing your produce well and/or by peeling the skins off.

7. False

6. b) 2 hours

Food-borne illness is a concern for everyone, but pregnant women are at higher risk. Symptoms of food-borne illness include: nausea, vomiting, diarrhea and fever.

Food that has been contaminated by harmful bacteria like Listeria or Salmonella is not always detectable by smell, sight or taste.

If you experience symptoms similar to the symptoms of food-borne illness, contact your doctor immediately. If you do get food poisoning, ensure you keep hydrated throughout the day.

8. True

Raw meats (including uncooked hot dogs), poultry, fish (eg sushi), eggs (eg. eggnog, Caesar salad) and unpasteurized dairy can be contaminated with Listeria. While rare, pregnant women are at higher risk of becoming ill with Listeriosis than the general population. The illness can have serious consequences including miscarriage or stillbirth.

26 9. False

Prenatal supplements only complement your diet. They do not replace missing nutrients. Follow Canada 's Food Guide and take the supplements that your doctor or dietitian has recommended for you.

CAUTION: Taking more than 5000 IU of vitamin A supplements per day could cause birth defects. In addition, liver is also not recommended during pregnancy due to its very high levels of vitamin A.

12. False

Herbal teas generally considered safe during pregnancy include: bitter orange/orange peel, echinachea, ginger, peppermint, red raspberry leaf, and rose hip. Limit to 2-3 cups per day.

13. False

Pregnant women should read food labels carefully to ensure they do not exceed acceptable daily intakes. Artificial sweeteners may be present in beverages, table top sweeteners, baked products, desserts, spreads, salad dressings or gum. Avoid cyclamates and saccharin which are not approved for use in pregnancy.

6. False

Research has not shown that avoiding high allergy food during pregnancy prevents allergies in baby.

7. b), c), d), e)

Nausea or vomiting, known as "morning sickness," are common during the first months of pregnancy. They can occur during any time of the day. The condition is linked to hormonal changes, but the causes are not known.

8. a), d), e)

Constipation during pregnancy is common. It may be caused-by hormonal changes, low fibre or liquid intake, physiological changes, lack of activity and iron supplements.

27 30. False

Heartburn occurs during pregnancy because your baby is pressing on your stomach, causing stomach acid to back up into your throat. While foods do not cause your heartburn, certain types of food could make the burning worse. - Avoid foods that irritate your heartburn (eg. fatty or spicy foods; mint or peppermint). - Eat smaller, more frequent meals and snacks. - Drink fluids between meals rather than with meals. - Eat slowly, chew food well and avoid tension during meals. If your heartburn is serious, consult a doctor before taking antacids or medications.

31. False

Any type of drugs, whether over-the-counter or illegal, can have negative effects on your unborn baby. Talk to your doctor before taking any item that is not food.

32.False

Avoid smoking and drinking alcohol during your pregnancy. When you drink or smoke or are exposed to second hand smoke, your baby does too. Alcohol, smoking and drugs can cause problems in your child that will never go away. If you have trouble quitting these products during your pregnancy, consult your doctor.

33.True

Taken in large quantities caffeine can have negative effects on your baby. Not only is caffeine in coffee and tea, it is also in chocolate products, colas and other pops. Caffeine can also be in some over-the-counter medications. Alternatives include: tap or sparkling water, milk, smoothies, 100% vegetable and fruit juices, grain-based non-alcoholic beverages, or water with a slice of lime or lemon.

Coffee and tea affect your body's absorption of iron and calcium from foods.

34.False

Regular mild-to-moderate physical activity does not affect the fetus and can benefit the mother in a number of ways. However, strenuous exercise may not be safe. Contact your doctor before starting or increasing an exercise regime.

Courtesy of Vancouver Coastal Health - South Community Birth Program January 2012

28 35. e)

The amount of weight you gain for a healthy pregnancy depends on your pre-pregnancy weight and height, known as your Body Mass Index (BMI). Ask your dietitian, nurse or doctor to determine the appropriate weight gain for you. Remember, your weight gain should be gradual and you should see your doctor if you gain more than 3 kg (6.5 lb) in any month.

In general, underweight women need to gain more weight and overweight women need to gain less weight than women entering pre-pregnancy with healthy body weight. Below are general guidelines for weight gain*:

Guidelines for Weight Gain Based on Pre-pregnancy Body Mass Index * Body Mass Index (BMI) Recommended Total Rate of Weekly Weight Before Pregnancy Weight Gain Gain (2" & 3r° trimesters) Underweight: <20 12.5 — 18 kg (28 — 40 lb.) Over 0.5 — 0.6 kg (1 lb.) Healthy Weight: 20 - 25 11.5 — 16 kg (25 — 35 lb.) 0.3 — 0.4 kg (about % lb.) Overweight: 25 - 27 7 — 11.5 kg (15 — 25 lb.) 0.2 — 0.3 kg (about 'Alb.) Obese: >27 6 — 8 kg (15 — 20 lb.) See your doctor or dietitian

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

36. True

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

Dealing with the Discomforts of Pregnancy

Self-Assessment Sheets Relaxation Measures (SAS) Common Discomforts Review SAS from Session #1 (Personal Goals)

Today’s Discussion Common Problems of Pregnancy, Why they Occur, What Might Help Body Mechanics and Exercise

Baby’s Best Chance . Common Discomforts...... pg 20-25 . Physiotherapy...... pg 44-47

______

NOTES:

Connecting Pregnancy Program

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

______sleep

______exercise (workout)

______exercise (light)

______bath/ shower

______backrub / massage

______reading /TV

______privacy /closed door

______music

______shout /make noise

______talk /phone

______laugh /funny stories

______meditate/pray

______eat

______have sex

______go shopping

______go for a ride

______journaling /writing

______drink tea, coffee

other method______

Connecting Pregnancy Program 25 SAS - COMMON DISCOMFORTS Please check how each of these common pregnancy discomforts affects you.

Discomfort Often Sometimes Never Low belly pain Leg cramps Varicose veins Sore breasts/nipples Frequent urination Bowel changes Heartburn Shortness of breath Bad dreams Moodiness Headaches Fatigue Low back pain Vaginal discharge Dizziness Swelling of hands/ feet Uterine cramping

Itchy skin PRENATAL BACK CARE Posture During Pregnancy Your posture changes as your baby grows and your weight increases. Proper positioning during your daily activities helps prevent backache Lying and other discomforts associated with · rest on your side with knees bent pregnancy. · use pillows for support; between knees and Standing under belly · stand tall · when moving in bed, tighten core muscles to turn · get in and out of bed from side lying 26 · keep feet hip width apart · keep knees soft, not locked · tighten core muscles

Walking · stand tall · take small steps Incorrect Correct · keep feet hip width apart · tighten core muscles Sitting · wear comfortable, and · sit well back in a firm chair supportive shoes · avoid crossing legs · hips and knees at 90°, use a footstool if needed · support the small of your back with a pillow

CORE MUSCLES include transverse abdominus (lower abs) and the pelvic floor muscles

Incorrect Correct

27 Pelvic Floor Muscles Pelvic Floor Muscle Exercises (Kegel's) Where is your Pelvic Floor? The following are two exercises to strengthen Your pelvic floor muscles are a group of your pelvic floor: muscles which attach to the bottom of the pelvis. They provide support for your bladder, 1. Hold'ems: uterus and rectum. Tighten your pelvic floor muscles. Hold them tight for a slow count of 5. Let go and rest completely. To progress this exercise, hold up bladder to a count of 10

tighten

relax 2. Speed'ems: Tighten your pelvic floor muscles for 1 to 2 seconds and then let go. Work on increasing How is your Pelvic Floor Affected by repetitions without losing coordination. Build up Pregnancy? to 5-10 in a row. This exercise helps stop During pregnancy, your pelvic floor muscles leakage when you cough, sneeze or lift. may become stretched due to the changes in hormones and the weight of your growing baby. tighten

Why Train your Pelvic Floor? · improves bladder and bowel control relax · improves support for your pelvic organs · helps your core muscle strength Remember: How to Find Your Pelvic Floor Muscles · do Kegel exercises 3 times a day Your pelvic floor muscles help stop the flow of urine. Imagine that you are trying to stop · start with 3-5 repetitions and do more when the exercises feel easy yourself from urinating and hold for 1-2 seconds. Then relax. The tightening you feel is · breathe normally the contraction of the pelvic floor muscles. · Kegel's are easier to do sitting or lying down If you are having difficulty finding these · do a Kegel whenever you cough, muscles, try this while sitting on the toilet. Try sneeze, laugh or lift to stop the flow of urine for 1-2 seconds. Then let go and allow the bladder to empty completely. Use this as a test only, not an exercise.

28 Stretching & Strengthening During pregnancy, muscle imbalances can occur. Certain groups of muscles tend to shorten and tighten while others lengthen and weaken. Stretching and strengthening can restore muscle balance and prevent discomfort. General Guidelines for ©2007 BC Women's Hospital &Health Centre Exercise Stretching · gently warm up prior to stretching 1. Avoid jumping and jarring activities and rapid (e.g. walk 5-10 minutes prior to stretching) changes in direction. · hold each stretch 20-30 seconds, repeat 2-3 times 2. Avoid overstretching. · you should feel a stretch without pain · ensure proper posture 3. Avoid holding your breath when you exercise. · do not overstretch · breathe! 4. Begin exercise at a low intensity and gradually progress/maintain activity levels. Ideas for stretches during your 5. Rise up from the floor slowly to avoid dizziness. pregnancy Triceps 6. Be aware of symptoms if exercising on your back. If you feel short of breath, · hold elbow with opposite nauseated, dizzy or unwell change hand position. · gently pull behind your head 7. Drink plenty of fluids before, during and after · stretch should be felt at the exercise to prevent dehydration. back of your upper arm 8. Extra energy is needed during exercise and pregnancy. Make sure you are getting enough calories.

9. Listen to your own body. Stop exercising and seek medical attention if you experience any of the following or if you are unsure if you should continue exercising. · increased pain ·uterine contractions ·vaginal bleeding ·leaking fluid ·dizziness/faintness ·shortness of breath ·chest pain

Ribcage/back Be sure to contact your physician/healthcare provider if you have · extend arm over head questions about any of the above. and reach towards one side · stretch should be felt Source: Joint SOGC/CSEP Clinical Practice Guideline along the ribcage of "Exercise in Pregnancy and the Postpartum your extended arm Period"

Mid-back 1 Buttock · move on to your heels pushing your chest toward the floor · cross ankle over opposite knee with your back straight · stretch should be felt in your mid-back region · lean forward through your hips · stretch should be felt in your buttock

Mid-back 2 · with feet hip width apart, bend knees and shift weight backwards, push your chest towards the floor · stretch should be felt in your mid-back region · to feel a greater stretch on your side, cross one arm over the other

Calf (gastroc) · keep back leg straight with heel down, shift weight forward · stretch should be felt in the calf of your back leg

Buttock · in side lying, bring your knee towards your chest and hold Calf (soleus) · stretch should be felt in your buttock and · bend lower back back knee with heel down · stretch should be felt in the

Hamstrings · with back straight, lean forward through your hips · stretch should be felt through the back of your leg and/ or calf

Strengthening

Pelvic Tilt · Pull in your abdominal muscles, tuck buttock under and flatten your back. Hold for 3-5 seconds and then relax. Let the curve of your spine return. · Try this exercise in side lying, sitting, on your hands and knees or standing against a wall.

©2007 BC Women's Hospital &Health Centre Transverse Abdominus (TA) Activation · Try this exercise on your back with your Everyday Tips knees bent (1st trimester), side lying (2nd (and other things to think about) & 3rd trimesters) or on your hands and knees. 1. Include relaxation as part of your daily · To find the muscle: routine. Take 10-20 minutes for yourself to rest and refresh. - Place fingers on lower abdominal muscles (find your hip bones and move fingers one 2. You can use heat (e.g. hot pack or gel inch in towards your belly button). pack) or ice to help relieve lower back - Draw in the muscles below your belly discomfort. Ensure that the heat or ice source button while breathing out. is not in direct contact with your skin (e.g. - You should feel a small to moderate wrap in a towel). amount of tension develop under your finger tips as you contract your TA (you 3. When lifting or carrying, tighten your core should not feel it push up against your muscles, hold load close to you and use fingers). your legs not your back to lift the object. Avoid twisting movements and get help with · Keep breathing. carrying heavy loads. · Think light and gentle. · Hold for 5-10 seconds, repeat 5 times. 4. Pace yourself. Start activities slowly. Progress difficulty or duration of the activity if you are pain free.

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

6. Daily activities: · working surfaces should be at hip height when standing · if standing for a prolonged period of time, rest one foot up on a stool (e.g. when washing dishes)

· stand and walk 'tall' · getting in and out of a car: sit down on the car seat by backing in and facing out, pivot and bring both knees in to the car together · change positions frequently

7. What to look for in baby equipment: · strollers: think about adjustable handles, how you are using it (walking, running), weight, does it fold · change tables: hip height working surfaces are ideal · baby carriers; look for supportive and adjustable straps Activity Ideas

 brisk walking • stairs • stationary bike

Activity Calendar *Remember to do your Kegel's every day. Monday Tuesday Wednesday Thursday Friday Saturday Sunday Walk Swim or Prenatal, Walk Example 2x20 Aquafit yoga or 2x20 Schedule minutes Class pilates class minutes

Your 1st Trimester

Your 2nd Trimester

Your 3rd Trimester

Adapted from BCW Physiotherapy Prenatal Back Care Pamphlet BCW#813

Relaxation and Stress Reduction Thinking about Infant Feeding

Self-Assessment Sheets Thinking About Breast Feeding (SAS) Today’s Discussion Family and Parenting Issues Stress Reduction and Ways to Relax The Relationship of Relaxation to Labour Is there anything you need to do to get ready for breastfeeding? Sexuality/Intimacy in pregnancy & post-partum Depression in Pregnancy

Baby’s Best Chance . Relaxation related to labour...... pg 59-64 . Stages of Labour...... pg 66-74 . Sexuality in Pregnancy...... pg 49-50 . Depression . Perineal Massage . So you’re going to be a parent...... pg 9-18, 85 & 88

______

NOTES: CONNECTING PREGNANCY PROGRAM

GROUP ACTIVITY OR SAS – THINKING ABOUT BREASTFEEDING

YES NO I have experience breastfeeding a baby I know women who have experience breastfeeding a baby My partner/family wants me to breastfeed

What I Have Heard About Breastfeeding

Circle the reasons you may choose to breastfeed:

Baby is healthier Fewer allergies Baby is more content Less expensive Makes night feeding easier More convenient Closer mother/baby relationship Baby is smarter Might help me lose weight My family tells me it is what I should do Other______

Circle the reasons you may find it hard to breastfeed:

I plan to go back to work/school I don’t eat the right foods My family/partner is against it I think breast babies are spoiled I don’t think I can make enough milk I don’t know how to breastfeed I want to smoke/drink My breasts will sag I take medication I will be embarrassed Other It may hurt me

CONNECTING PREGNANCY PROGRAM

34 GROUP ACTIVITY OR SAS – FAMILY & PARENTING ISSUES

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

The best thing(s) we did together as a family are (were):______The relationship between my parents was (is):______The most common form of discipline used by my parents was:______The rewards most often used in my family were (are):______The person in charge in my family was:______My experience with caring for young babies and children is:______These are the parts about my own family that I want to keep as I raise my children: ______These are the parts about my own family that I want to change as I raise my own children: ______

35 GROUP ACTIVITY OR SAS - FAMILY & PARENTING ISSUES

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

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

Feed the baby?

Give the baby baths?

Change the baby's diapers?

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

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

Decide how to discipline the children?

Work outside the home?

Decide how to spend money?

Decide how to spend time as a family?

Decide what foods we should eat?

Decide how many children to have?

Decide on birth control methods?

Decide on issues about safety for the baby; for example, will you allow smoking, alcohol, and drug use around the baby?

Do the meal preparation?

Labour

Doula Form Preterm Labour

Today’s Discussion Coping in Labour Stages of Labour (video) Positions for Pushing

Baby’s Best Chance . Stages of Labour...... pg 67-74 . Preterm Labour...... pg 80 . Hints to Help with Labour and Birth...... pg 59, 74 . Supplies for Hospital Birth and After...... pg 57 . The Tough Times of Labour – how to help a women through them...... pg 74

______

NOTES:

4-1 40 Doula: A woman who gives continuous physical, emotional and informational support during labor and birth

What are the cross streets closest to your home:

Other children:

Your first language:

Other languages spoken:

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

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

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

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

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

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

41 RECOMMENDED FOOD and DRINK for LABOUR

PRE-LABOUR – LATENT PHASE

Cereal with milk and sugar Hot milk with honey to aid sleep Toast with honey or jam Yogurt with fruit, honey, or jam Light, nourishing soup with bread You may feel nervous, and not be inclined to eat. SLOW DOWN. For most women, labour is a marathon, not a sprint. EAT SLOW.

EARLY ACTIVE LABOUR

Popsicles Jello And pre-labour foods or drinks listed above. Eat and drink small amounts but regularly.

ACTIVE LABOUR

Drink 6-8 oz. per hour You may not feel like eating, though you may if you want to. You do need to drink.

IMMEDIATE POSTPARTUM

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

All of these foods and beverages should be stocked in your refrigerator from 37 weeks gestation onwards. Also include any foods which you especially enjoy. Remember that during pre-labour and active labour your body is temporarily unable to digest fats and proteins. Your uterus needs a large and steady supply of simple carbohydrates in order to function effectively in labour. Your midwives or doctors may encourage the use of certain foods and drinks to prevent or correct dehydration or ketosis, and/or to augment uterine contractions. (I.e. coffee with sugar) Prior to labour be sure you have on hand food for a nourishing postpartum meal for yourself and possibly your birth attendants. Since our clients leave the hospital early, if you are having a hospital birth be sure to pack sandwiches and tea or coffee or cocoa for the first 6 hours post-partum, for you and your partner.

The Experience of Birth

Self-Assessment Sheets Decisions of Pregnancy (SAS)

Today’s Discussion Group B Streptococcus PIH Monitoring in Labour Complications of Labour and Delivery VBAC Precipitous Birth

Assignment Continue to Practice Relaxation Measures

Baby’s Best Chance . Experience of Labour...... pg 66-74 . C-Section...... pg 78-79 . Group B Strept...... pg 33 &158 . Hypertension...... pg 52 . Vaginal Birth after Cesarean...... pg 79

______

NOTES:

43 CONNECTING PREGNANCY PROGRAM

GROUP ACTIVITY OR SAS – DECISIONS OF PREGNANCY

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

Labour Decisions

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

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

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

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

2. What are my plans for coping in labour?

44 G ROUP A CTIVITY OR SAS - D ECISIONS OF P REGNANCY

After The Baby Arrives

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

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

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

9. Who will be our family doctor?

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

11. What will I use for birth control?

More on the Experience of Birth

Self-Assessment Sheets Comfort Measures for Labour (SAS)

Today’s Discussion Doula Information Video: the 3 R’s More about the Birth Process Comfort Measures Medical Pain Management

Baby’s Best Chance . TENS...... pg 74 . Medical Pain Management...... pg 75-77 . Movement and Positions For Labour

______

NOTES:

46 Connecting Pregnancy Program

SAS - COMFORT MEASURES FOR LABOUR

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

1 . Movement ______Walking ______Rocking

2 . Touch ______Massage ______Effleurage ______Back pressure

3 . Heat ______Shower ______Bath ______Hot towels

4 . Music ______Tapes ______Head phones

5 . Relaxation ______Breathing methods Imagery ______Self-hypnosis

6 . Medication ______Relaxants ______Narcotics ______Regional anesthesia (epidural)

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

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

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

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

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

Thinking About Birth and the Baby

Self-Assessment Sheets Self-Inventory (SAS)

Today’s Discussion Breastfeeding Follow Me Mum (video)

Homework Talk with your Support Person about the “Decisions of Pregnancy” (SAS)

Baby’s Best Chance . Breastfeeding...... pg 98-102 . Vitamin D...... pg 109 . Introduction of Solid Food to Infants...... pg 109

______

NOTES:

Breastfeeding Resources:

. www.drjacknewman.com . www.kellymom.com . www.llli.com . www.breastfeedingmadesimple.com (animated latch) . http://video.about.com (search for “breastfeeding”)

SAS - SELF-INVENTORY

Check the column that most closely corresponds to how you feel now. Often Sometimes Never

I make sure that I get regular exercise every day.

I am careful to eat foods that are good for me and my baby.

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

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

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

I have a good understanding of how my body functions.

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

I know if I have a medical problem I can get someone to help me.

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

The area that I need to work on the most is______

______

After the Baby Arrives

Self-Assessment Sheets Personal Assessment (SAS) Delivery

Today’s Discussion Common Newborn Procedures After Delivery Baby Care Sharing a Bed with your Baby Discussion on Feelings about Ourselves and Our Support Systems Siblings The Postpartum Period and the Need for Help and Support Soothing the Newborn Circumcision Infant Massage

Baby’s Best Chance . Newborn...... pg 110-118 . Cord Care...... pg 115 . Crying...... pg 121-123 . Eye Care...... pg 115 . Bathing...... pg 115 . Safety/Jaundice...... pg 116-117 . Talents of the Newborn...... pg 134-138 . Early postpartum...... pg 83-84 . Adjustment to Life with your Baby...... pg 82-88  Coping strategies  Sibling preparation  Coming Home

______NOTES:

Tummy Time Website: www.pathwaysawareness.org/?q=whatcanido/276

SAS - PERSONAL ASSESSMENT

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

When I think about being in labor I feel: excited worried scared anxious relieved unprepared happy thrilled

When think about caring for my new baby I feel: warm loving anxious uneasy

confident uncertain tired excited

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

comfortable anxious uncertain angry loving secure upset relaxed

When I think about myself I feel:

content unhappy unattractive secure satisfied unsettled alone proud

When I think about my family and friends I feel: loved abandoned secure happy hurt uncertain on my own supported

52 WHAT HAPPENS TO BABY AFTER BIRTH? COMMON NEWBORN PROCEDURES

Skin to Skin

The best way to greet your new baby at birth is by putting the baby on your tummy or chest, skin-to-skin, immediately after birth. When a newborn is put skin-to-skin it has an easier transition to life outside the womb! Skin-to-skin: o Helps keep a normal body temperature o Exposes baby the healthy bacteria on mother’s (or father’s) skin providing immune protection o Baby smells the breast and show interest in feeing within an hour of birth!

For more information on the benefits of skin-to-skin and early feeding: Http://www.babyfriendly.ca/challenge/2007/BFC2007_Mothers_Handout.pdf http://www.canadianbreastfeedingfoundation.org.basics/skin_to_skin.html

Newborn Exam

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

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

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

For more information on the normal newborn: http://www.bchealthguide.org/kbase/topic/special/hw42229/sec6.htm http://www.bchealthguide.org/kbase/topic/special/hw42229/sec1.htm

53 Eye Ointment

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

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

For more information on newborn eye treatment: http://www.rcp.gov.bc.ca/guidelines/NB1MasterEyeCareFebruary.pdf http://www.ctfphc.org/Full_Text/Ch16full.htm

Vitamin K

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

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

For more information on Vitamin K for the newborn: http://www.midwives.mb.ca/StandardsAndPolicies/Gdln-NewbornAdminOfVitaminK.html http://www.rcp.gov.bc.ca/guidelines/Master.NB12.VitK.pdf

54 Neonatal Metabolic Screen

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

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

The four metabolic disorders are:

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

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

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

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

For more information on the newborn screening test: http://www.bchealthguide.org/healthfiles/pdf/hfile67.pdf http://www.bvchildrens.ca/Services/SpecializedPediatrics/NewbornCare/NewbornCareScreeni ngProgram/default.htm

Adapted from South Community Birth Program January 2012

55 BABY SKIN CARE AND RASHES

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

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

Natural skin products: this is only a partial list; the important thing to look for is something that is non-medicated and unscented. (some babies will do fine with regular scented products, watch your baby for sensitivity)  Aveeno Baby – line of bath soap, moisturizers  Glaxal Base – hypoallergenic moisturizing cream  Eucerin – moisturizing cream  Laundry detergent – wash clothes prior to baby wearing them. Avoid fragrances or dyes.  38-40% Zinc oxide barrier cream for diaper rash  Wipes- most standard diaper wipes have chemicals, fragrances and can make diaper rash worse. Clean diaper area with soft wet cloth or wet cotton balls. Save wipes for when you’re out of the house, or use more expensive natural wipes. You can also rinse the standard wipes with warm water.

RASHES: Common in many newborns. Description and treatment:

 Newborn rash – erythema toxicum. Red with raised small white center. Moves around. No treatment needed.  Milia – tiny white bumps on nose, chin and plugged oil glands. No treatment needed.  Newborn acne – small red or white bumps on forehead or cheeks. Often develops within 4 weeks due to maternal hormones during pregnancy. Can clear up or linger for months. Wash with warm water several times a day and pat dry.  Heat rash – fine, clear or red spots, often on cheeks, neck, skin folds. Disappears on own, no lotions or oils. Dress baby in layers-typically they need one extra layer than you have. OK for hands and feet to be slightly cool as long as core is warm.  Cradle cap – Usually clears up on own in a few months. Thick, yellow patches of dried skin. Can use baby oil, gently loosen and comb out flakes, then shampoo off.  Thrush – bright red, defined, raised rash that doesn’t go away with diaper rash cream. Caused by candida (yeast). Treatment is antifungal cream (Nystatin, over-the-counter). Baby’s mouth and mom’s nipples (if breastfeeding) may be affected and need treatment. If nipples are suddenly painful, or you notice white spots on baby’s gums, cheeks, contact CBP for an appointment. To view a slideshow of common newborn rashes, see: 56 www.mayoclinic.com/health/baby-rashes/F10090

Courtesy of Vancouver Coastal Health- 2012 Connecting Pregnancy Program INFANT MASSAGE

What is Infant Massage?

Gently massaging your baby has many benefits for both you and your baby. · Relaxation. Loving touch lessens tension, fussiness, and irritability that your baby may have. It aids digestion and can provide relief from gas and colic. Providing this massage may also lessen the stress that you have been feeling from your baby's behavior. · Enhances bonding. Having this special, intimate time with your baby can contribute to the closeness that you feel. Touch conveys nurturing and love which are essential ingredients for emotional and physical growth and well- being. · Aids growth and development. Studies have shown increased weight gain and immune function. Even the nerves show strengthening which, in turn, aids the functioning of muscles and the brain. · Promotes communication. The better you know your baby the more aware you will become of the baby's non-verbal cues. This communication instills a message of love and security. · Improves the baby's sleep. As your infant learns to relax and release stress, sounder and longer sleep often is the end result.

How do I get started?

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

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

Don't worry if you cannot fully massage your baby the first time. Massage may be something new and different. It may take some time for your baby to relax and enjoy the new sensation. Start by massaging the legs and feet of your baby using long soft strokes and keeping contact with your baby. Progress on to the abdomen and then the upper body doing as much as your baby seems to like and that you enjoy.

The first learning experiences of a baby come from contact with parents and caregivers. What a wonderful way this is to strengthen the bond between you and your baby.

57 Courtesy of Vancouver Coastal Health- 2012

Putting It All Together

Self-Assessment Sheets Contraception (SAS)

Today’s Discussion Sharing of Birth Stories Exercises after Birth Contraception . www.optionsforsexualhealth.org . www.sexualityandu.ca Sharing Together: Thoughts and Concerns about the Birth Process and the Early Post-Partum Weeks Mood Changes after Childbirth Soothing a Fussy Baby Community Resources

Baby’s Best Chance . Immunizations/ Health Passport...... pg 119-120 . Contraception Options...... pg 92-95 . Sharing a Bed with your Baby...... pg 11-112 . Self-Care: The first Week after Baby is Born...... pg 86, 103, 105 . Taking Care of Baby...... pg 110-112 . Thoughts about Siblings...... pg 82 . Mood Changes after Childbirth...... pg 85 & 86 . Postpartum Depression...... pg 86 . Postnatal Exercise...... pg 47 ______

NOTES:

Reproductive Mental Health Self-Care Guide: www.bcwomens.ca/NR/rdonlyres/483927DE-698E-42A7-89E5- 6E7080D6ABA9/12518/ReproductiveMentalHealthSelfCareGuide.pdf Birth Control by Breastfeeding: www.breastfeeding.com/reading_room/lam.html

SAS - CONTRACEPTIVE USE

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

Have Used Method Plan to Use More info

______condoms, male ______

______condoms, female ______

______vaginal preparations ______

______diaphragm ______

______intrauterine device (IUD) ______

______birth control pills ______

______birth control patch ______

______depo provera shot ______

______norplant ______

______natural family planning ______

______pulling out (withdrawal) ______

______abstinence ______

vasectomy ______

tubal ligation (sterilization) ______

Now What Happens?

Self-Assessment Sheets All about my Baby (SAS)

Today’s Discussion Continued Sharing of Birth Stories Reviewing Plans for Taking Care of Myself, My Baby, and My Family Amazing Talents of the Newborn (video) Contraception

______

NOTES:

Sexuality and U: www.sexualityandu.ca

ALL ABOUT MY BABY

My baby's name______

My baby was due on ______but …

My baby actually delivered on ______at ______AM/PM

My baby weighed______lbs and______oz

My baby was ______inches tall

______helped deliver my baby

I gained______lbs carrying my baby

My thoughts during labor were:______

______

When I first saw my baby I felt:______

______

We hope you have felt supported in this journey, your Care Providers at Community Birth Program.

62 Sacred Space

Birth in Progress