The Globe and Mail has the headline "C-section not best option for breech birth" and everyone cheered. Everyone, but a few people maybe. I mean, I cheered and then I said "Don't get too excited."
Here is the thing; there are some pretty unclear things with the news story about the  Society of Obstetricians and Gynecologists of Canada releasing the new guideline that doctors should no longer automatically opt to perform a cesarean section in the case of a breech birth. The forget that for nearly 20 years in birth, c-sections have been performed for breech babies and therefor this idea is "new" to a lot of care providers. 

These care providers have been taught to be afraid of breech birth. So this guideline changes nothing until training is offered and more than just offered, demanded and expected. Without training and practice a guideline is useless. Until then we are still going to see doctors recommending c-sections because it is their comfort zone. To speak some honest truth the matter is that things will be more risky if a doctor isn't comfortable.

Women are going to continue to be disappointed. Maybe even more so disappointed because they will know this is a guideline now yet their care provider is not up to par of the expectation. Sounds like training will be coming but in what capacity, it doesn't say. Who is responsible for that? Who will enforce the need for training? How soon do they expect to have people trained? What expectation are we setting for mothers showing up to deliver? Will a doctor who is trained be there or be called in, if the doctor on call is not trained?  

There was also this quote: "If a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally." As a doula I know this statement to be true, but then I also ask, who is responsible for this preparation? Who is providing with this preparation? Where is the over worked system going to begin to even start preparing women for birth? Shouldn't that already be happening, breech aside? If this isn't already happening, why would we expect to see that change in regards to breech birth? This is a large part of what doula's do! It almost reads to me like the SOGC is recommending doulas. And childbirth education that focuses on a woman strength and ability. These are wins, to me. 

Today I celebrate the SOCG and their new guideline but I also feel the sighs of the women walking into the hospital in the near future who are told they will not be supported in their choice to deliver vaginally. ​ 

I will continue to watch how things progress locally on this front and will update the information as I can. 

Midwives can prescribe medications and recommend supplements in pregnancy, if needed. This includes pain management options in labour. (Yes, you can have an epidural if you have a midwife!) They can attend home births and hospital births, where they will monitor mothers and baby (babies), assess the labour and do all vital checks and exams. If concerns arise at home, they know when transfers to hospital should be recommended and made, and they continue the care once at the hospital. They are in charge of all clinical tasks and procedures. They can collaborate care with obstetricians if and when needed, to ensure the best care of everyone. Midwives have a very defined scope of practice in each province they practice in. You can see more info on midwives on the Saskatchewan College of Midwives website. 

If that is what midwives are all about, what are doulas all about?
In contrast doulas are not the primary care providers but rather focus on non-medical, no clinical topics. Doulas focus on the emotional, physical & information pieces of pregnancy, birth & postpartum period. While doulas are accepted in the medical community and the evidence for improved outcomes exists, the fee of a doula is not paid for through provincial health. The fee is paid for by the family.  There are some extended health plans that cover the fee. There are also some programs for financial supports for families if the cost of a doula is prohibitive. In Regina, the Doulas of Regina, have a relief fund. A doula is going to get to know their clients on a different level and help them plan for their birth and postpartum that matches their desires, needs and ideas. Doulas will direct all medical concerns and questions back to the primary care provider. If a client is concerned with something the primary care provider has suggested or misunderstands, a doula will help the client communicate more effectively with the care provider, but not on behalf of the client. Doulas are often in the know about other resources families would benefit from so they will guide clients to resources as needed. Doulas focus all their energy into the emotional and physical supports during labour without the distractions of clinical care needs. They also ensure the partner is supported and taken care of in the process. Doulas want to ensure mothers feel confident, informed, supported and comfortable during all aspects of pregnancy, birth and postpartum. 
​

When you are from the Queen City it is hard to not love the Royal family. With the birth of Prince Louis Arthur Charles everyone is talking about Kate and her beautiful baby, her stunning hair and makeup and that adorable red dress, honouring Princess Diana. What we talking about? 
​
What does our team at Queen City Doulas & Co think about Kate, her birth, her experience and her appearance? Quite a bit actually, and the best part is, we have varied opinions. We are talking about the variations of normal. I think this is quite telling to how unique we all are in our experiences, how individuals relate to Kate, how they might not relate to Kate and if that even matters!  ​

Now day 3...oh day 3, I wanted to hide in that lion den and not come out. I am sure Kate has a day 3 that many can relate to. There is crying  and leaking milk and inflammation in the nether regions and tender breasts. She is likely at home, snuggled into bed, feeding her baby, recovering from pregnancy and birth, being a protective mama bear as long as she can be. 
It is not a contest, that is for sure. So many variations of normal, but I actually think seeing Kate and believing that Kate is a real mother like every other mother, vs just believing it is a team of lady maids only making her appear that way, actually shows birth doesn't have to leave us wounded and broken and scared. In fact, part of why I wanted to share my experiences of births 4 and 5 was because 1-3 were hard pregnancies, challenging births and challenging postpartum times and I felt broken and scared.  4 and 5 were not like that and I wanted to tell everyone how damn proud I was of creating my own amazing experiences. 
You might be asking, did I do something different with 4 and 5. Yes, I sure did. I did a lot different, but one of the key differences was HypnoBirthing. It is well known that Kate also used HypnoBirthing. Here is a short video clip discussing HypnoBirthing and the benefits it has to birth.

Earlier this week Anna Baker was able to share some of her thoughts with CBC. You can have a listen to the conversation here. There are a lot of good tidbits in there - such as "do you and don't worry if it isn't what others do", or pointing out how it took a team to make Kate look that way. I would like to add she also had a team of care providers supporting her, not just a hair and makeup team!  You can also read a piece that Anna wrote for CBC as well. 
If you are preparing for a baby, what our team hopes for you is that you have a positive experience and that you are supported to have the experience YOU want. That is truly all that matters. This is why we exist, to be the support you need. If you have the desire to have a HypnoBirth, we have that class to give you those tools. If you need someone else on your birth team, we have doulas for that. If you need more practical in home support post baby we have doulas for that have that, too. As Anna mentions in her interview, breastfeeding struggles occur, so we have help to get back on track ASAP (and we have a class for breastfeeding, too).
I believe  you might not be as far off as having an experience like Kate, as you might think you are. You are just spared the pressure of having to present your baby to the world, 7 hours post delivery. ​

The Next HypnoBirthing Class starts Tuesday May 22nd and runs through June 19th. This is the last class until fall. Get more information here. 

The next Your Breastfeeding Experience class is May 5th. There are a couple spots still open in this class. ​

The next Your Life with Baby class starts May 12th. There are spots still available in this class also. 

If being a good doula was based on what is in our doula bag, Mary Poppins would be the greatest doula. ​

Mary Poppins had quite the bag and all things considered it could make a fairly decent doula bag! There are a few items I would leave out of my doula bag, if I was Mary Poppins. The first one would be her coat rack. I am quite certain I can find a place for my coat at the hospital or a clients home. I can probably do without a plant, but hey, if you want a plant in your hospital room to make it a little more homelike, you can bring one…I won’t complain. Although, keep in mind, you might get some flowers gifted to you after you deliver your baby, so take up more than you need to. 
Mary Poppins even brought her own lights. Lights are important, but again, I am not worried about the lighting at the hospital or your home. If you want dim lights, the doctors and midwives have flashlights - really, they do! Speaking of lights, some people like to have some flameless candles to create a nice ambience. I do have some in my doula bag, but as an FYI, they are a few dollars at the $1 Store. ​​

Now, of course, I know some moms would want to but in my experience it is not super common. Again, if that is something you think you might want to try in your birth, lets chat about it and make a plan about who should bring the mirror, just like the plant. 
That tape measure Mary Poppins has in her bag is amazing and I would love one! I mean imagine being able to measure people I am going to work intimately with and be told all about their personality. Wow, what a benefit that would be to me and to my clients. Wait, hold on! I do often have a tape measure in my doula bag…with my knitting. Yes, I pack knitting into my doula bag. What? Why on earth would I have knitting? We can talk about that later in another blog post. 
Back to this tape measure idea. I don't have a tape measure that will tell me easily what your personality is, but I do however have a tool that will help me discover more about your personality and help me connect with you to make our work together easier and a little more flawless. The “Your Birth Experience” (YBE) program allows me to connect with you, identify your needs and then equip you with the resources necessary to achieve your goals. This leave mothers and their families empowered to envision their ideal birth, prepare for that birth and ultimately achieve the birth experience they desire. That’s pretty close to the magical tape measure, right? It is close enough for me. 
So far you now know my doula bag has a few tea lights, running shoes, knitting and a tape measure. That tape measure isn't the good personality one - that comes from our prenatal meetings.  That is all I have in my doula bag? Don't I have a rebozo, massage balls, TENS machines, birth balls? Nope. I do have some gum, some cash for parking, some hair ties and some snacks. Why so simple? Largely, infection control. For real, I don't want to disinfect birth balls and I surely don't want to clients sharing “dirty” ones. I don't want to have to wash beautiful fabrics from Mexico in harsh chemicals made for industrial disinfection standards. I  can do some neat stuff with a hospital sheet instead. Bonus is that I can get that at the hospital and then leave it at the hospital to have it cleaned properly, just like the birth balls. Massage balls and TENS machines…what can be bad there? Nothing is really bad, but I prefer to not place an object between my clients and I. I find a better connection with direct contact and that increases endorphins which are great for labour. Again, if clients know they want to try a TENS machine or like the porcupine balls, I can help them use ones that they likely already own.  
What I do have that cannot be packed into a bag is my years of experience and my confidence. Relief comes to my clients simply by my being present, much of the time. Clients know they can count on me to be present for them. I am a familiar face they know already and our relationship is solely focused on me helping them have a positive experience. They are presented with a bendy straw in a cup of water to juice, before they even knew they were thirsty. I am leading them to the washroom to pee and get that bladder out of the way of babies path because they didn’t realize they needed to pee. I am lightly touching and stroking their feet to remind them to relax their WHOLE body. I am that voice in their ear telling them that they can and are “doing it” when they feel like you are not being strong. 
The thing is, people don't give birth every day, (truth be told, I don't attend birth everyday), but I do support women giving birth more often than the average person will give birth. I have been alongside many others before. Each experience is different and no path looks the same, but they are similar enough that I can follow the flow and go alongside and help women through it. They can say things like “Is this normal?” or “what else can I do?” or “what did that nurse/doctor/midwife mean?”. I will reassure them things are normal and they are doing great, I will make suggestions about what else they might want to do, or reassure them what they are doing is perfect & I will help them understand what the care providers are doing or saying. I can help the partner and encourage them just as much (maybe more, maybe less) as I do a labouring woman. 
My doula bag started out full of items, and honestly, I could have taken a small suitcase on wheels to births when I first started because I felt like I needed to bring it all. I now know that to "bring it all", we need to do more work in the time before labour, and when I “bring it all” now, I am bringing our conversations, unique goals, unique desires, unique choices and my confidence, my experience and can be “tricky” just like Mary Poppins. I am confident I can pull stuff out of thin air that will help me meet your needs without carrying a lot of baggage. ​

~Written by Kim Smith, Doula, IBCLC 

Our hospital stays are too short to catch the tongue/lip tie concerns. Another variable is that common birth practices in our society right now can mask or mirror the same concerns that would signal a tongue/lip tie issue. It can take some investigation and skill to sleuth out what is what and know confidently the issues are related to ties. 
Why does it seem like there are so many ties these days? I am not a researcher but rather a clinician so I am not involved in looking at what “might” be causing it (is it an external force or is it just always been this way) but rather dealing with the management of them. I will say, I have been in a breastfeeding helping role for 13 years and it is a subject that is brushed over in trainings of all sorts. I was an IBCLC for a couple years before I found myself in deep conversations about them - and if you know anything about becoming an IBCLC - there is a lot of training, education and exam taking...so a lot of opportunities to learn and to learn from different sources. I was NOT taught in any of my training how to do a proper infant exam. How crazy is that? That someone can become an IBCLC without learning how to do proper visual exam and functional exam. Once I learnt this skill I added it to my assessments, I began to observe and learn significantly more about infants oral structures. Do I see more tongue ties now than I did before then? Of course, I do. But I wasn’t looking for them before. We are taught that ONLY a heart shaped tongue, tissue right to the tip of the tongue and likely not latching, is a tongue tie. And that they are also not common at all.  This is why I also say you cannot see just any IBCLC and if you see one IBCLC and you are not getting the results you want, get another one. IBCLCs are not all created the same. All while this is happening and professionals are learning more, families are learning more about breastfeeding but also COMMITTING to breastfeeding. This means that when they have trouble, they are reaching out and saying “help me”. That means our population of babes to check for ties has gone up so of course we are going to see more. In previous times, these families would have said “I tried breastfeeding but it didn’t work”. Researchers are working on the questions of why are human babies born this way.  It sure would seem like the human race is setting itself up for failure as a species with how hard breastfeeding has become.
Who is the right person to see for tongue/lip ties and what are the steps after a diagnosis? Truthfully, I am biased in this. Maybe not biased but I am being aware of how my answer will be seen to others. I believe strongly the first stop needs to be a skilled IBCLC. There are so many reasons for this but with years of working with families with ties, I want to be able to set a plan for success up for families. This means all the steps and expectations are on the table, that before any treatment takes place, the parents know what it looks like, what to expect and how important a proper process is for success. Some plans are designed to fail and then it can leave the families more frustrated than they were with concerns. 
Let us think for a few minutes about what complaints we hear about breastfeeding…I will make a really short list just as an example:

• Sore nipples/breasts
• Low supply
• Babies are not gaining, slow gaining
• Colic
• Babies are not sleeping
• ​Lack of stool

All of these can be signs of a tongue/lip tie. But they can also be 10 other things. If someone’s first stop is a dentist or an ENT are they going to get a full assessment of breastfeeding to rule any other the possibilities conclusively? Not a chance. That is actually setting them up to fail. What has to be addressed before a revision is proper breastfeeding technique, supply, weight and anything else we can identify as an issue. Take a family with a low weight baby, with a mother who likely now has a low supply in response, and put the demands of getting babies weight up, a mothers supply up and add aftercare of a frenectomy onto their plate - that equals a recipe for stressed out *everyone* and no resolution, perhaps quitting breastfeeding and postpartum mood disorders. And yes, I said “after care” - if you have a provider who tells you you don’t have to do anything after a tongue/lip tie revision - go somewhere else. But honestly, what if it is just bad breastfeeding technique causing the issues? Who is assessing that in the ENT’s or dentist's office? There is so much improvement can be made with technique overall that can improve a lot of breastfeeding concerns. So, I start at basics.  After that, I help people find their next appropriate care provider - based on their specifics. 
I mentioned mothers health playing a factor - maybe there are indicators that her own health is impairing milk supply. Babies respond to flow and without that flow, they also don’t want to try and improve anything. Add in a tongue tie and they just don’t care to breastfeed nicely. If supply is low, again even with a revision, they just are not happy breastfeeders. Then we have people saying “the tongue tie wasn’t the issue” and sometimes add in that “they did the procedure for nothing”. Or because intake is low they supplement, babies stops breastfeeding and everyone says “it is because you gave a bottle”. I make plans to not only increase supply, but supplement in a manner that breastfeeding still works.
We also need to know that the baby is healthy enough and strong enough for a revision. By that I don’t mean babies have to be 7 lbs or some random weight. I mean where are they in regards to their expected weight gain. Maybe they are not gaining weight, maybe they are gaining weight, but slowly - so maybe a baby that isn’t back to birth weight at 2 or 3 weeks yet or just slowly gaining over weeks and months, maybe they are gaining weight a little faster and maybe not getting much concern from anyone but still not growing on “their curve” or are they babies who are gaining weight exactly like we expect and on their appropriate growth chart. This matters! This is a very important factor. No one is checking this before performing a procedure. Babies with low weights, have low stamina and low appetite and don’t care to breastfeed better tongue tie or not, with or without a revision. If they go ahead and have a revision sometimes they start to refuse the breast when they have previously latched or just are still sloppy feeders, or tired feeders, frustrated feeders. I am really making sure this growth part gets figured out first. If we can get the weight up first and not just up but to their appropriate weight for age based on proper growth charts, then when they have a revision, they usually get it all sorted out much faster and kick compensations like nipple shields, supplements, nursing all the time, being at the breast to soothe or moms having to be particular about positions, etc. Each baby needs a unique plan to get to their weight up and that is a key piece of what I provide. A breastfeeding plan HAS to include something more than “just supplement after a feed”. It also has to have a plan to assess if function is regained after a revision or if there needs to be some work put into helping baby use the tongue and other facial muscles to feed. Again, an IBCLC who is skilled is vital to this. It is not just "suck training" like a finger or soother that is going to do this. There are so many actions and exercises to help. 
Now, when I get called after a revision, I can still help and we can get past these remaining pieces, it just is in reverse but I find it is a bit more stressful for moms and families because they also have a cranky baby and after care exercises to get in, and often pumping & supplementing as all. It is better when I can set it up as steps and one focus at a time. Once supply and weight is up, it is one less stress, so then they can handle the stress of the aftercare and extra needs of the baby.
If you suspect your baby has any sort of tie - tongue/lip - and are needing some help navigating it all, I am happy to be a resource for you. You can see more of what I offer for consultations here. 

​

Every hospital is going to differ in what you will need to take with you for your hospital stay, but we have a few suggestions on what to pack. In Regina, at RGH, you will spend some of your time in Labour & Birth (L&B) and then move over to the Mother Baby Unit (MBU). We suggest that you pack separate bags for during labour and early postpartum and then the mother baby portion. This way you can take less luggage up with you and have less stuff to take back down to your vehicle when it is time to go home. After all, you are leaving with more than you arrived with...
For Labour & Birth
• Prenatal sheets ("pink sheets")
• Your birth plan, if you have one

​​• An old nightdress or a T shirt to wear in labour. It will probably get a bit messy, so
don't buy anything special to wear in hospital.
• You might want to consider massage oil or lotion if you would like to be massaged during your labour - the hospital is quite dry. 
• Lip balm - lots of mouth breathing! 
• Snacks and drinks for you while you are in labour.
• Things to help you relax or pass the time, such as books, magazines, games, essential oils and so on.
• A headband or elastic. If you have long hair, you might want it tied up.
• Pillows. The hospital might not have enough to make you really comfortable.
• Toiletries 
• Music to listen to. Make sure your batteries are charged.
• Extension cord to be able to plug things in.

For the birth partner
• Water spray, or a hand-held fan to keep cool down the mom-to-be while she's in labour
• Comfortable shoes. You may be pacing the corridors
• A change of clothes
• Your choice of recording device whether that's your mobile phone or a camera.
• Address book or a list of phone numbers. 
• Snacks and drinks. You don't want a dehydrated, hungry birth partner looking
after you!

For after the birth​
• Pillow and blanket for your partner - there is a chair that turns into a bed and a sheet is provided but not pillows and blankets
• Nursing bras or easy to nurse in bras
• Breast pads
• Maxi pads if you have a preference & consider some mesh panties. The hospital will supply you with a pair or two, but soon they will be limiting supplies. Better to have more than not enough. Some people like these at home for a few days after the hospital stay. Alternately, old or cheap underwear. Don't bring your best ones.
• Nightshirt wrap or t-shirt. Front-opening shirts are useful in the early days of skin-to-skin & breastfeeding.
• Toiletries
• Hairbrush, toothbrush and toothpaste.
• A going-home outfit. You'll need loose comfortable clothes to wear while you’re in the hospital and for the journey home. It will take a while for your belly to go down, so you'll be still wearing maternity clothes when
you head home - sorry!

For your baby
• An infant car seat. The hospitals won't let you leave by car without one.
• One outfit for the trip home (all-in-one stretchy outfits are easiest).
• Two or three sleepers for baby to wear while you are in hospital.
• Baby blanket. Take a warm one if the weather is cold.
• One pair of socks or booties
• Hat
• Burp cloths or receiving blankets (some parents report the hospital provided blankets and gowns cause rashes on babes) 

Hopefully this helps get some things ready for your stay - it seems like a lot! If you think we missed anything, comment below and we will consider adding it to the list. 

You can find many mothers who have tried HypnoBirthing who will explain it as a wonderful tool and transformative experience. Birth has that kind of effect on people! Birth can be amazing. We have been exposed to the idea that childbirth is an intensely painful unbearable process that we just have to cope with and get through. We want you to know, this is NOT truth.

We want women to not be terrified during pregnancy and in their birth experiences, as so many currently are. They are anxious about hours of pain, the agony of pushing and what damage might happen to their bodies. They know they are going to ask for pain management ASAP because that is the only way they know how to cope. ​

You will learn the practical stuff

• how to be comfortable (yes, you can be comfortable) 
• how to latch a baby (key for the next point)
• how to tell baby is getting enough milk
• how to establish a good milk supply 

That is usually what most people need to know to get off on the right foot and continue ahead. In this discussion will be the moments immediately after birth, what happens at the hospital, soother use, pumping (hmm, good idea or bad idea), coming home, breastfeeding lifestyle, etc. 

LOTS of information. 

Now we don't get into too much about the different reasons breastfeeding might be difficult. I know as an IBCLC people want to be really prepared for all the *bad* stuff that can happen. The class is really intended for normal expected management of breastfeeding. I could teach an entire class on all the ways breastfeeding can be hindered. Many of those issues could be alleviated for people, simply by taking this class.  The reality is that you might have zero issues breastfeeding or you might have one or two of those experiences but you won't have ALL of them. It really is best to get one-on-one help after baby is born if things are not as expected and you are  having difficulty, vs referring back to information given in a class on breastfeeding so you can have a plan and treatment specific to you and your baby. With that said, you will go home with a manual that has lots of information to read through and has a troubleshooting section so you can navigate breastfeeding common issues and know when to recognize when more help is needed. 

See you in class! 
 ​

“Hey Kim! Is there a place in Regina that I can donate frozen breast milk. I have so much more than I need and don’t know what to do with it.” This is a common text or email that I receive. The short answer is “Yes”.  There is a formal route and an informal route. 
Northern Star Mothers Milk Bank in Calgary is the closest milk bank that we have to donate to in a formal manner. In Saskatchewan, we do have several depot drop points for approved donors. Approved donors; what are those?  Mothers have to be screened and approved before they can donate to the milk bank or take to the milk depots. You can see eligibility criteria here.  If you are eligible you can start the intake process. At the Northern Star Milk Bank donated milk is pooled, pasteurized and tested. This milk is then provided, at a cost, to sick babies in hospitals and homes around the country.