Should you Choose a Midwife?
As soon as you know you're pregnant, it's time to start looking for a practitioner to care for you and help bring your little one into the world. We asked local expert Denise Fuller RM all about the option of midwifery care. Denise is not only a licensed midwife practicing at Ottawa South Midwives, but is trained as a naturopathic doctor. She is also the proud mom of one-year-old Kai.
Question: Can you tell me a bit about the practice philosophy of midwives?
Answer: The fundamental philosophy of midwifery focuses on continuity of caregiver and informed choice. In terms of continuity of caregiver, we try as much as possible to ensure that a woman works with the same midwives throughout her pregnancy, and that these same midwives would be the ones attending the birth and providing postpartum care.
As for informed choice, there are many decisions to be made during a pregnancy, birth and the postpartum period. We like to take the appropriate amount of time to educate and inform our clients about upcoming tests, services and possible interventions. A typical visit with a midwife lasts at least half an hour and sometimes up to an hour since it takes time to discuss all of the options for care. We really like to get to know our clients. This process of getting to know clients and providing them with information helps us ensure that they are properly educated and can become active participants in making healthcare choices.
Q: Are your services covered by OHIP?
A: Actually, our services are covered 100% by the Ministry of Health and Long Term Care for all residents of Ontario, even if they are not eligible for OHIP. However, if a client does not have OHIP, she will have to pay out of pocket for the services that OHIP does cover. This includes things like hospital services, certain tests such as ultrasound screenings and genetic screenings, blood tests, etc.
Q: Can you tell me about a woman's options for birthing when she is seeing a midwife?
A: Women actually have a couple of different options for the location of birth when they have a midwife. The first option is the hospital and most Ontario midwives have privileges in at least one hospital. Our group's privileges in Ottawa are at The Ottawa Hospital, Civic Campus. Secondly, a woman can choose to have her baby at home. The third option that will be available soon here in Ottawa, is our clients will be able to have their babies in a new birthing centre. The Centre, which will be opening within the next few months on Walkley Road, is a really exciting alternative for families in the Ottawa area.
Q: Does a woman need to have a physician to complement the care you provide as a midwife?
A: No, midwives are the primary healthcare providers for low-risk women during pregnancy, labour and delivery, and the postpartum period. We are qualified to assess for complications or high-risk situations. In some cases a consultation or transfer of care to another healthcare provider is appropriate. We routinely consult with obstetricians, family physicians, pediatricians and lactation consultants when needed. However, if a client has an uneventful pregnancy, her midwife is the only healthcare provider that she will see.
Q: Do you care for babies as well?
A: Yes, we also provide care for the baby for the first six weeks. Once the baby is six weeks old, care is transferred to another healthcare provider, often a family physician or pediatrician. Again, if consultation or transfer of care is needed during these first few weeks of a baby's life, we take the appropriate steps.
Q: What type of training does a midwife have?
A: Here in Ontario, the midwifery program is a four-year university program. It is currently offered at Ryerson, McMaster and Laurentian. We are licensed professionals, regulated by the College of Midwives of Ontario and Ontario midwives have had to go through a process of stringent exams to demonstrate competency in order to be licensed.
Q: Where can families find more information about midwifery care?
A: The Ontario Association of Midwives has a great website at www.ontariomidwives.ca. There is a lot of information there, and the website includes a listing of licensed midwives.
Smooth Beginnings: How a Postpartum Doula Nurtures Familes
What an event it is to bring a new baby into your life! Postpartum doula Mary Kuzniuk helps us understand how a doula can help with welcoming a new being into your world.
Question: What is a postpartum doula?
Answer: A postpartum doula is a trained professional who provides non-medical support to a woman and her family in the time following a birth or adoption. This support can be offered in only a couple of visits if appropriate, or over a more prolonged period. As a postpartum doula, I have the honour of being with parents during a very crucial and precious time of transition. A time of joy, confusion, stress, sleep deprivation, questioning, emotional changes, value development; partner relationship changes, expectation creation, tears, laughter, and much more.
Q: What is your role after a birth?
A: My role is shaped by the needs of the family I am working with. It can involve things like keeping parents nourished by preparing meals or assisting with siblings. Self-care is paramount for parents as they welcome a new baby and it is crucial that they take the time to care for themselves. Clients are also sometimes looking for instructions on the day-to-day care of their baby or seeking assistance on coping with all the change. Sometimes the most important thing I can do is offer a reassuring hug. Basically, I pitch in and help out wherever needed at that particular time. A little bit of extra help can make all the different for parents who could otherwise become somewhat overwhelmed with this shift in their lives.
Q: How does a postpartum doula's role fit in with the care of a midwife or obstetrician?
A: Well, one thing we don't do is get involved with the clinical portion of the care. Midwives and obstetricians do a fantastic job of taking care of a woman's medical needs and we do not get involved with medical care at all. Our role is a supportive one both physically and emotionally. Although the follow-up care with primary healthcare practitioners is fantastic, families sometimes need the added help adjusting to life with a new baby. New parents may not be getting the assistance they need for a few different reasons, such as family members living far away. Also, parents rarely ask for help as there is an underlying expectation that they should know how to handle things on their own and to be blissfully happy in doing so. The postpartum doula role has a very critical and special place as a community resource and we can help in bridging the gaps we have in our society regarding maternal and familial care.
Q: Can you help with postpartum depression?
A: Absolutely. Firstly, it needs to be said that postpartum depression can affect both men and women. A postpartum doula can often be the first to notice the signs and symptoms of postpartum depression in a parent, which I see as being really important. If parents don't realize that they are suffering from depression, they cannot get the help they need. The Journal of Affective Disorders published referral guidelines in 2004 that estimate at least 50% of cases of postpartum depression in women go undiagnosed. My role is not to provide medical advice, but rather to provide information and support. This might mean providing a referral to another professional who specializes in this area. It is imperative that somebody suffering from postpartum depression be supervised by a primary healthcare provider. I can also help clients create a support plan based on the individual family's needs in order to ensure that they have a network of people and community resources they can count on once my work is done.
Q: What kind of emotional support can a postpartum doula offer when a parent is suffering from postpartum mood disorder?
A: Here are some ways I help:
- Ask questions about the parent's feelings regarding anxiety or depression.
- Be a source of open, non-judgmental and nurturing support.
- Respect and honour what the parent is feeling.
- Support the partner, siblings and other invested family members.
- Talk about the birth experience with the parent.
Sometimes my time with a mom during the postpartum period has looked like this: I have given her a hug, made her tea, rubbed her back and given her space to cry. I encourage her to share her uncertainty, talk about her fears and help her ease up on her expectations.
Q: How can family and friends help?
A: This is a service that family and friends can purchase and offer as a shower or baby gift. Time with a postpartum doula is a much-needed gift of nurturing, care and support.
Q: Do you see the demand for this type of services increasing over time?
A: Oh yes, definitely. The popularity of doula services in general is increasing tremendously. I often hear that people have a challenge finding a doula as they typically only take on a few clients per month. Awareness is increasing of the services we offer and I also think that families are getting more comfortable asking for help as they balance the different facets of life.
The Balancing Act Called Life:
How to Stay Calm and Keep Perspective
We all know the scenario: meetings, kids’ activities, work commitments, social engagements. The list doesn’t seem to end these days. Sometimes it is difficult to catch your breath and life seems to march on at a steady, rapid pace. We asked psychotherapist Michele Glover to suggest ways for parents to better manage the business of life, while still squeezing in some time for fun.
Question: How do I avoid becoming overwhelmed as a result of volunteering too much of my time?
Answer: Having children is one of the most life-altering transitions we can go through. We are forced to take stock on our lives–the choices we have made, the communities we are part of, the supports we have. It is a wonderful opportunity for people to slow down and take an honest look at what matters to them.
When asked to volunteer for a board or an event at your child’s school, pay attention to your inner voice. Is it saying, “I can’t say no–who else will do it?” or “Hmmm, that sounds like something I’d like to be part of” or “Not another request!” If your instinct is NO, then say it. Nobody is served by a resentful volunteer. If an answer doesn’t come quickly, then buy yourself some time by respectfully stating, “My schedule is very booked over the next few months– let me give it some thought and get back to you.”
Q: How do I remain “present” in my life with all of the busyness around me?
A: A dear friend of mine likes to remind me that “These are the ‘good old days’.” Of course, we want to look back on these times without regret. A classic technique I often recommend in couples therapy is to plan a weekly “check-in” with your partner. Perhaps it could be a coffee date or a walk. Let your partner know what worked for you this week. For example, “It was so comforting to me when you showed up at my office with a cup of tea when you knew I was having a bad day.” Or it could be something that you haven’t had a chance to address because of a busy schedule. Instituting a weekly ritual of connection allows busy families to stay on top of their relationships.
You can also use this weekly check-in as a self assessment tool and an opportunity to connect with yourself. Ask these key questions on a regular basis: “Am I feeling peaceful, happy and rested? Am I feeling emotionally cared for and physically present?” Pausing long enough to create awareness around the answers to these questions is often enough to allow for conscious choices in time management for yourself and your family during a particularly crazy time.
Some of the common physical signs that you are running on overdrive are loss of sleep and feeling unmotivated. These signs, in turn, can result in a lack physical activity and poor dietary choices. As most of us know, this negative cycle can be difficult to break. Check in with yourself about what your physical and emotional cues are regarding the need for balance. And ask yourself, “How much time am I demanding just for me?”
Q: How can I increase the joy in my life when there is so much movement and activity all the time?
A: Simplify. We hear stories about middle-class families rejecting the “rat race” after many years of career building, fast-paced living and debt stress, and choosing instead to live more simply, in small spaces. The latest example of this I remember reading about tells the story of a family of four living in a 183 square foot home. This may seem like an extreme example, but simplifying usually involves getting rid of the “clutter.” What people often learn is that by removing all of the white noise, they can rediscover what is meaningful to them and they can find genuine calmness. Why do we fantasize about this? Sadly, it is because we often find ourselves living lives that are out of our control.
You don’t need to completely give up everything in order to move towards simplification. For example, in lieu of buying a new material possession that requires more of your energy to maintain, try something new. It could be something that you have always been curious about, something that is a real shift from the usual for you: dancing or singing lessons, drawing classes, a French cooking class. This type of break from the everyday routine helps to balance the right and left sides of your brain.
Q: How do I slow down enough to figure out what I need to do to make more time for the important things in life?
A: I believe that we can all benefit from therapeutic relationships– either professionally sanctioned or otherwise. Having sage ears to examine our lives, our worries, our plans, our hopes, is always wise. Making time to do that is also really important. The time invested in connecting with those who provide valuable, non-judgemental feedback will be repaid to you tenfold.
Go Local to Create Healthy Lunches for your Kids
Life is busy, especially with back-to-school time upon us, and packing school lunches can seem like just another task on your to-do list. Registered holistic nutrition consultant Elizabeth Friedman has some helpful advice on how to make lunch more interesting and help your children feel more connected to the food they are being offered.
Question: How can parents make food more appetizing for their children?
Answer: If children are dissociated from their food source they are less likely to eat it. In our modern times, children are increasingly separated from the source of their food. This is a crisis that can leave children malnourished and uneducated about a locally grown, sustainable, and safe food system. Children will favour food from the farm they have visited. It helps tremendously when they feel a connection to the farmer who grows the food they are about to eat.
Q: How can parents reconnect their children to their food source?
A: Parents can create “field trips” to visit a few local Ottawa farms during the late summer or early fall so that children of all ages are increasingly educated about where their food actually comes from. It is important for parents to get educated themselves and to learn how to incorporate locally, organically, humanely farmed produce and meats into their family lifestyle.Q: Is it difficult to source local foods for children’s lunches?
A: Actually, it has never been easier! There are many farmers’ markets throughout Ottawa, including the Ottawa Farmers’ Market at Brewer’s Park on Sunday and its satellite markets, as well as Main Street, Carp, Kanata, Preston Street and many others. Families can also participate in Community Supported Agriculture programs. A number of farms provide veggies and meats through CSA programs right through the winter months.
Q: What do you recommend to pack into your child’s school lunch this fall?
A: Start with fresh organic produce from local Ottawa farmers. Organic local fruits and vegetables will contain a higher nutrient density because the soil is richer and the food is fresher. Commercially grown produce can have toxic sprays that are harmful to your child’s brain and nervous system. Send fresh organic and local vegetables such as sweet carrots, grated or steamed beets, sweet turnips, peppers, cherry tomatoes, and locally picked apples, pears and berries. My advice is to keep it simple and to keep it local. Adding too many exotic vegetables and fruits from faraway places can become overwhelming to a child. Teach your children from a young age the importance of supporting local farmers for a sustainable food system and optimal nourishment.
Add high quality protein sources from local Ottawa farms to nourish your child’s brain and nervous system. Grass fed, pastured local meats and eggs will contain a better quality fat, including DHA which is essential for healthy brain function. Include in your child’s lunch easy-to-eat wild or grass-fed meats such as elk or wild game salami, elk or venison pepperettes, beef jerky, smoked duck or pheasant sausages, or any leftover meats from the previous night’s dinner, including pastured chicken, pastured lamb or beef, wild Alaskan salmon, or any other wild fish or wild/pastured meat. Boiled eggs from pastured, organically raised hens are highly nutritious. Also, cheese from local pastured animals that has not been highly processed will be a much healthier choice for your child’s lunch.
Q: How can parents encourage their child to eat their healthy school lunch?
A: First, the meals at home need to be consistent with what is being sent to school. Parents need to be educated themselves on how to prepare nutrient dense family meals. For education, a parent may choose to consult with a holistic nutrition consultant and learn how to make the transition to healthier eating within the home.
Second, the lunch choices should be kept simple, nutrient dense, and not include too many choices. Appeal to your child’s aesthetic sense by packing lunch in beautiful containers and arranged in an artistic way. You will be surprised at how the beauty and simplicity of the food arrangement will actually make a difference to your child’s tendency to eat it.
Thirdly, if at first rejected, keep sending healthy, local, nutrient dense foods as described above. If your child is older and has already acquired a taste for sugar and flour, you will need to be patient and persistent in making a transition. Older children will especially benefit from visiting local farms and learning about the effect of sustainable agriculture on our planet, as teenagers today are highly conscious about ecological and humane concerns. Touch them with the impact their food choices have on our planet. Young children have the advantage of being more open minded to trying new foods. The earlier you can start a child with nutrient dense whole foods, the more likely they will eat well throughout their lives.
Q: Can you recommend ideas for veggie dips, breads, and other treats to add to a child’s lunch?
A: Start with the following recipes to include in your child’s lunch. I bake with ground almonds for my child’s school lunch, yet I am aware that public schools are “nut free” zones, so I will also include nut-free options in the recipes to follow.
FAMILY FIELD TRIP LIST:
Alpenblick Farms: Robert and Petra run a beautiful farm with pasture raised beef, lamb and goat meat, and organic fresh goat cheese. Animals are humanely raised and loved dearly by this couple. Organic meats and cheeses can be purchased on the farm. (8138 Golf Club Way, Ashton, Ontario. Call Robert and Petra at 613-253-2640. Alpenblick Farms)
Bearbrook Game Meats Inc.: You will see pastured deer, elk, buffalo, wild boar, ostrich, emu, wild turkeys, ducks, geese and peacocks running about, as well as pastured hens for laying eggs. Bearbrook has a store on site for stocking up on pastured farm eggs, wild game salami, pepperettes, beef jerky, smoked duck &pheasant sausages, and much more. You can stock your freezer with abundant wild and pastured meats available from Bearbrook farms. (5396 Dunning Rd, Navan, Ontario, 613-835-2227 Bearbrook Game Meats Inc.
FermeDagenais and Le Tournesol: Children can pick organic (biodynamic) apples and pears from the trees. As well, the farm has pastured lamb, beef, pork, duck, rabbit, turkey, geese and chicken. These meats, pastured eggs, farmed honey and organic vegetables from their garden are available in their farm store. (Le Tournesol. (1155 Stevens Road, Embrun, Ontario,613-448-3167 FermeDagenais and Le Tournesol
Rainbow Heritage Garden: Located outside Cobden, this organic farm owned by Kylah Dobson and Zach Loeks produces 100% organic vegetables on high quality soil on their 7th generation family farmland. They offer regular tours for families, potluck dinners and can also be found at Ottawa Farmers' Market and Carp Farmers' Market. They offer CSA (community supported agriculture) shares in their supply of organic vegetables.(81 Stafford 2nd Line, Cobden, Ontario. 613-646-7428. Rainbow Heritage Garden)
Rideau Pines Berry Farm: Bring your children to pick fresh berries from the field. (5714Fourth Line Rd, North Gower, Ontario, 613-489-3601 Rideau Pines Berry Farm)
Some sources for fresh, local & pastured cheeses:
Introducing Solid Foods to Baby
A hot topic among new parents is when and how to introduce solid foods. Even the most intuitive parents may be hesitant about what to introduce first, and when to start this whole process. I went to La Leche League for some recommendations. La Leche League Canada has been providing breastfeeding support to moms since 1961. Sue Thériault Valin has been a La Leche League Leader for eight years and is an International Board Certified Lactation Consultant.
Question: When should solids be introduced?
Answer: This can really vary from child to child as babies meet milestones differently. The weaning process, by definition, starts once you introduce foods other than mother’s milk. It usually corresponds to the age of about six months, but you should be looking for certain developmental cues that signal baby is ready. As a baby matures and his digestive system prepares to process food, there will be developmental signs that demonstrate readiness for solids.
For example, the tongue thrust reflex should be lost. Babies are born with a reflex that causes the tongue to protrude when anything is introduced into the mouth, and this helps to prevent choking. If your baby thrusts his tongue out when you attempt to feed him, it indicates that he may not be ready. Also, baby should be able to sit up without being propped up. Another easy thing to look out for is that baby should be showing interest in solid food. Is baby reaching for the contents of your plate? Is he able to pick up a piece of food and put it in his mouth? Many moms tell us that their children demonstrated they were ready for solids by grabbing food off a plate and helping themselves!
Question: What should I start feeding my baby once I have figured out that he is ready?
Answer: There are no hard and fast rules here. Usually, first foods are based on what a baby’s parents are eating. A good place to start is with soft fruits and veggies like banana, avocado, cooked squash or sweet potato. The goal here is to have them start to explore food. Getting nutrients from solids should not be a concern since they are only partially absorbed at this point. Baby will get all the required nutrients from breastmilk or from formula. This is a way to introduce a baby to family mealtime whether they are in your lap, in a booster seat or a highchair. They usually play a lot with the food, and some of it gets into the mouth and most of it ends up everywhere else. This can be quite fun. Why not strip them down to a diaper and get out the video camera!
Question: Should I be feeding my breastfed baby an iron fortified cereal?
Answer: Not necessarily. Assuming that a mother's iron levels were normal at the time of a birth and baby was full term and healthy, a breastfed baby will have enough iron stores and will receive all the iron he needs from breastmilk for the first six to nine months. The term "fortified" means that the iron has been added to the cereal and is not naturally occurring; this results in a very different form of iron than that found naturally in breastmilk, this added iron is very poorly absorbed and it has been shown to alter bacteria in the gut. It is documented in the research that when a high iron cereal (or iron supplement) is introduced to iron-sufficient babies they are less able to absorb iron and sometimes even become iron deficient.
Try introducing iron rich foods to your baby rather than a fortified cereal. It is important that foods be as close to their natural form as possible, and that highly processed or fortified foods be avoided. Don’t forget that these foods can be geared towards whatever the rest of the family is eating. A list of iron rich foods, which can be introduced somewhere around the seven- to eight-month mark, can easily be found by searching online. u
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2. Canadian Pediatric Society (2005) Exclusive Breastfeeding should continue to six months. Paediatr Child Health 10(3):148.
3. American Academy of Pediatrics (2012) Breastfeeding and the Use of Human Milk. Accessed 08/05/12 http://pediatrics.aappublications.org/content/early/2012/02/22/peds.2011-3552.full.pdf
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5. Mohrbacher, N. (2010) Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo Texas, Hale Publishing.
6. Wiessenger, D., West, D., and Pitman, T. (2010) The Womanly Art of Breastfeeding. 8th Ed., La Leche League International.
7. Rapley, G. and Murkett, T. (2008) Baby-Led Weaning: Helping your Baby to Love Good Food. London: Vermillion.
8. Griffin, I.J. and Abrams, S.A. (2001) Iron and Breastfeeding. Pediatr Clin North Am, Apr;48(2):401-413.
9. Yang, Z et al,(2009). Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: comparison of data from 6 studies. Am J Clin Nutr 89(5):1433-1440.