Good luck
Labour

-	Birth Plans should state what your ultimate birth scenario is and then what you are open to if needed; make sure your labour partner is on board and aware of the birth plan; a woman in labour cannot be expected to advocate for herself and give birth; advocacy is the partner’s job
-	When baby drops it feels like lightening, they are no longer crowding your lungs, belly less heavy
-	Labour contractions start at the base of the uterus (in pelvis) and then move upwards
-	Pain is intensified by tension which can be brought on by fear and anxiety so stay calm
-	When a contraction starts take a loud breath in, use your comfort routine (sway, massage) and when the contraction ends loud sigh out; this lets everyone in the room know what’s happening
-	In early labour Mom is still walking and talking through contractions, her cervix is softening and shortening; use distraction techniques (go for a walk, watch a movie, play a game) for as long as possible, until your contractions absolutely need your attention
-	Take a bath in early labour and if your contractions space back out then it isn’t time to go in; take Tylenol and Gravol and a bath and try to sleep
-   Once you’ve started pushing it takes ~ 1 hour for baby to be born; so there is no need to call an ambulance to get to hospital unless you’ve already started pushing
-	Hormones make you tired so utilize that between each contraction to rest and relax
-	Make a rice bag heat pack; fill a sock with rice, tie it off, put it in the microwave for 2.5 minutes
-	Call the doc if your water breaks, when you think you should, or when contractions are at 4-1-1
4-1-1 : 4 minutes apart (start of one to the start of the next), last for 1 minute and stay this way for 1 hour; after this Mom should be 3-4cm dilated and can be admitted
o	If your water breaks your caregiver wants to know the colour of the fluid (it should be clear), the odour of the fluid (should be scentless or slightly musky-if you can assert it absolutely smells that’s bad), the amount of the fluid (trickle/gush), the time it ruptured
o	There are two membranes so you can have two separate ruptures
o	Your caregiver wants to know how strong the contractions are and when they started
-	Once in active labour (4-6cm dilated) the cervix is also dilating, not just shortening and softening
-	Labour partner should bring small pieces of fruit to feed to Mom in labour as well as clear drinks with a straw (water is okay but something to give energy like Gatorade or Labourade is better)
-	A midwife can triage you at home and then when she says it’s time to go to the hospital you’ll be admitted straight into your birthing room
-	When going to the hospital sit in the back seat so you aren’t trying to navigate/stressing
-	Labour partner should go through the cupboards when you arrive to find helpful supplies
-	At the hospital you have to ask for an exercise ball to be brought into the room; you might want to put a towel over it before sitting (but they do wash the balls)
-   If Mom says, “I can’t do it,” labour partner’s automatic response should not be, “then get the epidural.” Beforehand figure out what affirmations Mom likes to hear in difficult situations. What gets you through things, what would you like to hear?
-	For back labour you’ll eventually need to relieve pressure, squatting or being on hands and knees will help with the pain and encourages baby to flip and face your back
-	Transition (7-10cm dilated) should take an hour or less; once you’ve reached 10cm contractions may stop; you may get a 20-minute break where you can try to sleep/rest before pushing
-	Pushing takes ~1 hour; most caregivers will only let you push for 3 hours before using tools

Labour Partner’s 6 Jobs during Labour
1.	Make her feel safe
2.	Make her feel believed in
3.	Make her feel protected
4.	Give her water or a drink after every contraction (use a straw)
5.	Ask her to go pee every hour in early labour (don’t mention that an hour has passed, just suggest a pee)
6.	Try and make her more comfortable (slow dance sway, massage)

-	Massages should be light, long strokes across the shoulders and down the arms or across the low back and down the thighs (from behind); use one hand as an anchor on the leg; no jerky movements, you are encouraging her to breath slowly in through the nose and out through the mouth by your long, slow movements
-	If you want music in the room use slow dance, background music; no strong scents
-	When breathing out Mom’s jaw should be relaxed, this will help her cervix relax too; the way she breathes in is less important
-	Take it one contraction at a time, just get yourself through this contraction
Contractions are your own body doing the work to birth the baby, they are not greater than you, they are of you
-	In active labour the timing of contractions gets more consistent; your out breaths will be louder, you stop moving during your contractions and stop talking; your energy is being conserved and you are quietly focused
-	In transition labour Mom’s sounds get lower in tone; the lower the tone the closer to birth; lower vibrato is comforting
-	If Mom’s making high pitched noises at this point she is having a hard time- maybe epidural time
-	You have to ask for them to bring out the mirror so you can see the birth if you want
With the  ring of fire (head starting to crown), stop pushing and start blowing out quickly to relieve the pressure; this will reduce your chance of tearing
-	With an epidural you may not know when to stop pushing, increasing chance of tearing
-	Labour .P.A.I.N. is purposeful and progressing, anticipated, intermittent (you can take a rest in between), and normal (it does not indicate that something is wrong)
-   How do I usually get myself through challenges I have faced? I will need these tactics to get through labour
-	Hearing good updates, “you’re almost there, you’re 8 centimeters,” can give you drive; bad updates, “its been 7 hours and you are only 5 centimeters,” can deflate you
-	Things that can help people push through to achieve a goal: pride, setting small goals, self talk, positive affirmations, accountability, knowledge of consequences or bad outcomes
-	Your next push after the ring of fire will be small and you may not feel it as the baby’s head is pinching all the nerves; with this push the baby’s head will be born
-	Then you wait to have another contraction and after that you push; with just one or a couple pushes the baby’s body will come out
-	Forceps are used in just 4% of births in Ottawa; they cup and pull the baby’s head, they don’t squeeze; these are used only when the baby needs to be born now
-	The vacuum extractor is used in 7% of Ottawa births; you have to be very close to the baby being born/baby has to be crowning; they are used if Mom gives up on pushing or baby’s heart rate is bad and progress is stalled

Post-Delivery
-	Do skin to skin immediately for 1 hour; within 5 minutes the baby will recognize mom
-	Get Dad to do skin to skin with baby afterwards and within 15 minutes baby will recognize Dad by his scent and voice
-	Skin-to-skin: for 6 hours a day during the first 3 weeks and for 3 hours a day for the next 3 weeks
o	This has great results for baby and mom (less PPD/PPA, better breastfeeding
o	Breastfeeding counts as skin to skin if baby is topless and on your exposed skin
-	Baby gets an APGAR score at 1 minute and at 5 minutes following birth
-	Babies are born with 18 reflexes for survival
-	Baby may sleep before nursing and that’s okay; he will wake up and root around and try to find the nipple again; you don’t have to help him (put him on the nipple) but you can if you want
-	After baby is born labour partner should remember to give Mom something to drink
-	Skin to skin for 20 minutes is natural pain relief for baby prior to the painful procedure
-	Baby will not be bathed until they are 24 hours old or older; this reduces infection
-	At the hospital if they ask you if you want to try out the breast pump say yes so that you can practice using it and then take home the parts (tubes, flanges); this way if you end up renting a hospital grade pump you already have the parts
Umbilical cord: Keep it dry, don’t put products on it or bathe it; it should fall off in 3-5 days; cord should show change but the belly skin around it should not show change

Medical Pain Management

-	In early labour narcotics can be offered
-	In active labour epidural is preferred; narcotics can be given but are not ideal as they can stay in the baby’s system when they are born; Fentanyl is effective and safe and doesn’t last very long
-	In transition you can get an epidural but they may say it is too late because they believe you are almost at the pushing stage so an epidural is not necessary for you to get through this
-	Nitrous Oxide takes the edge off of the contraction, reduces anxiety, increases endorphins and doesn’t reach the baby
-	Lamaze worked because it was a distraction technique; women focused on making their breathing sounds and didn’t panic; there is no magic, pain-relieving breathing technique

Epidural
-	A good time for an epidural is when you feel you are suffering
-	Need an IV first to combat BP drop
-	Takes anaesthesiologist 5-45 minutes to come to your room
-	If you get an epidural headache (1% chance) and it last 3+ days check in with healthcare
-	If 80% of your sensation is gone then the epidural worked; 90% of them work
-	You are not allowed to eat after you’ve had an epidural
-	TENS machines are great, rent one
-	Sterile H2O injections are not recommended
-	Epidurals can slow labour; they will hook you up to continuous monitoring; they will add Pitocin to the epidural if contractions are slowing down; they will wait and monitor for 1 hour to ensure mom and baby are reacting well; try to rest but you won’t be as sleepy anymore
-	At the Civic and General they give walking epidurals but you have to do a walking test before they will let you get out of bed (sit-up, stand, lift each leg one at a time, all unassisted); you have to tell them you want to get up, they will not offer for you to get up; you can also try to go pee and if you can pee they won’t put in a catheter
-	Epidural takes about an hour to wear off after birth

Induction/Augmentation

-	Induction is not done in an emergency, this is done to reduce risk, so it is not “necessary”
-	Might be done because baby is past due, baby is too big, water broke, or if Mom’s health isn’t great (GD, blood pressure high)
-	If Mom is Group B Strep positive she will be offered antibiotics when her water breaks
-	They like babies to be born within 18 hours of water breaking if GBS+
-	If your labour fails to progress they will use augmentation
-	70% of first baby’s are born after their due date
-	The placenta cannot care for the baby forever so they typically schedule inductions for 10 to 14 days past due; you have a 48% higher chance of getting a c-section if you’re induced
-	Midwives will schedule inductions at 42 weeks because they have fewer patients and the risk of them not being available on day 14 past due and having to delay is very small; most women will go into spontaneous labour by day 10 and your outcomes are better if you’re not induced so midwives like to give you more time to go into labour on your own
-	If you are scheduled to be induced, bring entertainment and food as it could take a long time for you to be seen;
-	If a caregiver talks to you about risks always ask how your baby is right now and how Mom is right now; the answer to these questions will tell you whether the risk is statistical or specific to you or your baby’s current condition; then ask when you need to make a decision by; talk it through with your labour partner for 5 minutes alone and don’t be rushed or bullied into a decision; if you decide to reject an augmentation don’t just say no, you say “I am going to try x for x amount of time first”
-	A stretch and sweep, also known as stripping the membranes, stimulates the cervix, is the least invasive form of induction and the least likely to work; it does not involve hormones but can cause bleeding, which does not indicate that labour is about to start
-	A Foley bulb is inserted via catheter and then inflated with water in your cervix; the catheter is taped to your leg and you have to tug on it periodically; it is strange and a slow method but worth trying before moving on to chemical induction
-	They can only break your water if you have already dilated a bit but you haven’t progressed; they use an amnio hook for this and it is not painful; Midwives tend not to use this method; if your water breaks spontaneously and you have colour in the fluid you must go to the hospital immediately and get on a heart rate monitor; if you end up on a mobile monitor your labour partner should follow you around the room, keeping the bottom (baby) monitor pushed up against you so they don’t keep losing the heartbeat as you are moving around
-	Cervodil is the most popular form of induction and it is prostaglandin administered via timed-release with an applicator in your vagina; they will normally insert the cervodil and send you home to start your contractions
-	If cervodil doesn’t work they will likely add an IV with Pitocin; with Pitocin inductions you are more likely to get an epidural because you haven’t had time to adjust to the increasing pain with the intensifying contractions; they start off intense and very painful
-	Self-inductions will not work if your body and your baby are not ready; Stella Luna in Ottawa will give you a free chocolate and chili gelato on your due date; swimming, yoga, and sitting on an exercise ball instead of reclining from 32 weeks onwards can be helpful; hands and knees positions (scrubbing the floor or doggy style sex), eating 6 dates a day, and nipple stimulation for 20+ minutes are all known to induce labour; DO NOT use castor oil

C-Section

-	If you’re 4cm dilated or more and have failed to progress they’ll do an augmentation first, if that fails they will do a C-section; if you’ve been pushing phase for 3+ hours they will do a c-section
-	Baby’s heart rate (HR) should vary as a response to labour, if it doesn’t they will get you to drink, eat, move to stimulate the baby; if this doesn’t stimulate the HR they will tickle the baby’s head; if none of this works they may determine the baby is not coping with labour well and perform a C-section
-	Don’t freak out about HR dips, it may be the monitor picking up Mom’s HR; if your provider doesn’t seem worried about it just ask what’s going on
-	95% of c-sections are not actual emergencies; if they give you 15-minutes to get ready and your partner is allowed in the room then it is not an emergency
-	If you didn’t already have an epidural in they will do a spinal, wheel you out to the OR, and then someone comes back for your partner and gives them scrubs; partner can ask for a loose, bigger shirt so they can more easily do skin-to-skin (they can’t take off their top in the operating room)
-	Ask for the curtain between you and your incision to be lowered if you want to see the baby being pulled out- they might say yes
-	It takes 5-15 minutes for the baby to be born and then 45 minutes for Mom’s repair (they stitch the uterus, then the muscles, and then the skin closed)
-	You will likely be separated from your baby initially but you should still talk to them from across the room; in some hospitals if you advocate for yourself they will let you do skin-to-skin when the baby is born; you can also ask for your labour partner to do skin to skin; in some hospitals their standard procedure will be to do skin to skin right away
-	You will be taken to a recovery room; you may feel shaky and nauseous; you will be given an envelope with Tylenol and stool softeners to self-administer

Recovery

-	Your first pee will be had with your healthcare provider around; they will show you how to use the peri-bottle to squeeze warm water on your vagina while peeing in case there are any tears or scrapes; if you can’t pee you can’t leave the hospital
-	Ice your labia for 24 hours; you can make padsicles (put water in a pad and put it in the freezer) for night time
-	Your first poop should be soft anyway but you can also take stool softeners
-	Take Tylenol and Advil for swelling and discomfort, especially after a c-section
-	You may feel pain as your uterus works to contract itself down to a smaller size
-	You can have contraction pain for days afterwards if its not your first child; your body is working harder to shrink your uterus back down
-	Take home the SITS bath you use at the hospital; fill it with hot water, sit on it; do this everyday, it will speed up healing
-	Take home every single thing they give you/put in your room/put on your supply cart; they will bring more; just fill up your empty suitcase/duffel
-	No lifting anything heavier than your baby for the first 3 days after a vaginal delivery
-	Baby has an appointment at 1 week with their care provider; Mom’s appointment is at 6 weeks
-	Allow yourself a 2 month adjustment phase; if you still don’t feel like yourself (emotionally) after 3 months then see your doctor; if you have thoughts of self-harm or harming your baby see your doctor right away
-	You can track bad days and good days on a calendar;
-	Your partner/support network should be asking you about your sleep, what you’ve eaten and who you’ve talked to; these are everyday questions to help them assess how you’re doing
-	Your household should be on a vacation 6 weeks postpartum; during this time there are just 4 things that are so important that they must continue to be done; everything else can wait; for example in a two parent household each of you can choose 2 household chores that must continue to be done and figure out who will do them and how often; everything else can go by the wayside-you’ll be very tired and busy and mom needs to rest and heal

Bleeding
-	For the first 2 days you may bleed more than you would in a whole period
-	If you pass a blood clot the size of a grapefruit you should call your health care provider
-	After the second day the amount of blood should diminish every day
-	If you are resting you will heal much faster and bleed less; Mom’s can bleed for 1.5 weeks or up to 6 weeks; if your bleeding is diminishing the resting is working; if you start doing more and end up with lots of fresh new blood then you are doing too much and should decrease activity again
-	Try not to use the stairs in the first week; only go up/down the stairs the number of times that the baby is days old (i.e. if the baby is two days old you should only go upstairs/downstairs twice that day); you will need helpers around the house to achieve this if your living spaces/bedrooms span multiple levels

Breastfeeding

-	Don’t pump in the first 2 weeks as this is when your body is figuring out how much milk the baby needs and baby is best at stimulating production
-	Babies only eat 1 tsp at each feeding for the first few days and this is colostrum (which is very sweet and good for building antibodies)
-	On the first day they should have one good feed, any more than that is just a bonus
-	If baby puts his fist in his mouth you should try nursing
-	The day your milk comes in your hormones shift and it is an exhausting day- do not accept visitors; you will likely get engorged; take a hot shower, use hot compresses, hand express your milk (don’t pump); you can put frozen green cabbage leaves on your breasts for 10-15 minutes (no longer) or parsley under your armpits
-	Foremilk is better for hydration, it is thinner; hindmilk is more nourishing
-	You can label your pumped milk AM or PM to indicate when during the day it was pumped; Morning milk is designed to wake baby up; Evening milk is designed to help baby sleep
-	Formula can be fed to your baby via a pack with tubes that you sling over your shoulder so you can “breastfeed” your baby by having them take the tube and your nipple in their mouth; pre-mixed liquid formula is more convenient and safe/sterilized if you can afford it it is worth it; powdered formula is cheaper and sufficient but less convenient and sterile
-	Wait until baby is 6 weeks old to start bottle feeding, not because of nipple confusion, but because this helps your supply to sort itself out;  You are also resting while you are breastfeeding so this helps with Mom’s recovery
-	If breastfeeding hurts then it’s not working properly; a good latch won’t be painful; if it is painful wait 3 seconds to see if it improves and if not then pull them off and try again; wait these few seconds because at first it might just be a surprising amount of pressure
-	Baby shouldn’t be sucking on the tip of your nipple, they should have the areola in their mouth too; if it never seems to get better then see a lactation consultant
-	Don’t touch the areola to put it in baby’s mouth, have your hand a bit higher up the breast; smoosh your boob so it is flattened to go in baby’s mouth (like you would orient a hamburger to go in your mouth)
-	It is easier for baby to latch when they aren’t already very hungry because once they start crying from hunger it is hard to get your nipple in the right spot because their tongue is on the roof of their mouth where your nipple should be
-	After the first 24 hours wake baby up to feed every 3 hours until they are back to their birth weight (they should be back there at 2 weeks old)
-	A blocked duct will feel like there is a hard chickpea in there
-	Low Supply: If baby is on and off the breast repeatedly and hitting or pushing Mom’s chest that is because baby needs more milk than the breast has and they are letting your body know to produce more; it takes 24-48 hours for the extra needed milk to come in; in the meantime do not supplement as that will not help your body to create the right supply; this may happen during growth spurts (10 days, 3 weeks, 6 weeks. 3 months, 6 months)
-	When your placenta is born it tells your body to start making milk; if part of your placenta is retained your milk may not come in properly
-	Burp a bottle fed baby every time; breastfed babies usually don’t need to be burped- but if their belly is hard they may be gassy so try burping them; You don’t need to burp a baby the first 3 days while they are just eating colostrum
-	Pumped milk is good for 7 hours on the counter, 7 days in the fridge, 3 months in a fridge freezer, and 7 months in a deep freezer
-	If baby bites you while breastfeeding do not pull them off, smoosh their face into your breast and they will unlatch themselves as they need to get air
-	It’s a good idea to have little baskets of goodies Mom may need throughout the house in the places she will often breastfeed; you can put snacks, water bottles, burp cloths in there
-	When baby is full their hands will open up; if their fists are clenched they are hungry
-	If baby if breastfeeding and has one fist open and one fist clenched then they may just want more hydrating foremilk, switch them to your other breast
-	If baby doesn’t empty both breasts in a feed, switch to the other breast at the next feed
-	If baby falls asleep at the breast all the time when they start eating this is concerning if they are not gaining weight
-	Introduce solids at 6 months if baby can sit up by themselves; don’t give them water until they are eating solids
-	Pacifiers are useful if the baby and parents are separated; Don’t use them at first for soothing because they might actually need to eat but you’re skipping a feeding by using a soother instead
-	Baby may not react well to certain things you eat like coffee or cabbage; test it out; if you cut it out is the baby less gassy?
-	If Mom eats oats, barley, flax, leafy greens they can help bring in more milk
-	You don’t need to cut anything out of your diet immediately just because you are breastfeeding

Poop
-	Meconium (newborn poop leftover from when they are in utero) stains; you can put oil on their bum so that it doesn’t stick to their skin
-	If you have a yellow poo by day five, then high five
-	Input = output
o	Day 1 = 1 wet diaper
o	Day 2 = 2 wet diapers … increase all the way to day 5
o	Day 6 to 6 months = 5-8 wet diapers
-	A wet diaper is a diaper with 3 tablespoons of liquid in it
-	Baby’s urine should be clear but on day 1 or 2 they may have an orange or red pee
-	If you’re counting baby’s poops then only count poos bigger than a quarter