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Mom Squad with Rhondda Smiley (Doula and Yoga Instructor)

August 1, 2017
mom squad, rhondda smiley, smiley birth services, doula, yoga, breastfeeding, naturopath toronto, toronto naturopath

Meeting Rhondda blew my mind! I peppered her with question after question, because she’s just so knowledgeable about birth and catered her practice to truly helping mom in all aspects of her pregnancy. From prenatal yoga to supporting breastfeeding after birth, this woman does it all! Grab yourself a cup of tea and dig in – there are so many great pearls in this interview!

When can a woman begin prenatal yoga?

Whenever she feels like it. During the first trimester, she may choose to be conservative in her practice, watch her energy levels, and avoid twists, inversions, or jumps. Listen to what your body has to tell you. Yoga during pregnancy is a wonderful path to cultivate your own deep inner knowing of what’s right for you, your body, your baby and your pregnancy.

Does every yoga class have the same sequence, or do you modify it based on the yogis?

I don’t teach a set sequence. I like to change things up from class to class.

We do usually begin with some attention to the breath and a short mindfulness practice, to release tension and arrive to our practice. Then there’s a few minutes to check in with each other. Each person has an opportunity to share any news from the pregnancy or how they are feeling, whether they are working with any particular issues in their body and so on. Then I can tailor our practice to accommodate those individual needs.

Every class includes poses to bring the pelvis into healthy balance, movements that flow with the breath, standing postures that build the strength to power you through labour, and of course a yummy svasana or restorative pose to end on a relaxing note.

Is there one universal yoga pose that is beneficial for each trimester?

While there is never one-size-fits-all, a wide kneed child’s pose can be helpful to many during all stages of pregnancy. It helps to keep the pelvis open and relieves low back tension. It allows for a deep breath that moves through the belly, back and pelvic floor. It may encourage baby to move into an optimal position for labour. If it feels too crowded to bring your forehead down to the ground, you can support your upper body by resting on your forearms, a firm cushion or birth ball.

Why is a doula a great support to have during a birth?

There are soooo many reasons! But here are three that are key.

A hallmark of doula care is continuous support. As your doula I’m with you from early labour, through active labour and delivery, straight through until an hour or two after the birth, with no shift changes or extended breaks. I’m usually the only person on your care team who’s with you for the whole journey once labour starts, and that continuity can be just the reassurance you need.

My number one job is to do all that I can to ensure that the birthing person feels safe, nurtured and heard. The rest of your care team – your doctors and nurses or midwives –  have the physical health and safety of you and your baby as their primary role. Good clinical caregivers may also provide emotional support – but it’s not their first priority. When they are called to attend to your clinical needs, I will always be there to support your very real emotional needs. How you feel during your birth experience matters. The mind-body connection means that when you feel safe and at ease, you unleash a physiological response that allows your body to labour efficiently.

And then there’s this. A doula and a birth partner – whether it’s a spouse, parent or friend – make a match made in heaven. Your partner knows you, and I know birth! Partners – I’ll share with you my best tried and true comfort measures to keep her at ease, making you look like a rock star in her eyes! I could never replace you, and in fact do all I can to encourage connection between you. I also know you may be feeling overwhelmed and support you with information, experience, and breaks!

So many of my clients – and especially their partners – tell me after their birth, “I knew it would be great to have you there, but I had no idea how much you would offer me”.

What is a postpartum doula, and what does she do?

Think about a postpartum doula like having your BFF over – but one who knows ALL about babies! As a postpartum doula, I share experience, hands-on help, information and encouragement with parents of new babies. When I arrive to a postpartum visit, I look and listen to find out what is most needed in the household so that everyone can feel as nourished as possible in body, mind and spirit. I follow your lead and support your choices for what works best for your family without judgement.

What does that look like? An old hand who can tell you about normal newborn behaviour and development. Experienced support as you learn the ropes with breastfeeding. Warm arms to soothe your baby while you take a nap or shower. A friendly reminder to keep yourself fed and hydrated while bringing you a drink and nutritious snack. An extra pair of hands while you balance the needs of your new baby and your toddler. A companion who accompanies you to the pediatrician or midwife’s office, or runs a neighbourhood errand for you. An insider who knows all the best local resources. A compassionate ear who will help you process the tremendous changes you and your family are moving through.

Most expectant parents are so focused on the birth that they haven’t given much thought to how they are going to manage once baby is here. Parents who don’t have the support of near-by friends and family can benefit from booking a postpartum doula before the birth, as will any family that is feeling overwhelmed once baby has arrived. As a postpartum doula, I don’t take over the care of your baby. Rather, I share tools and impart confidence as you learn how to satisfy the unique needs of your baby.

Some doulas – yours truly included – even provide overnight support. This can be a lifesaver if you’ve got twins, your partner is away or sick, or just to help you get caught up on some much needed sleep!

What’s the first thing you do every morning to start your day off right?

Before I get out of bed, when I’m still lying there and thinking about what the day may hold, I try to consider how what I’m going to do may be of service to others. It’s so easy to wake up, map out the day, and think, “what do I have to look forward to today, what am I going to get out of it?” Instead I try to start the day by breaking that self-centred impulse and begin with the most positive motivation I can fire up.

What’s your favourite self-care practice?

Breathing. No, really!

The moments when I pause to take even just a few rounds of full, conscious breath make SUCH a difference. Even just ONE good breath can totally change how I’m feeling in my body, my feelings, my energy level, my state of mind, and how I am in my present situation.

Making time to spend a little longer exploring my breath is like a trip to the spa for my mind and body – delicious! And it’s always available! You don’t need to go anywhere, change your clothes, buy anything, get a partner, be in any particular position… It’s always available to us – right here, right now.

What is your favourite yoga pose?

I’d like to think that I’m like the mother of many children who is when asked, “which one is your favourite?”, replies “which ever one I’m with right now”. But I do really love to spend time in child’s pose.

How can moms connect with you?

Website: www.smileybirthservices.com
Facebook: www.facebook.com/smileybirthservices/
Instagram: smileybirth

Because I believe that the best way to get to know someone is face-to-face, I offer a complimentary in-person consultation for moms who’d like to find out more about how doula care can add value to their birth experience. I take the time to listen to what’s important to them, answer any questions about doula care and see if we’re a good fit, because in the end Mom’s comfort level is the first priority. Moms can connect with me at www.smileybirthservices.com to book a session.

On your way out

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Other #MomSquad members: Angelique Montano-Bresolin, Olivia Scobie, Beth Yarzab, Stephanie Kishimoto

Preventing GBS in Pregnancy

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July 24, 2017
GBS, pregnancy, GBS natural treatments, naturopath toronto, toronto naturopath

A common concern in the third trimester in pregnancy is GBS (group B strep). This common bacteria is found in 10 – 35% of all healthy, adult women (in the vagina, rectum and urinary bladder). It’s normally kept in check by the lactobacillis strains, but can certainly overgrow. While most women don’t experience any symptoms associated with GBS, it can be passed to baby during birth. This may lead to primary neonatal sepsis, pneumonia and meningitis during the baby’s first week of life.

Risk factors for GBS include:

  • African-American descent

  • Multiple sexual partners

  • Male-to-female oral sex

  • Frequent or recent sex

  • Tampon use

  • Infrequent hand-washing

  • Less than 20 years old

  • History of vaginal infections

  • Previous GBS+ pregnancy

When does the GBS swab happen?

A culture test is typically done to determine if a woman is GBS positive or negative. At 35-37 weeks a woman’s rectum and vagina are swabbed with a Q-tip, which is then sent for culture. If the woman tests as GBS+, she’ll be given antibiotics during labour, or if her membranes break early.

According to the SOGC, once women are tested at 35-37 weeks, they’re not tested again. Which means that if we want to get ahead of the game, and help cultivate a health vaginal microbiome – then we need to do so early. 

Current Research

A 2016 study looked a how probiotics could affect vaginal flora after a woman has tested positive with GBS. Ninety-nine women were were all diagnosed by GBS culture as being GBS positive between 35 to 37 weeks. They were then split into two groups – treatment and placebo group. The treatment group took 2 oral probiotics capsules before bed (containing L. rhamnosus GR-1 and L. reuteri RC-14) until delivery, and the placebo group took 2 placebos before bed until delivery. 

At time of delivery, the women were re-tested (vaginally and rectally) to determine if they were still GBS positive. In the probiotic group 42.9% in women were no longer GBS positive, whereas in the placebo group, only 18% were no longer GBS positive. This is obviously quite exciting as those two probiotic strains had a positive effect on the microbiome and reduced GBS colonization!

Preventing GBS

As I previously mentioned, the SOCG does not recommend re-testing moms who tested positive for GBS at the time of birth (although your Midwife may do so). Therefore, we need to be proactive about this and improve the vaginal microbiome before the GBS swab is done. 

The beginning of the third trimester is a great time to establish a foundation of healthy gut flora, boost immune function, and ensure that your diet is conducive to a healthy gut. 

Women who have a history of UTIs and bladder infections or were GBS positive during a previous pregnancy, may benefit from seeking support early on in pregnancy (such as during the first trimester). 

How I Treat It

First Pregnancy

At 32-33 weeks, I encourage women to book an appointment with me to prepare their vaginal microbiome for the GBS swab. I prepare the vaginal microbiome by recommending a probiotic and herbal immune support (that are safe to take during pregnancy) like garlic and echinacea to support vaginal health. 

Second+ Pregnancy

If you tested positive for GBS in prior pregnancies, I recommend booking an appointment at the beginning of the third trimester to begin to support vaginal health. I follow the same protocol as above, but treat for longer to help change the vaginal flora especially if you have had GBS before.  

If you have a history of GBS, UTI and/or yeast infections, and are hoping to improve your vaginal flora – book an appointment with me! We’ll work together to get your bacteria back in line, and hopefully stop those vaginal infections for good!

REFERENCE

Ho M, Chang Y, Chang W et al. Oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 to reduce Group B Streptococcus colonization in pregnant women: A randomized controlled trial. Taiwanese Journal of Obstetrics and Gynecology. 2016;55(4):515-518. doi:10.1016/j.tjog.2016.06.003.

Management of Group B Streptococcal Bacteriuria in Pregnancy

Note: This article only discusses research in preventing a GBS+ colonization prior to a GBS culture done by an OB/GYN or midwife. It purposefully does not discuss what to do in the case of a positive GBS+ test. 

Signs of a Miscarriage

July 17, 2017
miscarriage signs, signs of a miscarriage, toronto naturopath, naturopath toronto, fertility naturopath, pregnancy naturopath

Did you know that miscarriage is the most common pregnancy complication? If not – that’s not on you! Miscarriage isn’t commonly talked about. But once a woman experiences it, she begins to realize (thanks to stats and Google), that she’s not alone. Miscarriages occur in 15-20% of pregnancies, and most commonly occur within the first 8 weeks of pregnancy. After 8 weeks, rates decline to about 3%. Another truth is that miscarriage is no one’s fault – and once it’s happening, there’s often nothing that you can do to stop it. 

Causes of Miscarriage

Miscarriage can happen for a variety of reasons including: factors associated with baby, factors associated with mom, factors associated with dad, chromosomal abnormalities, age, environmental exposure, hormonal disorders, immune factors, coagulation disorders and nutritional deficiencies. 

Signs and Symptoms

The most common sign associated with miscarriage is vaginal bleeding. Bleeding at any point during pregnancy can indicate serious problems. Bleeding may be accompanied by the passing of clots, tissue or a gush of fluid. There may be cervical dilation. Abdominal cramping, pain or contractions may also occur and become regular. Lastly, you may notice diminishing signs of pregnancy such as nausea and vomiting and breast tenderness. Depending on the type of miscarriage you are experiencing, a pregnancy test may reveal a negative result. 

Diagnosis

Unfortunately, you can’t self-diagnose a miscarriage. You may see the signs and symptoms that are occurring, but diagnosis depends on an ultrasound and determining if there’s cervical dilation.  

Types of Miscarriage & Treatment

Threatened Miscarriage

This occurs when a woman notices vaginal bleeding within the first 20 weeks of pregnancy. She may also experience backache, abdominal aching or cramping. The cervix will appear closed upon vaginal inspection. The fetal heartbeat may be found via the ultrasound. Essentially, we treat this as a viable baby until we’re concerned that there’s no heartbeat.

Medical Treatment: Watch and wait, bed rest, possibly supplementing with progesterone and administering uterine muscle relaxants. 

Naturopathic Treatment: Watch and wait, assessing for stress, dehydration and malnutrition. UTIs should also be ruled out. Acupuncture may help to harmonize the different pathways in the body. In TCM terms, this is considered a kidney yang deficiency, and the uterus must be kept warm (think of warm foods, heat over the abdomen, stimulating the appropriate acupuncture points, etc.) Botanicals may also be introduced such as Viburnum opulus (Crampbark) and Dioscorea villosa (Wild Yam) as they are both uterine antispasmodics. 

Inevitable Miscarriage

Presentation of bleeding which may range between minimal to severe, along with some lower abdominal cramping. The cervix appears dilated. At this point, treatment should not include strategies to help prevent miscarriage. Diagnosis will depend on ultrasound. 

Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, dilation and evacuation to empty the uterus. 

Naturopathic Treatment: Emotional support, addressing blood loss, physiological and psychological stress. Supporting the menstrual cycle. 

Incomplete Miscarriage

Includes vaginal bleeding, contractions, cervical dilation and incomplete passage of conception products. Sadly, the baby has passed on or is part of the tissue that has yet to pass. Both methods of treatment will support emotional and physical wellbeing of the mother and partner. 

Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, dilation and evacuation to empty the uterus. 

Complete Miscarriage

All uterine contents of the pregnancy are passed. Cramping and abdominal pain may subside shortly after. The cervix will return to an undilated state, and a pregnancy test will read as negative. Both treatments will support emotional and physical wellbeing of the mother and partner. 

Missed Miscarriage

Unfortunately the baby has passed, but is still present in the uterus with no signs of miscarriage. This may continue for a few weeks before a miscarriage occurs, or it may be found at a routine checkup. Because it may lead to a serious maternal infection, medical care must be obtained. 

Medical Treatment: Confirmation by ultrasound, and evacuation of the products of conception. 

Naturopathic Treatment: Emotional support, regulation of the menstrual cycle. 

Recurrent Miscarriage

‘Recurrent’ is diagnosed if there is a history of 3 or more pregnancy losses. At this point, it’s advices that both partners undergo genetic testing to determine a possible cause of miscarriage. Moreover, the couple may need undergoing care if a chronic problem presents. Typically hormonal causes are the most prevalent and may involve the ovary, placenta or thyroid. Diseases also involved with recurrent miscarriage include: hypothyroidism, hyperthyroidism, PCOS, type 2 diabetes, gynecological disease (ie. endometriosis) and intestinal disorders (ie. IBS). It’s recommended that couples stop trying for about 3-6 cycles – to determine a cause and seek treatment for it. 

Medical Treatment: Determine a cause, chromosomal evaluation of both parents. 

Naturopathic Treatment: Determine a cause, prevent future miscarriages, supplement with a botanical like Vitex agnus-castus (Chaste Tree) if there is an issue with HPA axis and progesterone. In TCM terms kidney yin deficiency is the most common cause of recurrent miscarriages – this means that the uterine environment is hot and dry, the endometrial lining may not be thick enough to accept an embryo. 

Next Steps

It’s evident with many of the types of miscarriage – there’s nothing you can do to prevent them. That said if you’ve experienced a miscarriage, it’s best to wait a couple of menstrual cycles before trying again. For couples experiencing recurrent miscarriages – there is a lot that you can do to support your health before trying again. Now is a great time to look at your diet and lifestyle and work with a Naturopathic Doctor to make fundamental changes to support a healthy pregnancy. Moreover, if you are looking to supplement with herbs or vitamins – get an expert to assess them and educate you on what to look for and how to choose a product. Just because something is on sale or is the second cheapest one (you’re not choosing a bottle of wine here!) doesn’t mean it’s going to be high quality or even the right dose that you need. 

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Supportive Resources

Sunnybrook Resources for Grieving Parents – They have compiled a huge database of web resources and chat rooms. This site is definitely worth a visit.