The Last Chapter

- A Story of Fertility and Loss

The Last Chapter
A few years ago, my girlfriends and I decided over Mexican food to write a book about being pregnant. It would be hilarious! All the things you didn’t know but you wished someone had told you. We were all on the verge of starting families. We all had a baby, some more than one. We even wrote a few chapters (the best being Chapter 3 – How do You Spell Episiotomy?). And they were hilarious.

We laughed. And then.


Of all the things I didn’t know about pregnancy, this one hit (hits) the hardest. I didn’t know how hard it could be for two responsible, financially stable, willing adults, with good jobs and a home, the means to provide, and more love to give than you can measure, to get pregnant, carry, and deliver a healthy baby.

This is the last chapter of our book on pregnancy. It is my story but it could be the story of so many other women and men who want, want, want, need – but can’t.


The Sound of Silence 
October 2017. ‘We call it a Chemical Pregnancy. A Silent Miscarriage. Really – it’s the most common type of miscarriage and most women don’t even know they conceived. You might notice your flow is a little heavier. Maybe a little cramping.’ My family doctor doesn’t look up from his keyboard where he is pecking away. ‘I blame these high sensitivity pregnancy tests. Really. Testing five days before your missed period? Your body hasn’t had time to consider whether it actually wants to be pregnant at that stage.’ He huffs, and looks up. I am silent. He says my name in a way that lets me know he is exasperated with me. ‘You were only trying for a month. This is nothing to be this upset over. It might even have been a false positive, in which case - you are upset over nothing. You will get pregnant. You have one healthy child. You can have another.’ 

I nod. I thank him. I leave. I vow never to speak to or see him again.

A silent miscarriage. Most women don’t know. Well I did know. And it felt pretty fucking loud to me.

(You were real. We got excited. We talked about new cars, and where your room would be, and the trips we could take on my mat leave. You were real. Finding out you were not coming was a hard punch.)

The Christmas Present
It is easy to get lost in yourself when you want to become pregnant but can’t. The time between cycles drags. Pregnant women surround you like a mean taunting gang of high school girls. Your Instagram and Facebook pages become celebrations of the life you want but fear you will never have. Conversations with friends become difficult. The worst is the well-intentioned advice on how to fix things. Or the inadvertent ignorant comments from people who don’t know your circumstances. You smile. You nod.

You feel more than anything so fucking alone.

You are not.

Mid November, I was pregnant. We went for the heartbeat check and I watched the little flutter. We told our parents at Christmas – early yes, but hell we had a heartbeat! The chances of a miscarriage after seeing a heartbeat drops to around 5%. I rang in the New Year with my head hanging over a toilet bowl. By the end of January, my pants were getting tight and my belly was starting to show, much sooner than it had with my son. I started making plans to turn the guest bedroom upstairs into the new nursery. I unpacked all my old maternity clothes and felt a giddy sense of excitement hanging them up in my closet. My husband insisted it was another boy. We texted potential names to each other. I was beginning my second trimester, close to the fourth month mark. I was happy.

I was unprepared.

‘You need to speak to your doctor about this exam’. The ultrasound tech, an older man with a heavy accent, stared down at me. ‘What’s wrong?’ I ask. He refuses to discuss. I demand to see the baby. He refuses at first. I cause a scene. He shows me, reluctantly, and I see…. two perfect arms, and two perfect legs and they are kicking and dancing and what the fuck could possibly be wrong? He would not let me see any more than that.

We are sitting in my OBs waiting room. We had to wait two days before we could get in to see her. It was an eternity of worry. When I checked in, I reached for the pee strips they make you do before every appointment. The receptionist stopped me. ‘That won’t be needed.’ My blood ran cold. It was bad. It was very bad. My husband is on his phone. I wonder if I should warn him. I say nothing.

It was indeed very bad. ‘Edwards’ syndrome. Trisomy 18. Your baby’s syndrome is very severe. Most babies with this syndrome don’t present on an ultrasound until closer to 20 weeks. Your baby will almost certainly not live to term. If your baby lives to term, your baby will almost certainly die within a very short period of birth.’ (I might almost certainly die of a broken heart right here in your fucking office.)

We leave the office by the back entrance. I stumble walking to the car. (Keep going, one foot after another.)

We wait days for the Genetic Department of Mount Sinai to call us to discuss next steps. (First, your baby will die. Second – nope, sorry, that is the only step.)

I walk a lot. It is February; it is freezing. I sit by the lake in High Park. One day I come home to an empty house and scream, just fucking SCREAM, at the top of my lungs, over and over, until my throat is hoarse. I feel better after that for a short while.

The Amnio and the Mobile
Tests. Blood work. ‘Confirming the diagnoses’. Prolonging the inevitable.

I am lying on my back in the amniocentesis department of Mount Sinai. I have two gowns on and mesh bags over my feet. My husband sits next to me. I’m trying not to be afraid. ‘Let’s start with the ultrasound to see where baby is positioning, before we begin the insertion phase to draw the fluid.’ Sure. Sounds great. I stare upwards as the warm gel is smeared across my belly. Someone has placed a mobile directly above the ultrasound table. Butterflies dance above my head. I want to laugh at the lunacy of this – no woman lays on this table for a happy reason. I’m so focused on marveling at the insensitivity of the fucking mobile that I almost don’t hear my husband speak. His voice is small. Choppy. ‘It sure looks different than with….’ Our son. Yes. It does. I realize he is crying. My sweet, strong, stoic husband is crying. He takes my hand, says my name. ‘Look at me’, he says. ‘I don’t see a heartbeat. I don’t think there is a heartbeat.’ I nod. I see only him, his face, his eyes. I keep nodding. The spell breaks. I turn to the doctor. ‘I’m so sorry,’ she begins.

Wailing. There is wailing (its me, its me) and there are hands, hands, all over my legs, arms. I can’t think. I need to see the baby…. And there, on the screen, there…. Slumped in the corner of my uterus, a little body, with two perfect arms and two perfect legs, no longer kicking, no longer dancing, just still, quiet, gone. (I didn’t know. I didn’t feel it. I should have known. A good mother would have felt it.)

My husband helps me walk out of the room to clean up. My legs are shaking. I’m crying. The other couples in the waiting room stare at me, horrified. In the bathroom I get changed. I’m overcome by anger, rage, shaking me to my core. I want to smash something. I pound at the soap dispenser. There is nothing else to hit. I turn on the taps and start tossing handfuls of water at the mirror, blurring my reflection. It is petty destruction. I soak the room. When I leave the bathroom, the waiting room is empty. The other couples have moved away. I understand. I am what they fear. I might be catching.

At home, I stare at my belly in the mirror until I can’t, I just can’t, look at it anymore. I avoid the mirrors after that.

My husband was right. It was a boy. My son. Our son. I lay on the floor of the guest bedroom and cry. I hold my belly and whisper to my child. (Please can you hear me? I can’t bear the thought that you died alone, in my womb. I was here. I was always right here. I have loved you from the second I knew you existed. I’m still here.) I close the door when I leave. It will be months before I go back into that room.

The Therapeutic Abortion
Almost Valentine’s Day. Almost two weeks after we first found out there was a problem. I’m being buzzed through the first of two security doors at the Morgentaler Clinic for Women. I am here to have a D&C to surgically remove the ‘product of conception’. I grimace at the jargon. Up until they found my son had passed, the doctors called him ‘the baby’. After – the ‘product of conception’.

I fill out intake forms. I’m asked if I am sure I want to have this abortion. I write ‘The Baby Died’ at the end in the ‘More information’ section. I wonder if they got the hospital’s referral. They did; everyone fills out the same forms. My forms go in a gray folder marked “Genetics”.

My husband is not allowed to go in with me. They give me an Ativan to calm my nerves. I change into my nightgown. I’m in a waiting room with other women. I wrap myself in a blanket. I close my eyes.

The doctor talks to me before the procedure. If I had been able to have the procedure at the hospital, I would have received medicine the day before to soften my cervix because of how far along I am (was), so it would be easier and hurt less when the cervix is pried open. But the hospital was backlogged. At the abortion clinics, everything is done same day. I would have to hold pills in my cheeks for an hour and a half to soften my cervix. I’m one day shy of 15 weeks. At 15 weeks, they have to give patients the pills. It’s a bright line. I can choose not to get them at 14 weeks 6 days. The doctor has dark eyes, kind, tired. ‘You have been though a lot. You can handle the pain.’ I opt not to get the pills. I just want to get the fuck out of there.

I’m on the table. There is an ultrasound screen, so a nurse can guide the doctor. There is a second nurse to hand him equipment. The first nurse is also there to help me with the laughing gas. He begins. (I’m sorry, I’m sorry, I’m sorry.) And. Pain. I feel like I am being ripped apart. My nurse slaps the mask on my face and orders me to breathe deep. The other leans over to hold my legs down. (Forgive them all, they were trying to be kind. They are soldiers in a difficult and necessary war) My head is swimming. I can’t focus on the room. The machine sounds like a vacuum, like an industrial version of a car cleaner. And. I see on the screen my baby. I blink. He is gone. Bile wells up. It is over.

The nurses help me to recovery. I’m horrified and trying to process what I saw on the screen. ‘How could you let me see that?’ I sob at them. They keep telling me it will be ok. How sad they are for me. I am not grateful. I try to spit on one. I just dribble down my chin. They barrel me into a chair. It looks like a salon chair. It’s one of many, arranged in a large circle. Like a nail salon. There are crackers. I pick up the bowl and throw it. I am a petulant drugged child. They draw the curtain around me so I don’t disrupt the other patients. After a while, one of the nurses tells me my blood pressure has returned to normal range. I wobble to the change room, get back into my clothes, stuff a pad into my underpants, and stagger out to find my husband to take me home.

That evening, I am seized by a powerful cramp. My uterus is contracting, trying to return to normal size. Something about the contraction, the unfairness of it, the unfairness of everything, of having a contraction with no baby, of having only the product of conception somewhere in some medical grade box being shipped to a fucking lab for an autopsy, just breaks me. (I am broken. I will never be not broken.)

In my aftercare package, there is a letter to give to my doctor for my follow up care appointment. It reads: ‘Dear Health Care Practitioner. Your patient has had a therapeutic abortion.” I laugh out loud. To a follow up feedback email, I write “Consider calling it something other than a ‘therapeutic abortion’. It isn’t a fucking spa”. I don’t send it. I laugh again. It is not a good kind of laugh.

My 18 month old pats my cheek. ‘Mommy sad. Mommy you ok? Hug mummy.’

Yes, mommy is sad. Yes, mommy is ok. After a few days I can move around more freely. My sister comes. She smells like the ocean. She feels like home. When she leaves, I decide to go back to work. Even broken people need to move forward.

A Bathroom in St. Joe’s
We keep trying.

It’s the end of April. I’m almost 7 weeks pregnant. I’m standing outside my OBs building. Panic wells in my throat. I feel sick. I have to pee. I’m five minutes late for my ultrasound. Heartbeat check. Milestone #1.

I swore I would never come back to this fucking place. What am I doing here? I should have insisted on another ultrasound lab.

After day 2 of a hangover, I decided I had the flu or …… Damn. I called the OB. Blood tests. Check. Game plan set – ultrasound after 6 weeks to confirm a heartbeat. Genetic test at 9 weeks to clear that hurdle. And then we would all live happily ever after.

I should have gone to another lab. This fucking place is cursed. I’m in the waiting room now. Sweating. My name is called. Its Him. Are. You. Fucking. Kidding. Me. He acts like he doesn’t remember me. I stare daggers at him. The rage I feel at seeing him is a nice distraction. (It’s not his fault, it’s no one’s fault)

There is no heartbeat. The baby is measuring a few days behind expected schedule. ‘There are many reasons, do not be worried, we will try again in two weeks’. I leave the clinic. I knew it. This fucking place is cursed.

I feel bleary. Heavy. I will not cry. I will be positive. It is going to be fine, in two weeks. (Either that or the baby is dying. Shut up, shut up, shut up.)

May 1. Instagram is a sea of Justin Timberlake. It’s gonna be MAY. I’m almost 8 weeks. Close to safety. (Hang in there.) The next night, I feel it. A twinge. An overwhelming sense of wrong. I go to bed immediately after putting down my son. If I lay perfectly still, it will pass. I can will this to pass. (Don’t leave me, don’t leave me, don’t leave me.)

I wake at dawn. Nothing. I’m ok. It’s ok. I’ve beaten it, I think. The bleeding starts an hour later.

The doctor’s office is neutral: It could be normal. Many women bleed in first trimester! Try not to exert yourself. Take a personal day. If you start passing clots, or feeling cramps, go to the emergency room.

I spend most of the day watching Netflix, laying still. Mantra on repeat: Don’t leave me, don’t leave me. By that evening, the bleeding increases. Clots. A hot dull pain starts to spread across my back. (Is this what they mean by cramps? I didn’t know it would be like this.) I start to tell my husband we need to go to the hospital. And then I think – fuck it. No. One. Can. Help. Right. Now.

I sleep. Try.

In the morning, the pain has magnified. Hot waves across my lower back. I recognize this pain. May 2016. Early labour with my son. Early contractions, before the big ones started. Its gonna be MAY. I go to St. Joe’s emergency room. I tell my husband to go to work. ‘Call you when I know anything.’ I already know it’s done. 

The emergency room is hot, busy, loud. I can’t sit. I pace, rubbing my back. I am hit by waves of tightness, pain, followed by a gush of blood. I keep changing my pad. I wait. And then,

heat across my back. Pain, stronger than ever. I rush to the bathroom. I sit. I’m panicking. Pressure on my stomach, back – I’m straining, not sure where things will exit. Everything contracts. (I’m pushing. Am I pushing? I need to fucking PUSH)

               And then relief.             Gush.               Plop.           Relief.

I’m crying, sobbing, ugly fucking hiccup sobs, because I know, I just know…. I stand and look. At my baby in the toilet. (It’s not a baby yet, it’s just cells, and tissue and blood, a little red celled gummy bear…it doesn’t even have arms and legs so it’s not a baby yet… except it is and it isn’t and oh my god just stop crying people can hear you..)

Except. Except I can see. Except I know. The pressure is less. The pain is dull again. I think about calling my husband. I don’t. I just stand, hunched over, hands on the rim, and stare. And cry. Cry until I can’t breathe. Breathe. Be numb. And then, quietly, finally quiet, I wash my thighs, wash my face, wash my hands. And flush the toilet (goodbye, goodbye, I love you, I love you). I close the bathroom door behind me quietly and go and wait for the emergency room doctor to call my name.

The Birthday Party
We keep trying.

It’s June 30, a sunny Saturday afternoon. We are in the car, heading to a birthday party for my friend’s one year old.

I’m pregnant again. I’m bleeding again. Not a lot. Just enough. (Please stay, please. I love you.)

This time it’s early. (Is that better? Its better. I’m sorry.) Just over four weeks. We had only just found out. The following week, my blood work would confirm the pregnancy. It would also confirm the pregnancy hormone levels were too low, and declining. It would not be viable. But there would be no pain this time, just a heavy red tide of death. (A Silent Miscarriage. I’m fucking SCREAMING inside.)

At the party, I pretend I am a doll. I smile. My pretend dimples show. ‘Work is great. Busy. Yes, amazing weather.’ (I’m bleeding, I’m bleeding, I’m losing another one.) I see my dear friend who is over eight months pregnant. ‘How are you feeling?’ I ask her, because I care, I really do, and ‘You look amazing!’ I tell her, because she does, she truly does. (I’m bleeding, I’m bleeding, I’m losing another one.) ‘Not drinking eh?’ says another friend, eyeing my water glass knowingly. ‘Designated driver’ I reply, smiling. She smiles back, as if we share a secret. Nope. Sorry. Wrong. (There is still hope, don’t give up.)

Mostly I try not to talk to other adults. I keep busy with the kids. My wonderful son. My friends’ wonderful children. The birthday girl. At some point during the party, I excuse myself and sneak out the front door and go and sit in my car with the air conditioning on full blast and just cry.

The Raindance
It’s Canada Day. My girlfriend and I are at Massey Hall. We are laughing. (Is it ok to laugh? Fuck it. It feels GOOD to laugh.) My stomach hurts in that good way after a really funny joke. At the end of the concert I clap and cheer and whistle. I decide in that moment that I’m alive. I am lucky. My son is happy and healthy. My husband is happy and healthy. For the first time in a long time, I am overcome by the feeling that it will all be ok.

If.

Over the next few weeks, I stop holding it all in. I randomly tell people. I need to tell people. I can no longer do this alone.

I tell my husband I think we are under a curse. He laughs at me. He tells me we can do a rain dance with our son to clear the evil vibes out of our house. The next day I put Uptown Funk on at top volume and my son and I run and jump and dance and yell. The walls shake. We laugh. 

I open the door to the guest room. (It’s not a nursery, it’s not a tomb, it’s a guest room.) I open the window. I change the sheets on the guest bed. I lay it in for a little while.

I visit with family. I lean on them. No – I throw myself at their feet and beg that they pick me up. They do. I grow stronger.

I try to forgive myself. You cannot simply love something into being, any more than you could wish a life to blossom. This is not my fault. It is not something I did. It is not something either my husband or I deserve. It simply is.

I try to stop feeling ashamed.

I try to forgive my body. My perfectly flawed and aching body, with its raging hormones, its mood swings, and its practically manic highs and lows. My hair that has thickened and then fallen out and then turned gray. My stomach, hips, thighs, each of which that have widened, drooped, dimpled, than slimmed with each passing, then widened again. My eyes, sometimes dull and sad. The fine lines around them, around my mouth. (Forget it all. It was worth it. The toll of trying. It will always be worth it.)

I say goodbye. I tell my babies I love them. I do. I always will. They are me and I am they. I will carry them with me always. But. I also have to let them go. On the east coast, I whisper words into the ocean. I tell the ocean to watch over them, tell the sun to keep them warm. On the Mira River, I swim out, alone, and say each of their names, aloud, so that the waves can carry them away. I sit on a dock with my brother until 3 am and we let each of them drift off into the fog.
I leave pieces of their souls in the places that I grew up, the places I love. They will be safe there.

I choose a day to remember them. August 16. Our son’s due date.
(I will never kiss your face, your hands, your toes, your belly. But I will be your voice. I will tell of your life, however fleeting. Your brother will know of you. My family and friends will know of you. And in doing so, you will always be loved.)

We will keep trying.

I end this chapter here. I hope for me, my husband, and for all of the people out there who are struggling with fertility issues, who have lost babies, who are losing themselves – I hope there is a happy ending. But this is life. And life is not fair or kind. Life can be cruel and wonderful and without reason. I can only wait and see.

By Anonymous

Note from The WOMB: If you are struggling, in anyway, in anyhow, we are here to support, love and lift you up. Make an appointment with our counselling team today and/or connect with other families who have experienced loss in our Healing Circle for Pregnancy and Infant Loss.

Forget the Rain and Go Online for Educational Fun

Forget the rain go online smYou’ve been looking forward to this day off with the kids, having planned a wonderful trip to the park for some fun in the sun and a picnic on the grass. But the weather has frowned on your plans, sending gray clouds and pouring rain to spoil your outing and keep you stuck indoors when you should be playing outside. It’s a bummer, but don’t fret for long because there are plenty of indoor activities that are as fun as they are educational. In fact, the little ones may learn more than they do at school with you there to guide them. Here are some ideas.

Play Math Games
Sounds boring, right? Well, it isn’t if you know where to find the right lessons, and that’s where Coolmath Games comes in. You’ll find dozens of activities that’ll have your kids adding, subtracting, multiplying and dividing without even realizing how much work they’re getting done or how far they’re advancing in their arithmetic skills. The little ones will be too busy racing taxis and escaping monsters to even care.

Study Music
It’s not hard to locate lessons for piano, guitar and flute via webcam with qualified and engaging instructors from all over the country. If your child hasn’t started playing an instrument, now’s the time to introduce to them to some different forms of music so they know what’s out there. For budding vocalists, pick a song they like, find the lyrics and sing along together while clapping your hands to the beat.

Draw Pictures
Let them amaze you with their creative talents thanks to some online drawing tutorials. They’ll be guided step-by-step and line by line in rendering a variety of fascinating pictures that include their favorite Disney characters as well as dinosaurs, animals and monsters. The only problem is there are so many options they may have trouble choosing one.

Make a Snack
You may be feeling a little peckish at this point, so it’s off to the kitchen, laptop in hand, where the kids will do most of the work in preparing a delicious and healthy snack to keep everybody going strong. You’ll even find a recipe based on the famous Stone Soup tale. If that doesn’t tickle your fancy, try the wiener weenie dogs, which should get the little ones giggling and their mouths watering.

Explore Science
Bellies full, it’s time to get to work in your makeshift laboratory, and your kitchen should serve well once you’ve cleaned up the remainder of your snack. There are plenty of hands-on projects that bring science to life outside of the musty old textbook. Your little scientists conjure up bubbling lava using nothing more than a glass, food coloring, vegetable oil, salt and water.

Tell a Story Together
It helps develop verbal fluency, expands vocabulary and builds confidence speaking in front of groups, which is quite an impressive list of benefits for a fun activity that gets kids’ minds humming. Doing it as a group allows everyone a chance to participate, and if you have any questions on how it works, visit Super Easy Storytelling for some pointers.

Get Some Exercise
Bye this point, the kids are probably itching to get up and move their bodies a little, so let them, because they could use the exercise anyway. There’s no need to go further than Youtube as they have a variety of videos that teach the tikes aerobics, dancing, stretching and even yoga.

Watch the News
The little ones have probably wondered what keeps their dad entranced in front of the TV every evening. Well, the regular news probably isn’t for them, but there is a kid-friendly format that will teach them about the world. You’ll find it at Dogo New, which provides “fodder for young minds” by keeping them up to date with the current events that they’ll find interesting.

That should make for a great day of learning with activities for any kid to enjoy. In fact, you may just want to stay inside when the sun comes out. 
Image via Pexels.

Written by guest blogger, Jenny Wise, Special Home Educator

Navigating Pregnancy Options for New Canadians

By Abigail Corbin RM, Hawthorne Midwives

It can be overwhelming when you are new to Canada and pregnant. Every country arranges their healthcare differently. Even if a title - such as “midwife” - is the same, what they do and how they are trained can be very different. 

pregnant woman asia

In Ontario, when you are pregnant, you can decide whether you want to have a midwife or a doctor. Both options are paid for, though slightly differently. Doctors are paid through Ontario Health Insurance (OHIP) and midwives are paid through the Ontario Midwifery Program. This difference means that residents of Ontario do not have to pay for midwifery services, even if they don’t have OHIP. In fact, clients of midwives without OHIP have access to a grant that pays for their laboratory and ultrasound tests and any consultations with physicians. 

In Ontario midwives are experts in low risk pregnancy and birth. They follow you throughout your pregnancy, labour and birth, and for 6 weeks after your baby is born. Midwives can order any routine tests and can consult with a physician if complications arise. Midwifery appointments are longer than doctors, which is particularly beneficial if English is not your first language. Some even provide interpretation services. 

Midwives attend births at home and in the hospital. If you do not have OHIP you will need to contact your local hospital to arrange for payment for the birth (there is no cost for a homebirth). It is best to contact the financial office as soon as you know which hospital you want to deliver at.

midwifery

An obstetrician requires a referral from your family doctor (or walk in clinic if you do not yet have a family doctor). Midwives take self referrals - this means you can access midwifery care by filling in an intake on their website or calling their office. If you know you will be moving to Ontario you can request care before you arrive.  

AbigailCorbinAbigail Corbin is a registered midwife with Hawthorne Midwives in Milton.  Hawthorne Midwives specializes in providing care for new Canadians. For more information, go to their website www.hawthornemidwives.com

Affirming the areas of our bodies that are often shrouded in shame and guilt

July being self care month, I thought I’d share an experience I had while driving past a construction site one early evening in March this year.     

It was bitingly cold, and a sharp wind chased snow flurries over the yard. Two men were handing pieces of cold steel piping to each other, their breath clouding the air. Suddenly, one of them lost his grip and the pipe clanged out of his hand and struck his ankle. Immediately, a rush of expletives gushed out of him. A mix of the predictable everyday expletives interspersed with a synonym for female genitalia. While certainly not new words to me, on that night they struck my ear as forcefully as the steel had his ankle.

vagina questions

I encounter these genitalia and their supporting tissues every day.  The signs of incontinence, the sensation of pelvic heaviness or the pain of difficult intercourse. Those deviations are fairly easy to quantify and describe. Often, however, there is a degree of disconnectedness, an intentional or unintentional disengagement with the areas of our bodies that are often shrouded in shame and guilt. A disembodied way of describing them and their actions. Our sexual organs and defecatory organs: vaginas, penises, rectum and anuses do not seem to be aspects of life we want to spend much time honouring or engaging with. We’d much sooner refer to them in disgust, shame, in anger, in frustration and fear. We wield these words to convey how we feel. Are we thereby conveying, simultaneously and subliminally, how we feel about the areas and functions they are describing?  Do we feel disgust, shame, anger, frustration and fear when we describe any perceived deviation of the expected ‘norm’ in sexual encounters, in passing stool or urine?

A different spoken word environment may allow us to be more engaged and feel warmer towards these amazing, intricate life sustaining organs.A haven of warmth and the gateway to our fertility and life-giving womb.That cold, barren, uninviting and uninformed construction site was and is as different to the vagina and uterus as can be.

As we celebrate self-care month I’d like you to pause and consider how amazing each and every part of your body is - even if our words don’t always affirm this.

Gerda square

Gerda Hayden is a pelvic health physiotherapist at The WOMB Burlington and takes pride in delivering holistic care.  Gerda utilises manual therapy, electrotherapy and dry needling amongst other techniques and has a special interest in postnatal clients and all Women’s Health conditions.  Gerda has been a physiotherapist for 12 years in South Africa, England and now Canada! She is a mother to young boys and has taught Pilates for the last eight years as well

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A Father’s Day Gift – Skin to Skin from Birth: A Guide

I once took a workshop with the amazing Gena Kirby about the natural mammalian instincts that occur during the birth of a child. Given the freedom and absence of intervention, a woman most often will stand, squat or kneel to give birth to her baby. She will gently guide her baby’s entry into the world and slowly lower her baby to the ground. She will take her time to catch her breath, reconnect with her surroundings and those with her, and then lastly will acknowledge her baby. 

pregnant couple

We have done an amazing job in our community of educating, encouraging and providing the opportunity for women to do skin to skin with their babies right after birth, but what if a woman isn’t ready to receive her baby? It’s so much more common than we acknowledge. And unfortunately, without knowing this, women often feel like there is something wrong with them if they don’t have that ecstatic moment of utter connection to their little being right away. Giving women time to absorb their reality and giving partners the opportunity to be a part of the beginning of a brand new life is a win-win for all.

So the baby is just born and automatically the midwife or doctor will bring the baby up onto the mother’s belly (except in special circumstances). The umbilical cord continues to pulsate (pumping red blood cells and other great stuff into baby) and everyone oohs and aahs. Maybe everything seems frantic, maybe mom’s eyes are still closed and she is catching her breath, maybe the parents have no idea what to do next. It’s all good. Now imagine it’s you. Stay where you are and listen to what you and your body need right now. Maybe it’s connection, maybe it’s to be left alone. Maybe both your partner and the baby need connection - and you don’t have it in you right now to provide that. There’s many great reasons why that’s okay to let your partner do the parenting right now. Your doula will know that now is the time for your baby to be skin to skin with dad or partner but it may be a great idea for your birthing team (including your partner) to know that you are okay with your partner having that privilege to start. 

Skin to skin means having your baby naked (not wrapped in a blanket) and placed directly skin to skin on either your chest or your partner’s chest immediately after birth, for as long as possible.

So dads and partners, don’t worry about hairy chests, thin chests or big chests. The baby is happier just having its temperature more stable, its heart and breathing rates more stable, and hearing the familiar thump-thump of a heart beat. Skin to skin with both parents allows the baby to be colonized to the parents’ bacteria which strengthens its immune system. This, plus breastfeeding, are thought to be important in the prevention of diseases. Some other great facts about skin to skin include:

Dad preemie skintoskin

  • Even babies on oxygen can be cared for skin to skin. This helps reduce their need for oxygen, and supports good breathing.
  • The baby is more likely to latch on well to the breast.
  • The baby is less likely to cry.
  • The baby is more likely to breastfeed exclusively longer

And for those who give birth by caesarean, your partner will be invaluable to you and your baby in the operating room. Although mothers are sometimes now given the opportunity to provide this kind of skin to skin support to their babies on the table, it’s still an unfortunate rarity. So dads and partners, take this opportunity to get a stable chair to sit in and place the baby right skin to skin in the operating room. Dads and partners can prep for the baby’s caesarean birth by wearing a button down shirt and putting the hospital gown on with the ties in the front.

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Interestingly enough, studies also show that a father’s involvement from birth leads to

  • fewer behavioural problems
  • higher educational achievement 
  • higher self esteem and satisfaction
  • More satisfying sexual relationships
  • Lower criminality and substance abuse
  • Better friendships with better adjusted children

So here's the "how to do it" part: 

1. Place your naked baby’s chest directly on your naked chest in a vertical position. Don’t worry about hairiness – it’s soft and better than stubble. 

2. Allow your baby to turn its face to one side or the other, keeping its chin slightly lifted and airway open.

3. Allow your baby to stay in this position as long as it would like (preferably for at least the first 1000 minutes). Newborn procedures like checking temperature, heart rate, breathing, giving the Vitamin K injection and others can be done while skin to skin. At some point you may want to weigh the baby, but that can wait until after the baby has breastfed and then the baby can go back onto one of the parents’ skin again.

dad skintoskin

Preparing for Parenthood When You Have a Disability

From our guest blogger Ashley Taylor, disabledparents.org

disabilityWhen the blue line appears or the agency calls to announce the good news, your first thought is probably exultation — your family’s about to get bigger! But then… the doubt, anxiety and fear creep in. After all, you want to be the best parent possible, but. oh. my. goodness! You’re about to be responsible for the care of a helpless newborn. Yikes!

All new parents experience these crazy emotions—and when you have a disability to compound the changes, your stress may double or triple. But it doesn’t have to. The first few weeks after your baby’s arrival are the most challenging, but planning your new life, adapting your home, and setting up a dependable support system, should facilitate a smooth transition to parenthood.

Mental preparations

Not much trumps snuggling with a newborn. A newborn brings powerful joy—and sleepless nights, complete chaos, feelings of inadequacy, and worry that you’re doing it wrong.

Make a plan to take care of yourself during those early weeks—self-care is critical to maintaining your sanity. Whether it’s a cup of tea or an hour out while she hangs with the sitter, make time to rejuvenate your spirit. Know what helps you relax before your baby arrives, so that it’s easy to request assistance, plan a weekly lunch date, or schedule that house cleaning.

If you’ve got very little experience with brand, new tiny humans, educate yourself. Learn how to establish routines. You’ll quickly discover that just when you get the hang of things something changes. But, a plan and a healthy sense of humor go a long way to helping you feel prepared.

Acknowledge your limits. With a physical disability, it’s best to determine ahead of time what you can and can’t do, where you’ll need the most help, and how to adjust for everyone’s safety.

Home adaptations that make childcare easier

While your specific disability will dictate the changes you’ll need before the peanut arrives, here are some suggestions:

  • Replace steps with a ramp with railings on both sides; or add a ramp and keep the steps.
  • Use expandable hinges for doorways — a much more cost-effective way to increasing the width by 2-inches.
  • Installing skid-resistant flooring to prevent slips in the bathroom, kitchen, stairs and other uncarpeted rooms.
  • Replace door knobs with lever handles.

If you find that your home requires more extensive modifications, there’s a wealth of information and resources available. This article on home remodeling for parents with disabilities from Redfin.com is a great place to start.

Get the right equipment

Babies require an insane amount of stuff. From high chairs to changing tables and monitors to diaper genies, it won’t be long before your home resembles a baby supply store. This equipment does make child care easier, and more companies are recognizing the importance of designing equipment that works for people with or without disabilities.

Parents, who are hearing-impaired, can purchase baby monitors and alarms with flashing lights. High chairs have a variety of options, many of which are adjustable and include easily removable and cleanable lightweight parts.

Adjustable cribs are a boon for parents who use wheelchairs. These cribs also work great for changing your baby’s diaper or clothing.

Other equipment that you might consider includes:

  • Chest harness baby carriers
  • Accessible baby bathtubs
  • Accessible strollers that snap to wheelchairs
  • Breastfeeding slings
  • Boppy baby chairs and two-sided nursing pillows
  • Swivel base baby car seats

In one study, disabled parents named night care, bathing, and carrying babies as their biggest challenges. The study also concluded that furniture adaptations, assistance from caregivers and other supports make infant care absolutely doable.

Resources are out there. Don’t be afraid to reach out. Talk to your doctor, find a support group, and take classes to help you learn skills and tricks from others with similar experiences. And as your new life unfolds, embrace and enjoy the wonder and new memories you’ll make.

Photo Credit: pexels.com

Guest Blogger Ashley Taylor is a disabled mother of two wonderful, amazing, energetic children. She met her husband, Tom, while doing physical therapy. Tom had suffered a spinal cord injury due to a car accident and uses a wheelchair for mobility. Ashley and Tom knew they wanted children and knew they would have to adapt their lives and home in order to make this dream come true. Ashley is happy to say that they are the proud parents of two healthy, wonderful children and their disabilities haven’t stopped them from leading a happy, fulfilling life.

Celiac Awareness

Notice how the definition doesn’t say anything about digestive symptoms?

Celiac disease is estimated to affect approximately 1% of the population but many people suffer for years without a proper diagnosis due to the wide variety of possible symptoms. Undiagnosed celiac disease can have a significant impact on your quality of life and long-term health so it’s important for us to spread awareness and ensure this doesn’t happen to you!

celiacribbon

What is celiac disease?
The Canadian Celiac Association defines celiac disease as “a multi-system autoimmune disorder that is triggered by ingestion of gluten (a protein in wheat, rye and barley) in genetically susceptible individuals.” Do you notice how the definition doesn’t say anything about digestive symptoms? In all individuals with celiac disease, gluten damages the absorptive surface of the small intestine leading to poor absorption of nutrients. However, patients can present with either intestinal symptoms or non-intestinal symptoms (or both!).

celiac diagram

What are the symptoms of celiac disease?
The most common symptoms associated with celiac disease are: chronic diarrhea, abdominal pain, weight loss, and malabsorption. It can be diagnosed at any point in your life and is not just a childhood disease. In children, it is essential to screen for celiac disease if they are experiencing failure to thrive (not following their expected growth curve). 

One of the most common misconceptions about celiac disease is that the above symptoms MUST be present for a diagnosis to occur. This is not the case. The theme for Celiac Awareness Month this year is #GoBeyondTheGut. We need to start recognizing that celiac disease can be present without the classic digestive symptoms. Here is a list of just a few of the non-classical symptoms of celiac disease: 

Chronic fatigue• Chronic constipation
Recurrent Vomiting 
Iron Deficiency Anemia
Osteoporosis 
Infertility
Dental enamel defects
Neurological problems, such as peripheral neuropathy 

What is the testing process for celiac disease?
Talk to one of our Naturopathic Doctors about doing the screening blood test. If the screening test comes back positive, you’ll need to see your medical doctor for a referral to a gastroenterologist so that you can have an intestinal biopsy done to confirm the diagnosis. Celiac disease cannot be definitively diagnosed based on the screening blood test alone! 

Can’t I just try eating gluten free and see if I feel better?
Unfortunately, the answer to this question is no. First of all, you must be eating gluten to be accurately tested for celiac disease. If you start on a gluten free diet and then notice symptom improvement, you would have to start eating gluten again (often for up to 3 month) to get an accurate test result for celiac disease. For this reason, it’s ideal to get screened for celiac disease before starting a gluten free diet.  

You might be wondering why it would be necessary to go back on gluten to get a proper diagnosis if you’re feeling better anyways. Couldn’t you continue on your gluten free diet without a confirmed celiac diagnosis? Although following a gluten free diet is becoming increasingly popular, a gluten free diet by choice is very different than the gluten free diet that must be followed for the treatment of celiac disease. When you are diagnosed with celiac disease, your gluten free diet must be strict, life-long, and avoid even small amounts of gluten cross-contamination. It is important to have the proper diagnosis so you can follow the correct diet. 

celiac GF
 
How does this compare to non-celiac gluten sensitivity?
If you’ve tested negative for celiac disease but still feel strongly that you react negatively to gluten, you might have non-celiac gluten sensitivity (NCGS). There seem to be a subset of people who test negative for celiac disease but still develop symptoms when they consume gluten. 

The difference between celiac and NCGS is that people with NCGS have no celiac antibodies and no intestinal damage. There are also no biomarkers for the diagnosis of NCGS. The only way to be diagnosed with NCGS is to rule out celiac disease and then follow a gluten-free diet. If your symptoms resolve on a gluten-free diet, there’s a good chance you suffer from non-celiac gluten sensitivity. 

Do you read this and wonder if you should be tested for celiac disease? Or if your child or another family member should be tested? Book an appointment with one of our naturopathic doctors to find out whether testing is right for you. Our naturopathic doctors can also support you in starting a gluten free diet in a safe and healthy way. Check out Dr. Emily’s blog post from last year’s Celiac Awareness Month to read more about the gluten free diet and how a naturopathic doctor can support you! 

References:

Canadian Celiac Association. Retrieved from: https://www.celiac.caRashid M, Lee J: Serologic testing in celiac disease: Practical guide for clinicians. Can Fam Physician. January 2016 62:38-43. Retrieved from: http://www.cfp.ca/content/62/1/38.full

DrEmilyCasey squareDr. Emily Casey is a Doctor of Naturopathic Medicine at The WOMB Burlington.Through her own health journey, Dr. Emily has learned the importance of individualized treatment and healing the whole person. She believes strongly that your overall health begins with a healthy digestive system. Dr. Emily enjoys living an active life, including swimming and running, drinking tea, and she is always on the lookout for new and delicious gluten-free food!

No more sniffling, sneezing, itchy kids!

Preventing and Treating Your Child’s Seasonal Allergies

When springtime comes around, we want your kids to be able to play outside and enjoy the beautiful warm weather! But when your child suffers from seasonal allergies, outdoor play becomes much less fun. Did you know that seasonal allergies can be prevented and treated naturally with the help of a Naturopathic Doctor?

Why seasonal allergies?

allergies child

Seasonal allergies are the immune symptoms that develop with exposure to an environmental allergen, such as grass, pollen, weed pollen, tree pollen, animal dander, dust mites, mould spores, and more. In Canada, allergy season usually starts in April and can continue all summer and even into the fall depending on the type of allergy and the severity. By avoiding triggers, supporting the immune and digestive systems, decreasing inflammation, and consuming natural anti-histamines, we can see great improvements in allergy symptoms in children (and adults too!). Let me lay them out for you:

Avoiding Triggers

This can be the most challenging strategy with environmental allergies but the more information you can gather, the better you’re able to understand and avoid these triggers. 

Talk to an allergist (this requires a referral from your medical doctor) to get proper testing for your child. Figuring out your child’s specific allergy helps you better understand how to minimize their exposure to the allergen. 

Consider food sensitivity testing. Eliminating your child’s food sensitivity from their diet will support their immune system function, digestion, and decrease excess inflammation. The fewer allergens the body has to deal with at one time, the better. A Naturopathic Doctor can support you with getting testing, interpreting the results and establishing a supportive and appropriate diet for your child.

Supporting the Immune and Digestive Systems

Seasonal allergies are associated with an overactive immune system. Luckily, we have great options for balancing your child’s immune system. We can start with supporting the foundations of health, including sleep, stress, diet, and activity level. Then, we can consider the addition of the following two nutritional supplements. 

Vitamin D. Low levels of Vitamin D are associated with seasonal allergies. Proper supplementation can help avoid a deficiency and support the immune system. 

Probiotics. A large part of the immune system is located in the gut. Probiotics are an effective treatment for improving digestion and decreasing symptoms of seasonal allergies. 

allergies child2

Decreasing Inflammation 

When the immune system becomes overly reactive, it can cause excess inflammation in the body. Focusing on your child’s diet with the following recommendations is a great way to manage inflammation and improve allergy symptoms. 

Omega 3 fatty acids. Aim for at least 3 servings of fish per week. It can also be beneficial to consider an additional fish oil supplement to get the therapeutic dose of omega 3 fatty aids.

Bioflavonoids. These are the colourful compounds in fruits and vegetables. Work on ensuring your kids get 5-8 servings of fruits and veggies daily.

Limit added sugar. Sugar decreases the immune system's ability to function and can be even more inflammatory. It is recommended that children get no more than the equivalent of 6 tsp or 25g of sugar daily. Check your food labels for sugar added - sugar comes in many different names and forms!

Consume Natural Anti-Histamines

Did you know that anti-histamines don’t only come in the form of a pharmaceutical medication? We can find them all around us! Three amazing natural anti-histamines are vitamin C, quercetin, and stinging nettle.  Vitamin C. Aim to give your child Vitamin C from whole fruits and vegetables or from an added supplement, as opposed to fruit juices (which are high in sugar). Fruits and vegetables that are high in vitamin C include bell peppers, citrus fruits, and strawberries. 

Quercetin. This is a bioflavonoid found in most red, green, and purple fruits and vegetables, including apples, berries, tomatoes, and leafy greens. It is also available in supplement form.

Stinging Nettle. Consume nettle leaf as a tea for its beneficial effects of decreasing allergy symptoms. It has a mild flavour and is often well tolerated by kids. If not, you can try making it as an iced tea and add some honey and lemon for added flavour. 

As you can see, there are lots of natural options to reduce seasonal allergy symptoms in your kids! Also, many of these ideas are safe and effective during pregnancy and while breastfeeding. Book an appointment with one of our naturopathic doctors for more information on how you can treat your allergy symptoms. We want to help you and your kids get outside and enjoy the sun this season!

DrEmilyCasey squareDr. Emily Casey is a Doctor of Naturopathic Medicine at The WOMB Burlington.Through her own health journey, Dr. Emily has learned the importance of individualized treatment and healing the whole person. She believes strongly that your overall health begins with a healthy digestive system. Dr. Emily enjoys living an active life, including swimming and running, drinking tea, and she is always on the lookout for new and delicious gluten-free food!

Our Roots: Who Are We?

Why WOMB?

I think there comes a time in every person’s life when the age-old question starts to lurk in the back of their mind, ‘Who Am I?’ That nagging feeling that asks, now that I’m a parent, now that I have my dream job, now that I’m coming off of maternity leave, what defines me? Who am I becoming? Where am I going? IS THIS MY LIFE? 

Some would call this a crisis of the soul. Some would call this an awakening. Some would call this just part of life’s journey. Well, this is where The WOMB is in its life – on a path that twists and turns and sees something beautiful around every corner. Sometimes that path is strewn with rocks and sometimes it is as smooth as baby’s bottom (I couldn’t resist). Either way, the journey has made us sit back and ponder, “Who is The WOMB?” and “Why WOMB?”. And here is what we came up with.

tree roots

At its ROOTS, The WOMB grounds us. Its roots provide our foundation and nourish our vision and mission. They are our cause, our source and our origin of being. Today, these are our 5 core ROOTS:

1. LOVE & CONNECTION:

007 DuforFamily HRM 1

Love and connection are expressed in our relationships with our family, our team, our community, our earth and most importantly with ourselves. Love and connection nourishes, nurtures, and supports these relationships through compassion, communication, kindness, respect, inclusivity, synergy, faith and trust. As Brené Brown says in her book The Gifts of Imperfection, “Love is not something we give or get; it is something that we nurture and grow, a connection that can only be cultivated between two people when it exists within each one of them – we can only love others as much as we love ourselves.” 

So find your connection at The WOMB, first with yourself through your yoga and meditation programs, counseling and healing services, then with your community in Emerging Mothers Groups, drop-in groups, fitness and workshops.

2. INSPIRATION, TRUTH & AUTHENTICITY: 

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Expressing and connecting to our individual nature and essence allows us to each grow, develop, learn and evolve into the people that INSPIRE our families, friends, community and especially our CHILDREN. With kindness and compassion, awareness, inclusivity, integrity and wisdom, we can inspire the next generations to be true to themselves too. This means being REAL. This means not only allowing ourselves to fail, but also accepting our failures as part of being human, and then evolving and learning from them. It means being courageous in times of transition (don’t we all know transition!), trying new things, being vulnerable and reaching out for support when needed. It means remembering that Facebook and Instagram are just “highlight reels” and that “sleeping through the night” often means different things to different people. It also means acknowledging that families come in different shapes, sizes and make ups, such as LGBTQ, surrogacy, adoption and mixed. So be courageous. Be your own kind of person, your own kind of parent, your own kind of beautiful. There’s lots of THEM but only one YOU. And what your family needs is YOU.

Connect to your own spirit in The WOMB’s yoga and meditation classes, understand your own individual expressions of being in Birthing from Within and HypnoBirthing® courses, gain wisdom in The WOMB Talks Pregnancy, Birth & Parenting workshops or just drop in for a tea. Oh! Maybe even a massage while The WOMB looks after your little one(s)!  

3. GRATITUDE & GIVING BACK: 

guatemala Woman and child

This one is big for us. The vision of The WOMB began with 2 women, but it has grown to encompass whole communities of love that have nourished us too! We are so grateful that you’ve not only given The WOMB your support, you have trusted us with the support of your families and referrals to your friends. You have also come together in times of need to support others in our community who are in of love and a helping hand. Because of your generosity and our desire to 'pay it forward', we’ve chosen to put together what we call our “Angel Fund”. It is a fund that sees the light in every darkness by supporting families with services that they couldn’t otherwise afford or access. It means being able to provide breastfeeding support to women in hospital ICUs, gathering resources for brave women in shelters who have left everything behind to escape an abusive situation, providing in-home counselling sessions through our Well-Mama Program with Counting Butterflies, and providing pelvic floor rehab to refugees without any means of payment. These are just a few examples of how The WOMB has helped in the past. But there is so much more we can do! Our founders are currently working with a group in Guatemala to open a home that would provide birth and postpartum support to women who have experienced rape and incest. Please contact us if you would like to support this WOMB initiative. More info is coming!

4. PRESERVING MOTHER EARTH: 

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Since I became a mother, it was as if a lion took over my psyche and changed the fire within me. I suddenly was protective with all my being. My children are my roots, my legacy, my life-giving aspect of nature and I was their sustainer of life. It’s marvelous to me that this is exactly how our earth must feel about us. She protects us by providing life-supporting air, nourishes us with water to hydrate and land upon which to sow our crops. Thus, at The WOMB we believe it is our sacred and divine duty to respect our mother earth, preserve her legacy, conserve her resources and keep it as clean as possible. We use hand towels at The WOMB, organic products whenever possible, cold water in our washing machines to save energy, recycle waste products and never forget to thank her loving and giving spirit. She in return provides us with health and nourishment! 

5. LEARNING & EVOLVING:idea

This root very much ties into our deep belief that when you know more, you do better. We acknowledge that learning is a life long process. It means growing in awareness, taking the opportunities for education, developing intuition, living by our own core values, and listening to our inner wisdom. The opportunity to learn and evolve is everywhere. From moments of complete epic meltdowns in the arms of your doula, to laughter and hilarity in an Emerging Mothers Group. There may be moments of seeking your heart’s deepest questions in childbirth preparation classes or moments of pure evidence-based treatments with your health care practitioner. The WOMB believes in the evolution of the whole person, so find your learning opportunities in the physical, emotional, mental and spiritual support The WOMB lovingly provides to you and your family every day.

So WHY WOMB? Well because The WOMB believes in YOU and your full potential. The WOMB believes in your flaws and your strengths, and loves you for both. The WOMB believes that you can evolve, grow, develop and BE your own person – just as it continues to grow, develop, evolve and support its own roots. So I’ll see you soon, right? I’ll be the one with the tea in hand and the sign over our door that says, “Free Hugs”. Take me up on it. 😊

AngieStenback3Angie Stenback is Co-Founder of The WOMB, a Birth and Postnatal Doula, Childbirth Educator, Pre- & Postnatal Fitness Trainer, mother to 4 amazing kids and wife. When not at The WOMB, she can be found most often in the hockey rinks, her "taxi" or the dance studio. She heeds her heart's call by practicing yoga, meditating, dancing or spending time amongst the trees on a hiking trek.

Pregnancy-related Pelvic Girdle Pain:

Embrace the Evidence and Move beyond Biomechanics

Originally published in the Journal of Yoga and Physiotherapy
Volume 3 Issue 5 - January 2018

Sinéad Dufour, Assistant Clinical Professor, School of Rehabilitation Science, McMaster University, CanadaSubmission: January 17, 2018; Published: January 24, 2018*Corresponding author: Sinéad Dufour PT PhD, Assistant Clinical Professor, School of Rehabilitation Science, Director of Pelvic Health, The Worldof My Baby (WOMB), McMaster University, Canada, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

back pain pregnancy

Opinion:

Imagine you are 32 weeks pregnant with your first child and you start to have pain in the low back and pubic area when you change position, sit or stand for longer periods. The painmakes it very difficult for you to function and you worry about whether you can continue to work and manage your household.You are also concerned about the upcoming birth of your baby and whether you will be able to care for your baby, an often seemingly overwhelming task without having to deal with pain. Now imagine you have seen your health care provider and havebeen told that your pelvis is separating because of the “pregnancy hormones” and that you need to put up with this until after you have your baby, as “it will probably get better afterwards”. Imagine you are also told, to be careful because “your pelvis is unstable”. These are common words of advice or explanations pregnant women with pelvic girdle pain (PGP) receive from their healthcare providers, including physiotherapists. These words are not substantiated and do more harm than good.

Pelvic girdle pain (PGP) is defined as a specific type of low backpain that can occur with or without additional low back pain [1].Pregnancy-related PGP is a specific category of PGP impacting women in the perinatal period and differs in its etiology as it is related to pregnancy and associated biopsychosocial influences.It represents a prevalent condition with an incidence as high as 46-58% [2]. The cause of pregnancy-related PGP is complex and multifactorial [1,3]. Evidence has shown an alteration in motorcontrol in pregnant women [3] and more recently, central pain mechanisms have been considered and implicated [4-7]. As such,to appropriately address the complexity of pregnancy-related PGP, physiotherapists and others must both acknowledge and part with common yet unsubstantiated beliefs surrounding the concept of “pelvic instability” [8]. Instead, current advances in pain science support the notion that pregnancy-related PGP represents sensitization of the structures of the pelvis [4-7].Thus, attention must move away from biomechanics and engage the multiple underlying mechanisms such as the stress system (HPA axis) and associated coping, inflammatory load, status (HPA axis) and associated coping, inflammatory load, status of the gut microbiome and sleep quality to name a few [5-9]. Despite the evidence supporting the need for a biopsychosocialperspective, recent research demonstrates that when it comes to pregnancy-related PGP, physiotherapists continue to preferentially use a biomechanical approach [9,10]. Guidance for an evolved evidence-informed approach is available from the the most recent published CPGs for pregnancy related PGP [4]. From an assessment perspective, Clinton et al. [4] indicate the use patient reported outcomes as an important way to capture the various assessment domains relevant to pregnancy-related PGP[4]. Specifically, among other scales, the Pain Catastrophizing Scale (PCS) is recommended [4]. The PCS has three subscales:- rumination, magnification, and helplessness and has been utilized in various populations, including the antepartum population [11,12]. Using an outcome measure like the PCS is important to aid physiotherapists and others in assessing the mental processing that is associated with pregnancy-related PGP. The significance of patients’ beliefs and perceptions about their pain and their pain experience has been well demonstrated across a wide spectrum of orthopedic conditions including in the antepartum population [13]. Perception of pain has also been linked to the development of persistence [14-16], an important consideration for pregnancy-related PGP.

preg relaxation

From a management perspective, it has been shown that pregnant women’s expectations of care are not met and that their knowledge about how to manage the condition is lacking [17]. Further, a recent qualitative study elucidated women’s experience of care for pregnancy-related PGP highlighting the importance of perceived hope and self-efficacy [18]. Thus cognitive care strategies that focus on pain neurophysiologyand stress response education [4,6], mindfulness-based stress reduction [19], and tailored exercise [3,4,6] are advocated.

Science has evolved and to clearly guide practice well beyond a biomechanical approach where pregnancy-related PGP is concerned. Physiotherapists well-positioned to educate PGP is concerned. Physiotherapists well-positioned to educate and empower women so they understand how to interpret and respond to the pain they are experiencing. Knowledge translation efforts to support the provision of evidence-informed care herein are needed.

References

1. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B (2008)European guidelines for the diagnosis and Treatment of pelvic girdlepain. Eur Spine J 17(6): 794-819.
2. Rost CCM, Jacqueline J, Kaiser A, Verhagen AP, Koes BW (2004) Pelvicpain during pregnancy. a descriptive study of Signs and symptoms of 870 patients in primary care. Spine 29(22): 2567-2572.
3. Stuge B (2012) Pelvic girdle pain: examination, treatment, and thedevelopment and implementation of the European guidelines. Journal of the Association of Chartered Physiotherapists in Women’s Health111: 5-12.
4. Clinton S, Newell A, Downey P, Ferreira K (2016) Pelvic girdle painin the antepartum population: Physical therapy clinical practiceguidelines linked to the international classification of functioning,disability, and health. section on women’s health and the orthopaedicsection of the American physical therapy association.
5. Bergström C, Persson M, Mogren I (2016) Sick leave and healthcareutilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum. Chiro& Man Ther 24: 7.
6. Smith MC, Ramirez LO, Clarke G, John FC, Higgins MF, et al. (2017)Stress reduction therapy improves symptoms of pregnancy-relatedpelvic girdle pain and reduces salivary cortisol. Irish Pain SocietyAnnual Research Conference, Aug 26th, Galway, Ireland.
7. Felice VD, Moloney RD, Cryan JF, Dinan TG, O’Mahony SM (2015) Visceralpain and psychiatric disorders. Mod Trends Pharmacopsychiatry 30:103-119.
8. O’Sullivan PB, Beales DJ (2007) Diagnosis and classification of pelvic girdle pain disorders – Part 1: A mechanism based approach within a biopsychosocial framework. Man Ther12(2): 86-97.
9. Shoskes DA, Wang H, Polackwich AS, Tucky B, Altemus J, et al. (2016) Analysis of gut microbiome reveals significant differences between men with chronic prostatitis/chronic pelvic pain syndrome and controls. J Urol 196(2): 435-441.
10. Vandyken C, Hilton S (2012) The Puzzle of pelvic pain: a rehabilitation framework for balancing tissue dysfunction and central sensitization - a review of treatment considerations. J Wom Health Phys Ther 36(1): 44-54.
11. Dufour S, Daniel S (2018) Understanding clinical decisio making: pregnany-realted pelvic girdle pain. J Wom Health Phys Ther IP.
12. Bergbom S, Boersma K, Overmeer T, Linton SJ (2011) Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. Phys Ther 91(5): 754-764.
13. Grotle M, Garratt AM, Krogstad Jenssen H, Stuge B (2012) Reliability and construct validity of self- report questionnaires for patients with pelvic girdle pain. Phys Ther 92(1): 111-123.
14. Vøllestad NK, Stuge B (2009) Prognostic factors for recovery from postpartum pelvic girdle pain. Eur Spine J 18(5): 718-726.
15. Noren L, Ostgaard S, Johansson G, Ostgaard HC (2002) Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J 11(3): 267-271.
16. Ostgaard HC, Zentherstrong G, Roos Hansson E (1997) Back pain in relation to pregnancy: a six-year follow up. Spine 22(24): 2945-2950.
17. Crichton M, Wellock V (2008) Pain, disability and symphysis pubis dysfunction: women talking. Evidence Based Midwifery 6(1): 9-17.
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