Birth and Bowel Movements: Tips for the first BM after delivery

Bowel movements?!?  Really?!?  You want to talk about bowel movements?  

Yes. Yes, I do.  

This is one thing I certainly never expected or cared to research when I was having kids.  I was just focused on gearing up to get the baby out - I didn’t think so much about after the fact!  One would think that a bowel movement would be nothing in comparison to pushing out an 8 pound baby, no?!? Well…

Many women don’t anticipate this being an issue after delivery, especially if you’ve never had issues with constipation before.  However, a multitude of factors can throw things off and leave you feeling all “backed-up”.  Medications, prolonged sedentary positions and/or an altered diet are just a couple of potential culprits. Regardless of the reason(s), it makes for a less than ideal experience when the time comes to void those bowels.  Your healthcare provider will most likely be asking you and keeping track of how this process is going.  However, if you are having trouble in this department after giving birth, don’t be afraid to ask for help so they can set you up with a variety of resources like stool softeners and enemas to help move things along.  

Here are some additional tips that you can do yourself should you find you’re in the situation of dreading bowel movements after giving birth.  (These tips also work great for general constipation too).  

  1. Relax - Way easier said than done especially if you’ve had any type of tearing, an episiotomy, a C-Section or are just dreading having to “push” one more time!  Pelvic floor muscles relax and open much more easily when you are not stressing about it or anticipating pain.  How do you relax the pelvic floor specifically? One way is to use your breathing - inhale and simultaneously visualize opening the anus.  Sometimes it works well for people to visualize widening the SITs bones away from each other as you inhale (the “SITZ bones” are the two boney points you feel in your backside when sitting in a chair).  This relaxing or opening should NOT feel like you are pushing downwards, it’s simply a reflexive response to the breath. If you’re having trouble getting this down, ask for some help from one of our amazing physiotherapists.  
  2. Don’t clench your jaw - Also, if you’re having trouble relaxing the pelvic floor, check and make sure you aren’t clenching your teeth.  Strangely enough, keeping this area relaxed can also help relax the pelvic floor.
  3. Knees higher than hips - Those fancy commodes are handy so you don’t have to squat down so low, but sitting high doesn’t do much for optimizing the position of the rectum when trying to void those bowels.  Grab a stool or improvise with a garbage can (preferably empty!) tipped on its side.  Place feet up on something secure so your knees are higher than your hips and legs are supported and relaxed.  This can help align things more optimally for faecal evacuation.
  4. Position some more - Lean forward and rest elbows on your knees. This allows for further relaxation.  Let the tailbone untuck slightly to allow for easier passage of stool pass this area.  
  5. C-Section? Splint lower abdomen - If you’ve had a C-section, place a towel or your hands between thighs and lower abdomen for added support at the incision site.  Try not to block your belly totally however as forward movement of the abdomen can further help the muscles surrounding the anus to relax.  I know it’s going to feel like things will burst wide open if you strain too hard, but keep in mind that the surgeon stitches you up with the goal of keeping you closed.  If they thought the forces generated by pooping were going to be a hazard, they would tell you not to poop for 6 weeks or something crazy like that until things are all healed up.  Plus, after reading this article, you now have some strategies to minimize that horrible feeling of pain/pressure/pulling at the incision site! Ready for some more awkward suggestions??  I’m just warming up!
  6. “Moo”, “Grr”, “Hiss” or pretend to “Blow through a very small straw” - Ummm, WHAT?!??! If you didn’t already think I was crazy, I realize I just tipped the scale.  Please, bear with me (no pun intended).  Using your breath or vocalizations on the exhale can help modulate intra-abdominal pressure and act as an effective tool for assisting with a less strenuous bowel movement.  It can help you avoid the Valsalva Maneuvre (breath holding) that can increase downward pressure on the pelvic floor and/or the outward pressure on the C-Section incision site (if you have one).  Try all four sounds out - see which one feels like it opens the anus the most.  Generally speaking, half of these vocalizations will feel like they make you tighten at the anus, and the other half will create an opening effect.  However, which one is most effective will vary from person to person.  When you find one that feels like it creates the greatest opening effect (eg. “Moo”), use that as your go-to vocalization when on the toilet.  If you are having trouble finding one that works, make sure you try again using a low-pitched voice versus a high-pitched voice.  In attempts to try and redeem myself, I’m going to throw in here that you don’t actually have to make the sound so they can hear you at the nurses’ station (although that would be entertaining).  Simply causing that air movement with a whispered “Moo” can be just as helpful.  

Strange tips, I know, but these simple things can make a huge difference in keeping that first bowel movement or two after delivery a much less torturous experience.

If you have any questions about pelvic floor physiotherapy or preparing for birth, please call Rebirth Wellness Centre at, 226-663-3243, or email us at info@rebirthwellness.ca.

Jaclyn Seebach, PT ~ Certified Pelvic Health Physiotherapist

Six Steps to Escape the Mom Spiral

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Today felt like a mom fail. I couldn't get anything right. According to my toddler, the pants were wrong, the shirt was wrong, the breakfast was wrong, the shoes were wrong and even the method of transportation to school was wrong. It was a GREAT start to the day. You know, one of those days where you're right on the edge of falling apart or not giving a *!@#...it could go either way. 

Step 1: Questioning

So after dealing with an epic temper tantrum throw down at daycare drop off, I climbed back into our minivan (infant in tow) and began the process of what I like to call "the mom spiral". For me, the mom spiral is not just a downward one; it's full of all sorts of fun ups and downs. Mom spirals may be different for everyone and have different triggers, but for me it usually goes like this: step one is an incident resulting in me questioning a parenting choice (big or small). 

Step 2: Indecision

I am wracked with indecision over what I should or should not have done, could have done better or should have known better about.  Step two almost always involves some aggressive Googling; and, even though I am always the first to advise my other mom friends to NEVER Google something when in this state of mind…I of course ignore my own advice and type on.

“Hmmmm maybe someone else has gone through the same thing,” I think to myself.  

This quickly turns into “I must have done something that contributed to my child behaving this way”, or, my favourite, “how could I not have known that when it seems that all these other moms in this forum from 2011 knew about it.”

Either way, it is not often a constructive use of my time and definitely allows my mom spiral to continue. 

Step 3: Mom Guilt

This part of the mom spiral is the most draining and consuming. Unfortunately, this is the part of the mom spiral that I find myself stuck in and obsessing over the longest.  

Step 4: The Punishment

Since I clearly don’t have it together I guess I better punish myself with tasks, errands and chores. I often catch myself in this pattern where I keep busy with “things to do”. These are things that I have decided HAVE TO GET DONE now. As a result, anything else that I had planned for myself must wait. 

Once I’ve spent some time trying to run away from these feelings of self-doubt and mom guilt through obsessive multitasking it's time for…

Step 5: Exhaustion

I stop for a moment and look around only to realize that maybe I overreacted. 

How do I escape the "mom spiral"? 

Step 6: Commence Pep Talk

Ok breathe…don’t be silly. You’re not a bad mom. There is nothing you could have done differently. You did the best you can. A few years from now you won’t even remember this and more importantly neither will the kids. They will remember you being happy. They will remember you having confidence in yourself and encouraging them to do the same. They will remember you leading by example and picking yourself up after a bad day. They will learn to be kind to themselves if they see you being kind to yourself. So, yup, today was a bad day. I got yelled at by my toddler in public and had to make an impromptu performance of my parenting skills in front of some daycare parents and a few pedestrians. I got to take a spin on the "mom spiral". But it's ok. Tomorrow is another day and until then I am going to lean into the moments of joy, hug my kids a little harder at the end of the day and go to bed with a full heart ready for a fresh start.

Does the pep talk always work? No, of course it doesn't.  But I have always found remembering my successes as a mom helps a lot. So does a good cry.

If any of you moms out there have encountered “the mom spiral” or perhaps have dealt with your own version of it, please know that you are not alone. And the next time you are out and about and see another mom who is maybe having a bad day, send a little smile their way so they know they are not alone either. A little smile goes a long way on a bad day.

xo Adrienne

Adrienne MacDonald, Postpartum Doula

I am a mother of two children, two dogs, one horse and a cat.  I am currently completing my Postpartum Doula certification through Doula Training Canada and am fully insured as a postpartum doula in training. Some previous work experience that I bring into this new role includes many years volunteering in crisis intervention with Victim Services as well as a career as a legal assistant, where I learned both compassion and professionalism.

New parenthood can feel both exciting and overwhelming. Nothing can prepare us for this journey. Sometimes, the only way to get through the day is with the help and support of others. Some of my best and most valuable postpartum experiences were receiving the support and encouragement of another person when I was feeling vulnerable. It is through these moments that my passion for helping others navigate the postpartum period emerged.

I believe that when it comes to parenting, there are often 100 different ways of doing the same thing.  It’s our job as parents to choose what works best for our family, and it’s my job to provide you the support you need to make safe and healthy choices that help you achieve your goals during the postpartum period.

The Top 5 Foods to Make More Milk

Isn't it amazing how quickly the boob obsession can take over your life as a new parent? Am I making enough? Did they drink enough? Is the milk good enough? Are they getting the hind milk? What is hind milk?….? Thats the thing about breast/chest-feeding, it’s a little unnerving not knowing how much your baby is drinking. But here's the thing about that thing (too many things?), you don't need to measure the volume of breastmilk your baby is drinking to know if they are getting enough. The key is to look and listen to what your baby is telling you.

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Revolutionary thinking, I know.

When you are able to look and listen to your baby, and decode what it is that they are telling you, you learn so much.  If you are struggling to decode the mysterious signals your baby is sending in relation to hunger, drinking and satiety then let's chat in person. Once you have someone guide you to see the simple cues baby sends, it can change how you feel!

Also, I have a confession.  I have you here under a ruse...I've mislead you to believe that we are going to talk about how to increase your milk supply through food. And we WILL get to that...but first let me say this: the NUMBER ONE way to increase milk supply is to have a great latch, with baby draining the breast well.

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If your baby is latching well (big wide mouth, asymmetric on the breast, full tongue mobility), and able to drain the breast well, this will be the absolute *best* way to continue to produce the milk that your baby needs. It is supply and demand, if your body gets a strong signal to make more milk, it will!

Sometimes the stars don’t alight for this process to run smoothly right from the beginning, and that is ok-and completely normal. But getting you back on track is without a doubt the best way to make more milk. Sometimes other factors, like mood, sleep and breast-chest feeding parent nutrient, come into play as well. Please, if you are struggling reach out, use your community, we want to support you.

So, if you are reading this because you are struggling to produce enough milk for your babe, or your babe is gaining "slowly" then the number one way to boost that milk production is to consult a lactation consultant or breastfeeding professional. If you have and are still struggling, then see someone else.  The guidance you get can be invaluable for your breast/chest-feeding journey. There are so many ways that we can adjust latch and change breastmilk intake to help your baby and our body communicate effectively to get those mammary glands Rockin' and Rollin'.

Milk Boosting Foods

If the number one way to increase milk is to have a great latch, then what's the deal with milk boosting foods and teas?

Milk boosting foods are foods that will slightly increase the amount of water that is circulated to the mammary tissue.  When these foods do this it provides more water for your body to use to make milk. Being well hydrated is important for the galactogenisis process. These foods are high in protein, iron and B-vitamins, which provides some of the important building blocks for galactogenesis to occur, as well as supporting recovery in the post part period, and supporting overall wellness. Increased food intake and milk production go hand in hand. It is important to eat when hungry and drink when thirsty.

Having said all this, if you are looking for the top 5 foods to *support* the milk making process then here they are:

Adding these foods into your diet as a part of a healthy diet can help support the milk making process. And thereby slightly increase the amount of milk you make. Some breast/chest-feeding parents respond incredibly well and drastically increase production, others not so much. A simple way to add these to your diet is to start your day with a bowl of oatmeal, a handful of almonds, a spoonful of flax meal and Brewers yeast sprinkled on top, and a big glass of water.  For a more involved recipe here is my favourite Lactation smoothie recipe.

If you give it a try let me know what you think, or if you have any other questions send them my way. And as always, Nurse on!

~Rebecca

References: Compr Physiol. 2015 Jan;5(1):255-91.

Rebecca Robertson, Breastfeeding Counsellor, Doula, Childbirth Educator

I am a birth advocate, a breastfeeding educator, and especially an advocate for mothers and the choices they make. As a doula my main role is to support mothers and partners to ensure a satisfying and positive birth experience. I am trained in providing emotional and spiritual support, as well as physical comfort during labor. I completed a DONA training course in 2009 and it sparked my love for supporting laboring women. Since then I have been inspired to continue my learning to provide the best support I can with additional studies in lactation and natural medicine. Some of the things in my tool kit include massage, acupressure, and items to help with visualization and relaxation.  I am trained in different stretches and birthing positions to improve pain tolerance and pushing efficacy, as well I give lots of encouragement! In 2012 I enrolled in a Lactation Medicine Program at the Centre for Breastfeeding Education. There I was instilled with this goal "To enable the mother to manage her own breastfeeding experience, so she will be empowered to achieve her own breastfeeding goals." I accumulated over 90 hours in lactation specific education, as well as hours in observation at their breastfeeding clinic. Since that time I have been supporting new moms as they transition to motherhood and begin the breastfeeding relationship. During my time studying Naturopathic medicine, I was fortunate to expand on my knowledge on lactation medicine as well as how naturopathic medicine can play a role in the perinatal care of women and their new babes. I am passionate about my job, and I bring lots of enthusiasm and love for what I do.  

A Healthy Period: What You Need to Know

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Fertility, women's health

A thorough history of woman's menstrual cycle is something I always ask my patients in practice: whether they are tracking it for fertility, just getting it back post partum, or slowly losing it during menopause. Understanding our periods can tell us so much about our bodies and yet all too often I get woman who are unaware of the signs of irregular hormone imbalance and claim that everything is... well, fine I guess.  When I start digging deeper, some admit to having such bad cramps they need to take time off work, some bleed between periods or have such a heavy flow they change a pad every hour. A period shouldn't be a time of suffering. Neither should the weeks leading up to it. Now I have to admit, there is no one fits all perfect period. Every woman will have a different cycle length and experience different symptoms. What is consistent for each woman though is important to evaluate because it's a window into what's going on with her hormones and the state of her general body.  

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Cycle Length

The average length between periods should fall between 21-35 days and be consistent each month. A day or two difference isn't much to worry about, but if you're noticing that your cycle was 21 days one month, then 40 days the next, and then possibly one month skipped, this is a sign of irregular hormone balance and can either be caused by stress, dieting, or PCOS.

Length of Bleed

Anywhere from 2-7 days of bleeding is typical for woman. A period will start on the first day of a true bleed, as in the need for a liner or tampon. Some woman may experience bleeding between periods, after intercourse, for only 1 day or for over 1 week. These again are signs of hormone irregularities and possible issues with the endometrial lining.

Quantity and Quality of Blood

The amount of blood can be a large predictor of just how much lining is being shed during a period. Often woman who have very heavy flows and need to change even a super absorbent pad every hour will need to rule out estrogen dominance and conditions like endometriosis or iron deficiency as a possible cause.  Heavy dark clots are also something that should be investigated. If on the other hand there is very little blood, this could be a sign of estrogen deficiency, often caused by menopause, smoking, dieting, and stress.  

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PMS/Pain

This may come as a surprise, but women should not be experiencing irritability before their period and intense pain during it! Excess pain during a period is another hallmark sign of endometriosis, fibroids, or inflammation and should be evaluated by your health care provider. Mild twitching and aches can be felt on the first few days, as blood loss is often that highest, but the pain itself should never be severe or debilitating. Some woman are so used to heavy painful periods that they assume it's the norm. I often ask patients if they require medication, such as Tylenol or Advil, and how many of them. If it's 8 a day to get by, it's too much. It is, however, common to feel a slight cramp in the middle of a cycle during ovulation, this can actually be a good sign that ovulation is occurring.

Cervical Mucous

This isn't specific to a period per se, but to the overall health of a full hormonal cycle. In the first two weeks after day 1 of your period, estrogen is rising. This should be a state of happiness as estrogen is linked with serotonin and rising libido towards ovulation. Often you'll notice cervical mucous will be white and creamy. As ovulation approached, your body prepares to thin out this mucous in order for sperm to enter. Leading up to ovulation, you should notice that your cervical fluid increases and becomes thinner, clear, and more slippery - somewhat like egg whites. After ovulation, it will return to a thicker consistency.

Temperature

This is again an indicator of ovulation. Temperature will fluctuate throughout the cycle, with it being the lowest before ovulation, spiking during ovulation, and then slightly higher after ovulation. If you track your temperature daily (best to be done first thing upon rising before eating or even brushing your teeth) and notice there is no spike or a very erratic fluctuation, this should be evaluated as well. This could indicate an issue with ovulation or even thyroid imbalance.

What if my period isn’t “normal”?

All too often birth control is used to try and "regulate" cycles. Unfortunately, birth control simply stops your body from producing these wonderful hormones and instead causes what is known as a fake bleed. Often times, woman will be on birth control for 10 years or more and then once stopping, their cycles can become irregular and conceiving may even be difficult. If you think your period pain and overall cycle could be improved, talk to your naturopathic doctor about safe, gentle, and effective ways to optimize your period health!

Dr. Natalia Ytsma

From a young age, I knew that a career in health and medicine was in my future. Having spent time in doctor's offices and hospitals to correct a congenital heart defect, the idea of providing care to families in need and educating them on their health was something that I knew I had to do. It motivated me to always be cautious of how I treat my body and I grew to really appreciate what being healthy was all about, a lifestyle that ensures you take care of yourself from the inside out. I focused my education on science and business and gained experience in teaching, which allowed me to help others empower themselves with the knowledge they acquire. Having also traveled throughout the world, I gained work experience in North America, Europe, and Asia, which allowed me to learn from different work ethics and cultures. I grew a passion to learn about natural medicine and how to help others use it to achieve optimal health. I learned to understand that there's almost always a root cause to a health issue and that you can use safe, gentle, and effective treatment to address it. Ultimately, naturopathic medicine was my calling.
 
EDUCATION
•            Bachelor of Science and Business: McMaster University, Hamilton 2009
•            Holistic Health and Skincare: CNM, London UK 2013
•            Doctor of Naturopathic Medicine: CCNM, Toronto 2015

With 8 years of post-secondary school complete, I completed my clinical internship at the Robert Schad Naturopathic Clinic - with a full year rotation on the paediatric focus shift- and the LAMP Community Health Centre both in Toronto, Ontario. 
 
After graduation, I moved to Beijing where my husband was working at the time. While there, I designed pregnancy and fertility workshops for a local spa and ran a health elective for local teens to educate them on proper nutrition, mental health, and fitness. While abroad, we got pregnant with our son and decided to return back to Canada to begin raising our family close to home. Currently we reside in London, Ontario and I am practicing at Rebirth Wellness Centre, a thriving place dedicated to empowering woman into motherhood and providing family based health care at its best.