• Plugged ducts are common condition in breastfeeding. A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. A blocked duct usually comes on gradually & effects only one breast. This condition happens most often in the first six to eight weeks postpartum, but it can occur at any time during breastfeeding

• Symptoms of plugged ducts
• Plugged duct symptoms progress gradually, and can include pain, a hard lump, a warm and painful localized spot or a wedge-shaped area of engorgement on the breast.
• A blocked breast duct may appear as a tender lump the size of a pea or larger, and occasionally presents with a small white blister on the nipple. The breast may be sensitive and the tender lump may or may not be palpable with defined margins, the area should emit little or no heat, and occur without either redness or fever (< 38.4 °C). The baby may be fussy when feeding from the affected breast, since the milk flow rate from the breast may be reduced. The mom’s general state of health is not affected by blocked ducts. A plugged duct will typically feel more painful before a feeding & less tender & lumpy afterwards.
• There are usually no systemic symptoms for a plugged duct, but a low fever (less than 101.3 F/ 38.5 C) may be present

  What causes a clogged milk duct?

• Clogged ducts aren’t uncommon, and they ultimately form when milk isn’t emptied from your breast the way it should be. That can happen if:
• Your baby is having trouble latching or sucking. Both can cause her to take in less milk.
• You miss or skip feedings or pumping sessions. Sometimes it’s just the result of forgetting or having your baby sleep through her normal feeding time. But clogs can also happen because of abrupt changes in feeding schedules, like going back to work or weaning too quickly.
• Your baby is in the . Being separated from your baby means you may not be able to nurse as often.
• Wearing too-tight bra or clothes.Both can restrict the flow of milk.
• Engorgement or inadequate milk removal(due to latching problems, tongue-tie or other anatomical variations, nipple pain, sleepy or distracted baby, oversupply, hurried feedings, limiting baby’s time at the breast, nipple shield use, twin or higher order multiples, blocked nipple pore, etc.
• Inflammation (from injury, bacterial/yeast infection, or allergy).
• Stress, fatigue, anemia, weakened immunity

 What is an Effective Clogged Milk Duct Treatment?

• Rest
• Adequate fluids
• Nutritious foods will help to strengthen mom’s immune system
• Heat applied to the breast before feeding to better empty the breast, which can be applied by filling a disposable diaper with warm water, squeezing out the excess water and placing it on the breast
• Fully emptying the breast during each feeding through frequent feeding, hand expression, or pumping or feeding in different positions
• Nurse on the affected breast first; if it hurts too much to do this, switch to the affected breast directly after let-down.
• Massage, emptying breasts often by hand expression, frequent feeding, and pumping and feeding. Massage from the plugged area toward the nipple.
• Therapeutic breast massage taught by a certified lactation consultant
• Try nursing while leaning over baby (sometimes called “dangle feeding“) so that gravity aids in dislodging the plug.
• Use cold compresses between feedings for pain & inflammation

If the issue persists, check with a healthcare provider for additional treatment options.

A midwife provides medical care much like a doctor. Midwives also offer emotional support, information, and physical comfort during pregnancy, birth & post partum, but her priority will always be the physical health and safety of you and your baby.

Throughout the prenatal period, your midwife will order tests, perform internal examinations and cervical checks, take measurements, and perform clinical tasks.  She will manage your labor and catch your baby.  A doula can give you information about exams, but only a midwife or doctor can order the tests and carry out your clinical care.

During labour & delivery the main job of the birth doula is to be by your side offering nonmedical techniques during labor, such as breathing, massage, and helping you move into different body positions. Doulas do not provide medical care and do not deliver babies.

Midwives check on clients in early labor and assess its progress. Often, a midwife does not stay with you until you are in active labor. If you desire support and comfort in early labor, a doula will be there as soon as you request their care. A doula will stay with you throughout your labor and birth experience

Should complications arise while you are giving birth, your midwife will be focused on maintaining you and your baby’s physical health. Your doula will provide physical comfort, emotional support, and information. Doulas may explain what is happening, so you and your partner can better understand. Your doula can help you to remain calm and comfortable.

Can I have a doula & a midwife?

Yes! Having both a doula & a midwife ensures your physical & emotional needs will be met when you give birth.

Are doulas covered by MSP in BC?

Doulas are not covered by the BC Medical Services Plan.

What are the symptoms?

SIDS has no symptoms or warning signs.

WHAT IS SIDS and how can it be prevented?

There’s no guaranteed way to prevent SIDS , but you can help your baby sleep more safely by following these tips: Back to sleep.

• Back to sleep.Place your baby to sleep on his or her back, rather than on the stomach or side, every time you — or anyone else — put the baby to sleep for the first year of life. This isn’t necessary when your baby’s awake or able to roll over both ways without help.
• Keep the crib as bare as possible.Use a firm mattress and avoid placing your baby on thick, fluffy padding.
• Don’t overheat your baby. Keep your baby warm, not hot. Don’t cover your baby’s head.
• Have your baby sleep in in your room.
• Breast-feed your baby, if possible.
• Offer a pacifier. Sucking on a pacifier without a strap or string at naptime and bedtime might reduce the risk of SIDS. One caveat — if you’re breast-feeding, wait to offer a pacifier until your baby is 3 to 4 weeks old and you’ve settled into a nursing routine.

If your baby’s not interested in the pacifier, don’t force it. Try again another day. If the pacifier falls out of your baby’s mouth while he or she is sleeping, don’t pop it back in.

• Immunize your baby.There’s no evidence that routine immunizations increase SIDS risk. Some evidence indicates immunizations can help prevent SIDS.

Risk factors

Although sudden infant death syndrome can strike any infant, researchers have identified several factors that might increase a baby’s risk. They include:

• Sex.Boys are slightly more likely to die of SIDS.
• Infants are most vulnerable between the second and fourth months of life.
• For reasons that aren’t well-understood, nonwhite infants are more likely to develop SIDS.
• Family history. Babies who’ve had siblings or cousins die of SIDS are at higher risk of SIDS.
• Secondhand smoke.Babies who live with smokers have a higher risk of SIDS.
• Being premature. Both being born early and having a low birth weight increase your baby’s chances of SIDS.

Diagnosis

Diagnosis requires that the death remain unexplained even after a thorough autopsy

Rhythmic breathing during labour maximizes the amount of oxygen available to you and your baby. Breathing techniques can also help you cope with the pain of contractions.

During contractions stage 1 – Relaxation:

Deep breathing has a whole host of benefits.

In early labour:

Try belly breathing. As you inhale, expand your belly outward; as you exhale, relax your belly downward. Put one hand on your belly just below your ribs and the other hand on your chest. Take a deep breath in through your nose, and let your belly push your hand out.

In active labour:

• Relax your face and lips
• Close your eyes
• Focus on your breath
• Breath in slowly through your nose, quick pause
• Breath out slowly through your mouth

During contractions stage 2 – Managing Pain:

• Deep inhale through you nose or mouth
• Active forced exhale through your mouth until all the air is out– here you can make sounds if you want

During delivery – Pushing stage:

The best way to push is to take in a breath and use it to bear down for five to six seconds. Then gently release the breath and take another.

• Quick inhale through your mouth
• Chin closer to your neck
• Direct force down by holding your breath
• Exhale through your mouth, slowly

Note: If you are not yet fully dilated but you feel like you want to push, breathe like a dog instead – short and quick breaths through your mouth. Two short breaths and one deep exhale to let CO2 out.

If you’ve ever considered having a midwife, you’ve probably seen many of the benefits that the process would come with. There are a lot of reasons why people choose to work with us and we have listed some of them for you to understand those benefits.

Comprehensive care during pregnancy, birth & postpartum care for woman & her baby

It is important to always have someone with knowledge and experience in your corner. Working with Downtown Midwifery Practice will give you that reassurance.

Home visits for mom and her baby after delivery

Once you leave the hospital, we are still there for you! Working with a qualified midwife, you will have someone to support you from the beginning until the end.

Free midwifery in Vancouver, as the cost of midwifery care, is covered by her BC care card

Did you know that you are covered by the BC care card for midwifery services? If you need any help or information, feel free to contact us today!

Specialist referrals when required

We work with a lot of specialists all year round and we can refer you to them if you need us to. The priority is always your health and the health of your baby.

30-45 minutes appointments that allow time for questions and discussion

We want to be sure that you are confident and that you are ready for this amazing experience. This is why we have longer appointments to allow you to ask any questions you might have. Don’t worry, there is no such thing as a bad question when it comes to our services.

Choice of a hospital or home birth with our help

You can choose if you prefer giving birth at home or in the hospital. We will be there to accompany you either way and to guide you in this experience.

Vomiting in pregnancy or, better known as morning sickness, affects an estimated 80% of pregnant women during weeks 5-18. A generally mild condition that may be managed with simple measures, the severity of these symptoms can vary. A small percentage of pregnant women experience more severe onset of nausea and vomiting in pregnancy, with the most severe form being a condition called hyperemesis gravidarum. Although the definition of this condition has not been standardized, accepted clinical features include persistent vomiting, dehydration, ketosis, electrolyte disturbances, and weight loss of more than 5% of body weight.

Causes of Morning Sickness & Vomiting in Pregnancy

The causes of nausea and vomiting in pregnancy remains unknown, but a number of possible causes have been investigated. Gastrointestinal tract dysfunction, elevated levels of some hormones such as human chorionic gonadotropin (HCG) & estrogen- and chronic infection with Helicobacter pylori may play a role.

Treating Nausea and Vomiting in Pregnancy

There are both non-pharmacological and pharmacological approaches to treat morning sickness.

Non-Pharmacological Interventions:

Avoid triggers such as:

• Stuffy rooms
• Odours (eg. perfume, chemicals, coffee, food, smoke)
• Heat and humidity
• Noise o Visual or physical motion (eg. flickering lights, driving)
• Excessive exercise
• Being tired
• Consuming large amounts of high-sugar foods/snacks o Consuming spicy foods and high-fat foods o Stress
• Brushing teeth after eating
• Avoid lying down immediately after eating
• Avoid quickly changing positions
• Take prenatal vitamins before bed with a snack
• Dietary changes: Avoiding food or not eating may actually make nausea worse. Clinicians commonly recommend eating frequent, small, carbohydrate meals, such as crackers or dry toast. Dietary changes that help some women include eliminating coffee and spicy, odorous, high fat, acidic, and very sweet foods, and instead substituting snacks/meals that are high in protein, salty, low fat, bland, and/or dry (such as nuts, pretzels, crackers, cereal, toast). Fluids may be better tolerated if cold, clear, and carbonated and/or sour (such as ginger ale, lemonade, popsicles). Drinking peppermint tea or sucking peppermint candies can reduce nausea. Try eating ginger containing foods (for example: ginger lollipops, ginger tea) or ginger supplements. The smell of fresh lemon, mint, or orange, or using an oil diffuser with these scents, may also help to alleviate the symptoms.
• Acupuncture and Acupressure
• Hypnosis

Pharmacologic Treatment:

• Intravenous Fluids Pregnant women who are unable to keep down liquids and are dehydrated, or have abnormal electrolyte levels, may require intravenous fluids.
• Vitamins and Minerals If the patient is experiencing persistent vomiting, it is important to replenish low levels of vitamins, electrolytes, and minerals.
• Pyridoxine (vitamin B6) Pyridoxine has a good safety profile with minimal side effects; improves mild to moderate nausea, but does not significantly reduce vomiting.
• Antacids Minor symptoms can be treated with antacids containing calcium carbonate.
• Doxylamine succinate and pyridoxine Doxylamine is an antihistamine, and pyriodoxine is Vitamin B6. The combination of these two has been studied and is recognized by Health Canada as safe and effective for pregnant women, with no harmful effects experienced by the infants. In Canada, this is available as a medication called Diclectin® **There are other medications that may be suitable. Speak to your midwife about these options.

When to seek help:

• If you are urinating infrequently, have dark coloured urine, and or dizziness with standing- these are symptoms of dehydration.
• If you are vomiting in pregnancy repeatedly throughout the day.
• If you see blood in your vomit.
• If you are experiencing abdominal or pelvic pain/cramping.
• If you are unable to keep down any food or drinks for more than 12 hours.
• If you lose more than 5 pounds (2.3 kg).

Alternative Causes of Nausea and Vomiting in pregnancy

Not all nausea and vomiting in pregnancy is necessarily related to morning sickness. It is important to rule out other causes if the case appears to be more severe,

Author: Mitra Latifiyan, RM