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UPCOMING ISSUES |
PREGNANCY & DELIVERYWatching baby before birth
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------ Watching baby before birth One of the most pressing questions new parents ask: Is the baby all right? Here are the ways doctors screen your unborn baby to determine its state of health. Detailed Ultrasound Ultrasound can’t diagnose Down’s Syndrome; it can only warn of an increased risk. Multiple Maternal Screening (MMS) - 15–20 wks If you’re 38–39 years old: There are MMS protocols that are more accurate, but at present in BC these are offered only to women at higher risk (38 to 39 years old at the time of delivery). It is called Serum Integrated Prenatal Screen (SIPS). It consists of a blood test at 10 to 13 weeks’ gestation and then a second blood test at 15 to 20 weeks (it’s 90 percent accurate if mom-to-be is 38+ years ). If you’re 40+ years old: If you are 40 or more in age, have had a prior child with Down’s Syndrome or Trisomy 18 or 13, or are over 35 and have had three previous miscarriages or are HIV positive, you qualify for Nuchal Translucency (NT), a special ultrasound done at 11 to 14 weeks in special centres plus the two blood tests of SIPS, with an accuracy of 90 to 95 percent. Together the procedures are called Integrated Prenatal Screen (IPS). Having twins: If you are carrying twins, you qualify for NT, no matter what your age. First Trimester Screening (FTS) - 11–14 wks These tests combined with maternal age and accurate dating of the pregnancy can calculate the risk of genetic conditions. If the results of these tests show a very low risk of problems, you may decide not to have invasive testing which carries a small risk. Amniocentesis & Chorionic Villi Sampling (CVS) Amniocentesis is performed at 15 to 20 weeks. Fluid is removed from the amniotic sac through the mother’s abdomen under ultrasound guidance. A genetic diagnosis can be obtained from the fluid, such as Down’s Syndrome (Trisomy 21). The procedure carries a 0.5 percent increase in miscarriage. Chorionic Villus Sampling involves biopsying the placenta with a needle, either through the mother’s abdomen or through the cervix. It is performed at 10 to 13 weeks and is reserved for women with a higher risk of genetic abnormality. It has limited availability and carries a risk of miscarriage of one to two percent. With CVS, it is important to check for open neural tube defect separately with either a blood test at 16 to 18 weeks or an ultrasound. If your blood type is negative, you need a shot when you have either of these procedures to prevent Rh disease. If you are over 40 at the time of delivery you may choose either amniocentesis or chorionic villus sampling without screening tests, but it is still recommended to consider the screening tests before making the decision about invasive testing. Open Neural Tube Defect For these tests, a visit to your doctor or midwife is important to determine which of the above tests is appropriate for you. -------- Coping with morning sickness Morning sickness, which does not limit itself only to the morning, is the most common medical condition of pregnancy. In medicine, it is referred to as nausea or vomiting of pregnancy (NVP). It affects between 60 and 90 percent of all pregnant women and has been found to be equal to the nausea/vomiting that occurs as a result of chemotherapy used to treat cancer. It is most common in the first 12 weeks of pregnancy, and is usually limited to 16 to 18 weeks’ gestation. Rarely, it lasts for much longer (only five percent of pregnant women experience morning sickness until the end of pregnancy). It can cause great discomfort for the pregnant mom, for the family and for coworkers at the workplace. Risks and Prevention Hyperemesis Gravidarum Causes of NVP Treatment of Nausea/Vomiting of Pregnancy General Methods Ginger Acupuncture/Acupressure/Hypnotherapy Vitamins Antacids Medications Other Medications Acid-neutralizing medications are helpful in some cases and so far no safety issues have been identified. As in all medications, they should only be taken when necessary and under a doctor’s guidance. Some of these include: cimetidine and ranitidine (Zantac). Ondansetron (Zofran) is an expensive medication that is used commonly in chemotherapy-related nausea. It may be used in severe cases of NVP and so far has been safe for the infant and mother, but data is limited. If you are experiencing nausea/vomiting in pregnancy that you cannot relieve through rest and diet, you should visit your doctor or midwife and discuss the options for managing this problem before it becomes severe. You can take heart that having NVP reduces the chance of miscarriage and stillbirth and can be successfully treated in most cases. If you have had NVP in a previous pregnancy or you have motion sickness or migraines, be sure to start prenatal vitamins prior to attempting to get pregnant. For more information check out the Toronto Sick Kids Motherisk website ( www.motherisk.org) or helpline (1-800-436-8477). -------- Understanding gestational diabetes Gestational diabetes is a type of diabetes that occurs in pregnancy. It occurs in two percent of pregnancies. This disorder is a result of pregnancy hormones that are produced in the placenta and that increase the mother’s glucose to assure the baby’s nutrition and create some resistance to the insulin the mother produces. What happens if it isn’t treated? How is it diagnosed? There is debate over who should be tested – all pregnant women or only those at risk? Women who are at risk for gestational diabetes have one or more of the following risk factors: The test involves going to a laboratory anytime and drinking a sweet drink (50 gm of glucose), sitting for an hour and then getting a blood test from the arm. This is a screening test. The results indicate only if you are at risk or not. If the result is positive, a diagnostic test should be done to find out if there is diabetes. This diagnostic test is a more complicated test and involves fasting overnight, having a blood test first thing in the morning and then drinking a sweet drink (100 gm glucose). More blood is taken and measured at one, two, and three hours. If two of these measurements are elevated, you have gestational diabetes. How do you manage the diabetes during pregnancy? If diet and exercise do not maintain normal glucose levels, then insulin is added to the plan. Insulin is usually given two or three times a day by needle. The woman is taught how to administer the insulin to herself. She must continue to monitor her blood glucose levels. Usually as pregnancy advances, insulin requirements go up. If a problem arises with glucose levels or decreasing insulin requirements, the doctor may need to induce labour early to protect both the mother and the baby. What happens after the baby is born? -------- Trying to conceive, naturally Lately soy has become the food or beverage of choice for many. There is the milk for your morning cereal, the soy latte during the day, the tofu stir-fry or the ever-popular sushi dipped in soy sauce. But women who are trying to conceive may have to decrease their soy consumption. According to a recent study by a team of British researchers, soy products may decrease fertility. The culprit is a substance called genistein, which is present in all soy products, and even more so in fermented soy products such as soy sauce, tempeh and miso. The general recommendation is that people opt for fermented soy products. But if you’re trying to conceive, scientists advise that women steer clear of soy, especially around the most fertile days. Banning soy from your fridge might be too extreme, but consume it in moderation and opt for replacements whenever possible. While the results of this study are bound to cause worry especially among vegetarians, one thing is for sure: diet makes a difference when it comes to trying to conceive. Although diet alone can improve the odds of becoming pregnant, adding some exercise and a healthy sleep regimen to the mix will significantly increase the possibility of conceiving. And, yes, relax. And then...relax some more. Diet and more “The whole complex B vitamin is important,” says Dr. Lisa Polinsky, a naturopathic physician at Sage Clinic in Vancouver. The most important source of vitamin B12 is meat, but fish, clams and eggs are also good sources, Polinsky points out. Vegetarians can find vitamin B12 in seaweed and algae, such as spirulina and chlorella. Of paramount importance is folic acid, known to prevent spina bifida and other birth defects. “Folic acid should be taken at least three months prior to trying to conceive,” advises Dr. Anthony Koelink, a Vancouver family physician. “Even if a woman has a balanced diet she still needs folic acid supplementation,” he says. The Public Health Agency of Canada recommends that women of child-bearing age take 0.4 mg of folic acid daily before trying to conceive, continuing through the first three months of pregnancy. When preparing for a baby, couples should think about undergoing a cleansing process. “It is important to be healthy when conceiving, but it is just as important to have a healthy baby, and detoxification definitely helps and is recommended,” says Polinsky. A thorough detoxification process also helps with shedding extra weight, which could be a cause for concern when trying to conceive. Obesity is usually associated with chronic diseases such as diabetes, cardiovascular disease and arthritis, but excess body fat seems to cause hormonal problems such as irregular cycles, reduced fertility and an increased risk of miscarriage. Many studies have now clearly shown that losing weight has improved menses recovery, ovulation and fertility rates. Regular exercise before getting pregnant helps maintain weight within a healthy range; it regulates the sex hormones and boosts the energy level. Not only that, exercising before and during pregnancy helps both mom and baby. Part of the preparation for having a baby is getting enough sleep. Not because you won’t get much after the baby is born – sleep cannot be banked – but because sleep deprivation decreases your chances of getting pregnant. Adequate sleep boosts the immune system, and reduces stress, which is known to negatively affect fertility. Bottom line: If you are healthy, your body will get pregnant and nourish the fetus, says Polinsky. If you are the one who needs nurturing, both physically and mentally, take care of yourself first and pregnancy will happen when you are prepared. Smoking, Alcohol and Other No-nos Alcohol too, should be avoided. Abstaining is part of the detoxification process. Try to reduce your daily caffeine intake. Keep in mind that tea, iced tea, chocolate and some carbonated drinks also contain caffeine. In men, caffeine has been shown to decrease sperm motility, decreasing fertility. Recreational drugs are a definite no-no. As for over-the-counter drugs, consult with your doctor whether you could stop taking them or switch to the least harmful ones. When to Worry “Temporary infertility could be due to a slow functioning thyroid, which in turn influences the sex hormones,” says Polinsky. -------- Safe medications during pregnancy There is a general rule all people should follow: Do not take any medication or remedy or vitamin or herbal treatment without knowing exactly what is in it, what it does that helps you and what it can do to hurt you. This is extremely important for pregnant women who need to consider their unborn child. Most research on new medications intentionally excludes pregnant women, so information on drugs in pregnancy is mostly lacking. Medications that have been around a long time do have information on them because of use when the woman did not know that she was pregnant and because of conditions where her survival depended on the medication and had to be used even though she was pregnant. Women use many vitamins, over-the-counter medications and herbal preparations before they realize that they are pregnant. A big concern is when pregnant women used multiple medications or herbals at the same time. There is little information on combination medication/herbals in pregnancy. There are also times when medications are essential for the health of the mother and the baby. For example, insulin is lifesaving for the woman with diabetes and thus for her baby. Insulin has been found to be safe for the infant. Antibiotics can save the mother’s life in some circumstances (e.g. flesh-eating disease) and the use of many antibiotics has been shown to be safe for the baby. What is known to be harmful Thalidomide is an example of a drug that is very harmful to an unborn baby. It was prescribed as a treatment for nausea in pregnancy and it had an extremely serious effect on the unborn child – limb deformities. There are other drugs that have known serious risks and should not be used in pregnancy. Isotretinoin (Accutane) is used to treat acne and can cause severe malformations in the developing child. It should never be used during a pregnancy or when there is a chance of pregnancy. Tetracyclines, an antibiotic (including Doxycycline), can cause discolouration of teeth, bone malformations, and other malformations in the unborn child. Tetracyclines can also cause maternal liver toxicity. Most medications have an untested profile and thus are not used in pregnancy unless the need is greater than the perceived risk. Chemotherapy agents are used in pregnancy when the mother’s life is at risk. Although there may be some risk to the infant, with many agents the risk is small and acceptable in this circumstance. What may be harmfulAspirin especially when used in high doses or chronically can cause bleeding in the mother and baby. Aspirin in low doses (81 mg. or “baby aspirin”) is helpful for some conditions that cause recurrent miscarriage. This demonstrates the dilemma. It is not simply that the medication is harmful. At some doses or use patterns the medication offers an advantage to the pregnancy but at other doses or patterns of usage it may cause serious problems in the pregnancy. Vitamin A when used at recommended doses is not associated with harm to the baby, but in high doses (>10,000 IU) it can cause defects. Decongestants and antihistamines are not all the same but are often used for colds or allergies. You can check with your doctor or midwife to find out which ones you can use if you have bothersome symptoms. There are some that are safe and others that are not. Herbal medications can also have risks. Many of the herbals are mixed with ingredients other than the herb advertised. They are considered a dietary supplement and are not subjected to the vigorous testing of “medications.” Ginseng has been shown to cause congenital abnormalities in rats. Studies in humans are ongoing. It is recommended that you take no herbal products without checking with your doctor or midwife. What is safeAcetaminophen (Tylenol©) is used for pain or headache throughout pregnancy, it is considered to be safe in pregnancy. Doxylamine succinate/pyridoxine (Diclecti©) is prescribed for nausea and vomiting in pregnancy and has been tested more than any other medication in pregnancy and pronounced safe. Folic acid is important in pregnancy to prevent neural tube defects. Echinacea has not been associated with problems in limited studies. It is always best to check with your doctor or midwife before taking any medication, vitamin mixture or herbal remedy. A useful resource is the website for the Hospital for Sick Children in Toronto (www.motherisk.org). It provides information about medications that may be used in pregnancy including herbal remedies. With a decision to use medication, vitamins or herbal remedies, there must be a process of weighing the risks versus the benefits. Doctors and midwives have many sources of information that they can consult. Talk to your doctor or midwife before taking any medication, vitamin or herbal preparations – make sure you and your baby are safe. ------- The future of male contraception For years women have been seen as the ones who are generally responsible for birth control. The ones who will choose it, provide it and enforce it. In fact, of the many types of birth control available, most are used by women. I spoke with some men regarding the issue of contraception. All of them agreed birth control is the responsibility of both partners and one said it is the responsibility of the man. Perhaps times are changing and people are ready for another option when it comes to male contraception. Vancouver physician Dr. Marck Hudon says, “Most of my patients are looking for a safe, effective form of birth control, both male and female.” When it comes to non-permanent birth control, it seems safe to say a large responsibility is on women to choose and use the birth control method that suits her and her partner most effectively. But, when it comes time for a couple to discuss the issues of permanent sterilization, it is important to consider the risks of tubal ligation versus vasectomy. When the pros and cons are considered, vasectomy will continue to increase in popularity over tubal ligations. Both methods of birth control are equally accurate, but with ease of surgery and accuracy over time, the vasectomy comes out ahead. Doctors say concern arises for their male patients who are considering vasectomy, such as sexual function, complications, risks, recovery time and its reversibility, Hudon says, “Many of my male patients come in and reluctantly ask about vasectomy at the request of their wives or partners.” Dr. Neil Pollock, a Vancouver physician, who, after 10 years in family practice, decided to focus his practice on and invest significant efforts in researching and performing the no-scalpel vasectomy technique. Pollock explains on his website that vasectomy by any method is safe, reliable and a convenient option for male birth control and is more than 99 percent effective. He explains that the conventional vasectomy (also known as the incisional vasectomy) is by far the most common method used to perform vasectomies in North America. Pollock states that the no-scalpel vasectomy has the same end result as the conventional vasectomy, however the main difference between the two methods is the way the doctor locates the vasa (tubes). The no-scalpel procedure is a relatively quick and painless procedure says Pollock. An air jet injector delivers a spray of anesthetic under high pressure through the skin into the scrotal sac. Once the area is frozen, the doctor locates the tubes (one at a time). Making one tiny puncture into the skin of the scrotum, the tube is lifted through the opening. The tube is cut and the upper end is cauterized. Lastly, the fascial sheath, or covering of the sperm tube is brought over the cut tube to create a natural barrier between the two cut ends. Following the procedure, the testicles continue to produce sperm, but it is broken down by the bodies’ waste removal cells. Statistically 5 to 10 percent of the over 600,000 men who annually undergo a vasectomy, will choose to have theirs reversed. With this surgery, reversal is a four-hour micro-surgical procedure with a 50 percent chance of pregnancy rate. To take no-scalpel vasectomies one step further, on January 31, Pollock and the Shepherd Medical Company announced they were awarded a $1.4 million grant to conduct clinical trials on a device called the IVD (Intra Vas Device). The IVD is a flexible, hollow, silicone plug which is inserted into the vas deferens to block sperm transport. This IVD is the world’s first implantable and reversible male contraceptive device that could shift the responsibility of contraception from women to men. ------ Seeing and hearing baby in the womb Hearing the heartbeat of your unborn baby is one of the most memorable moments for many families. Here are some of the more common technologies currently used and available in Canada to hear your baby’s heartbeat during pregnancy. Baby heart beat listeners (monitors) are small devices with attachable headphones (about the size of a portable CD player) designed to detect sounds by using the bell stethoscope (non-ultrasonic) method. Baby heart listeners are suggested for use during the third trimester. These devices are sold in department and large baby goods stores and are intended primarily for personal use at home. Stethoscopes are in essence sound amplifiers. They are used in many kinds of routine medical care (not only during pregnancy) and most people are familiar with this equipment. Stethoscopes use a flexible disk to gather sounds from a relatively large body surface area (such as the pregnant belly) and then pipes these sound vibrations along insulated tubes to ear pieces. During pregnancy, to hear the baby’s heartbeat, the stethoscope is placed on the pregnant belly and, according to most literature, the baby’s heartbeat can be (on average) detected towards the middle of the pregnancy (18 to 20 weeks). Stethoscopes are most often used by a medical practitioner, but some people have them at home for personal use. Stethoscopes can be purchased through medical supply stores or medical suppliers. A fetoscope is an old-fashioned yet time-honoured method for hearing fetal heart beats during pregnancy, labour and birth. Fetoscopes usually utilize the same general technology as stethoscopes, but are intended primarily for use during pregnancy. A pinard horn stands on a flat base and looks a lot like a vase with a hollow core about the diameter of a pencil. It is through this hollow core that the sound of a baby’s heartbeat travels from pregnant belly to naked ear. The smaller open end of the cone is the part you put to the ear, while the wider, flat end is placed on the pregnant belly. As the heartbeat sounds travel up through the cone, the wide opening at the top amplifies them. Pinard horns are made out of wood, plastic, or aluminum. The sound of a baby’s heartbeat through a pinard horn is described as more subtle/less distinct; more like a vibration you feel with your ear. Pinard horns are available for use at home and can be purchased in alternative and holistic health stores, and are often the listening device of choice for many midwives. Like the stethoscope and fetoscopes, pinard horns require practice in order to adequately determine what you are hearing. A hand-held fetal doppler is designed for both medical and private use and is a pocket-sized, battery-operated device. A fetal doppler consists of a main piece or “body” about the size of the palm of your hand, a built-in speaker, and a probe. Dopplers have been used in routine pregnancy medical care in Canada for 30 years and can detect a baby’s heartbeat as early as 10 and 12 weeks of pregnancy. A fetal doppler works by sending out high-frequency sound waves which pass through the skin and tissue of the pregnant belly then ‘bounce’ back. This bounce is then translated into a sound that you can hear, for example, the sound of your baby’s heart beating. Since high-frequency sound waves do not travel well through air, a special gel (ultrasound lotion) is applied to the mother’s belly in order for the fetal doppler to detect the sound waves. It is not only your baby’s heart sounds that you can hear but also other organs (yours as well as your baby’s) that are translated into sounds. The other most common sound is the blood flow through your placenta. Dopplers are available for purchase or rental in Canada through private companies, and are also used by most physicians and obstetricians during prenatal care. The obstetric ultrasound also emits high-frequency sound waves from a transducer which is placed in contact with the pregnant belly, and is moved to “look at” (like a light shone from a flashlight) the content of the uterus. Ultrasound lotion must be used as a conductor for the sound waves. Repetitive ultrasound beams (sound waves) scan the fetus in thin portions and these images are reflected back and are collectively put together into a picture on the monitor screen (sometimes called a sonogram or ultrasonogram). The most common mode of ultrasound scanning is two-dimensional. In other words, the image is made up of thin slices and only one slice can be seen at a time. Although such an image is very informative to ultrasound and medical professionals, to the average person the picture may not look much like a baby! Movements such as fetal heartbeat and measurements of the fetus can be assessed through the images displayed on the screen and it is such measurements that often form the basis for assessment of gestational age, size and growth of the baby. Two-dimensional ultrasounds are routine for many pregnancies and are available through a medical practitioner. The three- (and four-) dimensional prenatal ultrasound is a relatively recent advance that can produce 3D images of the fetus that are as detailed as a photograph. This type of imaging may be used during targeted ultrasound exams when physicians are examining a particular fetal abnormality. With 3D ultrasound, a large number of 2D “slices” are taken, stored digitally, and shaded to produce life-like images of the fetus. A 4D ultrasound takes the images produced by 3D ultrasound and adds movement so that the activity of the fetus can be studied. The 3D multiplanar display on new ultrasound machine lets physicians look inside various organs including the fetal brain and its cavities. Three- and four-dimensional ultrasound imaging does not generally use increased frequency but a combination of increased data gathering (listening) by the transducer and software interpretation after data acquisition. Medical practitioners can order a 3D ultrasound if they need to have a better look at something specific. Currently, in Canada, there are also private organizations that (for a fee) will do a 2, 3 or 4D ultrasound at family request. These are considered non-diagnostic ultrasounds. Fetal heart monitoring is the recording of the baby's heart rate and the mother’s contractions during labour. Devices are connected to the mother’s abdomen and baby in one of two ways: · External monitoring uses external belts around the mother’s pregnant belly. · Internal monitoring involves placing a monitor electrode on the baby’s scalp and a thin tube or catheter is also inserted into the uterus via the vagina to monitor contractions. The use of fetal monitoring during labour should be discussed with a healthcare provider during prenatal visits in order to understand the risks and benefits of this testing. Fetal heart monitoring during labour is available only under the supervision of a health practitioner. Note: The information provided here is for consumer awareness and information only. Dopplers to Diapers Ltd. recommends readers discuss any questions about listening to your baby’s heartbeat with your health provider. ------- Maternity
benefits: FAQs How and where do I apply for Employment Insurance (EI) benefits? To receive EI benefits you must submit an EI application online or in person at your local Human Resources Development of Canada (HRDC) office. When should
I apply for EI? Delaying in filing your claim for benefits beyond than four weeks after your last day of work may cause loss of benefits. What information/documents
will I be asked for when I apply? How long
do I have to work to be eligible to collect EI? How long
can I receive EI? How much
can I receive? You could receive a higher benefit rate if you are in a low-income family (an income of less than $25,921) with children and you receive the Canada Child Tax Benefit (CCTB), your are entitled to the Family Supplement. How does
working while collecting EI affect the duration of a claim? The maximum
period of time in which you can carry out one claim is 52 weeks. An EI
claim will end if: To start a new claim you must work the minimum number of insurable hours required for regular benefits. The number of minimum hours depends on where you live and the unemployment rate in your economic region at the time of filing your claim. Can I
get EI if I quit my job? However, even if you quit your job, sickness, maternity and/or parental benefits may be payable to you if you have enough insurable hours to qualify for these benefits. For more information, contact your local HRDC office. Can I
get EI if I am fired from my job? However, even if you were fired, sickness, maternity and/or parental benefits may be payable to you if you have enough insurable hours to qualify for these benefits. For more information, contact your local HRDC office. How can
I contact HRDC? You can also get detailed information on your EI claim by calling EI Telemessage. Please have your SIN and your Telephone Access Code (TAC) ready. For more information, visit Human Resources Development Canada's website at www.hrdc-drhc.gc.ca. -------- Understanding
miscarriage Pregnancy can be a joyous time, a miracle. The science involved in pregnancy is a wonder. It is amazing that two little cells - the ovum and the sperm - can do their dance and bond most times with great accuracy and proceed to create a life. It is quite impressive that the process goes wrong only 15 to 20 percent of the time. Because of the complexity, there is a risk of pregnancy ending in a miscarriage, but it only occurs around 15 percent of the time. When it does occur, it has been found that 85 percent of the pregnancies lost had abnormal chromosomes - the egg and sperm did not get their dance steps right. A miscarriage can be a devastating disappointment, but it is a fact that after one miscarriage, there is still only a 15 percent chance of another one. In other words, a miscarriage does not mean that there is something wrong with you or your mate. It also does not mean that you did anything wrong. All it means is that your egg and sperm did not dance properly to perform all the complicated interactions that must happen to make a human being. I'm always sad when I hear women who have had a miscarriage, express total shock by its occurrence and tell me that they believe that they did something wrong or that there is something wrong with them or their partner. They don't know that 15 percent of their friends who were having children have suffered a miscarriage, too. And they don't realize that miscarriage is something that is not spoken about freely. Once they reveal to friends that it happened to them, they are always surprised by how many women then confide that they share the experience. Miscarriage is very difficult to deal with no matter what. There are all the hopes and dreams of having a child that have to be mourned - and this takes time. There are also the decisions of what to do medically - let it happen spontaneously or choose medical intervention (which can be medication or a "D & C" or Dilation and Curettage). Each circumstance is different and must be discussed with your doctor or midwife. Talking
about it Trying
again Occasionally, miscarriages repeat and the anxiety increases. Sometimes, there is a problem that must be addressed in order to help maintain a pregnancy. Once there have been two miscarriages, it is time to consider investigations that could point to a problem. At that point, genetic testing can be performed on the pregnancy to see if a genetic problem may have interfered with conception. Usually, the genetic problem is not recurrent - only a dance mis-step. Tests can be done on the mother to see if she has a condition that may interfere with the development of the fetus. But until there have been two miscarriages - and some argue three - there really are no advantages to having these tests - there is just too much of a chance that the next time will be successful. Diagnosing
a miscarriage Miscarriage can usually be diagnosed by ultrasound. The radiologist will see a fetus by about six weeks via ultrasound. He can measure the size of the pregnancy and see if the size is smaller than would be expected, and ask for a repeat ultrasound to determine if there is growth of the pregnancy - if not, it is diagnosed as a missed abortion. If further along, the fetus may be seen, and the heart can be identified and checked to see if it is not beating - usually after seven to eight weeks. Note: a pregnancy is dated from the first day of the last menstrual period. In medical jargon, a miscarriage is a spontaneous abortion. If the pregnancy is not showing signs of leaving the woman's body, it is called a missed abortion. If signs are evident - that is, pain and bleeding - it is called a threatened abortion. If you want to be pregnant, a miscarriage is a tragedy, but there is a very high chance that your next try will be successful, so don't lose faith. Give yourself time to mourn the loss and get good medical care so that you remain healthy for next time. Remember, you are not alone. Many women have been there. Where
to find local support: St. Paul's
Hospital Social Services Perinatal
Loss Support Group - Surrey Memorial Hospital Living Through
Loss Counselling Society of BC Family Services
of Greater Vancouver Griefworks
website -------- Inducing
labour: the truths and myths Labour does not always begin when it should. It is a mistake to assume that the baby will know when to be born. There are times when it is more dangerous for the baby to remain in the uterus than to be in Mom and Dad's arms. It is always a challenge for doctors and midwives to decide when it is better for the baby to be out than in. But that always must be on their minds to protect both the baby and mother. When it is riskier for the baby or mother to have the pregnancy continue (eg. when the baby stops growing in the uterus or when the mother has seriously high blood pressure), then labour is induced or started Inducing labour is often difficult. We do not yet fully understand what triggers labour. When the pregnancy is term (38 to 42 weeks), inducing labour is easier. When labour must be induced before term, it can be more challenging. What does
not work What rarely
works Stretch and sweep. This is something that is often done in the doctor's or midwife's office. During a pelvic examination, fingers are placed in the cervix (only if it is open) and the cervix is stretched. A finger is swept between the membranes and the cervix to loosen the membranes from their attachment to the cervix. This can rupture the membranes mistakenly and often is uncomfortable for the mother. It rarely starts labour. What does
work 1. Mechanical
Methods To rupture membranes, the doctor or midwife must give the mother a pelvic examination - fingers in the vagina. If the mother feels discomfort, it is from the examination alone. Occasionally a woman will feel a "pop" or a relief of pressure, but no pain from the rupture of the membranes. The procedure takes only a few minutes, and is done with a hook that looks like an extra-long crochet hook, or by the examiner's fingers. If labour has not begun within a few hours after the membranes have been ruptured, another method may be used. Foley Catheter: 2. Pharmaceutical
Methods Prostin®:
Cervidil®:
Misoprostil
(Cytotec®): Oxytocin:
These pharmaceutical and mechanical methods of inducing labour can be used in various combinations. They all have risks and benefits. If you need to be induced, you should have a discussion about your options with your doctor or midwife. -------- C-section
controversy The Caesarean section (C-section) is always a hot topic. There was a time when doing a Caesarean section was so taboo that dangerous vaginal deliveries were done just to avoid the controversial surgery. We now know that the C-section is a safe procedure and, under certain circumstances, may be safer than a vaginal delivery for both mom and baby. When a
C-section is necessary The Caesarean section is also used as a quick way to deliver when the baby or mother is in trouble - such as in the case of a cord prolapse, which is when the umbilical cord comes into the vagina ahead of the baby. A C-section is also used for babies in unusual positions such as breech or transverse lie (when the baby is lying across the mother's uterus, the baby's shoulder comes into the vagina first, and the baby is stuck). In this circumstance the baby and mother are at high risk if the child is delivered vaginally; a C-section is the safer alternative. What a
C-section is and how it is done Recovery
after the C-ection and the vaginal delivery Risks
associated with a C-section After a C-section, a vaginal delivery may be planned for a subsequent pregnancy (referred to as a vaginal birth after Caesarean section or VBAC). However there is a one-percent risk of uterine rupture; this can be catastrophic with extrusion of the baby into the mom's abdominal cavity, and is associated with serious complications for mom and baby. The elective
C-section If there is anything to avoid in obstetrics, it is not a Caesarean section. It should be the unreasonably long labour and second stage (pushing), followed by a difficult forceps delivery with a large episiotomy that extends into the rectum. That is a scenario that carries with it many complications both in the short and long term. -------- Maternity
leave in Canada: imperfect bliss In December 2000 Prime Minister Jean Chretien launched revisions to Employment Insurance Act that saw the length of parental benefits double from six months to nearly a year after the birth or adoption of a child. My own maternity leaves were the old-fashioned six month kind, so I was optimistic about what I'd find while exploring the impacts of this policy change. Six months getting acquainted with the new little person in your household flies by in a blur of adjustments, lack of sleep, and pure amazement. Surely the extra time would be nothing but positive for family members to settle in together. There is plenty of good news. Statistics Canada reported in March 2003 that "since the extension of parental benefits . . . qualifying mothers are staying home longer with their newborn infants (up to ten from six months), and more fathers are claiming benefits." As part of the amendment to the Employment Insurance Act, the threshold for eligibility was lowered from 700 to 600 hours of insurable employment. This, according to Statistics Canada, resulted in a "monthly average of 4,900 parents who would not have qualified under the old program (receiving) parental benefits in 2002." It should be a simple equation. One new baby plus one year paid maternity and parental leave equals one happy family with a well-adjusted toddler ready to face the world. Building a strong Canada, one baby at a time. But there are many more numbers to factor in. There's the minimum of 600 hours you need to work in the year before your claim to qualify. The basic entitlement of 55 percent of your average insurable earnings - hard to live on for low-income earners. The $413 maximum rate of weekly benefits. The unpaid two week waiting period. Variable rates of corporate support. Forty percent of new moms claiming no maternity benefits at all. Not to mention Canada's plummeting crude birth rate of 10.5 live births for every 1,000 population in 2002, the lowest since records were started in 1921. "Few parents are able to enjoy time at home with their babies without financial pressure," wrote Anne Marie Owens and Heather Sokoloff in their National Post feature, Living Large on Maternity Leave. In it they argue that Canada has a two-tiered maternity leave. "One class of workers, mostly in federal government jobs, enjoy generous financial top-ups" allowing them to receive up to 93 percent of their salary for the year, while another "much larger group struggles to make the best of an improved, yet imperfect policy that provides minimal financial compensation under Employment Insurance." This includes the 40 percent of all women who give birth in Canada who "still do not claim any benefit, because they are self-employed...work fewer than the 600 hours a year required to qualify, are not employed or choose not to apply." That's a pretty big number. It seems that Canada's maternity and parental leave policies are suffering from growing pains. While some are happy with the existing policy and others are not, none have challenged the status quo like the province of Quebec. In January 2004, the Quebec Court of Appeal ruled that the federal government's parental and maternity leave program is unconstitutional. Ottawa, said the ruling, cannot use the Employment Insurance Act to offer social benefits for programs that are exclusively a provincial jurisdiction. The federal and Quebec governments have since reached an agreement in principle allowing Quebec to opt out of the federal program with full financial compensation to help pay for its own program. Quebec has proposed a more generous program that would include self-employed and part-time workers. Its implementation, slated for January 2006, will open the doors for other provinces to do the same. To hear the many voices in the maternity leave debate is like listening to siblings bickering at the family table. Low income versus high income. Self-employed versus government employee. Top-up versus basic entitlement. Materialistic versus simplified lives. Responsibility for choices. Like the siblings at the table, our common ground transcends our disputes. We are a nation, a family governed by those among us. We struggle and change and grow, sometimes with ugliness, often with imperfection, and hopefully with the very best intentions at heart. For all its flaws, perceived and otherwise, Canada's maternity and parental leave policies are among the most generous in the world. I remember how grateful I was to have time at home with each of my new babies. And I'm glad for the parents who can take advantage of them now. In years to come, I hope to celebrate for the self-employed parents and all others who will have parental leave options that work for their families. Because we need to take care of each other to have a civilized life. -------- Fertility
after 35 You want to get an education, establish your career, be financially secure, find the right partner, have a child with your husband/partner, or just find the time to enjoy parenthood and the next thing you know, you are over 35. Myths abound about the dangers of having children after 35, but what are the real risks? In the recent past having your first baby over the age of 35 was called an "elderly primipara" (first birth). But today, women who are well into their 60s have had babies. In Canada, in 1982, 23 percent of babies were born to mothers between ages 30 and 39; by 2002, 45 percent of babies were born to mothers between 30 and 39 (Source: Statistics Canada). The two biggest considerations for women over 35 are getting pregnant and genetics. Myths
Facts
Genetics:
You can have genetic testing such as a maternal serum screening (a blood test done between 15 and 20 weeks) along with a detailed ultrasound at 18 weeks looking for "soft signs" of Down syndrome. These two tests combined are about 80 percent reliable for the diagnosis of Down syndrome. If you are 35 or older when you are due to have your baby, you can have an amniocentesis, a more invasive test that takes a small amount of fluid from around the baby through the mother's abdomen, under ultrasound guidance. Cells from the fluid can be tested for chromosomal abnormalities. An amniocentesis is 98 percent accurate in diagnosing chromosomal problems such as Down syndrome. It carries an increased risk of 0.5 percent over the usual risk of 15 to 20 percent for miscarriage. The overall risk (any age) of an abnormality in a child is about three percent. Miscarriage:
Gestational
diabetes: High blood
pressure: Women over 35 have a higher risk of Caeserean sections, but the reason for this is multifactorial - i.e. medical problems, lower threshold to C-sections, etc. I often hear my patients say that it was easier to keep up with a small child when they were younger, but they add that they were glad they had children when they were over 35 because life for them was more stable financially and emotionally. There often is not a choice. It is common to have children over age 35. With modern screening and care, the risks of pregnancy at older ages are very small, fetal abnormalities can often be detected early, and your health should not be ruined forever. Stay fit, eat well, take folic acid, keep yourself healthy and pregnancy later in life should be joyful. -------- Sex
and pregnancy? Yes! Yes! Yes! It is common for women (and men) to be nervous about sex when they are pregnant. I've heard the comment many times - what if we hurt the baby? With normal sex this doesn't happen. The baby is well protected by the cervix, uterus and amniotic fluid. Imagine a doll in a balloon full of water and the balloon is wrapped in a thick woolen sweater. For some women (and men) pregnancy increases desire, but for others desire disappears and sex is uncomfortable. There is no rule. Tips for
safe sex: Bleeding - Bleeding is possible if the cervix gets hit during intercourse, but usually it is only a small amount. You might not see it for a few hours. If you have bleeding from the vagina, you should call your doctor or midwife or go to the hospital. There are other serious conditions that can cause bleeding and these must be eliminated. But if no other problems are found, your doctor should ask if you have had sex recently. Don't be embarrassed to tell if you have - it's natural and you and your partner have done nothing wrong. Breast stimulation - Breast stimulation may cause release of breast fluid. Continuous breast stimulation of more than 15 minutes can cause prolonged uterine contractions that can be harmful to the baby. Intermittent stimulation is safer. Infection - Infection, including HIV, herpes, gonorrhea, syphilis and hepatitis, can be spread in pregnancy. A first infection of herpes in pregnancy is dangerous for the baby. So with new partners or partners with herpes, condoms are essential but they are not 100 percent protective. Labour - There is no evidence that intercourse or orgasm causes miscarriage, early labour, rupture of membranes or breech position. There have been some studies that suggest that intercourse can delay labour! It would appear that for most people, sex during pregnancy is healthy. Lubricants - Lubrication can be used if needed. Doctors use lubricants such as KY jelly when examining a pregnant woman. Positions - Intercourse can be rather difficult just from the logistics. Doctors prefer pregnant women to not be on their back in pregnancy, after the fourth month. Having the woman lying on her with penetration from behind or with the woman on top may be the most comfortable positions. Sexual alternatives to intercourse - For many women, intercourse is uncomfortable during pregnancy. More pleasure is found with hugs and kisses and great cuddling. Discussing your feelings and needs is very important. Manual clitoral stimulation and oral sex may be more comfortable and therefore more stimulating. If your partner has oral herpes (cold sores) then oral sex by the partner should be avoided. Air should also not be blown into the vagina. Vibrators - Vibrators can be used but external use is safest; internal vaginal use could cause trauma to the cervix and bleeding. When sex
during pregnancy may not be a good idea: If the amniotic membranes rupture (ie. water breaks) prematurely such as at 26 weeks, then every effort is made to let the baby remain in the uterus to mature if it is safe in the uterus. One thing that is unsafe for the baby is infection. There is a small possibility that having intercourse or oral sex could introduce vaginal or oral bacteria to the baby through the defect in the membranes. It would be suggested to avoid intercourse and oral sex under this circumstance. After the
delivery - will sex ever be the same again? ------ Making baby: addressing infertility Many couples spend most of their first family years trying not to get pregnant because they feel they don’t have a ‘worry-free lifestyle’ – secure jobs, a reliable family car and a mortgaged house. By the time they are ready to start a family, one in six couples discovers that conceiving a child doesn’t come easily. Fertility problems are not uncommon. While some couples can resolve fertility problems simply by changing their lifestyle, 15 percent of couples have unexplained fertility problems, says Dr. Albert Yuzpe of Genesis Fertility Centre in Vancouver. There are many events that must occur in order to conceive a child. After all, conceiving child is a very complicated biological process. Sperm cells must meet the egg, which then has to be released from its follicle in the ovary, and travel through the fallopian tubes, which are hopefully open. Then, if fecundation happens, the fertilized egg must travel into the uterus for implantation. And the trip is still not over. In clinically detected pregnancies, the incidence of miscarriage is one in six. So, although pregnancy happens easily for many couples, there are many things that can go wrong and affect pregnancy achievement. Know Your Body Opinions differ when it comes to using charts. Many health professionals, like Dr. Yuzpe, believe that having intercourse every two or three days throughout the cycle, without pinpointing the most fertile day with monitors and charts, should result in a pregnancy with most couples under 35, provided that there are no underlying problems. When Things Don’t Work When is said and done, and there is still no pregnancy after trying for at least two years – or six months to a year for couples aged 35 and older – the couple should seek medical attention and undergo fertility screenings. There are three things that a couple needs for pregnancy achievement, explains Dr. Yuzpe: ovulation, open tubes and adequate sperm. It is cautious, though, he mentions, for a couple to undergo basic tests if they had regular intercourse every two or three days, during the whole cycle, for an entire year, without any positive results. Ovulation Woes The most recommended drug for inducing ovulation and correcting irregular ovulation is Clomiphene or Clomid. While the drug can help many patients, the side effects, such as drying of cervical mucus, can threaten pregnancy achievement. Approximately 80 percent of women who are given Clomiphene do ovulate, but only 35 percent of these women will conceive, says Dr. Yuzpe. The American Society for Reproductive Medicine recommends that Clomiphene be prescribed for three to six cycles only. Secondary Infertility? Secondary infertility is present in 40 percent (the percentage of general population may be different but secondary infertility is considered to have a higher occurrence than primary infertility) of all patients seen by Dr. Yuzpe, although, in his opinion, secondary pregnancy also applies to couples in which the woman has previously conceived with a different partner, or to women who get pregnant, but are unable to carry a pregnancy to full term. Sadly, many couples who already have a child and cannot conceive another one will postpone seeking medical counsel. The emotional baggage associated with fertility problems the second time around can be overwhelming, especially since many tend to feel isolated in their desire to have more children. Many couples experience guilt and think that they are considered selfish for wanting a larger family. Last Word Helpful Resources Male Fertility Facts ------ The path to adoption Barry and Tarah are all smiles. They’re watching their daughter, 14-month old Julia, take a few wobbly steps using their dog Bandito for balance. Julia is a recent arrival in the couple’s life. It’s been just over a year – since Barry and Tarah started the process of adopting her from Russia. The path toward adoption wasn’t easy. While international adoption was always something that appealed to the couple, they tried to conceive for more than a year before starting the adoption process. “We got married when I was 40 and Barry was 43,” Tarah says. “At that time, we didn’t have an overly-strong desire to have kids, but it was at the back of our minds. Then about a year into the marriage, we decided, ‘yes, we’d like to have a family,’ so we started trying [to conceive].” Because Tarah was over the age of 35, the couple sought specialist care from an OB/GYN when they hadn’t conceived after six months. Until then, Tarah says, she hadn’t started to worry about their chances of conceiving. “You naively think you’re just going to get pregnant,” says Tarah. After trying unsuccessfully for three months, the couple started using a fertility monitor, which identifies a woman’s most fertile days by alerting her when she’s about to ovulate. “And then it’s ‘baby-making’ time,” Tarah laughs. “And right away that puts the pressure on.” “But that’s the reality when you’re older – you have to monitor things and really put effort into it,” Barry says. The OB/GYN ran “all the basic tests to see if there were any specific problems,” Tarah says. “She did a sperm analysis, blood and urine tests, checked to see if my fallopian tubes were okay, and checked the follicle stimulating hormone (FSH) levels of my eggs, which is supposed to give you an idea of what your chances are of having a successful pregnancy.” (High FSH levels indicate that a woman’s eggs may not be as fertile as they could be.) The tests showed “that apart from our age, there was no reason for us not to get pregnant,” Barry says. Nevertheless, the doctor suggested Intra-uterine Injections (IUI). “IUIs speed up the process of bringing together the egg and the sperm. So we started undergoing those, plus I started taking a drug called Clomid,” Tarah says. Clomid is one of the first drug treatments that women may come across for fertility. “And it did work – we got pregnant by the third month,” Tarah says. “But unfortunately, at 11 weeks, I had a sudden miscarriage in the middle of the night and ended up having a D&C [dilation and curettage] at B.C. Women’s Hospital.” Tests revealed that the miscarriage was caused by a chromosomal problem, “which is quite common in older women,” Tarah says. “It’s also true that miscarriage is quite common, and yet it’s just not talked about,” Tarah says. “I think that makes it harder on couples as they go through it because of that. We felt like, ‘why us?’ but then we did some research, and talked to others, and found out that there are so many couples that have experienced miscarriage.” It’s estimated that one in three pregnancies end in miscarriage among women 40 to 44. “It’s that much harder when it happens when you’re older because it chews up so much time – and there’s only so much time you have to do this, to make this work,” says Barry. “And if you have a miscarriage, you lose the three or four months you were pregnant for, plus the time it takes to recover from the miscarriage. Then you have to start the process all over again.” After that, Tarah says, “I could have gone straight to adoption. Personally, I have always felt that was a path that I wanted to take. But I also understand the other point of view. I think it’s just natural to want to conceive. But after the miscarriage, we started exploring adoption as an option. And at the same time, we were still trying to get pregnant.” Three months later, after undergoing more IUIs and taking Clomid with no results, Tarah’s OB/GYN suggested the couple go to a Vancouver fertility clinic that was receiving worldwide attention for its success rates with infertile couples. The specialist at the clinic did a Clomid challenge test, which indicated that Tarah’s FSH levels were elevated and above the ‘cut-off’ point for fertile eggs. “The specialist basically told us that our chances of conceiving and going full-term without a chromosomal problem were slim,” Tarah says. “He told us our only option was to get an egg donor. And in Canada, you have to find an egg donor personally – it can’t be anonymous and you’re not allowed to pay anyone,” says Barry. “Because there was no one here we felt comfortable approaching [to be an egg donor], the doctor suggested we go to the United States [where eggs can be obtained via anonymous donor egg programs].” “We thought about it pretty carefully,” Tarah says, “but eventually decided that we personally just weren’t comfortable with it.” The couple decided to pursue adopting a baby internationally. As they started the process, however, they had one last IUI scheduled and Tarah found out that she was pregnant for the second time. But at the 10th week, a routine ultrasound showed no heartbeat: they had suffered a ‘missed miscarriage.’ “That was a shock,” she says. “It was emotionally really hard on both of us. But at the same time it brought us together... it made our relationship stronger.” “So at that point,” Tarah says, “we said, ‘Let’s adopt’.” In the next issue of Urbanbaby & Toddler, we follow Tarah and Barry through the adoption process – and to Russia and back . ------ Ultrasounds: what technology can tell us Ultrasound has revolutionized obstetrical practice. Professor Ian Donald, an obstetrician/gynecologist at Glasgow Scotland in the 1960s, developed it for use in clinical medicine. Ultrasound uses sound wave frequencies of 2 to 10 million cycles per second and measures the speed with which they pass through tissues – quickly through fluid, slowly through solid. A transducer interprets these results and provides a black, grey and white picture (and some colours) of the area under study. A trained ultrasonographer usually performs the test. Pictures are taken and then interpreted by a specialist doctor, usually a radiologist or an obstetrician. Sometimes the doctor will also perform the ultrasound, especially in the labour/delivery area, or to clarify a finding. The ultrasonographer can use the ultrasound to see or determine different things at different stages of pregnancy. First Trimester (first 12 weeks) Dating (the number of weeks pregnant). This is very useful when we are unsure of the last menstrual period or if periods are irregular. Ultrasound dating in the first trimester is most accurate. Later in pregnancy the dates may be off by two to three weeks. Accurate dating of the pregnancy is very important when a problem develops and decisions must be made around the delivery of the baby. Miscarriage. When there is vaginal bleeding, the technician can see if the pregnancy is viable (alive) or whether a miscarriage has happened. Molar pregnancy. The ultrasound can detect this strange condition of the placenta, which can become cancerous. Multiple babies. The technician can accurately diagnose twins, triplets, etc., using the ultrasound technology. Other problems, like uterine fibroids, ovarian cysts, or a duplicated uterus, can also be detected, measured and followed. They can be problematic in pregnancy. Second (12 - 28 weeks) and Third (12 - 28 weeks) Trimesters Amniocentesis. An ultrasound can be used to guide a needle to obtain fluid for testing. Fetal development. A “detailed” ultrasound checks for fetal development. The organs of the baby can be seen. Sex of the baby. This is very accurate after 20 weeks gestation. Placenta. Placental position can be determined by 18 weeks. Early, many are found to be “low-lying.” The majority (90 percent) of these placentas by 30 to 32 weeks are in a normal position. If in third trimester it is still over the cervix then placenta previa or vasa (blood vessels) previa is diagnosed. These are very dangerous conditions if labour starts. In this case, a Caesarean section is the only safe way to deliver baby. Placental abnormalities (eg. accreta, percreta [invasion into uterine muscle]). Both are rare but serious complications of pregnancy. Growth/size of baby. An ultrasound is helpful but not 100 percent for these factors. With a multiple birth (i.e. twins) an ultrasound must be used to monitor their growth. If a baby seems too small clinically, ultrasound can help determine if the baby is not growing adequately. Ultrasounds are not good at determining the size of a baby. Baby’s position. Babies change position often in early pregnancy, but settle into their birth position around 36 weeks. Fetal health. When observing the baby on ultrasound, it is real-time. That means you can watch the baby move, breathe, etc. It is not just a static picture. Movements, breathing, and tone, can be evaluated, which is helpful to determine the health of the baby. An ultrasound can also measure the blood flow in the umbilical artery (Doppler), which can also be useful to determine the health of the baby. ------ The 3D/4D Ultrasound Ultrasound cannot predict when labour will begin, including premature labour; predict if the baby will fit through the birth canal; diagnose a genetic abnormality; tell if your baby will be brown-haired, blue-eyed; or tell us exactly the size of the baby or amount of fluid. While the 2D images provide an accurate image of the developing fetus, 3D ultrasound can detect smaller, less obvious defects, such as spina bifida, cleft/lips palate, and clubbed feet. 3D and 4D dynamic ultrasound make it possible for parents to see specific facial traits and observe baby’s activities, and some argue that it enhances bonding between parents and baby, especially if a malformation is present, giving parents the time to adjust. The best 3D/4D images are obtained after the 25th week of pregnancy. In Canada, prices range from approximately $135 for 20-minutes of non-diagnostic ultrasound, with extra charges for keepsake photos and DVD/VHS recording, gender assessment, and even a two-month web hosting, to $300 for a package that includes two non-diagnostic sessions, plus all the extras listed above. ------ The path to adoption… Part Two of a Two-Part Series In our last issue, Barry and Tarah shared their experience of trying to conceive a child with Urbanbaby & Toddler readers. They ultimately decided to adopt. Adoption was something that had appealed to Barry and Tarah for some time. In fact, even before she’d met the man she was to marry, Tarah clipped magazine articles about international adoption. So by the time they had made the decision to pursue adoption, then, the couple had already done a lot of research. “We did briefly look at domestic adoption,” Tarah says, “but there isn’t any guarantee a birth mother will choose you. And with Barry and I being older, we just didn’t have the luxury of time to wait.” Some Internet research lead the couple to The Adoptive Families Association of B.C. (AFABC), a group that aims to educate and support those considering adoption, or those who have already adopted. Through the AFABC, Tarah and Barry learned about a presentation on adopting from China and decided to attend. At the event, “there were couples and singles, all wanting to learn about the process, and even parents with their adopted children,” Tarah says. “It was such a positive environment, and we just felt like it [international adoption] was something we wanted to do.” Because all four of Barry’s grandparents emigrated from Russia, the couple decided to pursue adopting a child from Russia. While doing their research on Russian adoptions, they registered with an agency called Choices Adoption and Counselling Services, an agency based in Victoria that facilitated the B.C. end of the adoption, including the required homestudy. “Because Canada is a partner in the Hague Convention [on Protection of Children and Co-operation in Respect of Intercountry Adoptions] potential parents must go through a family assessment,” Tarah says. “A social worker arranged by Choices came to our home seven times to assess and prepare us for adopting a child.” Tarah relates. “She interviewed us and basically checked us out to make sure we’d be suitable parents. That was interesting. It was like being interviewed for a job, but instead you’re being interviewed to be parents!” “They require four reference letters, do criminal record checks, and check to see if you’ve had prior contact with the Ministry (for issues such as child abuse),” Barry adds. “It can get quite personal,” Tarah says, “because they want to get a sense of how stable your marriage is, and how stable a person you are. They ask about how you were raised, what you thought your parents did right, and what you’d do differently.” “Also as part of the homestudy process, you identify the age range, ethnic backgrounds, and any special needs you’d be comfortable with. You can also choose the child’s gender, if that’s important to you.” After successfully completing the homestudy, the couple was approved by the Ministry. Because there are only five or six agencies in Canada that are accredited to facilitate Russian adoptions, the couple’s next step was to find an agency to help them adopt from Russia. “We got information packages from all of the agencies with Russian programs,” says Tarah. “We ended up choosing an agency called Caring Homes for Orphan Children, based in Toronto,” Tarah says. Then the paperwork started. “We had to put together a dossier, which included letters from our employers, another criminal record check, medical reports, letters from our bank and photos of our families,” says Tarah. “Then all the paperwork went to the Toronto agency where it was translated and notarized.” “You find yourself writing out the same information over and over again,” Barry says. “This information goes to the province, this goes to the federal government, this goes to Russia. If you make a mistake you might lose a month in having to do it over again.” For many international adoptions, the country will propose a child (send information on the child they’ve chosen for you) and “from there you see if you want to proceed,” Tarah says. “But because it was going to be faster, we decided to take the alternative route and request an Invitation to Travel.” “So our dossier went to Russia, and three weeks later we received an Invitation to Travel,” Tarah says. With an Invitation to Travel, you’re “basically travelling blind,” she says. “You get a call from your agency in Canada telling you you’ve received an Invitation to Travel and you need to report to the Russian Ministry of Education a week later. You don’t see a description or photo of the child until you get there and they give you a ‘proposal’ for a child.” “At that point, unless you’re uncomfortable with something in the brief medical history provided, you accept it and go to the orphanage to meet the child.” The orphanage was just over two hours outside of Moscow, which they reached with the help of a driver and translator. Once they arrived, “they came out with Julia, which was pretty amazing,” the couple laughs. “You’ve been intensely involved in this process for months – and for some people it even takes a year and a half – you’ve been building up to this moment and then they just bring this little girl out,” Tarah says. “We got to spend six days with her, and at the end of that time we had to petition the Russian courts to adopt her. And then we had to come home and leave her behind. It was really hard.” Once home, the couple went through another round of paperwork while waiting for the Canadian government to approve Julia. Then, Tarah says, “we had to wait for a Russian court date. It could have happened in three weeks, or three months, or the program could have closed, which unfortunately does happen.” “Just recently, for example, the Ukraine closed adoptions to Canadians and Americans,” Barry says. “You could be halfway through the process of an adoption, and the government there could say, ‘we’ve put a moratorium on foreign adoptions’ and there’s nothing you could do about it.” As it was, the couple waited nine long weeks. “Finally we received our court date and were able to fly to Russia and pick up Julia from the orphanage. She left with nothing; we even had to bring an outfit for her.” The new family stayed in a Moscow hotel for a couple of weeks while they waited for Julia’s Russian paperwork and Canadian visa to come through. “We just wanted to get her home,” Tarah says, “so it was really tough to have to wait even longer.” Overall, the couple says, “we were lucky. The adoption process from start to finish, for us, was only 10-1/2 months, which is very unusual. For most people it seems to take over a year.” “It was a wonderful journey,” Tarah concludes. “I’m so glad we did it. I’m so very glad, obviously, that we have Julia, but the journey itself was amazing. Sure, it’s a lot of travel, and a lot of paperwork. It’s expensive and emotional and frustrating. But we didn’t have any regrets once we met her. We just had to remember that in the middle of it all was Julia. A little girl who deserved a home. People say that she’s lucky, but I feel that we’re the lucky ones. We can’t imagine life without her.” Tarah and Barry recently welcomed daughter Sara into their family. She was born December 20, 2005. ------ Vaccinations in pregnancy: the flu shot and more Immunization is an important way to prevent serious disease. In general, immunization in pregnancy is possible and important in some circumstances. Vaccines made from dead germs are safe in pregnancy, but vaccines made from live germs are not recommended in pregnancy with some exceptions. The ideal plan is to check with your doctor before becoming pregnant and make sure you are immune to rubella (German measles), mumps, measles, chickenpox, tetanus, diptheria, and hepatitis B. If you are not immune, you should get immunized at least one full month before becoming pregnant. Vaccines not recommended in pregnancy Most women have been immunized in childhood (since 1970) or have had the diseases and are naturally immune. If you’re unsure if you are immune, get tested before pregnancy and get immunized at least one month before trying to get pregnant. Getting an infection during pregnancy, especially in the first half of pregnancy, can cause serious problems for the baby. Doctors and midwives test all pregnant women with a blood test. If you’re not immune you should avoid any child with a rash (most children are immunized to rubella but a few are not) and you should get immunized immediately after the baby is born. It is safe to breast feed. Doctors do not give rubella vaccinations in pregnancy because of a theoretical risk from a live virus. However there has never been a problem when a woman inadvertently received this vaccine in pregnancy. Varicella (chicken pox). Chicken pox is a highly contagious disease and most women have had chicken pox and are naturally immune. If you’re uncertain if you have had chicken pox, you should get tested (a blood test). If you’re not immune, then get immunized before pregnancy at least one month before trying to become pregnant. Chicken pox can be a serious disease in pregnancy. If you’re not immune or do not know if you have had chicken pox and think you have been around someone who has chicken pox during your pregnancy, you should see your doctor right away to be tested; if you’re not immune then you should be given an injection of immune globulin within 96 hours to prevent the disease. Vaccines recommended in pregnancy If you are pregnant through the flu season — November to March — you should consider getting the flu shot. Talk to your doctor. Vaccines that can be given in pregnancy Pneumococcus. This vaccine is recommended for all people over 65 and women who are at risk such as those with heart or lung disease. One shot usually gives lifetime immunity. It can be given to pregnant women at risk if needed. Meningococcus. This vaccine is recommended when there is an outbreak in the community. It can be given during pregnancy if needed. Hepatitis A. This vaccine involves two shots and is important if you’re travelling to areas where this disease is common. You can get Hepatitis A from water and food. Hepatitis B. This vaccine involves three shots and is recommended for all citizens of BC. It should be given before pregnancy, but can be given to women who are at risk in pregnancy. Women at risk are women who receive blood products, use IV drugs or have sex with a partner who is a carrier. Hepatitis B can cause a serious disease of the liver. During pregnancy all women are tested by a blood test and if found to be a carrier, then their baby is at risk of getting the disease through the placenta. At birth the baby is given preventative shots – immuno globulin and vaccination. To learn about vaccinations needed for travelers consult with your doctor or health department. It is best to avoid traveling to these areas while pregnant. Websites for more info: ------ Spa treatments during pregnancy…what is safe? Your best friend has just given you a wonderful gift – an aromatherapy pregnancy massage! You head off to the spa, and find out that the therapist is mixing up a special blend of ‘essential oils’ just for you. You ask, Are these products safe in pregnancy? The therapist’s face goes blank, and she leaves the room. An extreme example, but something to consider. With the advance of ‘natural’ medicine, we have become aware that some herbs and oils can in fact be harmful in pregnancy; some are even used to help induce labour! Others are quite beneficial in the pregnant population, and may give you some relief from the aches and pains that come with the changes in your body. Here is some useful information about pregnant spa treatments, compliments of Dulce Paisana, of Cabello Salon and Spa in Vancouver. Aromatherapy Oils that are safe when used in proper dilution: bergamot, chamomile, grapefruit, neroli, lavender, lemon, rosewood, patchouli, sandalwood, ylang ylang, and tea tree. Clarysage and jasmin are safe for use during delivery. Patients will use a ‘diffuser’ while in labour to get the full affect. Massage Facials Waxing Hair highlights |
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