Pre-pregnancy / Trying to conceive

Will the vaccine impact my fertility?

Dr. Dixon: The information we know is very reassuring. There is no evidence that any of the vaccines affect fertility. I encourage everyone to get their COVID-19 vaccine when they’re eligible. This includes if you’re actively trying to have a baby or even just thinking about having a baby in the future.

I am 39 and am trying to conceive. Will the vaccination decrease my chances?

Dr. Dixon: I’ve been assuring my patients, regardless of their age, that there’s no evidence the vaccine leads to loss of fertility. While fertility was not specifically studied in the clinical trials of the vaccine, no loss of fertility has been reported among trial participants who have received the vaccines since their rollout.

Is it safe to conceive while awaiting the second dose?

Dr. Dixon: It is safe if you become pregnant at any point around your vaccine doses: immediately before or after your first dose, between your first and second doses, or immediately after your second dose. I advise my patients to get vaccinated as soon as they are eligible to ensure they do not become seriously ill from COVID-19.

Timing of vaccination during pregnancy

Is there an ideal time during pregnancy to get vaccinated? First or second or third trimester?

Dr. Ladhani: The best time to get vaccinated is when you become eligible. We know that COVID-19 in pregnancy can increase your risk of being hospitalized and also cause an increased risk of preterm delivery. Statistics suggest between eight and 11 per cent of people who are pregnant who contract COVID-19 will be admitted to hospital, and between two and four per cent will need intensive care. That’s compared to about eight per cent of all COVID-19 patients who have needed hospitalization and about 1.5 per cent who needed intensive care, so pregnancy puts you at higher risk than the general population. A recent study in the American Journal of Obstetrics and Gynecology found those who were pregnant had a strong immune response after vaccination, suggesting strong protection. The study also showed that COVID-19 antibodies were transferred to babies, and we are going to see the effects of this soon. 

I’m in my third trimester. Should I get the vaccine while pregnant or when the baby is born?

Dr. Ladhani: I would advise receiving the vaccine as soon as you can. You’ll be protecting yourself, as well as your baby, once your immune response begins to kick in (usually two weeks after vaccination). Please be sure to receive your second dose at the scheduled time. The antibodies you produce will be passed on to your baby through the umbilical cord and in the breast milk.

Pregnant and patiently waiting. Is it ever too close to the due date to get the vaccine?

Dr. Ladhani: Close to your due date is absolutely fine. You’ll be protecting two people – yourself and your baby – it’s a win-win situation.

Pregnancy & the COVID-19 vaccine

Can antibodies be passed to baby if vaccinated during pregnancy?

Dr. Ladhani: A recent study showed there was immunity transferred to babies via placenta and breast milk. This evidence points to the strength of vaccination, at any stage of pregnancy, and also for those who have delivered their baby and are breastfeeding.

What effects will the vaccine have on my baby?

Dr. Ladhani: The COVID-19 vaccines available for people who are pregnant don’t contain any live virus and do not put you at increased risk for pregnancy loss or harm to your baby. They will not give you or the baby COVID-19, and will not interact with yours or the baby’s DNA. You may develop a fever after you get the vaccine, but this will not harm the baby.

Does vaccination during pregnancy mount less of an immune response compared to non-pregnant?

Dr. Ladhani: In a recent study, COVID-19 mRNA vaccines generated strong immunity in pregnant and breastfeeding people. The immune response was the same as that observed in non-pregnant individuals. Immune responses from being vaccinated were significantly greater than if you had been infected with COVID-19.

Could post-vaccine symptoms be heightened due to pregnancy?

Dr. Ladhani: There’s no indication that if you’re pregnant you will have more severe post-vaccine symptoms. The vaccine can cause fever in some people (around 16 per cent of those vaccinated) and usually takes places following the second dose. The evidence shows there is minimal risk to your or your baby. A few hours after receiving the vaccine, if you have a fever, you can treat it with acetaminophen/Tylenol.

How do we know the vaccine is safe during pregnancy if trials have just started for that group?

Dr. Ladhani: Early clinical trials for the COVID-19 deliberately did not include people who were pregnant. It’s common practice for clinical trials to exclude those who are pregnant, with concerns about fetal development cited. However, we do know that some vaccine study participants became pregnant and to date there have been no adverse effects reported during pregnancy or related to the health of babies. The COVID-19 mRNA vaccines studied in people who were pregnant, breastfeeding and trying to conceive have been found to be safe.

I received the Tdap (Tetanus, Diphtheria, Pertussis) vaccine and Rhogam today. Do I have to wait two weeks to get the COVID vaccine?

Dr. Ladhani: There is no need to wait between vaccines. You can get both vaccines on the same day or within two weeks of each other.

Will the vaccine cause birth defects, miscarriages, or any other fertility or pregnancy complications?

Dr. Ladhani: From the data we have, there is no increased risk for miscarriage, stillbirth or congenital anomalies with the COVID-19 vaccines. I assure patients that there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications. This is based on the millions who have received the vaccines to date and were trying to conceive or were pregnant.

What happens if I get COVID-19 while pregnant?

Dr. Ladhani: If you begin to feel unwell with symptoms of COVID-19, please contact your obstetrician. Most people who are pregnant will have mild-to-moderate illness if they contract COVID-19. Your obstetrician will provide you with support and resources for managing COVID-19.

High-risk pregnancy & the COVID-19 vaccine

Is the vaccine right for me if I have an autoimmune disorder, asthma and recurrent losses?

Dr. Ladhani: Yes, we would recommend that you get the COVID-19 vaccine. Being pregnant and having asthma are both risk factors for moderate to severe illness with COVID-19. People with autoimmune disorders weren’t included in the vaccine trials, and so the effectiveness and safety profiles aren’t known, but NACI and the Canadian Rheumatology Association are recommending that people with autoimmune disorders are offered the vaccine. Given your risk profile, the vaccine may protect you from the severe forms of COVID-19. It may be worth discussing this more with your health-care practitioner.

I’m having a high risk pregnancy. Should I get the vaccine?

Dr. Ladhani: Yes, in most cases people who are pregnant with high or low-risk pregnancies will benefit from receiving the COVID-19 vaccine and being protected from the disease. Please speak with your high-risk obstetrician about the specific details surrounding your pregnancy to determine if you will benefit from the vaccine.

I’m expecting twins. Is it safe to get the vaccine?

Dr. Ladhani: Yes! You’ll protect yourself and potentially protect both of your babies!

I am pregnant after experiencing a pregnancy loss. Should I get the vaccine?

Dr. Ladhani: A pregnancy loss can be devastating, and it’s understandable you may feel anxious being pregnant again. I would recommend receiving the vaccine for additional peace of mind during your pregnancy, especially as contracting COVID-19 during pregnancy can put you at higher risk of hospitalization and preterm delivery. Please remember there is always support available for pregnancy and infant loss through Sunnybrook’s Pregnancy and Infant Loss (PAIL) Network.

Are there complications with heart arrhythmias?

Dr. Ladhani: COVID-19 can be dangerous for those who have an underlying heart condition. Both of the COVID-19 mRNA vaccines were tested in people with heart problems and found to be safe and effective.There is no evidence that the vaccine has worse side effects for people with underlying heart conditions, and having COVID-19 is much riskier than getting the vaccine, so we would recommend you get the vaccine.

Breastfeeding & the COVID-19 vaccine

Is the vaccine safe for both me and my baby while breastfeeding?

Dr. Ladhani: The vaccine is safe for your and for the baby. There is new data showing antibodies for COVID-19 in breast milk after vaccination. So you’re not only protecting yourself against COVID-19 with the vaccine, but also possibly passing along some immunity to your little one. A huge win!

Fertility treatments & the COVID-19 vaccine

Is the vaccine safe when undergoing fertility treatment, like IVF?

Dr. Dixon: I suggest speaking with your fertility specialist who knows your history and care plan, and can answer your questions to help you make an informed decision. Undergoing IVF can be a stressful time and your fertility team is a wonderful resource to help guide you. Your specialist may suggest waiting a few days between some treatment procedures (for example, egg collection in IVF) and vaccination, so that any symptoms, such as fever, might be attributed correctly to the vaccine or the treatment procedure. 

Is it safe to get the vaccine if you have a planned intrauterine insemination (IUI) or embryo transfer?

Dr. Dixon: We may consider postponing the start of assisted reproductive treatments – like IUI, ovarian stimulation and embryo transfer after your first or second vaccination. This allows time for the immune response from the COVID-19 vaccine to settle down – this recommendation is purely to help patients cope with potential side effects IF they occur. Please talk to your fertility specialist if you have any concerns about the timing of your vaccine with upcoming fertility treatments.

I did IVF and I’m still in my first trimester. How long should I wait to get the vaccine?

Dr. Dixon: You should take the vaccine as soon as it is made available to you. Please speak with your provider about the specifics of your case. This is consistent with the most recent fertility practice guidelines.

I got pregnant after my second IVF cycle, I’m on my fifth week. Is it safe to receive the vaccine?

Dr. Dixon: It is safe to receive the vaccine in your first trimester. The data from those women who became pregnant immediately after receiving both of the COVID-19 mRNA vaccines showed no adverse outcomes in the pregnancy and the vaccines have thus been deemed both safe and effective. Further, there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications.

Read more: Got your COVID-19 vaccine? What you need to know about infection prevention after getting vaccinated

The post Pregnancy, fertility and the COVID-19 vaccine: Sunnybrook experts answer your questions appeared first on Your Health Matters.

In December last year, she and her husband lost their son Josiah. He was stillborn. Then, in July 2020, the family welcomed twins, also at 27 weeks.

Elise was born weighing 908 grams and David was born weighing 1088 grams.

The twins are happy and healthy, home now with Danielle and her husband Akeem.

Danielle’s journey has been anything but ordinary. She went into preterm labour at 21 weeks of pregnancy, meaning she was in and out of Sunnybrook’s High Risk Obstetrics Unit until the twins were born.

The twins stayed in Sunnybrook’s Neonatal Intensive Care Unit (NICU) for 34 days before transferring to Michael Garron Hospital.

On top of that, she developed a brain condition that required her to have fluid drained from her spine.

Asked about her time at Sunnybrook, she breaks into a huge smile. “I remember every single staff person by name.”

She lists the names of nurses in High Risk Obstetrics who held her hand when she missed her husband due to visiting restrictions during the pandemic. It’s the same for the care team in the neonatal intensive care unit – she can name them all, from nurses to respiratory therapists to social workers.

One individual that left a mark was her maternal fetal medicine specialist, or high-risk obstetrician, Dr. Amir Aviram. “Dr. Aviram understood how difficult it was experiencing a pregnancy after loss and during a pandemic. It still brings me to tears remembering how we felt supported, so well informed and cared for.”

The twins stayed in Sunnybrook’s NICU for 34 days, then moved to Michael Garron Hospital for a few weeks. Danielle often thinks about her time at the hospital.

“When I was feeling down, staff always tried to brighten my day. They were professional but still warm and tried to gain insight into our lives. One nurse in particular asked the name of my first son. That meant a lot.”

Josiah, the name of Danielle and Akeem’s first son, means ‘God heals’. “We had faith we would have more children.”

The post Giving birth at 27 weeks: A family’s journey of heartbreak and joy appeared first on Your Health Matters.

“Watching them find their passions in life is incredible,” says mom Sandy Thompson. “There are no limitations. They want to try something new and they follow through.”

The twins had an early start to life. At 27 weeks of pregnancy, Sandy began experiencing a placenta complication. The girls were born, with Hailey weighing one pound, 13 ounces and Samantha weighing two pounds, eight ounces. Both were given a breathing tube right away and admitted to Sunnybrook’s neonatal intensive care unit. Samantha was able to progress from that in a couple of weeks to a continuous positive airway pressure (CPAP) machine after a few weeks.

Hailey developed an infection and was diagnosed with two serious heart defects. Her condition improved without the need for surgery. Samantha left the hospital 12 weeks after birth, and Hailey came home with Sandy and her husband Steven 20 weeks after she was born.

The family also learned the twins would be moved from the hospital’s Women’s College site to Sunnybrook’s Bayview campus, which Sandy describes as “seamless…the staff made the transition so smooth…and the new facilities were absolutely amazing.”

While thankful both girls are now healthy and thriving, Sandy admits their first couple of years of life were a blur. “It’s incredibly busy. You need to learn everything about caring for babies born prematurely, as well as trying to understand how to navigate the health care system and also transitioning from the hospital to community-based care,” explains Sandy, who adds that between both girls there were five to seven medical appointments a week during their first two years of life.

If she were to change anything about the girls’ stay in the NICU, Sandy says she would have taken advantage of the supportive resources at the hospital. “From social workers, to parent coordinators, there are so many supports. I would encourage families with a baby or babies in the unit to use all available services. I think they would have made my time easier as a parent.”

Looking at the family now, as they’re smiling, laughing and planning their next big hike, it’s difficult to imagine the challenging start Hailey and Samantha had in life. They’ve opted for remote learning during the pandemic, and the twins are excited to get back to a routine as grade five students.

Sandy urges parents of babies born prematurely to take each day as it comes. “If it’s a hard day, try to just get through it and hope tomorrow will be a better day. If tomorrow isn’t a better day, just hope that the next day will be better. Don’t be scared of the future. There is so much good ahead.”

The post Meet Samantha and Hailey: From the NICU to thriving 10-year-olds appeared first on Your Health Matters.

International Board Certified Lactation Consultants, also known as IBCLCs, help women who are experiencing breastfeeding problems such as latching difficulties, painful breastfeeding and low milk supply. Lactation consultants provide women with information about pumping and storing breastmilk when they are returning to work or school, and also help women if their babies are not gaining enough weight.

For breastfeeding women with questions or having issues, they can provide a unique body of knowledge and skill in routine and high-risk situations. Ultimately, this improves breastfeeding outcomes.

Many families want to know, “When should I call a lactation consultant?” You should call if you:

• have difficulty latching your baby;
• experience pain while breastfeeding;
• notice unusual lumps or redness in your breast;
• think your milk supply is low;
• are concerned about medications and breastfeeding;
• need help with weaning;
• need help with returning to work or school, or;
• have any questions or concerns about breastfeeding

Lactation consultants can also help if your baby:

• breastfeeds less than 8 times in 24 hours in the first 6 weeks;
• is not having 5-6 wet diapers in 24 hours in the first 6 weeks;
• is not gaining enough weight or you are worried about your baby’s weight, or;
• seems fussy at your breast or refuses to breastfeed.

You’ll find International Board Certified Lactation Consultants working in a variety of places including hospitals, clinics, and doctors’ offices, some have their own private practice.

They can assess you and your baby breastfeeding and then provide you with helpful strategies for your specific situation.

It’s normal to have questions and concerns during breastfeeding. To find a lactation consultant in your area, please visit the International Lactation Consultant Association.

If you are a health care practitioner, please visit our Breastfeeding Centre of Excellence.

Another great reference can be found at on the International Lactation Consultant Association’s website.

The post Breastfeeding? Here’s when to call a lactation consultant appeared first on Your Health Matters.

Rena Rosenthal, a registered dietitian in Sunnybrook’s neonatal intensive care unit, works with families to provide strategies to encourage happy feeding. A happy feeder is comfortable with eating and able to enjoy food and mealtimes.

“Parents who have had a premature baby are often concerned about weight gain for their infants and children, sometimes to the point where food, and eating enough of it, becomes a huge issue,” says Rena, adding that this can also be an issue for families who haven’t had a baby in the NICU. “There are a number of steps parents can take with the goal of making meal and snack times much less stressful.”

The ultimate goal is to have your child accept new foods, and also be in tune with their body to know when they are hungry and when they are full.

It’s normal for children in their toddler years (and beyond!) to be finicky eaters. The good news? There’s a lot you can do a lot to ensure your child is ready for a lifetime of enjoying food and mealtimes.

Here are Rena’s tips for families with children from age six months right through to the teen years:

Meals are partnerships

Everyone has a role to play in the partnership, with parents deciding what, when and where to feed and children deciding whether and how much to eat. This approach sets up kids, and their parents, for success. Children learn how to enjoy a variety of foods and parents learn to respect their kids’ hunger cues.

Meals = teamwork

Include your children in planning and preparing family meals. How much your child can do will of course depend on their age. For young children, sprinkling cheese on dishes or helping distribute taco shells to each member of the family is a fun role. Involving your children in menu and meal planning is a good idea too.

Schedule meals and snacks

Make a schedule and routine and stick to it. This means no grazing between meals, and all meals and snacks should be eaten together with your child either in a high chair or seated around the table.

“But she didn’t eat anything…”

What if your kid doesn’t eat much, or anything? Don’t panic, advises Rena. Children balance themselves by eating more at one meal and less at another. Focus less on what your child is eating and more on how they feel and behave at meal times. Your child should be offered the same food as the rest of the family. Do not prepare different foods for them.

Learn to trust your child’s cues

Respect that your child will learn to know when they are hungry and when they are full. Meal times are over once your child seems disinterested in eating or starts to misbehave (for example, throwing food). They can leave the table and play quietly while the rest of the family finishes eating.

Encourage family mealtimes

Come together over food and share stories about your day. It’s also an opportunity for your kids to see you trying new foods, meaning they’re more likely to try new foods as well.

Minimize distractions

Put away all technology, turn off the TV and separate mealtimes from playtime. Toys, as well as technology like phones or tablets, should not be brought to the table during mealtimes.

Embrace messiness

Let your child self-feed, even if they’re using their hands. Allow your child to feel in control when it comes to food and eating.

Don’t play games

Avoid entertaining or playing games to get your children to eat more. Don’t praise your child for eating or show disapproval when they don’t eat. Rena suggests no pressuring, bribing or sneaking food into your child’s mouth.

Be patient

Learning how to be a happy feeder takes time and patience. The more you practice with your children, the more comfortable they will feel about making their own decisions surrounding food.

Having a child who is a picky eater can be stressful. Remember there are constructive steps parents can take to shape their children’s view of food to ensure they become happy feeders.

If you’re concerned your child isn’t growing as they should be, or you and/or your child is feeling very anxious about meal times and feeding, be sure to make an appointment with your paediatrician or family doctor.

The post Is your child a picky eater? We have tips appeared first on Your Health Matters.

For families that have experienced such devastating loss, receiving more sensitive and personalized obstetrical care during their next pregnancy is essential, but it can be difficult to find.  A new pilot project at Sunnybrook is attempting to address this gap: the Subsequent Pregnancy Program.

“Our primary focus is on evidence-based, woman-centered care.  We are seeing women and their families who are experiencing another pregnancy after a late loss (past 16 weeks gestation) or the death of a baby within the first month of life,” says Megan Fockler, Advanced Practice Nurse. Together with Dr. Jon Barrett, Chief, Maternal-Fetal Medicine, she is leading the implementation of the Subsequent Pregnancy Program at Sunnybrook.

[pullquote align=”right”]“Linking women to a care team that knows about their history, and understands their story and preferences, will hopefully create a more positive experience for our families,” says Fockler.[/pullquote]

The one-year pilot project, which launched in the summer, has started seeing women who are expected to give birth in the fall and early 2015.  Within a family-centered model of care, women will receive care from an interprofessional team. The Advanced Practice Nurse will act as a navigator, connecting families with resources and providing seamless care and support when needed.

“Women are looking for excellent clinical care that includes sensitivity and continuity.  We focus on individualized care that begins during antenatal visits and extends through the birthing process and postpartum care. Linking women to a care team that knows about their history, and understands their story and preferences, will hopefully create a more positive experience for our families,” says Fockler.

After the initial pilot project phase is complete, the Women & Babies Program hopes to expand the Subsequent Pregnancy Program to take on more patients in early 2015.

The post Subsequent pregnancy program launches appeared first on Your Health Matters.

Our Butterfly Tree. Each butterfly was placed by a family or
staff member to honour a baby

We are so grateful to everyone who made today’s ceremony so special.

To Wendy, Maureen and Sonia, our lovely readers … thank you!

To Rebecca who shared her glorious voice with us …  we feel so fortunate that you were able to join us today. Your gift was greatly appreciated.

To Helen who cobbled together the most elaborate extension cord arrangement ever, and so as a result was able to offer us beautiful, healing music … thank you! You are a MacGyver and a musician.

To Kasia who pulled so many pieces together … your dedication and your hard work is wonderful.

To Rohan and his gardeners … your love for your work and your kindness gave us a beautiful place to hold our ceremony. Thank you!

To Anke, who with her kind serenity presides over everything and makes it all feel so healing and beautiful, we are so grateful to you for all that you do for us and for our families.

And to all the families and staff members who came … thank you so much! We hope that you found it a healing and helpful experience, and we welcome you back any time.

Many of you mentioned how much you loved the poem Sonia read. Here it is. If anyone knows the author please let us know!

These are my footprints

So perfect and so small

These tiny footprints

Never touched the ground at all.

Not one tiny footprint,

For now I have wings.

These tiny footprints were meant for other things.

You will hear my tiny footprints,

In the pattern of the rain.

Gentle drops like angel’s tears,

Of joy and not from pain.

You will see my tiny footprints,

In each butterfly’s lazy dance.

I’ll let you know I’m with you,

If you give me the chance.

You will see my tiny footprints,

In the rustle of the leaves.

I will whisper names into the wind,

And call each one that grieves.

Most of all, these tiny footprints,

Are found on Mommy and Daddy’s hearts.

‘Cause even though I’m gone now,

We’ll never truly part.

-author unknown.

The post Love, grief and beauty in our Butterfly Garden appeared first on Your Health Matters.