Dr. Noor Ladhani is Maternal-Fetal Medicine (MFM) Specialist in Sunnybrook’s DAN Women & Babies Program. MFMs are part of a team providing high-quality care during labor and childbirth.

You really are living your work right now.

Yes, I’m a pregnant obstetrician! My first daughter is almost 3, so this will be my second child.

Is it hard changing your hat from caregiver to patient?

No, I just let my amazing team take care of me. I delivered my daughter at Sunnybrook and plan to do the same with this baby. I trust everybody and we have a great centre so I wouldn’t dream of delivering anywhere else.

Knowing what you know, does that make pregnancy and labour easier or harder?

It probably does both, so I try to focus on the positive. I know what people can do in pregnancy and what helps them feel “normal” and healthy – like staying active – so I try to focus on that. Of course, there are risks and sometimes things don’t go as planned.

Are you able to bond with your patients differently being pregnant?

I think it’s fun, but I try not to get too personal because everybody’s path is different. For example, even though I’m having a pregnancy where I’m able to work and be active, not everyone is on that same path.

What are your thoughts on giving personal advice?

I think if people ask for advice, then that’s fine. But unsolicited advice is always tricky. The thing we have to remember with advice is that not everything applies to everybody, and that’s why we do research studies. We also shouldn’t give advice we can’t follow ourselves.

Is there any professional advice you give to patients that you find hard to follow yourself?

We always say to have a healthy well-balanced diet, but sometimes our pregnancy appetite doesn’t allow us to follow those Health Canada nutrition guidelines completely! I do my best, but once in a while I’ll have ice cream and some salty snack foods.

Are people extra judgy during your pregnancy because you’re a doctor too?

Generally, no, but sometimes I wonder what people are thinking when I get my coffee order in the morning.

What’s the hardest part of being pregnant for you?

Just the anticipation of what this person is going to be like, when are they going to come and how our family will look afterwards.

And the best?

It’s fun to have a buddy with you all the time. I love the baby’s movement and reassurance of that.

What attracted you to this line of work?

I’m the first doctor in my family. I always had an interest in public health so after medical school I wanted to do something that was a normal part of a person’s life. That’s why obstetrics was interesting, but I also really liked the surgery and the medical specialization.

It will be quite the moment when you are delivering the babies of the babies you helped deliver.

That’s when I know it will be time to retire!

The post How to live like the experts: Maternal-Fetal Medicine Specialist Dr. Noor Ladhani shares her approach to pregnancy appeared first on Your Health Matters.

When Diana Drake was injured in an ATV accident, she assumed her hopes of becoming a parent were over.

“I was paralyzed and broke my back in two places,” says Diana. “My life was turned upside down.”

Five years after the accident, Diana did become pregnant, and learned about Sunnybrook’s Accessible Care Pregnancy Clinic. The clinic is the first in Canada to care for patients with physical disabilities of all types during their pregnancy, delivery and postpartum phases.

“Patients with disabilities are often highly overlooked in terms of medical care and specifically pregnancy care,” says Dr. Anne Berndl, Director, Sunnybrook’s Accessible Care Pregnancy Clinic. “There is a significant amount of bias towards people with disabilities regarding reproductive care, and stigma when people interact with the health care system.”

The clinic at Sunnybrook was designed to be not only accessible, but welcoming, with the correct equipment and space available to care for patients. Most importantly, the hospital offers a collaborative team of people who are familiar with the concerns a person with a disability may have during pregnancy and birth. This core team pulls in specialists from other areas of Sunnybrook – such as anesthesia, neurology, hematology – to ensure a healthy pregnancy and delivery.

“The vast majority of people with physical disabilities can have a healthy pregnancy,” says Dr. Berndl. “If growing a family, and becoming a parent is your dream, having a physical disability does not mean this is out of reach. You can become pregnant. You can become a parent. For most people, this is a safe choice.”

Dr. Berndl strongly recommends patients have a pre-pregnancy consultation and notes it is not always a smooth road for everyone. There are some increased risks across the spectrum, but she notes going into a pregnancy with your eyes open, and a supportive care team, is key.

The clinic has cared for people with spinal cord injuries, like Diana, as well as little people and those with severe arthritis, spina bifida, a history of traumatic physical injuries, cerebral palsy, multiple sclerosis, a history of amputations, and myasthenia gravis.

“Patients sometimes feel apprehension and trepidation, and wonder ‘is this an okay thing I’ve decided to do…to become a parent and to start a family’,” says Dr. Berndl, who has cared for hundreds of pregnant patients with disabilities. “When you see a new parent, holding a baby in their arms for the first time, it’s a wonderful moment.”

Hear more from Diana about her journey in the video above.

The post Inside Sunnybrook’s Accessible Care Pregnancy Clinic: Diana’s story appeared first on Your Health Matters.

Each week, Dr. Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook, sees patients who are pregnant and have depression. After reviewing general risks, like the increased likelihood of giving birth to a preterm baby at a lower birthweight, she talks with patients about treatment options.

Psychotherapy, or ‘talk therapy’, can be very helpful. “A lot of people prefer it over medication because there is no fetal drug exposure,” says Dr. Grigoriadis. “One of the problems is that therapy can take weeks to months to help with depression, so the patient and baby can be exposed to the negative impacts of depression during that time.”

Antidepressant medication can improve symptoms of depression very quickly and with very few side effects. However, medications do cross over to the baby to some extent and some patients may be hesitant to take them while pregnant.

This new approach, tDCS, uses a small electric current to locally stimulate a part of the brain that functions abnormally when an individual is depressed, requiring 30 minutes of daily treatment over three weeks. It can be done by patients at home after receiving training, while also continuing to see their regular health care team, including pregnancy care provider and psychiatrist.

“Our team has already done a small study with 20 pregnant patients with depression, which had promising results for safety and effectiveness. We’re looking for more patients for a larger study to see whether this should be offered widely during pregnancy,” adds Dr. Grigoriadis. The study is randomized, meaning patients will have a 50/50 chance of receiving tDCS or being placed in a control group which receives a similar looking device but does not deliver any electric current.

For more information and to enroll in the study, please visit https://sunnybrook.ca/content/?page=tdcs-pregnancy-depression-research-study.

The post Depression in pregnancy: Studying a new treatment appeared first on Your Health Matters.

Thinking I had a stomach flu, I went home. Over the next five days that “stomach flu” didn’t go away and the advice at that time was to rest and it will get better. Finally, after urging from my family, my husband drove me to Sunnybrook, thinking I likely only needed IV fluids.

That night, as my nausea was treated, I went to the bathroom and noticed blood. I called in the nurse who then called the doctor, and after checking, began to gently tell me that they could no longer find the heartbeat, and in that moment, was eight centimetres dilated.

That was an emotional rollercoaster. Within 20 minutes and with no epidural, I gave birth to my stillborn baby girl. I was heartbroken. My story doesn’t end here though, as my vitals were dropping, and I suddenly found myself being rolled into an operating room, sedated and confused. My heart stopped twice, was resuscitated twice and was on three different blood pressure medications just so I could have a pulse.

I woke up six days later, after learning I was in a medically induced coma and in the intensive care unit. Turns out, I didn’t have the stomach flu, I had necrotizing fasciitis. The condition targeted my stomach and caused toxic shock. General surgery removed my entire stomach as it was completely blackened. Dead. The only way to save the rest of my organs was to remove it and figure out the best course of action.

Three other surgeries later, within the span of six days, the decision was made to staple my esophagus and my intestines shut and do corrective surgery in the future when I become stabilized.

Since my digestive system was not intact, I had two tubes coming out of my stomach, one of which was a feeding tube. Since I was not stable, I couldn’t have the reconstruction surgery right away, and lived like this for 14 months. This timeframe was the most torturous time of my life and one that I wish no one ever endures. It was in this time that I did not eat a single thing. The feeding tube nourished me with 3,000 calories a day through a machine.

But life doesn’t stop. Thanksgiving meals don’t stop. Weddings happen. I had to continue to be a mom, and prepare meals for my family, and then sit at the dinner table watching them eat, when I could not eat. Just the smell of sautéed onions smelled so good, sometimes I had to go to the bedroom just so I wouldn’t have to smell the yummy dinner. You don’t notice how many food commercials are on TV until you can’t eat what they’re advertising. It was within this timeframe that I experienced depression and suicidal thoughts, was addicted to opioids, on a ton of medication, and was in and out of Sunnybrook’s Emergency Department for a variety of issues with the unanswered question of “why me?”

The day finally came when the team of doctors performed my reconstruction surgery. This involved attaching my small intestine to my esophagus (stomach transplants are not a thing). I experienced a huge sigh of relief when they did the ‘leak test’ to see if the connection was sealed.

Seven years later, this experience has taught me major life lessons like resilience, gratefulness, thankfulness and spirituality. I have a completely different viewpoint on life altogether. I am now a self-proclaimed foodie and enjoy eating with a different lens. I learned that the joys in life revolve around surrounding yourself with people you love and to share a meal together.

I learned that my case was a once in a lifetime “career case” for the team of surgeons, with the odds of someone getting this was one in ten million people. And the people that get this don’t survive. But I survived. I had an anesthesiologist come to my room saying “I heard a rumour you were alive and I wanted to confirm.” I was famous at Sunnybrook, anytime I went into the Emergency Department, someone was bound to say “Oh, that story was you?”

The surgery team at Sunnybrook is absolutely incredible and their skilled team gave me my life back to what it was, albeit some changes. Everyone that I and my family encountered was professional, delightful and empathetic. I want to thank all the doctor teams, nurses, porters, and administrators who provided excellent patient care. I no longer experience depression, PTSD, and my body works as it should.

I’m forever grateful. Thank you.

Note: If you or a family member have experienced a pregnancy or infant loss and live in Ontario, please consider seeking support through the Pregnancy and Infant Loss (PAIL) Network.

The post My condition happens to one in 10 million – Now I have a completely different viewpoint on life appeared first on Your Health Matters.

As a volunteer with Sunnybrook’s Pregnancy and Infant Loss group, I was honoured to share my story yesterday with a group of health-care workers. The purpose of the workshop was to educate and empower health-care professionals on how to deal with patients experiencing possibly the worst day of their lives and the fallout of their loss(es). Here was some of my advice:

1. Never assume.

When I was in hospital after experiencing a 20-week loss, a hospital porter entered my room with a flower delivery. As she set the bouquet near the window, she innocently looked around and asked, “Where’s the baby?”

Years later, in another hospital high risk unit I was in, I noticed butterfly stickers outside some of the hospital rooms. Those stickers symbolized to outsiders that the patient behind the door had experienced a loss. Every hospital needs something like this. And/or, ensure grieving moms don’t have to share the ward with celebrating moms.

2. Never start a sentence with “At least you have…” or “Just be grateful for…”

I tended to attract these well-intentioned comments because I have other kids. But, these comments felt like they were suggesting I wasn’t thankful enough for my current family. Losing one baby, doesn’t require a reminder (from your doctor) that you should “just focus on your babies that are alive.”

3. Please stop with the “how many pregnancies” and “how many live births” questions.

Surely, this information is already in my file. Please take a minute to find the answer before asking me to recount how many of my babies have died and at what gestation. While this might be a routine question for you, it’s triggering to someone who’s experienced loss. There were times that I was asked the same question during every weekly ultrasound, and sometimes, during the same hospital visit by various staff. Please have a better system in place.

4. Have a bad news plan.

Ensure that if bad news is delivered, your patient is going to be cared for when she leaves the appointment, is given written information on what to expect and what comes next because she won’t remember what you tell her. And, make sure she gets home OK (rather than going back to the office — which I did, more than once and, do not recommend). After one of my losses, I was given a backpack of self-care items and reading material and recall being so touched by this act of kindness, from a hospital volunteer versus another loss when I was told by the radiologist to “follow up with your doctor on Monday because he’s probably gone for the weekend since it’s Friday afternoon.”

Pregnancy and infant loss is not a “women’s issue.” It’s a terrible fact of life and it affects parents, families, companies, health-care systems and communities. I’m grateful to finally be in a place where I can share my experience without shame, and hope that through my sharing, I can help inspire small but meaningful changes in our health-care system.

The post Lisa Marie, a Pregnancy and Infant Loss Network volunteer, shares her story and advice for working with grieving parents appeared first on Your Health Matters.

The tattoo is just one way she remembers her first born son, Easton. Easton was born just shy of 22 weeks, without a heartbeat, in 2018.

Mother’s Day, for Lisa and many others who have had a pregnancy loss, can bring mixed emotions. The peer support volunteer for Sunnybrook’s Pregnancy and Infant Loss (PAIL) Network shares her journey.

What has been helpful following your pregnancy loss?

My husband Chris and I share our story of loss with anyone who is open to listening. We’ve learned to not feel embarrassed if others are uncomfortable when we talk about Easton’s death. If I were to say anything to a parent who has a loss it would be: it’s your story and you own it. You earned the right to grieve and process however it feels right for you. Regardless of “normal” timelines and expectations.

In March of 2020, your family welcomed baby Nash. Can you talk about the experience of “trying again” following your loss?

There is no right or wrong or a certain timeline in grief. I know some people feel guilty about trying to conceive after a loss. It can feel like everything stands still when you’re grieving. When I first learned I was pregnant again, I felt happy. Later, for sure, the uncertainty and concern set in, but in that moment it was joy. We weren’t “replacing” the baby we lost, we were continuing to build our family. Now, Nash is a healthy, happy and thriving toddler. He’s incredible.

How do and your family remember Easton?

We honour him on his birthday each year. And when Nash is old enough, we will have him pick a gift for the age Easton would have been that year and donate the present. We’re going to continue to be very open and speak about his brother. Both Chris and I got tattoos following the loss. I like that it’s a way to open up the conversation and our way of carrying him with us always. On my wrist, I have his hand and footprint, and Chris has the same on his chest, along with “Father of an angel.”

What does Mother’s Day mean to you now?

I remember my first Mother’s Day following Easton’s death. I kept thinking, “Am I a mom or not a mom?” It was like I was at a party I wasn’t invited to. This Mother’s Day, I don’t mind feeling sadness. The sadness comes with a bit of comfort as it means we haven’t forgotten about Easton. I have a baby, but not both of my babies. That is just our reality in how we celebrate and honour the day and really, I think speaks to the diversity of the makeup of a mom.

The post One mom’s story about having a baby after experiencing a pregnancy loss appeared first on Your Health Matters.

There is hope, and treatment, for anxiety during pregnancy.

A new study – Treating Anxiety in Pregnancy (TAP) – by Sunnybrook Research Institute and Women’s College Research Institute is looking at a type of talk therapy called Mindful Adaptive Practice in Pregnancy to determine how the treatment works in reducing anxiety. If you are 18 years of age or older, live in Ontario and are between 12 and 30 weeks of pregnancy, you may be eligible to participate.

Dr. Sophie Grigoriadis, Head of Sunnybrook’s Women’s Mood and Anxiety Clinic: Reproductive Transitions, answers questions related to pregnancy and anxiety, and about the study.

I’m pregnant and feeling quite anxious and overwhelmed. What should I do?

Don’t keep it to yourself. Talk to your family doctor, midwife or obstetrician. There is help available.

What will my doctor or midwife do when I reveal my anxiety?

Your health care provider will use screening tools and ask you questions like:

• How are you sleeping? How’s your appetite? Can you focus and concentrate?
• Are you getting pleasure out of any activities, or is everything overwhelming? Are you thinking of harming yourself?

How will my anxiety be treated?

There are different approaches to treating anxiety during pregnancy. These include community resources like support groups and apps to connect you with techniques for reducing anxiety. Your family physician, obstetrician or midwife may also refer you to a psychiatrist. Following a psychiatric consultation, you may be given resources and may be further referred for individual or group psychotherapy. Medication is reserved for moderate to severe anxiety in those diagnosed with an anxiety disorder or depressive disorder with prominent anxiety.

What’s involved if I’m selected for the TAP study?

Our team has adapted a talk therapy treatment called Mindful Adaptive Practice in Pregnancy, which can help women who are pregnant learn how to reduce their anxiety very quickly. It is an exciting and innovative treatment because it is:

• Ultra-brief in duration (one month)
• Specific to pregnancy
• Delivered in a group format
• Provided over the internet and done from home

What is talk therapy?

“Talk therapy” is also sometimes called psychotherapy. It’s a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts, and behaviour. Talk therapy is recommended to treat mental health problems but some treatments are not often utilized because they take time to learn and use. The pandemic has added another layer of burden because in-person treatment is not routinely available.

Have questions about the TAP study and eligibility? Please contact our research assistant, Morgan Sterling at morgan.sterling@sunnybrook.ca.

The post Anxious and Pregnant? You’re not alone appeared first on Your Health Matters.

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.

Advice from our experts:

» What to do if you or your loved one has postpartum depression
» Pregnant or just had a baby? Tips for looking after your mental health

May 5^th is World Maternal Mental Health Day – take our quiz* to test your knowledge of postpartum mood and anxiety disorders.

*Sources are Postpartum Support International and PostpartumDads.

1. Which of the following is NOT a symptom of postpartum depression?
   1. Irritability/anger
   2. Guilt
   3. Withdrawal from friends/family
   4. Delegating chores to others
   5. Lack of energy and motivation
   6. Headaches

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: Delegating chores to others.
   [/mks_toggle]

2. Risk factors for postpartum mental health diagnoses are:
   1. A family history of mental health
   2. A preexisting mental health history
   3. A mental health diagnosis or coping difficulty in pregnancy
   4. Psychosocial stress including relationship issues, domestic violence, and a lack of social support
   5. A difficult birth experience, upsetting events and/or separation from your baby in the immediate postpartum period
   6. All of the above

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: All of the above.
   [/mks_toggle]

3. If I am worried that I might have postpartum depression, I should speak with my:
   1. Family doctor
   2. Obstetrician
   3. Midwife
   4. Public health nurse
   5. Partner
   6. Close friend or family member
   7. Any or all of the above

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: Any or all of the above. Plus, call 911 or go to your local emergency room if in crisis.
   [/mks_toggle]

4. Partners can experience postpartum depression and other postpartum mental health issues.
   1. True
   2. False

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: True.
   [/mks_toggle]

5. Postpartum depression will go away on its own. 
   1. True
   2. False

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: False.
   [/mks_toggle]

6. Untreated depression may have long term effects on children’s health and development.
   1. True
   2. False

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: True.
   [/mks_toggle]

7. Medications prescribed for postpartum depression are safe if breastfeeding. 
   1. True
   2. False

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: True.
   [/mks_toggle]

8. What is the definition of postpartum blues?
   1. A mood disorder with symptoms including sadness, frequent crying, feelings of worthlessness, irritability and obsessive thoughts. May occur any time during the first year postpartum.
   2. A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
   3. An adjustment reaction with transient depressed mood that occurs within the first two weeks postpartum and resolves spontaneously.
   4. The process by which parents form an emotional relationship with their infant over time.

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: An adjustment reaction with transient depressed mood that occurs within the first two weeks postpartum and resolves spontaneously.
   [/mks_toggle]

9. What is the definition of postpartum depression?
   1. A mood disorder with symptoms including sadness, frequent crying, feelings of worthlessness, irritability and obsessive thoughts. May occur any time during the first year postpartum.
   2. A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
   3. An adjustment reaction with transient depressed mood that occurs within the first two weeks postpartum and resolves spontaneously.
   4. The process by which parents form an emotional relationship with their infant over time.

   [mks_toggle title=”View the correct answer” state=”close “]
   The correct answer is: A mood disorder with symptoms including sadness, frequent crying, feelings of worthlessness, irritability and obsessive thoughts. May occur any time during the first year postpartum.
   [/mks_toggle]

10. What is the definition of bonding or attachment?
    1. A mood disorder with symptoms including sadness, frequent crying, feelings of worthlessness, irritability and obsessive thoughts. May occur any time during the first year postpartum.
    2. A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
    3. An adjustment reaction with transient depressed mood that occurs within the first two weeks postpartum and resolves spontaneously.
    4. The process by which parents form an emotional relationship with their infant over time.

    [mks_toggle title=”View the correct answer” state=”close “]
    The correct answer is: The process by which parents form an emotional relationship with their infant over time.
    [/mks_toggle]

11. What is the definition of mental health?
    1. A mood disorder with symptoms including sadness, frequent crying, feelings of worthlessness, irritability and obsessive thoughts. May occur any time during the first year postpartum.
    2. A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
    3. An adjustment reaction with transient depressed mood that occurs within the first two weeks postpartum and resolves spontaneously.
    4. The process by which parents form an emotional relationship with their infant over time.

    [mks_toggle title=”View the correct answer” state=”close “]
    The correct answer is: A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.
    [/mks_toggle]

The post Postpartum depression: Take our short quiz appeared first on Your Health Matters.

After a family she was caring for recently experienced a pregnancy loss, Dianne realized there was a gap in her knowledge. “It was really an ‘ah-ha moment’ where I realized these families have unique care needs. In particular, those first words to someone whose baby has died, and how to respond compassionately to women and their families. I want to provide the best care I can when someone has a loss.”

Dianne was familiar with the Pregnancy & Infant Loss (PAIL) Network; some of her patients had used their peer-to-peer resources. When she learned about the network’s Compassionate Care Workshops for professionals, she jumped at the opportunity.

“I knew these workshops were exactly what our local health care and social services community needed,” says Dianne, who works as a member of a professional group serving five small communities with a combined population of about 4500.

A workshop was arranged for the northern community, covering grief, cultural safety and what to say and not say during a loss. Two facilitators were present, one a professional with experience caring for families who have had a pregnancy or infant loss, and one with lived experience of loss.  Another parent came from Kenora to share about her lived experience of loss.

The group quickly identified a challenge. Most women in the area do not deliver in Red Lake.  They travel to a variety of communities, including Dryden, Kenora, Thunder Bay or Winnipeg to deliver their babies. Hospitals sometimes don’t have a process for returning remains to the families’ local community, a huge stress for families anxious to arrange a memorial for their baby.

Together with facilitators, the group brainstormed ways to support families through the grieving process. Attendees proposed using an existing committee to develop a community plan to support families. A local committee marks Pregnancy and Infant Loss Awareness Day on October 15 each year.

“We are a very small community, and people don’t always want to talk about their loss and their grief with friends, family and neighbours who live here. For some, it can be comforting to have anonymity when speaking about your own experience and journey,” explains Dianne. Useful tips were provided accessing PAIL’s peer-to-peer resources available to families, linking them with others across Ontario who have had a loss.

Dianne says the session was jam-packed, and attendees particularly liked the focus on family experiences and memory-making.

“You can never have enough information. The workshop provided us with the tools to support and care for our local families. We are grateful,” says Dianne.

For more information and resources on supporting families, please visit PAIL. To see upcoming Compassionate Care Workshops, please visit here. If you have questions, please email pailnetwork@sunnybrook.ca or call 888-303-7245 (PAIL).

The post Caring for families experiencing a loss appeared first on Your Health Matters.