Whether you meant to have a c-section, or childbirth took an unexpected turn, your recovery will look a little different than that of a vaginal birth. Here are some basic things to consider as you navigate the pre and post-operative world.

Preparing for a C-section:

Not everyone will know ahead of time that the birth will be via c-section, but if you do know, here are some things you can do to prepare:

• Build up your iron stores: Having good iron reserves going into surgery will help with your recovery, improve your ability to breast/chestfeed and improves overall birth outcomes. Remember to look for a full heme iron supplement. (I like Bob's Iron)
  
• Build up your energy reserves: I suggest eating slow cooked soups and stews. If you are not a vegetarian, I highly suggest slow cooker beef stews, chicken/turkey soups, yams, beets and cooked dark green vegetables. Try cooking a big batch of soup or stew, eat half and freeze the rest.
  
• Pelvic floor physiotherapy: If you have coverage or the means to do so, I highly suggest booking a pelvic floor assessment for 6 weeks postpartum. The physiotherapist will be able to assess and give you the green light regarding if your body is ready for exercise, or if you have some internal pelvic floor strengthening still to do. Just because the baby wasn't born out of the vaginal canal doesn't mean your pelvic floor wasn't impacted. Both the pregnancy and the surgery will greatly impact your pelvic floor, and getting a sense of where you have 'landed' 6 weeks postpartum, will let you know what you need to work on before you start working out.

Navigating recovery post C-Section:

• REST!!!!  Other than getting up to pee, maybe an occasional shower and whatever the frequency your healthcare provider says for blood circulation, don't get too active too soon. This is not a time to be hosting, or cleaning, or cooking. If you have other children, have them come to you in your bed. This is when extra care is most needed. This is not a luxury; this is necessary for your full recovery. The government of Canada now offers 5 weeks of separate parental leave (that doesn't affect your leave), so if you have a partner who can, get them to take it!! For those without partners, I suggest seeking the help from a family or friend in your bubble, or hire the care of a postpartum doula. There are postpartum doula services that provide free or discounted services for marginalized and low income families if you don't have someone in your bubble to help. (check out Doula Services Association)
  You will know if you have pushed it too far with activity (like grocery shopping or going for too long of a walk) because your scar will begin to ache and you will get a pulling sensation. for the first 3 months, use you scar as a gage to keep you in check with your level of activity.
  
• Timeline: You are looking at an 8week recovery period minimum. Even if you feel okay, remember to lay low regardless. If you don't feel okay, be gentle with yourself and know that it will get better with time, and seek extra care to help with your recovery.
  
• Lactation consultant: Be warned that milk coming in is often delayed with a c-section. (it usually comes on day 3 postpartum) Lots of skin to skin, circular breast massage, plenty of fluids and nourishing food will help it along. If you are experiencing pain or struggling with breastfeeding, seeking support from a certified lactation consultant can make all the difference. Breastfeeding can be hard and overwhelming, especially if you have a surgical scar to maneuver around. The sooner you get the support, the greater your chance of success and a positive experience.
  
• The scar: Oh the scar. The hospital and your provider will hopefully give you some tips on how to side roll out of bed, and to place a pillow over your belly and hold when you have to cough (yes, it's a thing).  It will likely 'eek' you out and you probably won't want to touch it for a long time. Once you are fully mobile and ready to address it (usually 3months+), acupuncture and gentle manipulation can help with breaking up any scar adhesions that cause pulling and discomfort.
  
• Keep eating nourishing foods: The best food in the immediate postpartum is warm, easily digestible soups and stews. Just like I wrote in the pre-surgery section, if you are not a vegetarian, I highly suggest slow cooker beef stews, chicken soups, yams, beets and cooked dark green vegetables. This allows for maximum nourishment with minimal effort for your digestive system. Smoothies and salads are also okay, but try to favour the warm and cooked foods in these first few days if you can.
  
• You will dread your first bowel movement . Ample water, prunes, apricots and stool softeners are your best friend at this stage.
  
• Your mental health: Mentioning what you are feeling to a close friend, or to your doctor or Midwife at your well baby visit is a great way to find out if what you are experiencing is something that could benefit from a little extra help or if you just need someone to listen as you process everything that you have just experienced.  
  
• Supplements: Remember those supplements you were so diligent with your whole pregnancy?... It’s time to get back on them. Taking a prenatal for at least 6 months postpartum, and longer if breastfeeding, will help ensure you get your vitamin and mineral stores back up to normal, and get you feeling strong and well as fast as possible. Include an omega fish oil with high DHA content, Vitamin D3, your prenatal and a magnesium if constipation is an issue.
  
• If you are struggling with your recovery, or not recovering as fast as you would like, feel free to reach out to see if acupuncture or Chinese herbal medicine can help you with your recovery.

The first month after a csection can be a rollercoaster. Remember that pushing too hard now may slow your recovery in the long run and could lead to messy complications. Take your time, rest, ask for help.

Dr. Emilie Salomons Dr. TCM, FABORM, OBAAM, Doula.

In the lead up to birth and in the postpartum period, I suggest eating slow cooked soups and stews. If you are not a vegetarian, I highly suggest slow cooker beef stews, chicken/turkey soups, yams, beets and cooked dark green vegetables. This allows for maximum nourishment with minimal effort for your digestive system. Smoothies and salads are okay, but try to favour the warm and cooked foods, especially in the first few weeks of postpartum.
Try cooking up some big batches of soups and stews in the last month of pregnancy, eat half and freeze the other half for postpartum.

Below are some go to recipes for labour and postpartum (and a few low glycemic pregnancy breakfast options):

Labourade (electrolyte drink for during childbirth)

1/3 cup fresh lemon or lime juice (for energy)
1/3 cup liquid honey or maple syrup (for energy)
1/4 teaspoon sea salt or Pink Himalayan salt (prevents dehydration)
1/4 teaspoon baking soda (calms the stomach- this is optional)
2 crushed calcium/magnesium tablets/capsules or liquid (relaxes muscles and needed a lot during childbirth)
Add enough water to make up 1 litre, then add either an additional cup of red raspberry tea or a cup of your favorite juice to flavor the beverage.

Instructions:
Blend together and pour into ice cube trays or drink "straight" during labour/childbirth. Also good after if you are noticing a lot of thirst as your milk comes in.

Major Milk Makin' Cookies
Recipe by Kathleen Major

1 1/2 c. whole wheat flour  (or Gluten free oat flour if needing GF)
1 3/4 c. oats
1 tsp baking soda
1 tsp salt

3/4 c. almond butter or peanut butter 1/2 c. butter, softened
1 c. flax
3 T brewer's yeast

1/3 c. water
1 tsp cinnamon
1/2 c. sugar
1/2 c. brown sugar
2 tsp vanilla
2 large eggs
2 c. (12oz) chocolate chips
1 c. chopped nuts of your choice

Preheat oven to 350 degrees Fahrenheit

Combine flour, baking soda, cinnamon and salt in a bowl.
In a large bowl, beat almond butter, butter, sugar, brown sugar, vanilla, brewer's yeast, flax and water until creamy. Mix in eggs.
Gradually beat in flour mixture.
Mix in nuts and chocolate chips.
Add oats slowly, mixing along the way.

Place balls of dough onto greased baking sheets or baking stones. Press down each ball lightly with a fork.
Bake 12 minutes.

Emilie’s grain free-protein pancakes

Makes 6 pancakes (roughly 2-3 servings)

¾-1 banana (ripe but not frozen and super mushy)

4 eggs

¼ cup of coconut flour

½ tsp baking powder

¼ tsp salt

1 tsp vanilla

Instructions: Mash the banana in a large bowl, then add the rest of the ingredients in and blend with a hand blender. Blend until you have a smooth, slightly frothy texture.

Heat up your frying pan, add some coconut oil or ghee and make the pancakes as you normally would. Flip pancakes once you start seeing bubbles.

Pancakes should be nice and fluffy. They can also be made the night before and just heated up the next day, for those who don’t have much time in the morning.

Toppings: almond butter (or grass fed butter), blueberries, raspberries, strawberries

Gluten Free Coconut flour lemon blueberry muffins

1/3 - 1/2 cup coconut flour

1/2 tsp baking soda

1/4 tsp salt (fine sea salt)

6 large free range eggs

zest from 1/2 lemon

1/4 cup maple syrup

1/4 cup grass fed butter melted (or avocado oil)

1 tsp vanilla

1 cup blueberries (also good with blackberries)

Preheat oven at 350F. Mix dry ingredients and set aside.

Beat wet ingredients until frothy. Mix in dry ingredient. Fold blueberries in gently.

I like to use silicone muffin cups. But if you don't have any, use paper or just greasy the muffin tin.

Bake until the tops are brown, and the kitchen is filled with the sweet smell of muffins. Sorry...I inherited my French grandmother's lack of timing ...or measuring things... maybe 20-25 mins?

Witch Hazel Postpartum Pads

While your body is healing in postpartum, witch hazel should be your go-to product. It helps relieve swelling and can also reduce the size of hemorrhoids and varicose veins. Witch Hazel also relieves pain of a sore perineum and speeds healing time. You can put it right on your skin, in a sitz bath or make these fantastic postpartum pads with it. Buy some large overnight pads, saturate in witch hazel. Often people suggest sticking them in the freezer. The cool pads will reduce inflammation and itch, and the witch hazel will soothe and ensure prompt healing of a sore perineum. With that said, in Chinese Medicine, cold around the uterus is not suggested after birth, so another option is to have either warm or room temperature-soaked pads, or sitz baths. If the idea of ice on the perineum is just too appealing, then just remember to stop the cold version as soon as the initial swelling is down.

There are few things in the world more isolating than a miscarriage. Often friends and family are at a loss for how to help or feel awkward bringing up the loss, leaving you with the internet and your healthcare provider as your only support (and sometimes, not even a healthcare provider)

Losses can be broken down into, chemical pregnancies which are losses before 5 weeks, miscarriages which are losses between 6-20weeks and stillbirths which are losses after 20 weeks.
Chemical pregnancies often happen on their own, but in the case of a miscarriage sometimes an ultrasound diagnoses a loss before you start bleeding. This is called a missed miscarriage. In the case of missed miscarriage or one that is not complete, you will likely be offered either medication that will help the process begin, or a medical procedure called a D&C. It is important to let your primary care physician or midwife know if you suspect you are having a miscarriage so that they can guide you through the process, outline your options and follow up to make sure you recovery has been complete.

When I am working with and caring for someone who has had a pregnancy loss, I always individualized my treatment plan to the unique circumstance of the loss, as well as the form of care they are receiving regarding the loss (medication, wait and see or medical procedure). Some patients get Chinese herbal formulas, some get acupuncture; some the focus is on recovery and others we review what we can do differently supplement and lifestyle wise moving forward.

There are however, basic guidelines I almost always suggest for during and after a miscarriage: 

1. Rest: Being told to rest isn't ground-breaking advice, but how many of us actually take time off to rest and recover?

For an early and straight forward miscarriage, or if you feel strong and relatively unscathed. I would still suggest taking a day or two off just to allow your body a chance to reset.

For pregnancy losses that are more intense physically or emotionally, it would be ideal to request a week or more off from work (if you can afford it, or if you have a great workplace that understands...sadly we aren't all from New Zealand who just passed paid leave from work for after miscarriages). If requesting time off is proving complicated or is being met with resistance, ask your doctor for a note stating you need time off for 'medical reasons'. Most doctors will back up your request.

Note: Resting and taking time off is not a sign of weakness. You should not be sucking it up and moving on. Take some time if you can. Drink tea, watch some shows, read a little, colour, write, cry, whatever you need to allow your body and heart  a moment to process what just occurred.

2. Stay warm: Take a note from the wisdom of 2000+ years of Chinese medical texts and keep your body warm.  Make sure to wear socks, cover your lower back and mid-drift, and stay bundled up if you have to go outside in the cold. We are weaker and more susceptible to the elements after a miscarriage. Cold contracts and congeals, which can worsen cramping and clotting. Staying warm and eating warm foods helps support blood flow, which is key when that new fresh lining is being formed.  

3. Comfort food: No...not that comfort food. Although I will not judge if you if you down a pint of ice cream or two. What I am referring to is old fashion food you would give someone who isn't feeling well. Things like soups, stews, slow cooked meals with quality meat and root vegetables. This is a gentle way of nourishing the body with the least amount of digestive energy. The nutrients are also more easily absorbed by the body this way.

4. Iron supplementation.  Iron often takes a plunge in pregnancy. Iron can be further depleted if there is heavy bleeding during the loss as well. Having your ferritin checked or at least staying on your prenatal or full-heme iron supplement, will ensure your levels come back up to a healthy range. Iron is required for embryonic development and low iron stores are associated with a reduced ability to conceive. So, if you are planning to try again sooner rather than later, iron supplementation may be something to look into. I also suggest staying on your prenatal supplements.(More on prenatal supplements here)

5. Tuning in to your internal dialogue. Feelings and thoughts will come and go, and strong emotions may catch you by surprise. We often search for a reason for the loss, someone or something to blame...and we often point the finger at ourselves (something we did or should have done). Being mindful of what you are telling yourself can help steer you away from dark places. Let the thoughts come, acknowledge them, then let them pass. Be kind to yourself. You do not need tough love right now! Not from doctors, friends, family, or yourself. It is also worth seeking professional support from a counsellor. There are many different styles of counseling and finding a good fit can help you navigate all of the feelings and thoughts that come up. (Here is a link to some free resources)

Be aware of important dates. If you knew your estimated due date, or if you have a friend who got pregnant at the same time as you, be aware that those major milestones may surprise you with strong emotions, even if you thought you had processed and moved past the loss. Acknowledging the pregnancy and the loss in a way that feels right for you can feel healing and empowering.

6. When to start trying again.
This is not a straight-forward question, so I don't have a straight-forward answer.

With a chemical pregnancy or a loss before 5 weeks, often you don't have much a delay in physical recovery (emotional recovery is a whole other story and can vary greatly).  The time you take off here is more based on how you feel physically and emotional and if you would like to change anything in your lifestyle or preconception care before trying again.

Losses 6-11 weeks: I suggest waiting 1-2 cycles for the uterine lining to reorganize, for your body to take a moment to process what happens, and possibly, to do selfcare to get you ready to try again (this may be supplements, regulating your menstrual cycle, working on egg/sperm quality to reduce chances of genetic reasons for the miscarriage, or looking deeper into if there is a reason to suspect immune or other factors that could be contributing)

Losses 12 onward: This varies too much to give a range. Loss recovery can be anywhere from 3 months to a year. I treat anything over 20 weeks like a birth and support the body in the same way. This often includes a more thorough investigation into what might be the cause of the loss, and various forms of emotional and physical support.

Final thoughts:

I can’t promise that time will heal everything. All I can say is that you deserve to be cared for, you deserve to be supported, and I want to see you strong and healthy. From there, healing will happen in its own time and its own way.

With love, 

Dr. Emilie Salomons 

Improving semen parameters is one of the easiest ways to speed up the time to conception and decrease the chances of genetic caused miscarriages. These tips are not just for people with diagnosed sperm issues, this is for everyone trying to conceive! Because good sperm is good, but great sperm is better. So here is a basic breakdown of what you can do (or not do) to improve sperm health and improve fertility.

If you google infertility, 90% of what you will find is geared towards egg and uterine health. Repeat pregnancy loss is another area where most of the 'blame' is carried by the woman or non-sperm side. This is also reflected in who shows up to my clinic seeking support for infertility or repeat pregnancy loss.

The truth is:

50% of the genetic material of an embryo comes from the sperm.
40-50% of infertility is due to sperm (aka. male factor infertility).
60% of Repeat pregnancy loss is due to genetic factors, with an increased connection to sperm quality (like in this study)

So why the misconception?! Why is the fertility industry only focused of half of the equation? It's time to treat baby making like the team activity it is. Every player is important 🙂

Sperm basics: The lifecycle of sperm is 90 days from when it is created to when it is mature enough to be ejaculated. This means that 3+ months of lifestyle/diet changes can dramatically change the health of someone's sperm.

LIFESTYLE BASICS: WHAT TO AVOID

High Temperatures (Don't cook your balls!): The human body sits around 37 degrees Celsius. Sperm however, functions best at 32 degrees Celsius. When the scrotum’s temperature is elevated over a period of time, the sperm is essentially overheated and often times killed or damaged.
Things that increased scrotal temperature: Hot baths/Hot tubs, saunas, sitting for extended periods (car seat warmers), tight-fitting underwear, and athletic support straps, lap tops directly on your lap.

(Don't radiate your balls either): Carrying cell phones in your front pocket has been linked to impaired motility and quality. So please, put that phone in a coat pocket, a back pocket, a side bag…anywhere but right next to your testicle.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074720/

Smoking cigarettes & vaping: Smoking increases free radicals in the body, free radicals damage cells and among those most affected by free radical damage are sperm cells. Smoking can result in reduced sperm count and motility as well as increased amount of abnormally-shaped sperm. It will take 3-9months to reverse this damage, so quitting sooner rather than later is better.

Alcohol: Alcohol interferes with the ability to make testosterone and also speeds-up the conversion of testosterone into estrogen. Alcohol breaks down in the body to form acetaldehyde, which is toxic to sperm. Studies suggest limiting drinks to under 6/week and no more than 2 in a sitting.

Marijuana: The chemical ingredient in marijuana is very closely related to testosterone, which causes the body to produce less of its own. Marijuana also builds-up in the testes, lowering libido, causing impotence, and sometimes even causing sexual anxiety. There is evidence to support that cannabis use leads to reduced sperm count, reduced sperm concentration, changes in sperm motility and morphology, hormone changes and reduced sperm viability. Here is a systematic review .

Cocaine: The effects of cocaine on fertility are similar to those of marijuana.

Caffeine: Too much caffeine may impair sperm production, cause chromosomal abnormalities, and effect sperm motility. This doesn't mean you need to complete avoid caffeine, but limiting it to a moderate to low amount (1 coffee a day?) may be beneficial.

Excessive Exercise: Though moderate regular exercise helps your reproductive health, exercising to exhaustion may lower sperm count (due to heat), a redirection of blood flow away from reproductive organs, and may temporarily reduce testosterone production.

Toxins and Pollutants: There are unfortunately a wide variety of toxins and pollutants that can harm the development of sperm. For example, pesticides and heavy metals are toxic for sperm – they’re designed to disrupt the reproductive cycle of the insect, fungus, or weed they’re trying to kill. Ever since the use of chemical pesticides was introduced after World War II, male sperm counts have plummeted. Avoid as much pesticide consumption or contact as possible by eating organic foods and not using pesticides in your garden.

ACUPUNCTURE'S ROLE IN IMPROVING SPERM HEALTH:

The reason acupuncture helps improve semen parameters is through hormonal regulation and increased blood flow to the testicles. The more blood flow to the testicles, the more oxygen and nutrients are available for the developing sperm.

"In conjunction with ART, or even for reaching natural fertility potential, acupuncture treatment is a simple, non-invasive method that can improve sperm quality." (Dr. Jian Pei, Fertility and Sterility 2005)

Recent studies have shown that acupuncture can effectively: Like this one. And this one.

• Increase sperm production
• Increase the percentage of healthy sperm
• Improve sperm movement (motility)
• Improve the levels of hormones responsible for fertility
• Increase the rate of pregnancy when used in conjunction with ART studies

Acupuncture needles are NOT inserted into the genitals....just in case you were wondering.

BASIC SUPPLEMENTS FOR IMPROVING SPERM HEALTH:

Antioxidants: Support mitochondrial function in sperm, and have been shown to optimize sperm maturation, count, and motility.

Vitamin C: This vitamin has shown to improve sperm count, motility and morphology. Some research has shown a doubling of sperm count within a few months after starting Vitamin C. It is a water soluble vitamin meaning you don't store it in your fat, so you need to take it daily.

CoQ10: is one of my favorite sperm booster supplements!
CoQ10 is a substance which helps the body produce energy and protects our cells from oxidation. As CoQ10 protects the body from oxidative stress it helps to protect sperm from damage improve male fertility.  It also boosts motility (forward movement) of sperm.

Vitamin D3: Vit D deficiency correlates with lower sperm counts, decreased motility and abnormal morphology. Living in the lower mainland means most of us are deficient, even during our sunny summer months.  This is even more critical for people with darker complexions, who require even greater amounts of Vit D.

Lycopene: (food source: Tomatoes, carrots) Lycopene is a type of carotene that is bright red and found in many red vegetables. A high diet of lycopene can improve both sperm count and motility.  

Selenium: (food source: Brazil nuts) When combined with Vitamin E, Selenium shows to increase sperm count and sperm morphology.  

Omega 3s: (food source: wild caught fish, oysters, walnuts and chia seeds) A ratio higher in omega 3 vs omega 6 is correlated with increased fertility. Omega 6 is pro inflammatory, while Omega 3 anti-inflammatory.  Wild salmon, cod, sardines and oysters are high in omega 3s.

Prenatal vitamins for sperm health: For those wanting a multivitamins that improves semen parameters and has all of the above mentioned vitamins and nutrients, I suggest: Male fertility SAP by NFH

TESTING AND OTHER CONSIDERATIONS:

Here are some other tests and considerations to explore if lifestyle changes are not yielding success. These tests and treatments usually don't happen until you have been trying unsuccessfully for a pregnancy, for over 1 year.

Semen analysis: This is where you give a sperm sample which is analyzed for count, concentration, motility (forward movement), and morphology (shape). This does not look into the DNA health of the sperm, but can give you a basic sense of if they have any major issues

Varicocele: Some low sperm parameters are due to a blockage of blood supply to the developing sperm, called a varicocele.
This is essentially a varicose vein in the testicle. This is usually identified by a specialist and can be treated with a canulation.

Undescended testicle: This can also be assessed by a physician.

Failed vasectomy reversal: This would be confirmed by a semen analysis.