Class 2 Part 1: Preconception

Question 1

List the examples of cultural genocide

Answer 1

• Destruction of governance and family systems; (Indian Act, Residential Schools, 60s Scoop, CFS)
• Destroy political/ social institutions (Indian Act)
• Land is seized (resource rich areas) (did not sign a treaty, was forcibly taken away)
• Populations forcibly transferred (Stolen lands)
• Movement restrictions (reservations and pass systems)
• Languages banned (IRS)
• Spiritual leaders persecuted (legislation to ban ceremonial practices)
• Families disrupted to prevent transmission of cultural values and identity from generation to generation
• Biological genocide – destroy groups reproductive capacity, forced sterilization

Question 2

Statistic of First Nations women that have no year-round access to services to assist with giving birth

Answer 2

1/3

Question 3

Reproductive Health trauma Informed Care

Answer 3

An approach to delivery of care that recognizes the impact of trauma and emphasizes physical, psychologic, and emotional safety for both practitioners and survivors

Practices that seek to create physical and emotional safety for survivors that help them to rebuild their sense of control and empowerment during interactions

Question 4

Definition of birth traumas

Answer 4

Refers to a birth experience that is not only characterized by actual or threatened injury or death to the mother or her baby but also by negative interactions with care providers resulting in women feeling unsupported, disconnected, helpless, and isolated during birth

Question 5

How do you apply trauma informed care principles to maternity care?

Answer 5

Routine screening for history of trauma (including childhood sexual abuse and intimate partner violence (IPV), in order to tailor care and plan ahead for childbirth

Screening for adverse childhood experiences (ACEs), including sexual abuse, during routine prenatal visits

Question 6

Teratogen definition

Answer 6

Environmental substances or exposures that result in functional or structural disability

Question 7

Preconception assessment and diagnostic tests

Answer 7

1. Height, weight, BMI
2. Blood pressure
3. STI screening:
   - should be offered to all sexually active individuals
   - urine sample or cervical swab for gonorrhoea and chlamydia
   - serology for HIV, Hep B & C, syphilis → bloodbourne infections
   4, Pap test - test for precancerous or cancerous cells on the cervix, screening starts at age 21 once individual has had sexual contact and every 3 years
4. Other labs as required

Question 8

Risks/ barriers to preconception care

Answer 8

Inadequate/ insufficient/ inaccessible care
Lack of culturally safe care
Lack of community services/ supports
Financial stress/ poverty

Question 9

Folic acid recommendation for individuals with low risk

Answer 9

Folic acid 0.4mg daily x2-3 months prior to conception, and throughout the pregnancy and 4-6 weeks and postpartum (or as long as breastfeeding)

Question 10

Folic acid recommendation for individuals with moderate risk

Answer 10

Folic acid 1mg daily x 3 months prior to conception - continued x 12 weeks gestation, then decreased dose to 0.4mg folic acid throughout the pregnancy and for 4-6 weeks postpartum (or as long as breastfeeding)

Question 11

Folic acid recommendation for individuals with high-risk

Answer 11

Folic acid 4mg daily x 3 months preconception, decrease dose at 12 weeks gestation (may be personalized based on risk factors) and continue throughout pregnancy and while breastfeeding (or at least 4-6 weeks postpartum)

Question 12

Risk modification to optimize health for pregnancy

Answer 12

• Nutrition (diet rich in folate)
• Physical activity
• Healthy body weight (BMI > 30 kg/m2 is considered obesity)
• Safer sex practices
• Update vaccines, discuss travel
• Discuss: Alcohol use/ Smoking/ Drugs*/ Intimate partner violence
• Oral health
• Occupation