You're Having a Baby!

Victoria Maternity Doctors

Victoria Maternity Doctors is a group of experienced female physicians who share maternity and hospital care at the Victoria General Hospital.
WHO WE ARE WHEN TO CALL
who-we-are

WHO WE ARE

Victoria Maternity Doctors is a group of experienced female physicians who share maternity and hospital care at the Victoria General Hospital. We have worked together for many years and share a philosophy of safe, compassionate and supportive practice, so you can be assured that you will receive consistent care and advice throughout your pregnancy and delivery.

Most of us have offices where you will be seen for your regular prenatal appointments. There is always one of us on call 24 hours a day, either by phone or at the hospital for urgent maternity issues as well as labour and delivery.

You can reach the doctor on call after office hours for urgent care by calling 250-590-4884 and leaving a brief voice mail. When needed, we work closely with a team of obstetricians, pediatricians and anesthetists that are in hospital 24 hours a day.

We all look forward to being a part of the exciting experience ahead of you.

counter
when-to-call

WHEN TO CALL

We are available to all of our patients on call 24 hours a day for urgent maternity concerns.

You may reach us by calling 250-590-4884 and leaving a brief voice mail.

This number is also available on each of our office’s answering machines, if you call after-hours. We usually respond to calls quickly, but occasionally we are tied up in a delivery. Please call us again if we have not called back within 30 minutes.


If you have an emergency concern such as heavy vaginal bleeding or severe pain, please go directly to the hospital. If you are less than 20 weeks please go to the Emergency Room at the Victoria General Hospital or to Labour and Delivery at the Victoria General Hospital if you are greater than 20 weeks. For less urgent bleeding concerns, please call the doctor on call.


We prefer that you call either your maternity doctor, or the doctor on call, with any health concerns, rather than seeking care at a walk-in Clinic or calling the Nurses Help Line.


If you are concerned about a reduction in your baby’s movements, please call the doctor on call and we can arrange to assess your baby’s health at Labour and Delivery.

If you are preterm ( less than 37 weeks), and you think that you are going into labour, please call the doctor on call. If you are at term, and think you are in early labour with a first baby, it is generally recommended that you come into hospital once the contractions are regular, about 3-4 minutes apart, and usually lasting 45 seconds or longer.


If you are known to be Group B Strep positive and your water breaks, even without contractions,you need to come to Labour and Delivery for your first dose of IV antibiotics. If your water breaks and you are Group B Strep negative, you may generally stay at home to await contractions as long as the fluid is clear or pink-tinged and as long as the baby is moving normally.

Please call the doctor on call in the morning to discuss when you should come into Labour and Delivery. If the fluid is green or bloody, you should head into Labour and Delivery directly. If you have a history of rapid labours, or if you feel that labour is progressing rapidly, please head directly to Labour and Delivery.

sleeping-baby
team

OUR DOCTORS

All of the physicians in our group are active teachers for both the UBC Island Medical Program and for the UBC Family Medicine Residency Program. We truly appreciate the opportunity to teach the future generations of physicians and are thankful for the willingness of our patients to assist in the learning. We often have students and residents working with us in our offices and at the hospital. We always support our patients in their decision whether to have learners involved in their care and always ensure a high standard of care.

Dr. Shireen Alam

Dr. Shireen Alam

View Details
Dr. Susan Amundsen

Dr. Susan Amundsen

View Details
Dr. Kendra Daniel

Dr. Kendra Daniel

View Details
Dr. Donna Doyle

Dr. Donna Doyle

View Details
Dr. Eunice Fast

Dr. Eunice Fast

View Details
Dr. Judy Jones

Dr. Judy Jones

View Details
Dr. Suzi Leggatt

Dr. Suzi Leggatt

View Details
Dr. Nancy McLeod

Dr. Nancy McLeod

View Details
Dr. Darcy Nielsen

Dr. Darcy Nielsen

View Details
Dr. Laura Birdsell

Dr. Laura Birdsell

View Details
Dr. Shireen Alam

Dr. Shireen Alam

I was born in Connecticut and raised in Calgary. I attended Queen’s University for my undergraduate degree in Life Sciences in 1987 and the University of Calgary for medical school, graduating in 1991. I interned in Victoria and had a family practice with maternity care in Victoria until 2001, when my husband and 2 young children uprooted ourselves halfway across the world.

We moved to the tropical paradise of Saipan, a small island in the middle of the Pacific Ocean. Our family enjoyed the relaxed pace of life as well as the fantastic travel opportunities and cultural richness there for four years.

We returned back to Victoria in 2005, and I have been practicing as a permanent locum within our Maternity group since that time. I feel fortunate to be part of such a cohesive group, most of whom I have known my entire career.I enjoy Family Practice, as we see a wide spectrum of medical issues, and have the opportunity to build long term relationships with our patients. Maternity care has always been an especially rewarding part of my practice, as little else matches the intensity of labour and the joy of seeing a new life enter the world.

I enjoy running, especially with my favourite running partner, my German Shepherd, who is always happy to go for a run at any pace! I also enjoy hiking and camping, often on Cortes Island, where we spend a chunk of time each summer.

Dr. Susan Amundsen

Dr. Susan Amundsen

I grew up in a small town in southern Alberta as the oldest of three children. In 1994 I moved to Edmonton and started my studies at the University of Alberta. In 2004 my husband and I left the cold winters of Edmonton and moved to Victoria to complete my Family Medicine Residency. Obstetrics and women’s medicine have always been an interest and passion of mine. It is an absolute pleasure to have it as part of my practice since graduating. When I’m not working I keep busy cycling, running, playing violin, paper crafting and running after two young boys.

Dr. Kendra Daniel

Dr. Kendra Daniel

I was born and raised in the snow belt of southwestern Ontario. Wisely, after finishing my Bachelor of Science at University of Waterloo, I flew the coop and moved to beautiful British Columbia. In 2006, I completed my medical degree at UBC. Thereafter, I decided to try island living and moved to Victoria. I am so happy to call Victoria home and feel privileged to practice family medicine and maternity. I find joy in each and every delivery.

My true passion in life is being a mother to my two wonderful daughters. I adore spending time with my family outdoors and having lazy snuggly mornings with a coffee nearby. I can often be found having dance parties with my girls and also curling up with a good book.

Dr. Donna Doyle

Dr. Donna Doyle

After growing up in beautiful Nelson BC, I completed a Bachelor of Science in Rehabilitation Medicine (Physiotherapy and Occupational Therapy) at UBC. I went on to complete my Medical Degree, also at UBC, graduating in 1990. After graduation I joined my husband in Victoria and completed my internship here. I opened my practice in 1992 and have worked in Full Service Family Practice with a focus on Maternity since then.

I have a keen interest in teaching and have served as the Clinical Educator in Obstetrics for the Island Medical Program and the Post Graduate Residency Program since 2010. I also teach Medical Residents in my office.

I have always had a special interest in Obstetrics. I never seem to tire of the cute little faces, fingers and toes and often wonder who they will grow into and become. There is no more momentous event in the lives of parents than the birth of a child and I feel privileged to be part of this intimate, joyous, and challenging time in peoples lives.

In my leisure time I love being in the outdoors cycling, running, skiing, and hiking. I am married with 2 grown boys who also share my love of cycling and seeing the world by bike.

Dr. Eunice Fast

Dr. Eunice Fast

I was born and raised in northern Alberta, but have lived in all four western provinces as well as California. I came late to the practice of medicine after working for financial institutions in investments and mortgages. While I enjoyed mortgages, especially helping people purchase their new homes, I was somewhat restless. So back to school I went. I have a couple of undergraduate degrees in psychology and science and studied medicine at the University of Manitoba. I completed my internship in Victoria and then worked in Vernon for a year. However, I missed the ocean and my friends and so returned to Victoria, to practice full service family medicine. I feel fortunate to have had the opportunity to do some international volunteer medical work for a couple of months in Haiti and a few weeks in Guatemala.

I consider it a gift to be with patients at important transitions or milestones in their lives. This can be happy times as with the birth of a precious baby, sad times when there is a loss of health or loved ones, and all the times in-between. While maternity ranks high on my list along with paediatrics, I am also interested in life style and preventative medicine.

I am enamoured with travel to warm oceans and climates, and if I can practice my limited spanish there, it is a bonus. I tend to be attracted to a non competitive version of sports, like kayaking, boogie boarding, golfing, cycling, hiking and yoga. Reading under a shady palapa while listening to the roar of waves has few rivals (maybe a glass of Malbec while visiting with family and friends). Although not a skilled gardener, I get a fair bit of satisfaction from putzing around attempting to tame my yard. I will always treasure being able to be a part of the growth and development of my delightful and talented daughter.

Dr. Judy Jones

Dr. Judy Jones

I have been practicing in Victoria since 1994. I graduated from UBC medical school in 1991 after completing a BSc at UVic. My practice has always included obstetrical care and I have worked with most of the people in this call group for my entire career. 
 
I love delivering babies because it is a wonderful time to really get to know a family at a particularly special time in their lives. Just as this will be one of the defining experiences of your life, it is also a defining part of my relationship with my patients.
 
About half of my practice involves maternity and pediatric care. The other part is a general family practice. This diversity allows me to understand the transitions that people go through in their lives in the context of their relationships and medical needs. It also allows me to use a lot of general medical skills in higher risk pregnancies.
 
I have been married since 1987 and have a daughter born in 1993 and a son born in 1994. My children have now left home but their cats stayed behind. I enjoy lots of outdoor activities, especially hiking, skiing, cycling, camping, and running. At home, I enjoy reading, crafts, puzzles and games. I grew up in Northern B.C., the youngest of 8 children. My husband is also from a large family. We spend a lot of time with our large extended families.

Dr. Suzi Leggatt

Dr. Suzi Leggatt

I attended both UVic and UBC, finishing my MD in 1995. I was a locum doctor in Victoria for four years, before joining Dr. Eunice Fast and sharing her practice since 2001. We have a general family practice, with an interest in maternity and delivery care. Being a family doctor is both varied and rich for our relationships with our patients. There is something interesting about each and every day!

I love that my job is to care for patients of all ages, and sometimes four generations within one family! Care of families during their pregnancies and deliveries is very special work.

On a personal note, I have four children, including a set of twins.  I enjoy walking, crafts and playing piano. Excepting four years of my life, I have always lived in BC, with my hometown being Chemainus.

Dr. Nancy McLeod

Dr. Nancy McLeod

I grew up in Saskatoon then went to med school at the University of Saskatchewan, graduating in 1988. I moved to Victoria to do my internship in 1988-89. I stayed in Victoria and started my own practice in the summer of 1989 and have continued to practice in Victoria since then.  

I love the maternity and pediatric components of my full service family practice.  

I am married and have have a girl born in 1994 and a boy born in 1996. They have been involved in horses and hockey respectively.

I believe it is a privilege to do this job and be involved in my patient’s prenatal care, delivery and early postpartum and newborn care. I still get a thrill when a baby is born and never tire of witnessing the amazing miracle of a new life.

I am very pleased to share a call group with these very kind and talented colleagues of mine. I look forward to meeting you.

Dr. Darcy Nielsen

Dr. Darcy Nielsen

I have been working at Hillside and Shelbourne St. since 1993. I have always included obstetrics in my practice, and have been working with most of the wonderful members of my call group since I started.

Before I was a doctor, I was an emergency room nurse. I met my husband, who is also a family doctor, in medical school at UBC, and we have two lovely daughters. I also have a grown son who lives in Saskatchewan, and am proud to have two young grandchildren, although I do wish they lived closer! I am also an animal lover, and have two big labra-doodles, and a cockatiel.

I feel very privileged to be part of people’s lives as they have their families. Helping to bring a baby into the world is a true joy!

Dr. Laura Birdsell

Dr. Laura Birdsell

I grew up mostly in Greater Vancouver but completed all of my post-secondary education in Alberta, starting with an undergraduate degree in Biological Sciences at the University of Alberta. I spent an additional two years in Edmonton doing cancer-related research, then headed southwards to the University of Calgary for medical school where I graduated in 2009. After spending 10 years in Alberta, I was more than ready to move back to British Columbia and be near the ocean again. I completed my family medicine residency training in Victoria and fell in love with the area.

I have always enjoyed working with children and young families and knew that I wanted to make it a focus of my practice. Providing obstetric care allows me to do just that. Helping to deliver babies is a wonderful experience and I feel privileged to participate in the journey that parents embark on with each new child they bring into this world.

In 2017 I began the task of taking over the practice of my mentor, Dr. Elizabeth Grant, who has been an inspiration to work with. I only hope that I can provide the same level of care to her patients that she has managed to provide for so many years. Luckily I have the help of my colleague Dr. Jana de Bruyn who I will share the practice with.

Outside of work, I spend all my free time with my amazing husband, our three beautiful children, and our beloved family dog. We love to explore the region, bike, hike, and search out all the fantastic local food this area has to offer (the bakeries in particular).

sleep_baby_two
advice

ADVICE

Our group has compiled our thoughts on the most common topics of discussion around labour and delivery. Please feel free to discuss these topics further and any other questions that arise with your maternity care physicians.

Click on a section title to read the information.

Pain Management in Labour

When discussing the best methods to manage labor, it is helpful to divide labor into its different components. Latent phase labor is when you are having contractions but they are not really changing your cervix. Some women can experience these contractions as quite painful and others hardly even notice them. It is normal for these contractions to last from a few hours to several days. The best place to manage Latent phase labor is in the comfort of your own home.

It is important during this time to get as much rest as you can and to eat regularly. This will help you to deal with the contractions with the least discomfort. A warm bath if your water has not broken or a warm shower if your membranes have ruptured can be very helpful. Walking around is also a good way for you to manage this initial phase.

The active phase of labor starts when the contractions are changing your cervix and you are 3 or more centimetres dilated. The contractions are usually stronger and closer together. Some women manage this stage without any medication by continuing to walk, comfortable massage from a partner, sitting on birthing balls, or sitting in the shower. Slow regular breathing during the contraction and focusing on your breath with complete relaxation between contractions can be helpful. Some women find meditation or self hypnosis works for them. There are some other therapies that need to be arranged by yourself and brought with you to the hospital. These include TENS (transcutaneous electrical nerve stimulation)devices, massage or the use of acupuncture.

Each room is equipped with nitrous oxide, sometimes referred to as “laughing gas”, that works well for some women. The gas is delivered to you by breathing from a mouth piece. It does not really make the contractions less painful but does help with your perception of the pain. Once you stop breathing the gas, it is quickly eliminated from your system. You then use it again with the next contraction using the same regular slow breathing pattern.

There are two narcotic medications that are available when needed during labor. Morphine, usually given as an injection with Gravol, works well for about 3-4 hours. Fentanyl, also a narcotic, is given intravenously. It will last for 1-2 hours but can be given again if needed. Both of these medications can relax your body to allow the contractions to do their work. You will still feel the contractions but they will seem shorter and not as strong. Sometimes you are able to sleep a bit between contractions.The advantage of fentanyl is that it works very quickly and morphine’s advantage is that it lasts longer. Both of these medications can make a baby drowsy and if given too close to delivery, the baby may need some help with breathing for a short time after being born. This is a very uncommon occurrence but would be done in an isolette just across from your bed.

If the above methods are not effective for you or you are needing more help with the contractions, sometimes an epidural is the best choice. This is the placement of a small catheter to deliver medication in your back around your spinal cord, which blocks the pain sensation for the uterus. It takes 15-20 min to make you comfortable after the catheter is in place. You may have a control device that you can use to give yourself an extra dose of medication if you are noticing increasing pain. Although you may have some movement with your epidural, most women will need to remain in bed. You will also have continuous monitoring of your baby after the epidural is placed. Once it is working well, you can often nap while your uterus is doing the work so you will be more rested for the second stage of labor when you will need energy to push. The epidural is a safe procedure with only extremely rare serious complications. More commonly, but still less than 1% of women, will experience a headache 1-2 days later.

We will work with you to find the right options for your labor.

Epidural Analgesia

An epidural is a type of pain relief technique that can be placed by an anesthesiologist during labour. It involves a small tube placed in the lower back that delivers a small amount of anesthetic and pain medication to numb nerves in the lower back and pelvis.

TECHNIQUE
You will need to sit upright, with your lower back curved outward, as in a cat stretch. You need to sit very still during certain parts of the procedure. The skin is then numbed with local anaesthetic. A needle is inserted between vertebrae into the epidural space and a small plastic catheter is then threaded into this space while the needle is removed. The tube is secured in place with an adhesive dressing. The tube stays in place for the duration of labour and delivery to deliver anaesthetic and pain medication.
It often takes effect within fifteen minutes, reaching full effect usually by thirty minutes. Often our anesthesiologists place PCEA(patient controlled epidural analgesia), which allows you to give yourself more medication if you begin to experience more pain with your labour. It is pre-set so that you cannot accidentally give yourself too much medication,

EFFECTIVENESS
Epidurals are most often extremely effective in reducing the pain of contractions. Many women experience only mild pressure with contractions. The dose of medication is adjusted according to the patient’s needs. It does not completely relieve the pressure sensation in the vagina and rectum during the later stages of labour. Occasionally, pain relief is patchy or one sided. This can usually be improved by adjustments that the anesthesiologist makes in catheter placement, but does uncommonly require the epidural catheter to be replaced.

COMMON SIDE EFFECTS
It is common for blood pressure to fall, but this can be treated quickly and effectively. Numbness, tingling or heaviness in the legs is a frequent occurrence, and disappears within a few hours of delivery. Itching is also possible due to the narcotic medications infused though the epidural catheter. As well, bladder sensation is occasionally temporarily affected, and may require a catheter to empty the bladder. This sensation returns within a few hours of delivery. A less common side effect (2-3%) is a post-epidural headache, which can be caused by inadvertently placing the epidural catheter though the dura, the outer covering of the spinal cord. This headache can occasionally be severe, but is temporary and can be treated by laying flat and by placing a patch over the dural space.

RARE SIDE EFFECTS
A small number of patients experience minor neurologic symptoms post delivery, such as patches of numbness. This usually resolves with time, and is not necessarily related to epidural analgesia, as delivery of the baby’s head through the pelvis also can cause compression of pelvic nerves.

COMMONLY ASKED QUESTIONS
Does an epidural increase the chances of a C-section?
There is no evidence to suggest that epidurals increase the risk of a Caesarean section. This is the position of the American College of Obstetrics and Gynecology.

Does an epidural affect the progress of labour?
An epidural can occasionally slow down contractions during the first stage of labour(0-10 cm dilated). This can be treated by giving the hormone oxytocin. It often has no effect on progress through the first stage, and occasionally speeds progress through the first stage of labour, as it allows relaxation even during contractions. The second stage of labour (from 10 cm dilated to delivery) can be slightly longer with an epidural, but there is no evidence that this is harmful to either mother or baby.

Induction of Labour

Near the end of pregnancy, the cervix normally begins to soften, thin and shorten to prepare for labour and delivery. If labour does not start naturally on its own, and vaginal delivery needs to occur soon, labour can be started artificially. This is called induction of labour.

Labour is usually induced when it is felt that it would be safer to deliver the baby than to wait .

Labour is usually induced for one of the following reasons:

  1. Your pregnancy has gone beyond 41 and a half weeks gestation
  2. You have a complication of pregnancy or a known medical condition that may threaten your health or the health of your baby if your pregnancy continues
  3. Your water has broken but active labour contractions have not started

There are several ways to induce labour contractions, depending on whether your cervix is ripe( thin, short and open) or not. If your cervix is not yet ripe, a prostaglandin medication may be inserted into your vagina. This helps to ripen the cervix. It often causes mild cramping. This process may take several days to occur. It occasionally causes you to go into labour on its own.

Alternatively, a balloon catheter may be inserted into the cervical opening to slowly dilate the cervix. The catheter is left in place until the cervix has opened enough for the balloon to fall out. Once the cervix is felt to be ripe, a medication that is given intravenously, oxytocin, is used. This causes the uterus to contract.This is the same hormone that is produced naturally by the pituitary gland to help your uterus to contract. Oxytocin is administered by very slowly increasing the dose until you are in labor. This may take a number of hours. Monitoring of the baby’s heart rate and your contraction pattern occurs as part of this process, although you are often able to walk and move around at times during your labour.

Group B Strep Infection in Pregnancy

Group B streptococcus (GBS) is a bacterium that is commonly found in the vagina, rectum or bladder of women. It typically does not cause infection in women, with the exception being an occasional cause of urinary tract infections. It becomes significant in pregnancy because newborn infants are susceptible to infection with GBS, and they may become seriously ill if infected. Infection usually occurs during labour, after the membranes have ruptured (water has broken), when the baby is exposed directly to the bacteria in the vagina and rectum.

Group B Strep Screening
Between 15-40% of women are colonized with Group B Strep, which means that they carry a significant number of GBS in their vagina and rectum without any symptoms. It is estimated that between 40-70% of colonized women pass the bacteria to their newborns during labour and delivery. While it is rare for newborns to develop serious infection after being exposed to GBS, illness can be severe, including meningitis and septicemia (blood poisoning). In order to reduce the number of babies exposed to GBS, we routinely screen women at 34-36 weeks gestation, in order to determine whether they are colonized. This is done by collecting a culture sample from the opening of the vagina and rectum, and having it cultured and tested at the lab.

Treatment for Group B Strep
If a woman has a positive culture at 34-36 weeks, or if she has Group B strep bacteria in a urine culture during the pregnancy, she is treated with IV antibiotics during labour or after rupture of membranes without contractions. IV Penicillin is the preferred antibiotic, but if women are allergic to Penicillin, alternative antibiotics are chosen. The use of IV antibiotics in labour has reduced the number of babies with early onset GBS infection by approximately 80%.

A BIRTH PLAN?

Many of the books that you will read about pregnancy, labour and delivery will encourage you to create a birth plan. Learning as much as you can about your pregnancy, labour and delivery is an excellent idea that we highly encourage. The knowledge you will gain will help to empower you through your journey to parenthood. We welcome the opportunity to discuss any specific requests or concerns that you may have surrounding the birth of your baby. We are always open to questions at any time.

As a group, with many years of experience, we would discourage you from writing out a detailed birthplan. If one becomes rigid in their thinking as to what they may or may not want during the labour process they are setting themselves up for disappointment if things don’t go as planned. Our physicians are happy to take direction from you as to your preferences for or against pain medication/epidurals/or other pain relief techniques. Every woman’s labour is different and does not always go as planned. Our philosophy is to provide safe compassionate maternity care with the least intervention possible to ensure a healthy baby and a healthy mom.

Childbirth is one of the most exciting and treasured moments in a parent’s life. To be left with any sense of disappointment or failure that it did not go according to your birthplan would be unfortunate. People deliver babies in many different ways, all beautiful experiences when a new life enters this world and gives its first cry!

Tearing and Episiotomies

During a vaginal delivery, some tearing of the perineal tissue (around the vagina) is not uncommon. We do our best to control the baby’s head during delivery to minimize tearing, however, some tearing can happen for a variety of reasons. We will repair tears with dissolvable sutures, and good pain control. The sutures dissolve over several weeks, allowing the tissues to heal during that time. You are given instruction in care for the area while in hospital.

Uncommonly, we will perform an episiotomy which is a cut into the back of the vagina to create more space during delivery. Most often this is done for concern about the fetal heart pattern and a need to expedite delivery, but can be done to protect your bottom if the tissue strength is hindering the delivery process.Repair of an episiotomy is similar to that of a tear.

yawning_baby
maternity-links

Maternity Links

The links below will provide you with valuable information regarding your pregnancy.

MEDICATIONS DURING PREGNANCY

http://www.motherisk.org

VIHA REGISTRATION AND RIGHT FROM THE START PROGRAM

http://www.viha.ca/children/pregnancy

LA LECHE LEAGUE CANADA

lllc.ca

ROURKE BABY RECORD – EVIDENCE-BASED INFANT/CHILD HEALTH MAINTENANCE GUIDE

http://rourkebabyrecord.ca/parents/default.asp

GESTATIONAL DIABETES INFORMATION and FOOD GUIDES

Click here to download and view the PDF.

VICTORIA MATERNITY DOCTORS CONTACTS