July 29, 2020 by gentlemidwife

Understanding Gestational Diabetes (and your testing options)

I recently worked on updating the information I give to clients on Gestational Diabetese screening during pregnancy. Compared to 12 years ago when I was first delving into midwifery studies, there is so much more helpful information out there about this subject! For this month’s blog post, I decided to share my updated “informed consent” handout (this is something that each client recieives in order to help them make a truly informed choice regarding their screening options), as well as some links that may be helpful for those who are wanting to research this topic further.

Informed Consent Regarding Glucose Testing and Screening for

Gestational Diabetes

What is Gestational Diabetes?

John Hopkins Medicine describes Gestational Diabetes as follows: Gestational diabetes mellitus (GDM) is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin, but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational diabetic symptoms disappear following delivery. Approximately 3 to 8 percent of all pregnant women in the United States are diagnosed with gestational diabetes.

Although the cause of GDM is not known, there are some theories as to why the condition occurs: The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

For more information on understanding Gestational Diabetes and Insulin Resistance during pregnancy, I highly recommend checking into these websites: EvidenceBasedBirth.com and LilyNicholsRDN.com, and by reading Real Food for Pregnancy by Lily Nichols (available through my office lending library).

Risks Associated with GDM for mother and baby:

Increased risk of developing Pre-eclampsia

Increased risk of developing Type 2 Diabetes

Maternal injury

Increased risk of Cesarean section

Shoulder dystocia

Macrosomia (infant weight over 8lb 13 oz)

Neonatal hypoglycemia

Neonatal jaundice

Stillbirth

NICU stay

Birth injury

Predisposing Risk Factors can include:

Pre-pregnancy BMI >25

Family history of diabetes

GDM in previous pregnancy

Polycystic Ovarian Syndrome (PCOS)

Chronic hypertension

Maternal age over 25

Ethnicity (African-American, Native American, Hispanic, South & East Asian, Pacific Islander)

Previous macrosomic infant

History of Cardiovascular disease

Poor nutrition

Potential Signs and Symptoms of GDM:

Not all mothers will have any symptoms, but these are indicators of the possible presence of GDM:

Polyuria (excessive urinary output)

Polydipsia (extreme thirst)

Weakness

Poor healing/susceptibility to infections

Size large for dates

Recurrent glucose in urine

Recurrent yeast infections

Ketones in urine

Excessive weight gain

Polyhydramnios (excessive amniotic fluid)

Polyphagia (excessive hunger)

What are my testing options?

The American College of Obstetricians (ACOG) recommends universal screening for every mom between 24-28 weeks for pregnancy. Women with a history of GDM or have high-risk factors are encouraged to screen as early as possible in pregnancy, and typically Glucola is used as the glucose load. Due to the preservatives, dyes and other ingredients found in Glucola, other glucose options are offered, such as a dye-free glucose drink, or the option of consuming 28 jelly beans per the article published by American Journal of Obstetrics and Gynecology. If opting for either of these tests, it is recommended to eat an average of 150 grams of carbohydrates daily for three days before testing. The standard testing procedure is as follows:

1 hour Oral Glucose Challenge test: This involves drawing blood for blood sugar testing one hour after consuming a 50g glucose load (non fasting). Blood sugar levels should be under 140mg/dl. If the blood sugar levels are higher than this, then a 3 hour test is recommended to confirm or rule out a diagnosis of GDM.
3 hour Oral Glucose Tolerance Test (GTT): This four-step test is performed after fasting for at least 12 hours, and includes drinking a 100g glucose drink. Blood is drawn fasting, and then again at 1, 2 and 3 hours after drinking the glucola. If two or more levels are out of range, the mother is diagnosed with GDM. Consultation with a physician is recommended, and transfer of care may become necessary should diet changes be insufficient to keep sugar levels within target ranges.

During recent years, more physicians are becoming comfortable with an alternative to the above traditional protocol as described here by Rebecca Dekker at Evidence Based Birth (near the end of the article):

Home blood sugar monitoring: “Another alternative could be for people to monitor their blood sugar levels at home and discuss the results with their care provider. This is another controversial way to screen for GDM. We didn’t find any studies on GDM screening that compared home blood sugar monitoring versus a standard oral glucose drink.

However, we hear of some people using this method. Basically, they are following a similar path that people do when they’ve been actually diagnosed with GDM. Usually, after a GDM diagnosis, mothers monitor their blood sugar levels four times a day, once after fasting (first thing in the morning) and again after each meal (AGOG, 2018).

The ADA and ACOG recommend that fasting blood sugar levels should be <95 mg/dL, and post-meal blood sugar levels should be <140 mg/dL at 1-hour. Other recommendations for healthy blood sugar level targets during pregnancy are even lower. For example, the California Diabetes and Pregnancy Program (CDAPP) Sweet Success recommends fasting/premeal levels at <90 mg/dL and post-meal levels at <130 (Shields and Tsay, 2015).

Monitoring your blood sugar levels at home might be an option for someone who cannot take a glucose test because of the side effects, or prefers not to drink the glucose solution. However, home blood sugar monitoring is demanding and has some drawbacks. Mothers may have to purchase their own testing kits, and they have to remember to set alarms and carry their testing supplies with them throughout the day. Some people would consider it a major downside that blood sugar monitoring requires constant finger sticks, although others may not mind. Since home blood sugar monitoring is usually done after GDM diagnosis, there is no clear-cut standard for screening/diagnosing gestational diabetes based on home blood sugar checks. It’s important to discuss any results with a care provider to determine if testing can be stopped, if home monitoring should be continued, or if consistent high values mean that treatment for GDM is needed. Also, with this method, it is important that mothers follow their normal diet while testing, to get a “real-life” picture of their blood sugar results over time.”

While this testing method has gained acceptance in some medical communities, it is important to note that it has not been officially documented as a standard for diagnosing GDM. However, research is ongoing, and this method does provide you with an accurate day-by-day picture of how your body is responding to your normal diet. For clients who choose to do home glucose testing (whether in addition to or in place of the Glucose Challenge Test), I am happy to provide you with a glucometer, supplies and a chart that you can use to track your glucose readings for two weeks.

What if I have Gestational Diabetes?

Many women are able to control GDM through regular exercise and dietary changes. For clients who test positive for GMD, I will ask you to read Lily Nichol’s books Real Food for Gestational Diabetes and Real Food for Pregnancy, and we will discuss a plan for your care, including necessary diet changes and logging, home glucose monitoring, and exercise routines. If additional insulin is needed to control sugar levels, this will result in a transfer of care, as insulin-dependence significantly raises risk factors making a homebirth not a safe option for mother and baby.

Conclusion: Informed Consent

I highly recommend checking out these websites for more information on Gestational Diabetes Screening:

I also would encourage you, regardless of your choice to screen for GDM, to spend time reading Lily’s Nichol’s books (mentioned above) and implementing her dietary suggestions for pregnancy. Excellent information is available at her website: LilyNicholsRDM.com

As an expectant mom, it is your responsibility to choose first whether to screen for Gestational Diabetes, and if so, which method of screening to utilize. This document is intended to begin the conversation and aid you in researching what is best for your health and the health of your baby, and I welcome your further discussion and questions at any time.

In your Client Information Folder you will find a document entitled “Consent & Waivers for Common Procedures”, on which is listed screening for Gestational Diabetes. Please indicate your choice on this form, after you have spent time reading the risks and benefits of screening and the type of screening.

Did you find this information helpful? I’d love to hear about your experience with GDM and your testing/treatment options! If you’re wanting to research this topic further, here’s some links to other helpful posts, many written by moms sharing how they made a decision regarding GDM screening for their pregnancies (note, many of these posts are personal opinons shared for your consideration, though they may not include documented studies or be supported by general medical literature):

If you have more to add, or resources to share, feel free to comment below!

May 30, 2019 by gentlemidwife

Preparing Well for Postpartum Recovery

The longer that I am a mom and midwife, the more I have come to realize how important it is to adequately rest and recover after giving birth. But this does not “just happen”…it takes some serious thought and planning!! Why is it that we spend hours and hours preparing for pregnancy and birth, yet no time or focus is given to what happens AFTER the baby arrives? With this in mind, I’m hoping that these questions and comments will help families to come up with a plan on how to cultivate an intentionally restful and healing postpartum period. I’d encourage you as a couple to sit down and talk about these questions, and figure out what you could do to be better prepared emotionally, mentally and physically for the initial 6 weeks after giving birth.

If you want to read more about some of my own favorite items to have nearby during the initial days postpartum, check out the link here

Reading and Preparation:

Let’s start with some book suggestions. We spend lots of time reading books about pregnancy and birth, right?!? So why not read about how to care for oneself postpartum? Here are some titles to get you started. I’ll note that I don’t endorse everything these authors share, but I do appreciate the way they help me to think through our thoughts and expectations surrounding postpartum adjustments and recovery.

Some Facts to Consider:

As you talk about your expectations for postpartum, it’s good to think about some facts, especially for the dads who wonder if it’s really necessary for mom to spend so much time resting! I love to show the new parents the placenta after the birth, which is generally the size of a small dinner plate. Picture a wound of the same size on the inside of mom’s uterus. Seriously! That’s the wound that needs to heal, and even though the uterus continues to contract and get smaller over those first days/weeks, there is a still a significant amount of healing that needs to happen inside. Add to this any amount of blood loss, any stitches/tears, the length of labor, swelling, and the amount of work it takes to push a baby out, and you can quickly see why it’s important for mom to take care of herself! All of a sudden the reasoning behind “not lifting anything heavier than your baby” makes complete sense, doesn’t it? Along the same note, almost anyone recovering from any type of surgery is usually given a two week minimum recovery time…new moms need AT LEAST that long!

As the postpartum days progress, mom’s body is going through a lot of changes, which include a drop in hormones from the expulsion of the placenta and baby, and a surge of more hormones as her body transitions into producing milk. Keep this in mind those first days…mood swings and emotional roller coasters are NORMAL. But it sure helps if you are expecting that as part of those initial days. And it’s good for husbands to know that this is a normal part of adjustment. Mom needs rest, understanding, and sometimes NO MORE VISITORS!

Another thing to remember is that you won’t be getting a lot of sleep those first few weeks. It’s good for baby to eat every 2-3 hours to establish good nursing habits and milk supply, but it does not contribute to a restful mom. Keeping life low key, and expectations to a minimum can really make a difference in allowing this time to be as stress-free as possible. Along the same lines, nourishing foods and lots of liquids are also hugely important in helping to establish a plentiful and healthful milk supply.

Lastly, try to view the postpartum period as a 6 week MINIMUM. I understand you may not be able to take that much “time off” of your normal home duties. But the longer you can rest and care for yourself in the initial weeks, I can promise you the better off your long-term postpartum experience will be. These initial 6 weeks your baby needs you as much as he needed you when he was inside, and this means an unpredictable schedule, lots of nursing, skin-to-skin time, and lots of cuddles. A slow re-entry into normal life will be beneficial to everyone, and lowering your personal expectations of this time can be a life saver!

Initial days postpartum:

Consider staying in bed for several days, getting up only to use the restroom, and perhaps joining the family for one meal a day. This can be beneficial for several reasons: visitors don’t stay as long if you’re in bed, you can sleep when baby does, and it reminds everyone that you are recovering!!
Prepare your room or a special corner ahead of time to make it a pleasant place for recovery. You’ll relax better if you find your space enjoyable and refreshing. Think about getting some special reading material or audio books together ahead of time to enjoy while you spend hours nursing your new baby. And don’t forget to have some comfortable clothes to wear that promote easy nursing access and yet allow you to rest well!
Limit visitors, and the amount of time that they stay. This can be dad’s job: remember that even if your wife loves people, new moms find extra company more draining than they initial expect. Short 10 or 15 min visits are sufficient, and this allows mom to not be separated from baby too long (since many visitors want to hold the new baby the entire time they are present).
Have nourishing snacks, foods and drinks gathered ahead of time: a new nursing mom is ALWAYS hungry and thirsty that first week!
Remember that your body is going through some major changes and may need some help: have some ibuprofen, nipple cream, icepacks, heat packs, hemorrhoid balm and magnesium available in case you need them.
Consider some ways to have meals taken care of: freeze some ahead of time, or ask a friend to organize a meal train or signup list where friends can bring food. It can be nice for the entire family to have meals provided for the first days/weeks as the whole family adjusts to the new baby.
If you have older children, it’s a good idea to think about how to implement the “no lifting” rule…sometimes it can be helpful to invest in a step stool that the older sibling can use to climb up beside mom so that she isn’t tempted to lift him or her up.

First Two Weeks:

An old midwife’s adage is “5 days in the bed, 5 days on the bed and 5 days around the bed”. While many moms balk at this amount of recovery time, it’s not a bad idea to consider! Mom will continue to bleed for around 2 weeks, and the longer she rests oftentimes the shorter the time she bleeds.
Continue to follow the “no lifting anything heavier than baby” rule until at least 2 weeks to maximize the uterine healing that needs to happen.
Keep stressful visitors to a minimum-this may mean telling well-intending friends and family that they need to wait to come see mom and baby, especially if that entails a lengthy visit of several days. Sometimes it’s hard for people to remember that mom is recovering and needs to spend time with baby, so this is NOT the time to be socializing and holding a newborn for hours on end.
Consider getting some household help these first weeks (longer if possible!). This would preferably be someone who can come and keep up housework, prepare food as needed, entertain older children if present, and take care of household duties so that mom can rest mentally as well as physically. As you consider this possibility, keep in mind that this works best if it is someone that mom feels completely comfortable with-sometimes this is a family member, but sometimes it is someone totally unrelated, and even hired for this express purpose. Talk honestly about what type of person would work best in your family situation. After my fourth child was born, we were blessed to have a girl who was willing to come spend 2 days a week with us during the first three weeks. This was sufficient time to catch up laundry, clean the house, and keep after work that wasn’t getting done, as my husband had a flexible work schedule the other days of the week. I found it much easier to rest when I knew the house wasn’t falling apart while I rested!
As you feel your energy increasing, start slow…remember that the sooner you jump in to “normal life”, the sooner everyone else will expect you to stay that way!
If people offer to help, take them up on it! An offer to babysit can mean an extra nap for mom, and many friends are more than willing to run get your groceries if they know you need something. Don’t turn any offers of help down!

Weeks 3-6:

This is when it can get hard to remember to rest. Even though you feel much better by now, remember that you need to go slow, and say no to anything extra in life, even if you FEEL energetic. Your baby still needs lots of time to nurse, and your body is still going through significant changes. One day you feel on top of the world, and the next you are in the dumps…all of this is part of your body learning to regulate it’s hormones again! There are supplements you can take to help with this-check with your midwife if you experience lots of these swings.
Start slow with exercise. It’s best to wait the full 6 weeks before engaging in anything specific to rehab, but I do encourage moms to get out in the fresh air and start taking slow walks if they are having minimal or no bleeding by week 2 or 3. Put baby in a stroller or in a carrier, and stroll. Don’t push yourself, just give yourself the chance to get some sunshine and fresh air.
Make sure you are taking your prenatal vitamins and consider adding some extra Vitamin D and Evening Primrose Oil to help with hormonal balance.
Try figuring out a way to get just a little bit of time to yourself each day…perhaps your husband can take care of the children while you slip out for a short walk, or perhaps you can meet up with a friend for coffee (and let her hold the baby!), or even get a chance for a short nap by yourself. These things can help with managing the mental load, and can be a big step in preventing postpartum depression.
Find a friend you can talk with and share with as you go through the many adjustments during these weeks. It’s always reassuring to be reminded that this stage of life doesn’t last forever, and you will sleep again someday!
Continue to get help with basic household duties as you can, and don’t turn down the offer of food!
Consider trying to get some intentional time as a couple: the unique stress of this period, combined with mom’s unpredictable hormones, interrupted sleep, and all the other factors can add some significant stress on your marriage. Getting away for an hour (with baby in tow) to concentrate on your relationship can really help you to navigate this time and grow stronger in your relationship.
Eat nourishing, healthy foods, and don’t worry about weight loss while your body is establishing milk supply!

In closing, I’d love to hear what you would add to this list? What was most helpful to you when you were anticipating the arrival of your little one? What helped you recover? Please share your tips and input!

February 28, 2019 by gentlemidwife

Midwifery and Mom Life: 10 Year Anniversary Interview ~ Part 2

Interview: 10 Year Anniversary of Gentle Delivery ~ Part 2

Thanks again to each of you who contributed questions for this “virtual interview” as Gentle Delivery celebrates 10 years of practice! I’ve enjoyed this opportunity to connect with various readers, and I’ve loved hearing from so many of you. If you missed the first post, you can check it out here. Here is installment two as I continue working my way through the questions entered:

How do you manage being a midwife and a mom?

Sometimes I’m not sure that I do! But seriously, it comes down to having a very supportive and involved husband. I could not do it without his help & support, and without him having a flexible job. He works from home, and generally speaking is able to set his own schedule. Without these key factors, I don’t think it would be possible. We both feel strongly that our children need to be our priority, especially while they are in their young, formative years, and Joel’s job situation allows us to almost always have one parent present. If I need to run off to a birth or client emergency, than Joel changes his schedule for the day and takes care of the children, which greatly simplifies my life! I honestly do not know how midwives serve year after year with a busy client load combined with stress of needing to figure out babysitting, especially at the last minute. A few months ago, I was called to cover for another midwife who had two moms in labor at once, and the second mom was moving fast. Without having the ability to just load up the car with my gear and run, I would have missed the birth! But since Joel was working from home (his office in our basement), I was able to be out the door in ten minutes, and he took over managing the children. His work-from-home arrangement also allows me to sleep in after a birth, and he will sweetly get children up, feed them breakfast, and care for things while I get some rest.

Hot breakfast made by Joel and snuggles with the baby after being gone all night at a birth!

There are also some practical ways we have found that help to maintain balance, as well. As much as I am able to, I schedule appointments during my youngest children’s nap times, and I try to keep appointments confined to one day each week. This way I am limiting the amount of scheduled time I need to spend away from my children, especially since I never know how much unscheduled time I will be away at actual labors/births/emergencies. Another practicality is hiring cleaning help during especially busy months. My husband maintains that if I’m enjoying midwifery work and getting paid for it, then I might as well pay to get some of my other work done, instead of getting exhausted and stressed out! Oftentimes after a birth we will purchase supper (or take the family out) as a way to get some quality family time AND as a way to provide me with some extra time to do paperwork and miscellaneous business projects. I also get help with school, which is HUGE! My school-age children are part of a hybrid model co-op, where the parents help to teach classes, but they also have a classroom teacher who covers the “basics” and stays on top of the school details. If I was homeschooling full-time there would be NO WAY to do midwifery on top of it.

Each of my children have attended births with me as babies…quite the adventures we’ve shared together!

Balancing midwifery and mom life includes another factor when I have a nursing infant myself. Whenever I interview with potential clients who would be due after I have a baby, I make it clear that if you hire me, you’re also getting my baby. I always have an assistant or specific helper along who can care for my baby whenever I need to focus all energies on the laboring mom (and who needs a baby crying in the background when they are ready to push?!?), but otherwise I keep my tiny ones close so they can nurse and be with mama as much as possible. Some families are not okay with this arrangement, and that is their choice. I would much prefer they know what to expect ahead of time, and decide if they are comfortable with my boundaries, are there are always other options out there for them to consider!

One more key factor has been working with a midwife who is willing to trade call at times, which provides me with occasional time off to take trips and spend some focused time with my family. Without this arrangement, I would be tied to my phone and location almost 24/7 all year round! But this has allowed me to still spend some quality time making memories with my children, while knowing that clients are cared for, which is a tremendous blessing. While I still try my best to make it to my clients births, it’s also a relief to know that I can go “off call” occasionally for special events such as a school program.

Twice I’ve caught babies just before delivering my own…one time a week before, and another time two days before!

Is it realistic to consider being trained as a midwife, and starting your own practice as a midwife, with small children? What advice would you give?

This is a good question that deserves considerable thought. I had the opportunity to do my midwifery training when I was single, which was ideal. In my opinion, training to be a midwife was decidedly more of a time and energy commitment than practicing as a midwife. Here’s the reason why: when you are training, you need LOTS of experience. You need to be able to be completely available to your preceptor midwife, and willing to take advantage of every opportunity you can be part of. The only way to get the experience you need to be a good, safe midwife is by spending an incredible amount of time immersing yourself in pregnancy, birth, postpartum and women’s health. There are a number of midwives who did this training while they were balancing a family, but it is HARD, and you need to be prepared that it will take a long time. As a single young woman, I had the flexibility of time & energy which enabled me to finish my studies and obtain my required clinical experience in about two years. But this included spending 18 months at a birth center where we literally immersed ourselves in the world of birth by living, speaking, and breathing everything birth related. Seriously! I don’t remember a day passing that didn’t include a significant discussion about something to do with an ongoing client situation, lab values, birth stories, complications, etc. This type of immersion would have been impossible had I been trying to spend time with family, and it certainly sped up the training process.

Now that I am an independent midwife, I can make my own decisions about how many clients to take on in a month, what risks I am comfortable with, what my parameters of practice will be (for instance, when I do prenatal appointments, or what seasons I may not be available for first time moms), and when I want to take personal time off to give my family some breathing space. In most apprenticeships, a supervising midwife counts on a student midwife to be available whenever needed, and the student cannot set these types of parameters and still get the training she needs along with keeping a good preceptor/student relationship. So these factors all need to be considered, and I think there needs to be some serious conversation with your husband and family about whether your family is at a good place to make the sacrifices that training would require. I don’t think one will ever regret spending quality time with her children while they are young, but you might regret not spending that time later on!

I would encourage any young mom interested in midwifery to read as much as you can, as learning more about your body and about the birth process is going to be beneficial no matter what. There are excellent books out there that can lay a great foundation of knowledge about how the pregnancy and birth process works. Watch videos & documentaries, read birth stories, connect with other moms and learn about their birth experiences. Look for opportunities to get involved on a small scale. Perhaps you’d be able to provide doula services for a friend, which would give you and your family the opportunity to experience what it is like to live an “on call” lifestyle (ready for mom to leave at any time day or night!), seeing how it works to have mom leave and how to figure out babysitting fast. This would give you a chance to see what this aspect of being involved in birth can be like. I don’t think any birth experience is wasted time, especially if you’re hoping to be a midwife, so slowly looking for opportunities and taking advantage of them as doors open can help as you consider further commitment. Always remember that if God wants to be a midwife, He will make a way for you…but in His timing, and in a way that it will be a blessing to your family. Be patient, pursue the small opportunities as they arise, and see how He directs as time goes on…one older midwife told me once that “women will always be having babies, but you won’t always have young children, so make sure you don’t regret not enjoying them while you have them.” Excellent advice!

I’d also recommend that any aspiring midwife read A Midwife in Amish Country, as Kim does an excellent job of detailing her experience training to become a midwife as a homeschooling mom of young children, relating her experiences and lessons along the way.

How many births do you take on, and why that many?

This really ties in with the whole mom/midwife balance topic, as this is another way we try to walk this line. As a general rule, I cap a month with two due clients. Occasionally I will take on a third, if my family is at a stage where this is more possible, and if I have a slower month before or after. As a mom approaches her due date, her prenatal visits need to take place more frequently, resulting in more mamas needing to be seen each week. Then you factor in a home visit (an additional afternoon besides my usual appointment day), the birth (for anywhere from 3-30 hours), birth paperwork, another visit to their home for a postpartum check, and the frequent contact via phone/text/email that takes place over this time, doing this more than twice a month in additional to caring for other moms is about what I can do and still enjoy my work. Here again, if I didn’t have young children, and all the unexpected things that factor into life as you care for little people, it would be much easier to add more clients due in a month. But I want to enjoy both my own children and the opportunity to do births, and this number seems to be working well for this stage in life!

Thanks for taking the time to read this second installment in this interview series! If you’d like to contribute a question for a future post, feel free to add it in the comments below. As always, thanks for sharing, and feel free to check out Part One if you haven’t read it yet. See you next month!

September 20, 2018 by gentlemidwife

New Resources to Help You Achieve a Healthy Pregnancy, Lovely Birth & Successful Postpartum Recovery!

Some of the resources featured in this post

Hoping for a Healthy Pregnancy, Lovely Birth & Successful Postpartum Recovery? Here’s some resources to get started!

**Note, I am NOT affiliated with ANY of these resources, and I do not receive any financial gain or otherwise for promoting these products!**

As you might know, I love trying to stay up-to-date on current research and information about having a healthy pregnancy and postpartum recovery. I really want to be able to give clients good, solid information, and help them to achieve their desires for a low-risk pregnancy, beautiful birth, and end up with a supported, successful period of postpartum recovery. None of these things just happen, though. It takes concerted effort on the part of mom and her support team, and having some quality resources available to you can make all the difference in the world to achieving these goals!

These days, there are so many resources available, that it’s often hard to know where to start. And so many places have conflicting information, which only adds to the confusion about who to believe, and what is actual fact. Between blogs, articles, mommy boards, books and free advice, you might be wondering just where to concentrate your efforts in getting some basic information.

I have been so delighted to be made aware of some great resources that are available, and the purpose of this post is to introduce you to a few of these. This is by no means an exhaustive list, so if you have more resources to suggest, please add them in the comments so we can all learn from each other!

Nutrition:

This is a MUST READ for all pregnant women, and anyone even thinking about having a baby. Optimal nutrition starts now, and builds a foundation for a healthy mom and healthy baby. Real Food for Pregnancy: The Science & Wisdom of Optimal Prenatal Nutrition by Lily Nichols is the BEST book on nutrition that I’ve read in a long time. She will help you to understand how lacking our standard American diet is in real nutrients, and why so many moms end up with gestational diabetes, high blood pressure & pre-ecclampsia. For all the incredible information, it’s written in a very easy-to-understand style. She will help you understand why you need quality vitamins that utilize activated forms of B vitamins and folate, how much protein and good fats you need, what type of salt your body actually needs, how to reduce your carbohydrate intake, what type of exercise you need, and so much more. There is seriously so much more in this book than JUST nutrition, and your body will reap benefits from applying the information it contains! There is another book by the same author entitled Real Food for Gestational Diabetes that is especially geared towards helping moms to balance their blood sugars and manage gestational diabetes through quality diet changes.

Pregnancy Guide:

Have you seen the old “What to Expect” series for expectant moms? Well, you can think of The MamaNatural Week-by-Week Guide to Pregnancy & Childbirth by Genevieve Howland as a new, up-to-date version from a natural, holistic perspective. It’s great, and I think it should be a standard baby shower gift for every expectant mom (though they should probably have it well before the baby shower, honestly!). With input from a CNM and a doula, this guide goes through all the typical questions you face week-by-week, and gives advice on nutrition, tests to consider (and why you’d do them or why you might opt out), what you should be thinking about and preparing for, and how to go about choosing the right caregiver, birth location and options that are right for you. I love the fact that the book gives great info on home, birth center and hospital options, helping moms to achieve a great birth no matter where their location, but helping them to do so as healthily and naturally as possible.

Exercise:

So, while the other two books I mention touch on exercise, there are also some resources available that FOCUS on exercise. As I’m sure you know, exercise is important during pregnancy especially as you prepare for birth (you wouldn’t expect to run a marathon without training for it, right? We should think the same way about training for birth…), but did you also know that exercise is important for your body AFTER pregnancy? Our bodies go through some pretty amazing transitions as they grow a tiny human from smaller than a speck to 7-9lbs, which pushes our stomach up, our bladder down, and challenges our circulation. And then the baby has to come out…and our internal organs all must shift and readjust, and the muscles are stretched and then must get smaller…which means that there is A LOT of changes and stress for the body to recover from!

You’ve probably read or seen articles that talk about healing from diastasis after pregnancy, and/or about incontinence issues, pelvic pain, etc. that can occur postpartum, which can increase in possibility as you have more children, or have babies fairly close together without a lot of time for needed healing. But did you know there are actually things you can do about these issues? And that there are answers out there which can help you recover from pregnancy, and help you go into and through another pregnancy in even better physical condition than before?

One of the resources that can help is to take a prenatal or postpartum class through BirthFit. I love their motto: Giving birth might be the most athletic event of your life. Train for it. Isn’t that true?? In our area, classes are taught by Julie Kulig, a local chiropractor who uses her extensive knowledge to help moms develop a program that works for them. Her prenatal classes focus more on exercise, diet and birth options, and her postpartum classes focus specifically on helping the body to heal and recover from birth. She helps moms to strengthen their core in the correct way to heal any disastasis recti, guides you in exercises to tone and strengthen the pelvic floor, and teaches you how to move (picking up fat, chunky babies off the floor, anyone??) correctly so as to prevent injury. I personally took her BirthFit Postpartum class, and have been very excited with the benefits I received…and it was really good for me to realize I was capable of doing more than what I realized I could do when it came to good workouts. You can check online to see if there is an instructor near you, and you can also access a lot of the BirthFit information on their website-they offer online classes, as well.

Now, maybe you don’t have access to a BirthFit class, or have lots of little people around, and wonder how you could ever fit something like this into your life. I get it! I’ve been on the lookout for years for a good, tailored-for-moms exercise program that could be done in 20 min. or less each day. Honestly, there are times in my life where I just don’t have more time than that, and if an exercise program is going to take longer, it just won’t get done. So I was really excited to get ahold of the Trim Healthy Mama “Workins” DVD series. What has been fun is to see so much of what I learned at BirthFit being re-affirmed by Serene & Pearl, only this program is one that I can do at home, and working along with the DVD helps to provide me with more motivation than going at it alone. Each exercise routine can be completed in 19-20 min, using mostly items you have at home, and they are geared specifically towards moms in the childbearing stage. This means they are specifically targeting pelvic floor strength & core stability, and they include modifications to use during pregnancy, or if you’re just getting started postpartum or in exercising regularly in general. I love their down-to-earth style-it makes you feel like you’re working out with your girlfriends. You can find out more and watch an intro video about the program here.

I hope you can find some of these resources helpful in your own journey to better health, especially in relation to pregnancy & postpartum! I’d love to hear what you would recommend, so please feel free to share!

January 4, 2018 by gentlemidwife

Looking Back & Looking Forward!

As we head into 2018, I want to say thanks to each of the families we served last year. It is always an honor to be asked to care for each mom & baby, and it’s a special privilege to be present when the miracle of birth occurs. It was definitely a year full of variety, with many random & unusual situations and circumstances. Babies ranged from 6 lbs to over 10 lbs, arrived anywhere from over two weeks early to just past two weeks late (!), most came during the night (yay for cooperating with my own sleeping baby!), many were fast labors, and all the moms were amazing! Being a midwife you end up walking with families experiencing great joy as well as heartache when families have to say goodbye before they meet their little ones. There are also the situations that tax your skill and abilities, and the challenges that leave you researching and looking for answers. I am grateful for the opportunity to expand my experience an education, but I’ll also be honest and admit that I’m hoping for less of these experiences in 2018!

Some of our sweet babies in their “born at home” onesies!

I continue to be grateful for the help of my backup midwife, Rose Marie (who took such good care of clients when I was out of town, and then later on maternity leave), and that of my assistant, Lynelle. Besides being a great assistant, Lynelle also expanded her experience when she ended up catching her first baby (my son!) just as Rose Marie arrived. That was a special surprise for her! Having a team of ladies to depend on, call when needed, and work with definitely helps to make the work of midwifery much more sustainable long-term.

Fun birth memories with Rose Marie and Lynelle!

As we head into a new year, and anticipate the first babies of 2018 due soon, here’s a few updates:

We have some new resources in the library! Two NEW books were published in 2017 that are excellent reads for pregnant moms. The Positive Birth Book by Milli Hall is just what the title describes. And my new favorite pregnancy book is Mama Natural’s Complete Guide to Pregnancy & Birth. It’s a week-by-week guide that covers all the details from growth & development of baby to what you should be eating, thinking about and considering-all from a natural perspective! So far my clients have enjoyed it so much that I now own 3 copies so moms can keep it longer! We also have a copy of the “Why Not Home?” Documentary, which is available for those of you who may want that perspective as you contemplate home birth.
A *NEW* birth kit item: upgraded camera! While we can’t promise you professional photos (we are midwives, not photographers!), we have been delighted to add better photos for families who find that aspect important to them. A number of our families are delighted to have some better-quality photos before, during and after birth, especially if hiring a birth photographer is desired but out of reach financially. We occasionally add a third member to our team if photos are something you really want, and a number of our clients have been delighted with the result. Be sure to ask about this at your next visit.
New Playdates! We hosted our first mommy meet-up/playdate in the fall of 2017, and it was SUCH fun to see the families and clients that have become friends-we miss you! It was popular enough that we plan to do it again, so if you want to be alerted specifically about the next date, be sure to let me know!
Fun with moms and babies at our first playdate!
New, upgraded phone for the midwife. 🙂 I know, it’s about time! But if you don’t have my new number and are a former client (current clients all have the new # by this time!) be sure to drop me an email and ask for it!
And finally…a new student! Charity is just beginning to “test the waters” to see if midwifery is her calling, so she’s hoping to attend births in January (as long as babies give her enough time to get here!). We’ll see where things go, but we’re excited to have Charity join our team this month!

And as always, please let me know if you have any topics or suggestions of things you’d like to see covered in future blog posts. I hope to make the website more educational for clients, and would love to have it become a helpful resource for all expectant families! Be sure to follow Gentle Delivery on facebook and instagram, as well, as you never know what news or info may pop up over there!

Blessings in 2018…until next time!

December 7, 2017 by gentlemidwife

Topics for 2018 & a Give Away!

Since my fourth child arrived in May, I’ve been pretty quiet on this site! But now that baby has reached 6 months, and life is settling into more of routine, I’m thinking about the new year. Here’s where I need your help: I would LOVE to hear your ideas of what you would like to see covered in future blog posts! I’d like to realize my goal of one post a month throughout 2018, but I could use some input as I try to sketch out a plan for the next year. I often try to post about topics that are relevant & beneficial to my clients, and for families who are considering midwifery care and/or healthful, natural living. So send me your ideas, and topics you would like to hear more about!

And here is your incentive: each person who submits an idea (either in the comments below, or on our Facebook post with this same title) will be entered into a drawing to receive a copy of one of my favorite pregnancy/birth related books that was published this year. The Mama Natural Week-by-Week Gide to Pregnancy & Childbirth is a wonderful addition to your pregnancy and birth library. Think of it as a “natural version” of the old “What to Expect” favorite. “Mama Natural” covers everything from nutritional needs, what is happening to baby & mom each week of pregnancy, how to prepare for natural birth, pros and cons of multiple caregivers and birth locations, and so many of the questions that moms wonder about during pregnancy. I think you’ll love it, and if you don’t need it yourself, you just might have a friend that would enjoy it!

So here’s the details: submissions can be entered until midnight on Sunday, December 10, and a winner will be announced on Monday, December 11 (unless a baby changes my schedule-I’m a real life midwife, so there’s always the possibility that I may have to announce the winner later!). Entries can be made below in the reply/comments section, or you can enter by leaving a comment below the facebook post with this headline. I’m looking forward to finding out what you all want to discuss, learn and/or find out more resources about in the next year. Thanks for helping me out!

Feel free to share this with friends, so they can enter too!

February 2, 2017 by gentlemidwife

Preparing for birth-some excellent resources!

I love collecting birth resources-be it books, DVD’s, magazines, articles-you name it! The only problem is, with the limited amount of “extra” time I have (or don’t have!), I don’t always get a chance to preview and read the resources I collect right away. And I find myself hesitant to pass along information to clients and friends that I haven’t read or previewed myself.

This winter I’ve found myself in the remote hills of Arkansas, with more time on my hands than usual, as my husband is teaching at a small winter Bible School for young people. Keeping the children occupied is my main job here, but with the absence of our usual activities and schedule AND having all our meals provided, I’ve enjoyed the chance to finally dig into some of the resources that have been sitting on my shelves at home waiting for me to get to them.

So, with that introduction, I want to mention a few EXCELLENT resources that would be worth any of you expectant moms, or anyone wanting to learn more about birth, to take time to watch or read. I can’t believe I’ve had these around this long and didn’t realize what treasures they were!

The first one I’ll mention is the Parent Class DVD by Spinning Babies teacher Gail Tulley. I’ll confess that this one I have recommended to clients as I’ve taken one of her classes in person myself, and know she has alot to offer. But I didn’t realize how many jewels were in this educational presentation! It was a great refresher to me as a midwife, as Gail does and excellent job of teaching you how to help “make room” for your baby in your pelvis, and help your entire body to function more efficiently with less discomfort. The only drawback with this DVD is that, while she is teaching this class to a participating group of expectant couples, she does get fairly technical with some of her explanations. But in the long run it is helpful, as I think it helps you to get a better idea of WHY some of her positional suggestions and exercises help to eliminate certain issues. Using a great variety of teaching aides, examples, charts and object lessons, Gail shows you how exactly the uterus, baby, brain and body all work together, and how you can help. This would be great DVD for an expectant couple to watch together, or for any midwife or doula to watch in order to give you some great ideas of how to help your clients through specific issues and achieve better positioning for babies. It is well worth the $ you would need to invest, in my opinion! You can find out more about Gail, and purchase this DVD here.

Next in my pile of resources was a book by Ina May Gaskin. If you’ve been in the childbirth realm long, you’ll recognize this name as one of the most famous midwives in the USA. Ina May has been practicing since the 1970’s, and is probably most well known for her involvement with births on “The Farm” in rural TN. People have come from all over the world to have their babies in this community that has come to be known for it’s amazing work with natural childbirth. I’ll admit that while I’ve appreciated many of the things I’ve read or heard taught by Ina May, I was still a bit skeptical of her book “Guide to Childbirth”. I think I was expecting it to have a real “back to earth” or “hippie” type flare, which I know can turn off families who are looking for evidence-based and scientific information on preparing for birth. I was in for a big surprise! Ina May’s Guide to Childbirth has been amazing. Written in an easy-to-read manner, it is full of so much helpful information. Starting with birth stories to help women realize that birth is both natural and do-able, it then proceeds to teaching you about the things you really need to know about how your body works, how to care for yourself during pregnancy, how to understand tests and the “whys” behind them, helpful suggestions for choosing both caregivers and birth locations, ways to prepare for labor, and the list goes on. I love her honest, down-to-earth style of writing, yet all of her information is based on evidence, research, and studies, and she includes citations and information for further study. If you are wanting just one book to help you understand pregnancy and prepare for birth, this one is it. And it’s not just for moms planning to birth at home-there is information in this book that would help anyone to be better prepared and ready for the amazing experience of labor and delivery.

The last resource I’ll mention here is a DVD that was given to me by one of my clients. She had purchased it during her last pregnancy, and wanted to pass it on to other moms when she was done with it. “Practicing for an Active Birth” is basically a childbirth class presented by Instructor Neri Choma by Birth Coach Method. While Neri could probably be a bit more dynamic in her teaching style (I’d suggest watching 30 min. at a time-the DVD is about 2 hrs. and 15 min. long), she does a very good job of helping you to understand the process of labor and the terms used to talk about each stage, and gives couples LOTS of great position and relaxation techniques. Using charts and models, she helps you to learn how to visualize what is happening during each stage of labor, and how you might be able to help facilitate comfort and relaxation during each stage, working together as couples. While I think that it is best for couples to take a live childbirth class whenever possible, this would be an excellent option for those who might not have that opportunity in their area.

I personally feel like much of preparing for a great labor and birth involves understanding how your body works so you are not tensed with fear of the unknown. If you KNOW what is happening, understand WHY you are experiencing certain sensations, and have IDEAS for what to do and when, you and your partner will be able to relax and work together much better. Moms (and dads!) that are prepared tend to do much better emotionally and physically through the marathon of labor. I would strongly recommend you look into any or all of these resources as ways to prepare for a wonderful experience of bringing your baby into the world.

I’d love to hear about what worked for you. Do you have any favorite resources you would care to share with others? Tell us about it in the comments! And consider sharing this post with your pregnant friends to help them hear about ways they can prepare for labor and birth from the comfort of their own home.

January 16, 2016 by gentlemidwife

Some Recommended Reading

As we’ve headed into a new year, I’ve been taking the time to update old records/files/paperwork, etc. One of the fun things I’ve updated is my current library list. While the internet can be an excellent resource for many topics, I still enjoy a good book that can stay on my nightstand, or be read while I nurse baby (one of the best things about having a nursing baby is getting guilt-free time to sit and read a book!). This past year I was introduced to a number of books that I had not read before, and I thought it’d be fun to share a few of those titles to you, in case you’re looking for something new to read!

One of the library shelves in my office

Ina May’s Guide to Breastfeeding by Ina May Gaskin: I found this jewel at a thrift store this summer, and picked it up just because of Ina May’s name. It’s a great resource to have on hand if you’re wanting some extra help or information on breastfeeding issues. One thing I appreciated was that she actually dove into the issue of tongue-ties causing nursing difficulties, which is something that many manuals on breastfeeding overlook. Overall, this book was a great easy-to-read book that I would recommend adding to your home library!

Pushed: The Painful Truth about Modern Maternity Care by Jennifer Block: This book is not your “feel-good-warm-and-fuzzy” type, but if you’re in to making informed choice, and understanding the politics and protocols that go on behind the scenes, especially here in the US, this is an eye-opener. Jennifer explores the history behind different changes to the maternity care scene, how insurance companies dictate much of hospital’s protocols, how our lack of understanding our bodies and understanding the normal function of birth contributes to the rise of interventions, the limitations in so many areas of good alternative care options, and more. While it can be a bit depressing at times, it was definitely educational, and helpful in understanding risks vs. benefits of different medical choices.

The Official Lamaze Guide: Giving Birth with Confidence by Judith Lothian: While this one has been around for awhile, I had never taken the time to pick it up and read through it. I found that it really wasn’t all about a particular “method” for birth, but more about understanding how your body works, and how to work with it. Clear, concise information written in an easy-to-read style, with birth stories to boot.

Cut, Stapled, and Mended: When One Woman Reclaimed Her Body and Gave Birth on Her Own Terms After Cesarean By Rosanna Rosewood: This one deserves a disclaimer-while the story was fascinating, I don’t recommend or agree with everything this mama pursued in her quest for a VBAC. However, this book helped me to understand many of the challenges that brave VBAC mothers must make as they recover, heal, and prepare for birth from an emotional, spiritual and physical standpoint. I found it valuable as I seek to help mothers who desire a VBAC without having personal experience.

Besides the mentioned books, I’ve encountered a few new resources that I would heartily recommend:

Spinning Babies DVD’s: The Parent Workshop & Daily Essentials. Gail Tully, the instructor of these DVD’s and the brains behind the Spinning Babies website, has so many tips, suggestions and information to offer-and it all helps to make pregnancy more comfortable, understand your body, and encourage baby to be in good postion…which ultimately helps your labor, birth and recovery to go so much smoother! If you haven’t spent time on Gail’s website, it’s worth looking in to!

VBAC:Know the Facts by Jen Kamel: Jen has compiled an immense volume of research and facts surround VBACs, and presents them in a fascinating seminar that can be taken online or attended live. This 6+ hour seminar addresses subjects such as myths, actual research results, how and why different hopsitals have different protocols, what complications can increase risks (and how to avoid some of them!), and the list goes on and on. If you are considering a VBAC and have questions, or just want to learn more about the subject, this would be a very worthwhile investment. I learned so much from it!

More books…and they don’t all fit here, either!

This past year I had a friend who contacted me-she was newly pregnant, lived in another state, and wanted to know where to start in figuring out what she wanted for her pregnancy, birth, caregiver, etc. What a list of questions! And where do you start?!? So I’ve been on a quest to find factual, evidence-based information to help new moms in making decisions and sorting through all the myriads of opinions and information. If you have a resource that was particularly helpful to you, I’d love to hear about it! Feel free to comment (below), leave a message on the facebook page, or send me an email at: gentlemidwife@gmail.com. I’d love to hear from you!

And if you want to check out my updated Recommended Reading/Library List, feel free to look at it here: https://gentlemidwife.wordpress.com/recommended-reading/ Remember, clients have access to this library as part of their maternity care package!

Gentle Delivery Midwifery Services (Centre Co. PA)

"…He shall gather the lambs with his arm, and carry them in his bosom, and shall gently lead those that are with young." Isaiah 40:11

books