It’s hard to believe another year is almost completed! As we head towards the New Year, I wanted to take a few minutes to update you all on happenings here at Gentle Delivery, as well as thank each of you for your continued support. Whether it’s returning clients, new clients, supportive local services (lactation consultants, medical teams, ultrasound technicians, etc.), back-up midwives, students or assistants, I am blessed to be part of the local midwifery community, and I’ve been grateful to see the way this community works together!
So far in 2022 I’ve been privileged to assist in welcoming 15 babies, most of whom were little girls. Several of these were born to first-time mamas, and once again I was amazed, humbled and stretched throughout the experiences of assisting these families with the unique challenges and victories that accompany the unknown journey of becoming parents for the first time. Besides the first time babies, the rest ranged from being sibling #2 to sibling #8 for their families, and I had the special privilege of attending 3 moms for the 3rd time. Seeing children that I remember catching as tiny babies become big siblings is a fun perk that comes from providing ongoing care for client families! The smallest baby this year was 6# 4oz, and so far 8# 14oz was the biggest, with one more baby pending who could change these statistics!
Lanna and Christine, my usual assistants during 2022
The teamwork of our community stood out to me in greater ways throughout the pregnancies and births this past year. Over and over again I have been thankful for good working relationships both with other midwives and the medical community—which is such a key factor for providing sustainable, safe midwifery care options. There were times this year where additional medical help was needed in order to provide us with the ultimate goal of having a healthy mom & baby, which made me especially grateful for several MFM’s and CNM’s willing to provide consultations, input & care for clients as well as for a welcoming hospital environment when complications necessitated a transfer of care. Along the lines of providing good care options, it was exciting to add the services of a diagnostic ultrasound tech who has been able to regularly perform scans right in my office!
Birth teams have varied this year depending on availability of different assistants & midwives, but each one of these ladies have added to the birth experiences and help me in so many different ways, bringing their own special support and care to births. There are many behind-the-scenes details that these women take care of, besides their willingness to drop whatever they have going on to come help me in any way they can at any hour of the day or night, and I couldn’t continue to provide midwifery services without them! Due to a family emergency for one local midwife, I ended up covering at various times for her over the year, and catching several babies while she needed to be out-of-state. While I know it can be disappointing to not have your expected team for your birth, it was also a blessing for these families to still be able to continue with their homebirth plans despite the need for the original midwife to attend to important family needs. Along similar lines, I was very thankful for midwives willing to cover for me so that I could spend a few weekends away with my family, both for vacation and a family wedding. The strain of on-call life is challenging (especially with young children!), and being able to rest knowing that your clients are in competent hands while you take a break is a huge factor in maintaining a sustainable midwifery practice!
Denae, a midwife in Philipsburg who assisted and covered for meEmily, a local birth assistant who helped me out a number of times when I was in a pinchHannah, a midwife who covered for me and assisted with births & appointments…and Christine, my faithful assistant this past year
In closing, I also wish to express my thankfulness to my supportive family. The way they pray for me when I’m at births, pick up the slack when mama needs to rest or is away, and adjust their lives and schedule is such a vital part of midwifery work, and it really is a family effort. Also, I realize that none of this could happen without God’s continued blessing, provision and care. As we head into 2023, my children are very excited about the addition of a baby sister arriving in early spring, Lord-willing. I’ll be taking a few months off for maternity leave, and trying to put into practice the things I tell all of you about rest and recovery postpartum! Blessings to each of you in the New Year!
The photo we sent to our families, to let them know baby #6 was on the way!
Please note: I am NOT affiliated with any of the mentioned companies, and I do not receive any sort of reimbursement from sharing their products other than occasional free samples that are sent to my office (which is how I was introduced to several of them!). Some of these companies have offered discount codes for my readers, and I’m passing those on when available, at no benefit to myself!
As a mom who has struggled with severe morning sickness with most of my pregnancies, I know from experience how incredibly difficult and challenging those first months can be when you feel so miserable! In fact, the mere thought of going through those early weeks and months of sickness makes me desperate to find some type of relief to try. Because of this, I’ve spent quite a bit of time reading any new research, thoughts and suggestions that I can get my hands on regarding combating morning sickness over the past couple of years. My hope with this post is to help you understand what might be going on under the surface, and to provide you with a number of suggestions and resources so that you can hopefully find something that works for you! I know each mom (and each pregnancy!) can respond differently, and that there is NO cure-all that works for everyone. But sometimes you find out about something that can make a difference, so my hope is that you might discover something new that can bring some relief to you as you nourish and carry that tiny baby that is already requiring so much from mama!
For the foundation, it’s important to be caring for your body BEFORE pregnancy whenever possible. If you haven’t done so, I would highly recommend that you take the time to read Real Food For Pregnancy by Lily Nichols. Having a high quality diet in place that is low in simple carbs and refined sugar and high in quality protein has made a big difference for many moms, but this provides the most help for morning sickness if this has been a way of life long before pregnancy. Along these same lines, taking the time to do a liver cleanse and possibly a candida cleanse have made a big difference in pregnancy health for moms.
Talking about the liver brings me to the first important suggestion for morning sickness relief, and that is LIVER HEALTH. As you know, a mom’s body works hard to support the massive amount of growth that is happening for baby during the first weeks after conception, and one of the organs under a lot of stress is the liver. It is fascinating to study into this more, and realize how gentle support of the liver can help alleviate the severity of morning sickness (you can read more about this here). A great way to provide liver support is through taking Milk Thistle twice a day (and if you are planning a pregnancy, start taking this a couple of months before pregnancy for even better success!). Some good Milk Thistle options are: Jarrow Milk Thistle & Natural Hope Herbals Milk Thistle Tincture. If you want more support (and possibly more success), consider taking a liver support complex such as the pregnancy-safe tincture from Mountain Meadow Herbs Liver Glow II. This product from Earthly Wellness includes dandelion which is another herb that provides liver support, along with some additional herbs to aid in reducing nausea: Mama’s Tummy Relief (use code “gentlemidwife” for 10% off your first order from them!). Another form of liver support comes through the addition of lemons to your diet, which is most easily done by squeezing fresh lemon juice into your water that you sip on throughout the day (add some honey for a bit of a natural sugar boost!).
Another factor that can make morning sickness worse, and be especially problematic when a mama is vomiting often, is maintaining good hydration and electrolyte balance. Staying on top of this before it gets to the point of needing IV treatment is key, and one of the ways to help with this is having some high-quality electrolyte drinks available (that are not full of artificial flavors & dyes like Gatorade!). A few good choices that I’ve personally tasted an tested are: GoodOnYa Organic (this one tastes like delicious lemonade, yet it has only healthy ingredients: use the code “gentlemidwife” for 10% off + free shipping on your order!), Nectar (another organic, sugar-free option with multiple flavors), LMNT (available in several different flavors-you can purchase a sample mix on Amazon to get you started), and DripDrop. You can even make popsicles out of these electrolyte drinks in order to sip on them…just make it a priority to stay hydrated and prevent your electrolytes from orbiting out of order…we want to prevent the need for an IV or other intervention whenever possible!
A “newer” remedy that I am finding quite fascinating is that of additional magnesium supplementation for morning sickness relief. Here’s a couple of articles that go into more detail: Magnesium for Morning Sickness Relief, & Magnesium for Morning Sickness: My Story. If I have another baby, I’m definitely planning to try this idea! Besides swallowing pills or drinking magnesium-containing drinks (which many sick moms can’t handle), a few ways to supplement with magnesium that might be easier on your stomach are creams and sprays. Pink Stork carries this Magnesium Spray for Morning Sickness, and a local company that I highly recommend carries this cream: Shade Mt. Naturals Magnesium Cream . Another magnesium cream I have used personally is this one: 8 Sheep Organics Magnesium Cream
If you’ve read other posts on my blog or talked with me long, you probably have heard how strongly I feel about incorporating high quality probiotics into your life for pregnancy, nursing and newborn health…and now I’m finding proof that probiotics can also help with morning sickness! These two articles show how: Study: Probiotics Reduce Nausea & Vomiting and Study Finds Probiotics Significantly Improve Nausea and Vomiting in Pregnancy. Based on this research, as well as knowing how beneficial probiotics are to your overall health, it seems like it can’t hurt anything to increase or start your probiotic intake during the early weeks/months of pregnancy. If you’re looking for some good quality options, here are a few that have been recommended by other midwives and clients that I trust: Klaire Labs Therbiotic Complete, This Is Needed: Prenatal Probiotic, and Entegro:Flourish. Another way to increase your probiotic consumption is through fermented foods, such as raw sauerkraut and drinks like Kefir. Some moms have found the “sparkling” aspect of water kefir to be especially appealing while feeling sick, and many stores carry options such as Kevita in the cold drink section. You can also learn How to Make Water Kefir at Home or purchase something like this: Coco-Biotic Coconut Water Kefir
Some moms can obtain relief by supplementing with some specific vitamins & nutrients. Adding a few drops of this Liquid PhosFood by Standard Process to your drinking water (it tastes similar to lemon) has been beneficial to a few clients. Other times your body really needs some additional B vitamins, both for the B6 that specifically helps with nausea, and for the energy that is so lacking during the first trimester! My favorite B complex for those early weeks is the Max BnD Fermented B complex that helped me SO much with my last pregnancy. Whatever type of B vitamin you find, make sure that is contains bio-available forms, such as folate and methylated Bs, in order to obtain the most benefit. Jarrow and Seeking Health are two good brands to purchase.
Now we’ll move on to some random suggestions and options that have helped other moms (thanks to so many who shared in response to my question on what has helped!):
Ginger: many people find ginger helps to settle the stomach, and you can try it in the form of Ginger Ale, Ginger supplements, or even through chews & candies such as these: Gin-Gins Ginger People Candy & Chews
Pink Stork offers a product called Total Morning Sickness Relief that contains needed vitamins & minerals for nausea.
Frequent snacking (don’t let your stomach get empty!), and eating something light before you get out of bed in the morning. Make sure you’re getting protein in whenever possible, even adding it to smoothies if needed!
Some moms find that they need to quit taking daily prenatal vitamins during this time, as they can be too hard on the already sensitive stomach. Don’t stress if you need to do this-you & baby will both do better overall if you can keep food down, and this is more important than the vitamins during these weeks! Remember, baby needed the vitamins the most during the first few weeks, so by the time morning sickness hits with a vengeance this key foundation is over, so the goal is keeping mom hydrated and healthy! An alternative is to find a different vitamin and see if it might be gentler on your stomach. There are gummies, powders and pills, so another form may work during these initial weeks, especially if it does not contain iron which can be particularly hard on a queasy stomach.
IF you really are struggling to keep anything down, and need to move past the natural supplement stage, don’t hesitate to reach out to your care provider for additional support. Some moms MUST have prescription meds to survive these months, and that is totally warranted depending on the situation. Other moms need to have an occasional IV in order to restore hydration, and we are thankful for these interventions when they are desperately needed. Some over-the-counter yet more medically-based solutions are:
I would love to hear from you readers: what did you find helpful?? Any suggestions that aren’t on this list? Did anything listed here benefit you? What did you find helped from one pregnancy to another? Thanks so much for sharing so that we can all learn and hopefully be better able to handle these early weeks and months of pregnancy!
I’ve had several ladies reach out this year asking for information to consider as they hope to conceive sometime in the next few months. As I started replying to some of these inquiries, I realized that it might be helpful for others in similar positions to have some of this information at their fingertips. My hope is that some of these suggestions can help you to achieve the healthiest pregnancy possible as you actively prepare your body for the amazing stress and strength that growing a baby places on your entire system-this is certainly worth seriously considering and prepping for, and I can guarantee you won’t regret any time and effort you invest before pregnancy!
Let’s start at the beginning:
Educate Yourself on Your Hormones and Cycle:
Understanding how your body works, and how to read your fertility signs (temperature, cervical mucous, etc.) can make a huge difference in both your ability to conceive and in determining an accurate due date. There are some disorders or challenges that can be identified early on if you have been keeping track of your fertility signs, and this can save you time, money and heartache if you know what to look for and when to get medical intervention. Simple things such as knowing you ovulate “late” compared to traditional due date calculators can save you the challenge of being considered “overdue” when you actually didn’t have an accurate due date to start with!
For better understanding, I highly recommend the book Taking Charge of Your Fertility by Toni Weschler. This guide helps you to really get to know how the women’s body works, how to chart your cycle, and how to understand all the information you are pulling together. The TCOYF app is also a great way to track your cycle, and it’s free! Another helpful book on the subject is The Fifth Vital Sign by Lisa Hendrickson-Jack (as a disclaimer, I JUST ordered this book and have it sitting in my “to read” pile-it looks great, but I haven’t read through it yet!).
For those particularly wanting to use fertility tracking as a guide to Natural Family Planning, the Art of Natural Family Planning Student Guide is a good way to delve into some of the details, which can also be an aid in achieving pregnancy.
Birth Control/Hormonal Contraception:
If you’ve been on hormonal contraceptives, it’s important to remember that it can take up to three months for normal cycles and fertility to return. The sooner you can get off any hormonal BC the better for your overall health! Aviva Romm has a great article on fertility issues after hormonal contraceptives and getting off the pill here: Post Pill Reset and I highly recommend the new documentary The Business of Birth Control for better understanding of how hormonal contraceptives can negatively affect your overall fertility and health while providing an introduction to other non-hormonal options.
Deal with Any Current Health Concerns Now
Do you have weight you need to gain or loose? Start understanding healthful eating, and work on that now BEFORE you add pregnancy to the mix! I’ll add more on diet below, but healthful eating habits should begin now, and will provide a great foundation for the demands of pregnancy on your body.
Are you currently on any medication that could have a negative effect on a developing baby? Many health challenges (such as elevated BP) can be managed by diet, lifestyle and supplement changes, and these are best achieved before pregnancy. If you’re hoping to have a low-risk delivery at home, this is even more important to consider, as any compilation of medications can increase your risk and rule out homebirth. Also, remember that you should be under the care of a physician or medical provider before attempting to wean off any medications, especially for BP, anxiety, depression, etc. You need to do this safely, and sometimes these changes can take time!
Thyroid health: many women these days experience thyroid imbalances, and it can make a huge difference on your ability to carry a healthy pregnancy if you are on top of these imbalances before pregnancy, and have a provider who can work with any sort of needed thyroid medication especially during the early days of pregnancy. Learn more about thyroid and it’s effect on pregnancy by reading Aviva Romm: Thyroid in Pregnancy
Learn more about healthy food choices:
There are so many things to learn about how food and our daily choices affect the way in which our body works! From supporting the organs, optimizing brain function, regulating blood sugar…the food we eat has so much to do with how our entire body operates. Add to this the growth and development of an additional entire human body and placental organ, and you’ll start to get a glimpse of how important solid nutrition is to your body and that of your future baby! The best book on the subject that I have read is Lily Nichol’s Real Food For Pregnancy, and I would encourage any woman who is pregnant or considering pregnancy to read it and really digest her wisdom and suggestions. Lily covers more than just diet, and her overall suggestions when it comes to regulating blood sugar, exercise guideline, and prenatal vitamin recommendations are all amazing and educational.
Did you know that Gestational Diabetes is a real issue for many women during pregnancy? This can also be changed through diet, and Lily has a specific post on this topic here: Gestational Diabetes & Preconception Nutrition
Support your Liver!
This might seem like an odd topic, but did you know that your liver performs under extra stress during pregnancy? There are many pregnancy complications that can arise when the liver is not functioning well, and there are some studies that suggest that a healthy, supported liver can reduce the amount of morning sickness a mom might experience. With all of these factors on the table, I highly recommend either purchasing a liver cleanse and using it a few months before getting pregnant, or at least taking a high-quality Milk Thistle supplement for a month or two before conception, and continuing to take it during the first trimester. Here is an article that addresses this further: Milk Thistle for Morning Sickness
Prenatal Vitamins:
Start your research on prenatal vitamins now, and begin taking them daily. Remember, the critical time for baby’s development are in the early weeks, so your body needs to start getting a good foundation of nutrients so that your body is ready to nourish the developing brain, organ and other nutrient needs of a growing tiny baby. Many moms end up sick enough that they cannot continue taking prenatal vitamins during part of the first trimester, so having this foundation laid ahead of time is key!
Not all supplements are the same: do your research and be willing to pay for quality. Making sure your prenatal vitamin has bio-available nutrients (for instance, folate instead of synthetic folic acid!) can make a huge difference in how much actual benefit you receive from them. Some helpful links: Folate vs. Folic Acid, Prenatal Vitamins by Aviva Romm and some information with recommendation links: Basic Supplements for a Healthy Pregnancy
Further Reading:
If you’re wanting to read more about how to optimize your fertility and prepare well, many providers recommend the book It Starts with The Egg. Rebecca Fett goes into detail about diet, supplements and other foundational principles of helping your body to achieve healthy conception!
In closing, I hope you’ve found these suggestions informative! I’d love to hear what else you would add to this list, and what has helped you as you’ve prepared for pregnancy. Maybe you’re not pregnant yet, but you’ve found a great resource…or maybe you followed some preconception guidelines and are currently in the middle of pregnancy…either way, I’d love to hear what you found most helpful!
If you’ve recently given birth, you’ve probably wondered how to really help your body heal as you navigate the postpartum period and adapt to your post-baby body. Over the years I have developed a greater passion to see women really cared for and their bodies aided in this healing process, realizing that taking the postpartum period seriously can have long-term benefits for mom’s health & well-being in a variety of areas.
One component to long-term women’s health that often lacks attention is that of the physical rehabilitation needed after birth. If you think about all the changes that the body goes through during pregnancy (stretching, repositioning of internal organs, increased blood volume, muscle strain, weight gain, uterine growth, etc.) and then during birth (the physical exertion, movement, muscle & tissue stretching, internal organ placement changes, and more!), we should consider it normal that our body might need some help in recovering and rehabilitating in order to be able to function optimally. But there are SO MANY voices out there telling you what you should & shouldn’t do, and it can feel overwhelming to know where to start and who to listen to! In light of this (and because I wanted some better information to give to my postpartum clients!), I reached out to several local experts who provide support and services to postpartum women in our area. I’m grateful that they were willing to share a little bit about themselves, the services they have to offer (if you’re local, they are great options to consider as you prepare for postpartum recovery!!), and give us a few tips when it comes to understanding the recovery process and how to integrate physical exercises that will actually help our bodies heal without causing further trauma or injury.
By introducing you to these women who are aiding local moms specifically in their pelvic floor and post-birth rehabilitation health, I am hopeful it can give you an idea of some of the options you have right here in Centre County. Any of these providers will be happy to aid you in recovery from the marathon of growing a baby and giving birth! I also know that many moms are hesitant to reach out for this type of support and therapy, sometimes due to having many unanswered questions about what physical therapy or other services might entail. After learning more about these professionals and the specific focus and background each one has in their respective areas of expertise, you will hopefully have some of your questions answered, and perhaps have a more informed idea of what care might be best for your situation, preference, and recovery.
Hi! I’m Dr. Julie Kulig, a chiropractor in Bellefonte at Kulig Chiropractic & Rehabilitation. I have a strong interest in treating pregnant and postpartum women (and their littles). I have 2 children currently of my own and find joy in observing and assessing these littles movement patterns and developmental milestones.
My educational background is Doctor of Chiropractic, Webster Certified (for all you pregnant mommas), Birthfit professional, DNS (dynamic neuromuscular stabilization), and MDT (the mckenzie method of mechanical diagnosis and therapy.) Previously I held BIRTHFIT postpartum classes 2x/ wk for 4 weeks to help women improve core and pelvic floor function postpartum. I still treat pregnant and postpartum women daily and am happy to offer this service alone if you are interested (no adjustment needed).
Dr. Julie gently caring for my own newborn!
The BIRTHFIT exercises are based on DNS: dynamic neuromuscular stabilization. These are a series of exercises based on the study of babies and their motor milestones that occur 0-18 months. We use these movements to help treat moms both pre – and post – baby! The exercises are based off of diaphragmatic breathing and the relationship the diaphragm has with the pelvic floor (much more intricate and we can talk about that more!!)
We treat: pain, pelvic floor pain, urinary stress incontinence, diastasis rectus abdominus and more. Trunk stability is the basis of all of our movements and essential in our recovery postpartum. Wondering if we could help you?? ASK: drjuliekulig@gmail.com. I’m always happy to chat more! www.kuligdc.com
Hello! I’m Becca Beck. Originally from GA, I live in State College with my husband and 3 sons. I am a Functional Movement Teacher who specializes in the Core and Pelvic Floor and a Certified Restore Your Core® Teacher. Restore Your Core® is a movement program, founded by Lauren Ohayon, that takes a whole-body approach to the Core and Pelvic Floor. It uses exercises that are a mixture of corrective exercises, yoga, pilates, and functional movement to help women reboot their core and pelvic floor. I educate my clients on the contributing factors to core and pelvic floor dysfunction, help them to uncover their movement blind spots and repattern their core and pelvic floor to be functional, reflexive, responsive, and supportive to their bodies.
Here are some things I want my clients to consider and try in their Postpartum Recovery
Rest. Even if you are feeling good, you still went through a dramatic physiological experience and you still have a dinner plate sized wound on your uterus. I hear all the time from women who regret getting back into things too soon after birth but I have never heard a woman regret giving her body time and space to rest and heal. You have to think of it as an investment. This time you take to rest now, sets you up for a better recovery and getting back to the things you love sooner.
Reconnect With Your Core. Your first 6 weeks do not have to be without movement but we want to be smart about how we approach it. You wouldn’t sprain an ankle, rest 6 weeks and then jump into the same movements you were doing before without doing some rehab. Your abdominal system just spent 9+ months rearranging itself and being stretched to new limits. Those early postpartum days are a great time to start reconnecting with your core, waking up your brain to this area of your body, and preparing your body to return to the daily movements of life and the activities you love.
Where to start: Dandelion Breath. Sitting, standing, or laying down. Place one hand on your lower abdominals. Imagine you are holding a dandelion right in front of your mouth. Inhale, and then on a long exhale blow all the seeds off your dandelion and keep blowing smooth and steady until you have no air left. Did you feel a natural drawing in of your abdominals away from your hand? It’s okay if you didn’t. Try a set of 5 about 1-2 times a day. You may not feel it right away, but the more times you ask the stronger that brain connection will become and you will get there eventually! When you feel more comfortable with this exhale and feel that natural corseting in use this Dandelion Breathing whenever you are going to lift or exert. Remember, “Blow before you go.”
Show Your Back Some Love. Early post-partum can be a beast on the low back with all the sitting, feeding, bending over for changes and lifting out of the crib.
A few tips to try:
When sitting, try to sit on your sits bones (the bony parts you feel where your legs and butt meet) instead of letting your pelvis tuck under (don’t feel militant about this advice, slouching isn’t evil we just want you to change it up some!). You may find it easier to sit up if you place a pillow under your sits bones.
When you bend over, think about sticking your bottom out vs tucking your tail like a sad puppy dog. Also consider putting a step stool by your baby’s crib so you don’t have to round as much in the upper back to get baby in and out of the crib. This will allow you to use a squat for lifting and lowering baby putting less strain on the low back.
Working with me or a Pelvic Floor PT can be a great way to learn exercises for early postpartum and how you can progress them as you move through the 4th trimester and beyond. It is never too late to get started. www.beccabeck.com or email: beccabeckmovement@gmail.com
Hello! My name is Kyla Dunlavey and I am delighted to be included in this group of women! I have been an orthopedic/sports med physical therapist for almost 25 years and I launched my private practice Core Physio LLC in February 2021 with a special interest in helping active women stay active. I am originally from NW Pennsylvania and spent 14 years of my career at Walter Reed National Military Medical Center in Washington DC before moving back to Pennsylvania in 2018. I started my own practice in order to practice the way I wanted to… Instead of the typical PT clinic ‘mill’, I wanted to see fewer clients for longer sessions, offering the true one-on-one, in-depth, unique, holistic attention to my active clients deserve. I don’t do any internal pelvic floor work, but rather I approach the entire system through exercise, pressure management, breath work, and mindfulness. I refer as necessary to pelvic floor PT. I look at the entire person and empower them with knowledge about their bodies, movement, and the breath, for greater carryover into activities like running, or even just picking up and carrying a child!
I have an endless curiosity and fascination about the human body and I constantly strive to keep up on the latest research and treatment techniques, as what we know about the human body is continually evolving! Case in point, over the past few years, research has started honing in on the pelvic floor and its connection to low back, SI joint, and hip health…and vice versa! Not only this, but also identifying it’s buddy the diaphragm and proper breathing technique, as part of a missing link in establishing true core stability, along with its teammates: the pelvic floor, the abdominals, spinal extensors, and intra-abdominal pressure. The way women stand, move, and breath typically changes during pregnancy, as the baby grows and hormone levels alter. Ligaments become more lax, abdominals are on stretch, the back extensors may become taut, it’s difficult to get a breath down into the abdominal cavity, and postural alignment changes impacting optimal muscle recruitment like the glutes. This often carries over into postpartum life, impacting return to activity or just simply keeping up with the demands of motherhood. Women may experience things like diastasis recti, leaking (with coughing, sneezing, laughing, or jumping), hip pain, SI joint pain, pelvic floor pain, or low back pain. A bonus, in establishing proper breathing technique, is tapping into our parasympathetic nervous system which gets us out of the tense fight, flight or freeze state most of us stay in all day! Try the 10 minute-Time Out: Go to a quiet area. Have hubby watch the kids. If you don’t have 10 minutes, do 2 minutes! Lie down on the floor with your legs up on the wall and a pillow under your head, (or on your bed with legs up on the headboard if it is flat). Without getting into specifics of proper breathing, just breathe through the nose slowly for 4-5 seconds, letting go of any tension in the body. Exhale. How long did you exhale for? It should be at least 4-5 seconds, if not double your inhalation! How do you feel afterwards? Hopefully relaxed and energized!
If you think you might be interested in tackling your issues, call for free 15min consultation: 814.314.8880 www.TheCorePhysio.com
I have 20 years of experience working as a physical therapist. Born and raised in Belgium, I graduated from the Catholic University of Leuven as a Physical Therapist in 2001. Afterwards, I pursued a 2 year program at the University of Ghent to become an Orthopedic Manual Therapist. I have worked as a physical therapist across the world: in Belgium, the Netherlands, Turkey, New York City and State College, PA.
Becoming a mom in 2010, I became more acutely aware of the need for pelvic rehab in the US compared to Europe. I decided to expand my practice and become a Pelvic Health Specialist. I have done extensive continuing education through Herman and Wallace, the APTA Women’s Health Section, Pelvic Guru, and others. I take pride in staying up to date in the emerging field of pelvic rehab, women’s health physical therapy and pre- and postpartum care with extensive continuing education, literature, and books.
I feel extremely passionate about providing the best possible care to all people experiencing challenges with their pelvic health. Being able to help people achieve their goals and highest potential is my biggest reward.
Why Pelvic Shanti?
Pelvic Shanti was founded to provide resources to women during their pregnancy and in the postpartum period (and beyond). A lot of the symptoms that we experience during this time in our lives are quite common but not normal.
We recommend a consultation with a pelvic floor physical therapist if you experience:
● Urinary or fecal incontinence
● Urinary or fecal urgency
● Heaviness, pressure, bulge or dragging in the pelvic area
We are here to answer all your questions and guide you as you return to your physical activities. To best support the new moms we work with, we offer office or in-home visits and remote consultations. www.pelvicshanti.com
I’m a licensed Doctor of Physical Therapy and a researcher at Penn State University. My clinical practice focuses on treating women with pelvic floor problems like incontinence, pelvic pain and prolapse (heaviness in the pelvic organs), and my research aims to better understand pelvic floor muscle function, how it works with the rest of the trunk, and develop innovative new treatments for pelvic floor problems.
Pelvic floor physical therapy aims to restore optimal function in the muscles that support bowel and bladder use, sexual function, and keep the pelvic organs lifted. These muscles get stretched and can even tear during pregnancy or delivery and can contribute to problems of leaking (bowel or bladder), scar tissue or painful areas of the muscles, and poor support of pelvic organs causing dropping or prolapse. Treatment with a physical therapist may involve local pelvic floor interventions to improve the scarring, strength, mobility and tone in the muscles. It may also involve exercises and movements focused on the whole integrated body so people can return to the movement that matters most to them, whether that is playing on the floor with babies or training for a triathlon. In my practice, I treat the pelvis and pelvic floor as a piece of the puzzle and will also address the whole body and the whole individual.
I will be resuming my private practice in the spring/summer of 2022 and will provide updated information on my website: www.centered-physio.com
NOTE: Dr. Rudavsky will also be recruiting participants for her research in pelvic floor functioning in the spring of 2022. For more information on participating in pelvic floor research, please email Dr. Rudavsky at axr5794@psu.edu
In closing, I want to thank each one of these women for taking the time to share their thoughts, suggestions & tips as well as providing us with an introduction to themselves and the services they provide. If you’re local and end up using one of these providers, please let them know you read about them here! And if you’re not local, it’s my hope that you at least learned more about the services pelvic floor therapists, chiropractors and other professionals can provide to postpartum moms, and perhaps you can use this information to aid you in your search for good postpartum care. I know you won’t regret taking care of your body now and avoiding potential long-term challenges!
If you’ve used a pelvic floor therapist, chiropractor or other professional during the 4th trimester and beyond, would you tell us about your experience?
As we head into flu season and continue to navigate the Covid-19 pandemic, I wanted to share some suggestions for pregnant moms wanting to boost their immune systems. There are so many ways we can proactively support our bodies in order to provide better resistance to germs and illness, and possibly prevent severe sickness. Many women find their immune systems face greater stress during pregnancy, so it’s extra important to try to support your body as it grows a baby while exposed to germs!
Before mentioning specific supplements, it’s important to remember that there are some key factors that also play into your overall health. These factors include:
Sufficient, regular sleep: you need ENOUGH sleep to support your body’s needs, and these needs are often increased during pregnancy. Make a habit of going to bed early enough to get the hours of sleep you need! If you’re having trouble sleeping, let your midwife know (I have some suggestions for pregnancy-induced insomnia, so don’t hesitate to reach out!).
Reduce Stress Levels: stress wears your body down, and makes it harder for your immune system work properly.
Eat a healthful, whole-foods diet with lots of variety. If you need information on what a good pregnancy diet looks like, I highly recommend Lily Nichols’ book Real Food For Pregnancy (check out her blog for helpful info, as well: Lily Nichols, RDN)
Stay hydrated: this helps to keep your body flushed and supported.
Add fermented foods to your diet, such as raw sauerkraut, kefir, etc.
Get 15-20 min of direct sunshine daily whenever possible!
Exercise regularly, especially in the fresh air: a 30 min walk outdoors daily is excellent for ALL pregnant moms!
Consider the following supplements daily (check with your prenatal vitamin to determine your needed dosage to reach the recommended levels below):
High Quality Probiotic: it’s no secret that our culture’s frequent antibiotic usage and lack of cultured and fermented foods are contributing to inadequate and/or imbalanced intestinal flora and correlating issues. A good probiotic with multiple different strains can help your body to work the way it should! One that specifically targets Candida overgrowth can be especially helpful in supporting the immune system. Klair Labs and Jarrow are two brands I recommend, but there are many options out there!
Vitamin C (preferably with bioflavonoids) 2000mg daily: this can be split up throughout the day.
Vitamin D34,000IU daily: for best absorption take with a meal containing fat.
Zinc lozenges5-10mg daily: preferably in the form of acetate.
Elderberry1-2TBL daily
When needing extra support (feeling run down, extra or direct exposure to illness, etc.) you may want to add the following to your regimen for 7-10 days:
Gargle with Salt Water 2-3x/day for 15-30 seconds.
Echinacea: 300-500mg dried herb (capsule or tablet) 3x/day or 2.5-5mL of tincture up to 3x/day
The following are some combination immune boosting blends that are wonderful to have on hand for extra immune support (they contain combinations of the above suggestions):
For clients of Gentle Delivery, you know that routine Group B Strep testing is offered to every expectant mom in accordance with the ACOG standards of care. While the pros and cons of testing and subsequent treatment plans are discussed in detail elsewhere, the purpose of this post is to help you to minimize your risk of developing Group B Strep colonization during pregnancy, thus promoting better health for you and baby (and increasing your chances of obtaining a negative test result!).
If you are interested in researching Group B Strep info, I’d strongly encourage you to read Aviva Romm’s article: Group B Strep in Pregnancy: What’s a Mom to do? You’ll find clear explanations of GBS, risks and benefits of antibiotic treatment, and tips on promoting health. This post by Wellness Mama also includes further links for study along with Katie’s suggestions for avoiding GBS colonization with natural methods: How I Avoided GBS Naturally And finally, this article provides a few other options to consider while making decisions on prevention and treatment: Decrease Your Chances of GBS
As a practicing CPM in a state that does not offer licensure, I am currently unable to offer IV antibiotic treatment to GBS+ clients. This increases my desire to do all I can to help support a mom’s immune system and decrease the possibility of a GBS+ test result, as it greatly simplifies the care protocols and necessary decision making for clients and their families!
So here are the primary suggestions for making your vaginal flora inhospitable to Group B Strep:
High Quality Probiotics (if not started early on in pregnancy, then beginning at 28-32 weeks orally, adding vaginal support at 32-34 weeks)
“Many species of Lactobacillus have been shown to be beneficial to the vaginal flora; Lactobacillus reuteri and Lactobacillus rhamnosis are species known to be especially helpful for supporting healthy vaginal (and bladder) flora, while these and others, including L crispatus and L. salivarius strains, have been shown to to inhibit the growth of vaginal pathogens including Gardnerella vaginalis and Candida albicans, and also reducing the frequency of bladder infections in addition to vaginal infection.
In one study, 110 pregnant women at 35-37 weeks of gestation who were diagnosed by GBS culture as being GBS positive for both vaginal and rectal GBS colonization were randomly assigned to be orally treated with two placebo capsules or two probiotic capsules (containing L. rhamnosus and L. reuteri ) before bedtime until delivery. All women were tested for vaginal and rectal GBS colonization again by GBS culture on admission for delivery. Of the 99 who completed the study (49 in the probiotic group and 50 in the placebo group), the GBS colonization results changed from positive to negative in 21 women in the probiotic group (42.9%) and in nine women in the placebo group (18.0%) during this period. The researchers concluded that an oral probiotic containing L. rhamnosus and L. reuteri could reduce the vaginal and rectal GBS colonization rate in pregnant women.
In another study involving 57 healthy pregnant women, L. salivarus was taken daily by the 25 GBS positive women in the group from weeks 26 to 38 of pregnancy. At the end of the trial (week 38), 72% and 68% of the women were GBS-negative in the rectal and vaginal samples, respectively. The researchers concluded that this seemed to be an efficient method to reduce the number of GBS-positive women during pregnancy, decreasing the number of women receiving antibiotic treatment during labor and birth.” (copied from Aviva Romm’s article here)
In light of these studies, and knowing that probiotics are vitally important to the health of both mom and infant for a variety of reasons, supplementing regularly with probiotics during pregnancy can be beneficial in more ways than one. For GBS specific support, it’s recommended that you begin supplementing orally at 28-32 weeks (though earlier is even better!), and then increasing your oral dosage and consider using a probiotic vaginally for at least 2-4 weeks before your Group B Strep test (and then continue the oral support through the rest of your pregnancy).
As you shop for probiotics, pay attention to the different strains it includes, as not all probiotics are created equal, and they will be most effective against GBS strains if it includes L. Rhamnosus, L. Reuteri and L. Salivarus.
Some brand suggestions that other midwives have given me are:
Eating a diet high in fermented foods/drinks (kefir, sauerkraut, kombucha, yogurt, etc.) help to promote a healthy gut flora.
Eliminating sugar and simple carbs are also effective in promoting beneficial gut flora.
Add 1-2 tbl of coconut oil into your daily diet for it’s antibiotic properties, specifically in the few weeks prior to testing.
Apple Cider Vinegar consumed daily or in capsule form may be helpful.
Vitamin C
Consuming 1000-2000mg of high quality vitamin C daily (in divided does) can help to increase your body’s immune response, which makes it more difficult for unhealthy microorganisms to grow. You can begin this regimen around 30 weeks.
Garlic/Allicin (active component of garlic)
Garlic has been used as an antimicrobial agent for generations, and for good reason. However, high doses of garlic can cause blood thinning, so I don’t recommend staying on high doses of garlic or allicin after obtaining your GBS test. But it is a treatment to consider to reduce the possibility of GBS colonization before getting tested. Currently there is a midwife practice conducting a study where participants are instructed to use Allicin Gel 2x daily for 12-14 days along with ingesting 180mg of Allicin capsules 2x daily for 12-14 days prior to testing. The basis for this study is from a preliminary study done in 2009 where Allicin was shown to reduce the possibility of early rupture of membranes and chorioamnionitis, both of which can be complications of GBS infection. Other methods of using garlic include: taking garlic capsules daily, consume raw garlic daily, and/or insert a raw garlic clove vaginally at night before going to bed.
While we still have a lot to learn about Group B Strep (how exactly it is transmitted, best ways to treat it, and how to prevent it from the beginning), and while there still seem to be a few moms who naturally carry Group B Strep bacteria in their vaginal tract no matter what they try to do about it (antibiotic or otherwise!), one of the benefits of utilizing these suggestions is that they promote health for mom and baby regardless of the GBS presence (or lack thereof). While obtaining a negative Group B Strep test does eliminate a certain amount of worry, risk and decisions, the benefit to your body of increasing the good bacteria and gut flora through healthy foods, probiotic supplementation and other factors may provide long-term benefits that you will see later on. I’d highly encourage every pregnant mom to consider these suggestions, and wish each of you a healthy and safe pregnancy and birth!
I’d also love to hear: did you try any of these prevention methods? How did it affect you and your GBS status? Did you test positive in one pregnancy and then negative in another? What was most beneficial for you?
If you’ve followed my blog for long, you’ll know that tongue & lip ties and nursing challenges are a passion of mine, especially after having experienced challenges with all of these factors with several of my own children. I’ve also been in contact with many moms who are struggling with nursing issues or fussy babies, and so many times there is a connection to either a tongue or lip tie (or both!). Recently, a mom shared her story in a Facebook Group for Moms that I’m part of. Her story touches on so many of the factors that I have seen and/or experienced, that I contacted her and asked for her permission to share her post with you all. I am so grateful, as Tanisha covers many factors to consider in her story, and I think it will be beneficial for many moms who might be struggling. If you are struggling with nursing issues, I really want to encourage you that you aren’t alone, and that there are answers out there!! And if you resonate with this story, I would love to hear about your experiences! It can help other moms when they can hear first-hand what worked for others in similar situations.
~Kelsey
Now on to our guest post, written earlier this year by Tanisha Gingerich:
**Shared by the author’s permission**
I thought I’d make a post for whoever it might concern, about our journey sofar with tongue and lip ties. They are becoming increasingly common it seems, and I thought sharing my experience might be a good way to bring awareness so that any other moms going thru something similar can benefit from (or add to) what I’ve been learning.
A week post partum, I was scabbed from nursing, and in a lot of pain every time I fed Micoma. She was gaining well, so we probably could have made it work (a lactation consultant can help you and baby work past a multitude of feeding problems), but I knew from experience that although I could “make it work,” my milk supply was going to tank around 4-6 months. Ties can also cause speech, dental, and sleep issues down the road, along with a host of other problems.
So in the interest of short-term pain for the long-term good, I took Micoma in at a week old for a consultation and ended up getting her lip and tongue ties lasered right away so we could begin the healing and retraining process as soon as possible before bad nursing habits were formed.
I cried and prayed over her before they did the 3 minute procedure, and sobbed compulsively while they swaddled her and used a laser to cut the ties open. The woman doing the procedure was a mom too, and was so compassionate and kind with Micoma. Then they left us alone in a cozy room to nurse, and I heaved more sobs as I comforted my baby. Being able to hold and nurse her was probably just as healing for me as it was for her.
Her latch was instantly better. Over the next few days I had to continually remind myself of the long term good, as I did stretches on her wounds. To my relief, the stretches were done in under 30 seconds, and Micoma always recovered quickly… I soon realized she was screaming louder over getting her diaper changed than she was over the oral invasion, so that made me feel better. I told her all the time how brave she was, and gave her every comfort to guide her through the rough patch.
That first week dragged on for me. I hated having to keep stretches in my mind every 4-6 hours even thru the night—got kind of sick with dread thinking about it. I kept Micoma on Tylenol the first 2 days, and again on day 4 when there was a flare up of discomfort. Other than that though, she continued to eat and sleep very normally (not everyone has it so easy, some babies will hardly eat for a day or two, and cry all the time. Thankfully Micoma nursed for comfort, and seemed to tolerate gracefully any discomfort she was feeling). At one week we had a follow up appointment and they said everything was healing well and there was no reattachment. I was so relieved.
By the second week all was routine, and the scars were nearly healed up. Sometimes she wouldn’t even wake up when I did the stretches so I knew they weren’t painful. Currently we have just passed the 3 week mark, which means I can de-escalate the stretches rapidly and they will disappear in a few days. Hooray! One hurdle over. Now on to the next. I had a lactation consultant come at week 3, to help me teach Micoma new nursing/sucking habits. I learned so much!
First of all, babies begin practicing how to suck from week 12 in utero. This is how they build the oral strength they need for nursing. Unfortunately, when a part of their tongue is tied down, they are unable to fully lift and tone those muscles. When they are born and begin nursing, the restrictions to their lip and or/tongue, make it hard or impossible for them to latch correctly or suck efficiently. As a result, nursing is laborious for them. You may hear a “clicking” noise or notice milk dribbling out the sides of their mouth, these are telltale signs. They frequently fall asleep while nursing, just from the strain it, and are unable to properly empty the breast. This can obviously cause low-weight issues, milk supply issues, and severe frustration to the baby. The baby will often resort to chomping or some other measure in an attempt to get milk, resulting it a lot of discomfort or pain for the mom.
But even after ties are released, there is still some work to do. Baby’s latch will probably be better right away, but you’ll need to help hertone her oral muscles and relearn how to suck correctly with the new range of motion in her mouth. I was given a series of simple tongue exercises to do with Micoma every day… they are more like games, and activate her reflexes to get her tongue moving, especially in the places she’s not used to lifting it.
Now, to back up a bit, there are two kinds of ties—lip ties and tongue ties. I’ve also heard of buchal ties (cheeks) but know very little about them at this point. A lip tie is easiest to spot (example of one in comments) and if a lip tie is present, a tongue tie is almost always present too—they tend to go hand in hand. Keep in mind that some care providers are not trained to look for *posterior* tongue ties (these are in the back of the mouth and not as obvious as anterior ones), so those often get missed. Ties vary in severity (where they are attached and how drastically they are affecting function of the lip/tongue. Sometimes it may be negligible).
Next thing I learned, tongue tied babies are notoriously “tight.” The tongue sits at the very top of the spine, and if there are restrictions in the tongue, you will see restrictions all the way down through the body. Sure enough, Micoma is very tight in her shoulder/neck area, has over compensated for it in her lower back, and has tight hips. Once again, I was given a series of simple rhythmic motions and stretches to loosen those areas up and bring everything into alignment. She has a bit of a “C” shape curve when she lies down, that’s another common sign of tongue-tie related tightness. (Pic in comments) I wish I would have known this with my oldest daughter Verona. She was incredibly C-shaped, and these stretches would have loosened up her uncomfortably tight muscles.
Looking back, both of my children before Micoma had ties of some kind. I always had to use a nipple shield with Verona, and I remember Benny getting so angry when I nursed him. My supply going down around 4 months was another telltale sign. Both children despised tummy time, which was most likely because of how tight they were in their neck and lower back. I suspect “ties” is some of why they slept so poorly and aggravated colic symptoms early on… In-efficient nursing brings more air into the stomach and causes gas discomfort/excessive spitting up. And in a very strange twist of fate, if the tongue cannot reach up to the top of the pallet and rest there while sleeping, the top of the mouth becomes domed, crowding teeth and restricting airway. This can lead to mouth breathing, sleep apnea, and dental issues.
Verona’s lip tie comes all the way down between her teeth, which is why she has a gap between her front teeth. Neither of the children seem to be having difficulty eating, speaking, or maintaining good dental hygiene and structure other than that. So I’ll just keep an eye on them, and only resort to doing anything about theirs at this point if I see it’s going to cause them major problems down the road. But I do grieve the suffering we all went thru with months of screaming colicky baby, and the eventual loss of breastfeeding bond. That pain far surpasses whatever me and Micoma went through the last month in laser-correction and recovery.
So for that reason, I would support moms in pursuing tie-releases if you feel it would be beneficial for your baby. As with everything child-related, there is controversy surrounding the issue—whether ties are really a thing, whether they’re a big deal, clipping or lasering, stretches or no stretches. In my case, I saw enough consequences in my last 2 children that I was willing to believe ties affect quality of life enough to warrant a minor surgery. Lasering has a lower rate of re-attachment and requires no stitches, so I went that route. And the stretches I did because Micoma tolerated them well and I was determined not to let the fibers re-attach while they were healing… and I grilled my caretaker about whether it was necessary, and she says she does see a fairly high rate of reattachment if stretches are not done. Albeit, I did the bare minimum I thought I could be get by with, and with good results. That was my story, you get to write your own. Decide what’s best for your child, whether that’s therapy to work past a tie, or a surgery to correct it, or whatever and don’t let people throw a lot of shame or fear onto you for it.
Currently I am pumping a few times a day and using an SNS (supplemental nursing system) several times a day to stimulate my supply and simultaneously get Micoma the extra food she sometimes can’t get herself. I’ll keep working with Micoma’s body and tongue to get everything loosened up and toned… hopefully within a month we’ll be at a place where she can keep my supply up on her own. In the mean time we’re not goning to go many places this month, just stay home and focus on the task at hand.
Many people take their children to chiropractors pre and/or post tie release for body work. It helps with nursing if your baby is aligned properly. For the time being, since I have bodywork I can do at home with her, I am skipping that… see if I can get by without it. Cranial Sacral therapy is another thing highly recommended… I don’t know, it could possibly be a legitimate thing with babies since their skulls are still un-fused and somewhat mobile, but I have heard of enough occultist ties connected to this practice done in adults that I plan to avoid it all together.
This post was not meant to diagnose or treat any illness. It’s my personal story and some things I learned along the way, left here for people to sift thru and take whatever is for them.
If, btw, you decide lasering is the right option for you (and you are local to central PA), I had a good experience with Dr. Katherman in York. Her office felt like such a warm and caring place to me, and she was on call at all hours if I had questions later. Also, do yourself a favor and hire a lactation consultant. You won’t regret it! Do a bit of research first and find one that people you know have had good experiences with (there are a few bad eggs out there). Again, I had a wonderful experience with the one I found, and I’ll link her website for reference.
The cost to get two ties lasered was $750. I am going to turn it into my insurance sharing plan, but I do not know yet if they will cover it. The lactation consultant fee for an hour and a half session was $175. So it is a good chunk of change. But when compared to the potential costs of not doing it, it is a very reasonable investment.
I hope that’s everything. My mind is still kind of whirling from all the things I’m learning, so this was my way of processing it. Hoping it will be helpful to someone else.
P.S. Out of curiosity, I asked both the doctor and lactation consultant if ties have become more common recently or if they’re just being diagnosed more, so we’re more aware of them. They both said ties are becoming increasingly common. I don’t think even my mom’s generation would have seen very many, so this seems to be a rapidly developing problem. Presumably, Western diet and lifestyle as well as the declining quality of foods (grown from nutrient-depleted soils) plays a role. There seems to be evidence to support that lack of folate and other B vitamins in the early stages of embryonic development contributes to ties forming—or the presence of the synthetic B vitamin folic acid commonly in prenatals and fortified foods. And others say there are indications that genetic mutations (the MTHFR gene) play a role. But no definitive studies have been done, that I know of. Everything is speculation at this point. Someone gave me two articles so I’m linking them below. My midwife gave me some resources to dig into and I’m hoping to do more research to see if this plague is avoidable.
I maintain a decently healthy diet and take quality supplements including methylated B vitamins so it’s hard to believe that was the cause of all 3 children having ties. Except that I was under exponential stress the past few years, and as I understand it B vitamins are created in the gut… if you have bad gut health or are under stress, B vitamins do not form well. So that could be a factor. Like I said, I’m going to keep digging and see what answers I can find.
Proactive Preparation Tips: Helping You Achieve a Successful Vaginal Birth
If you’ve read much about preparing for birth, you probably have realized that there tends to be two different “extremes” when it comes to how much or how little you do to prepare your body for the marathon of birth. On the one hand, there are those who feel strongly that you need to “trust your body” to do what it was made to do, and that the addition of herbs and other proactive methods give moms a sense that their body is broken and unable to work on it’s own. The other hand tends to view the whole process of labor and birth as an “accident waiting to happen”, and rushes to medicalize every situation (for example, routinely inducing labor at 41 weeks just because it’s a week past your due date).
My personal opinion (and take this as my opinion-as with anything, you must do your own research and make your own decisions about these suggestions!), is that there should be a balance between these two extremes. I feel strongly that a women’s body was designed to grow, nourish, carry and deliver a baby, and that you can have confidence that this a totally normal and natural process (and not a medical emergency!). But just like any other capabilities your body may have, these abilities can be supported, enhanced and enabled to do their job more efficiently, smoothly and successfully. With that mindset, I’m going to share with you some suggestions on how to support and prepare your body in order to provide you with a greater possibility of achieving a low-risk, normal, natural vaginal birth.
Some of the biggest factors that arise that prevent moms from their desired birth outcome include: pain in pregnancy that prevent them from moving well at the end of pregnancy, going so far past your due date that your care provider feels like an induction is necessary, a long early phase of labor that prevents mom from getting adequate rest and results in exhaustion (which often ends in transport from home and/or an epidural to provide needed relaxation), and a long pushing period that sometimes ends in surgical or assisted delivery. While there are varying factors in all of these situations that can all be prevented, there are MANY things you can do to reduce your risk of these situations occurring, if you just know what to be aware of and how to help your body to prepare!
Movement, Alignment and Positioning:
One key factor that makes a difference in your pregnancy comfort level, baby’s ability to descend efficiently, and your overall length of pregnancy/labor is the position of your baby in relation to your pelvis. I highly recommend you find a good chiropractor in your area (for those who are local you can find some recommendations when you click on the “Local Resources” tab) who is certified in Webster technique and works with pregnant moms, and get regular adjustments specifically throughout the last 6 weeks of pregnancy. If your pelvis and muscles are out of alignment, they can keep baby from being able to descend into a position that is optimal for triggering the start of labor, and the ability of the baby to navigate the birth canal, which can then cause labor to stall and/or make it more challenging for you during the pushing phase.
For the best explanation of position and how this can affect labor (and what you can do about it!), I highly recommend that you take the time to watch the Parent Class taught by Gail Tully at Spinning Babies. Once you’ve watched it, check out the Spinning Babies website for more tips and suggestions on optimizing your baby’s position. And finally, if you are getting near your due date (or are past your due date and are waiting for baby!), taking time to complete a few rounds of the Miles Circuit exercises has been shown to improve baby’s position and encourage labor to happen.
Exercise:
As they say, you don’t decide to run a marathon and then complete it tomorrow! I think it’s wise to go into labor with a similar mindset as one would in preparing for a long-distance athletic event. Regular exercises that help to strengthen your legs, open your pelvis (think deep squats and lunges) and build your stamina can play a role in encouraging baby to come in good time, helping to improve your ability to handle the rigors of labor and provide you with a much better recovery. Even if you’re only able to include ten minutes of purposeful exercise a day, it will give you great benefits. Here’s one to get you started: 10 Minute Pregnancy Workout. Long, brisk walks and swimming are also great exercises to consider including in yoaur routine.
Herbal Supplements:
Red Raspberry Leaf Tea has amazing health benefits, besides helping to prepare and tone your uterus making contractions more efficient. I have more information on this great tea in my post over here, and you can begin drinking one cup a day during the 2nd trimester, increasing to 3+ cups per day as you near your due date.
Birth Preparation Formula: I have personally had great success taking an herbal supplement during the last 5-6 weeks of my pregnancies that is specifically geared towards preparing your uterus and cervix for labor. Yes, I take it in addition to Red Raspberry Leaf tea. If you have a history of preterm birth, you would want to wait to start this until 36 weeks, and on the flip side, if you tend to go way past your due date, you could begin taking it at 34 weeks up until delivery. The moms that I have had take this tend to have shorter labors, earlier deliveries, and minimal postpartum bleeding (myself included!). There are several different brands available, though I tend to think the tincture forms work the best. My all-time favorite is the Gentle Birth Formula. You will need 4 to 6oz in order to take it daily for 5-6 weeks, and it’s best to not consume the tincture in the late afternoon/evening, as it can cause contractions that may prevent you from sleeping!
Evening Primrose Oil or Borage Oil: The high GLA content in either of these oils can help to soften and prepare your cervix for labor, which can assist the body in working more efficiently once labor actually begins. You want a “mega” gel-cap with 1000mg or more per capsule, and this can be taken orally every day for the last trimester, and then also inserted vaginally at bedtime during the last few weeks of pregnancy.
Abdominal Support:
Some moms just need some extra support for their abdominal muscles, especially if they have had a few babies, or if their babies tend to be large. The muscles that support the uterus and help it to contract efficiently can become stretched (think of a rubberband that has been completely stretched out, and doesn’t quite return to “normal”), and are unable to “hug” baby enough to get a consistent labor pattern started, or even get baby low enough to obtain a good position to begin with! One way to work with this is to consider regularly providing your uterus with support, in particularly during the last 6-8 weeks of pregnancy. You can purchase a maternity support belt (Belly Bandit has some great, albeit expensive options), but many women find that using a rebozo or long scarf/piece of scarf works great, such as is illustrated in this post here and another option here. The goal is to pull the uterus slightly up and towards you, mimicking the way your muscles naturally pull, with provides a firm, consistent support (which also relieves pressure from your back!).
Eating Dates!
The benefit of consuming dates during the last weeks of pregnancy has only recently been discovered. The suggested protocol is to eat 4-6 dates daily beginning around 36 weeks until you deliver. To find out more, you can check out the details of a recent study at Evidence Based Birth and see what Mama Natural has to say here.
With the exception of eating dates (this is newer option I’ve discovered!), I have personally tried all of the above suggestions for my own five pregnancies and births, and have seen many women successfully use these recommendations throughout my midwifery practice over the past 11+ years. I wish I would have known about many of these earlier in my practice, as I think it would have prevented more transfers and unnecessarily lengthy labors. Another side benefit to following these suggestions is that your body is that much more prepared and ready should an induction actually be medically indicated. While I rarely have reason to need to get labor started, when there is this need and the body is ready for labor, then there are many more options available that have a high likelihood of actually working (in case you’re wondering, one method many midwives use is the Midwife’s Brew, but you should never attempt this without discussing the details, risk vs. benefit, etc. with your care provider!). And if you end up needing a hospitalized induction, the above suggestions will also increase the chances that you end up with a successful induction and normal vaginal birth.
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):
With the COVID-19 crisis in full swing, it can be hard to know where to go for good information. As a midwife wanting to give my clients the best, up-to-date, evidenced based care as possible, I have found it extremely challenging to navigate all the information being thrown around as everyone scrambles to learn what they can about this new virus. Even information from reputable sources can contradict each other, leaving one’s head spinning, and making you unsure of what measures should be taken to protect your clients and your loved ones from any unnecessary exposure, while also caring for the emotional and physical needs of expectant moms! I’m sure you’re probably in a similar boat, so I’m wanting to make available some information sources for you as you try to understand how the current crisis may or may not affect you, your baby, your care, and your birth.
While information is changing on a day-to-day basis, I am currently implementing the following changes to my practice in order to minimize risk for my current clients, and enable safe midwifery care to continue in my community:
I am available to answer any questions clients might have via email or phone/text at any time.
Pushing prenatal visits further apart to minimize person-to-person contact.
Practicing social distancing and limited exposure for myself and my family, and not seeing any clients if myself or one of my family members are sick.
I will be performing April prenatal visits in client’s homes to reduce the risk of transmission or exposure. My current client load is light as I am just coming off of maternity leave, so this feels like the best option as I look into ways to make my home office space more practical for office visits due to the stringent recommended disinfectant protocols.
I am not taking on new (non-repeat) and/or long distance clients during April. I hope to resume new client consults and prenatals in May, but will base this on information as it becomes available, as well as on how able I am to handle the extra time needed to maintain the possible new protocols, etc. Having to unexpectedly homeschool two children this month, as well as juggling the demands of a nursing infant (and trying to understand what risk there could be to her health) all combine to make my days extra full right now, without adding in the hours of research needed to stay on top of current medical news!
If you are just beginning to look into the option of homebirth due to concerns with exposure at the hospital, I would suggest you begin by reading these two links:
I am also asking clients to follow these guidelines:
Please reschedule your visit if you or one of your family members are experiencing any of the typical Corona symptoms, including:
Fever
Coughing
Shortness of breath
And remember that Covid-19 care is outside of the scope of practice for your midwife to advise you on, so please contact the proper medical authorities if you suspect you may have contracted it!
Try to limit your exposure to illness by practicing safe social distancing from ill persons, and practicing good hygiene and hand washing.
Due to the unknown severity of respiratory complications for both mom and infant, a home birth will be out of the question if you test positive for COVID-19 over the time you are in labor.
Realize that there may be some changes in birth practices as more information and studies become available, so feel free to reach out with any questions, and stay tuned as I continue to research and keep you up to date on current research and practice guidelines/changes. Some of these changes may include restrictions on children attending prenatal appointments, amount of people in attendance at your birth, etc. As time goes by, I hope to have more concrete information to guide our practice protocols for the safety of everyone.
I would also strongly encourage all expectant moms to do what you can to boost your body’s (and your family’s!) natural ability to fight any virus (there are other illnesses out there you don’t want to catch, as well!). I don’t think we need to just sit back and hope we don’t get sick-you can be proactive in assisting your body in being able to resist and fight illness right now. There are some great resources available that help you to consider how healthy eating (low sugar, lots of whole foods) combined with adding some immune-boosting supplements (such as high-quality vitamin C, regular vitamin D, probiotics and others) and regular exercise can help you and your family to stay healthy and strong. Here are some resources to get you started in thinking about the possibilities:
If you’re interested on hearing additional perspective on the crisis from a well-known, more “naturally minded” pediatrician, then you may appreciate Dr. Sear’s podcast series: Coronavirus Update: Are We Doing it Right? Pt. 1
And finally, some practical ways to help you handle the extra challenges from social distancing right now, tips on reducing anxiety, and helps in understanding more about the virus: COPE Updates on Covid-19
If you have found a source to be especially helpful as you navigate the news surrounding Covid-19, I’d love to hear about it. And if you are in a different area, I’d love to hear how your midwife/care provider is implementing changes to their practices. Blessings to all of you expectant mamas navigating this new territory during this time in your life-I know it’s a challenge, and I am committed to continuing to provide you with personal, safe, gentle midwifery care!
Gentle Delivery Midwifery Services (Centre Co. PA) 