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Proactive Preparation Tips: Helping You Achieve a Successful Vaginal Birth
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Proactive Preparation Tips: Helping You Achieve a Successful Vaginal Birth

Proactive Preparation

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.

Understanding Gestational Diabetes (and your testing options)
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Understanding Gestational Diabetes (and your testing options)

GDM

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:

Ÿ Increased risk of developing Pre-eclampsia

Ÿ Increased risk of developing Type 2 Diabetes

Ÿ Maternal injury

Ÿ Increased risk of Cesarean section

Ÿ Shoulder dystocia

Ÿ Macrosomia (infant weight over 8lb 13 oz)

Ÿ Neonatal hypoglycemia

Ÿ Neonatal jaundice

Ÿ Stillbirth

Ÿ NICU stay

Ÿ Birth injury

Predisposing Risk Factors can include:

Ÿ Pre-pregnancy BMI >25

Ÿ Family history of diabetes

Ÿ GDM in previous pregnancy

Ÿ Polycystic Ovarian Syndrome (PCOS)

Ÿ Chronic hypertension

Ÿ Maternal age over 25

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

ŸPrevious macrosomic infant

Ÿ History of Cardiovascular disease

ŸPoor nutrition

Potential Signs and Symptoms of GDM:

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

Ÿ Polyuria (excessive urinary output)

Ÿ Polydipsia (extreme thirst)

Ÿ Weakness

Ÿ Poor healing/susceptibility to infections

Ÿ Size large for dates

Ÿ Recurrent glucose in urine

Ÿ Recurrent yeast infections

Ÿ Ketones in urine

Ÿ Excessive weight gain

Ÿ Polyhydramnios (excessive amniotic fluid)

Ÿ 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! 

Resources and Info on COVID-19: Links, Practice Changes, Recommendations & More
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Resources and Info on COVID-19: Links, Practice Changes, Recommendations & More

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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.

Here are some links that I have found helpful:

Aviva Romm Series on Covid-19 Info

WHO info for Pregnant and Nursing Mothers

National Association of Certified Professional Midwives: Covid-19

WHO Info-graphs

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:

Advice from a Pediatrician

Aviva Romm on Natural Remedies

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!

 

Pregnancy Health: Red Raspberry Leaf Tea
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Pregnancy Health: Red Raspberry Leaf Tea

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For a bit of a different post this month, I’m passing on one of my favorite ways to drink Red Raspberry Leaf Tea. Perhaps you’ve heard of this “women’s health” herb-there are seriously so many reasons why you should be consuming Red Raspberry Leaf on a regular basis, even when you’re not pregnant! It’s high in minerals and vitamins that your body needs, and has the added benefit during pregnancy of helping to tone and prepare your uterus in preparation for labor. In light of this fact, it’s wise to avoid this herb during the first trimester, as that is one season in which your uterus needs no extra stimulation. But once you reach the second trimester, I highly recommend making this supplement part of your daily routine. You can receive benefits by taking this herb in capsule or tincture form, but tea form is a great way to get the maximum benefit out of this particular herb.

If you’re wanting to learn more about the benefits of Red Raspberry Leaf, here are some great resources to check out:

One of the downsides to this tea, though, is that it doesn’t remotely taste like raspberry! And if yours does, the you’re drinking the wrong thing! If I drink red raspberry leaf tea straight, it doesn’t take long to be turned off-which is why today I’m sharing with you my favorite way to make it. If you have a favorite method, share it in the comments below so we can benefit from it, too!

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First, gather your ingredients:

  • Organic Cut & Sifted Red Raspberry Leaves (I use Frontier Co-op brand that I purchased through Amazon)
  • Raspberry Zinger Herbal Tea Bags from Celestial Seasonings
  • Lemon
  • Stevia or your choice of sweetener (honey also works)-pictured above is the NuNaturals Pure Extract Stevia that I use.
  • Purified Water

Fill a small pot with about 4 c. of purified water, bring to a boil. Turn off and add your tea: I like to use several re-usable tea strainers, that I fill with Red Raspberry leaves. For one batch, I use about 1/3c. total of loose leaves. Then I add four bags of Raspberry Zinger tea, to help improve the flavor. Stir this around, then cover and let steep for about 20-30 min.

Pour your concentrated tea into a glass pitcher (about a half gallon), and add the juice of half a lemon. Next, add a few dashes of stevia or other sweetener to taste. Fill the rest of your pitcher with purified water, and let sit until cool. Pour over ice, and enjoy! I store this in the fridge, and drink it cold, and I can consume so much more tea this way. Even my children love it!

Preparing Well for Postpartum Recovery
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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!

Miscarriage Questions: 10 Year Anniversary Interview Part 3
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Miscarriage Questions: 10 Year Anniversary Interview Part 3

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Interview Pt 3: Miscarriage

This month I’m continuing to answer questions that were submitted by readers for Gentle Delivery’s 10th anniversary “ask the midwife” series (feel free to check out Part One and Part Two if you haven’t read them yet!) There were several questions asking about miscarriage and how that affects future care, and I’ve decided to make that the focus for this month. Sadly, miscarriage is a reality for many moms, and I’ve had more moms than usual experience miscarriage throughout this past year. Hopefully some of these suggestions and this information can be a blessing to those of you walking through this valley, or those of you wondering what happens next…

What is your approach when a client has a miscarriage? What do you say or do to help her through the process, and if she gets pregnant again later, does your prenatal care for her and the baby look different in any way?

This is one of the “flipsides” of midwifery practice…it’s not always dealing with excitement and new babies. Oftentimes miscarriage occurs “out of the blue”, and usually there is no obvious explanation, even though we usually wish we knew why, or what happened.

Typically, a client will have just been in touch to let me know that they are excited to set up a time to talk about homebirth (or resume care if they were a previous client), and then they let me know that they are having some spotting. Spotting in and of itself can indicate an impending miscarriage, or it can be indicative of an irritated cervix, or it can be sign of a “subchorionic hematoma” (which usually results in spotting/bleeding without harming the baby, and resolves on its own). Quite honestly, if a miscarriage is going to occur, there really isn’t much that you can do, as oftentimes if it is indeed going to progress into a miscarriage then the baby has already died by the point you are experiencing spotting. But the unknown is not easy, as you want to KNOW what is going on. Our options at this point include doing labwork to see where the progesterone and Hcg levels are by now and going in to an OBGYN or an ER for an ultrasound (usually this is a vaginal ultrasound in order to get the best look at the uterus in early pregnancy). If the mom is 5 or 6 weeks or more, they should be able to visualize the baby, and be able to tell if the heart is beating, and labwork can reveal whether the pregnancy hormones are continuing to increase as they should. If mom prefers to wait, then there are some herbs that can be taken, and some moms choose to also use progesterone cream to help support the body until we know for sure what is going on.

If the ultrasound or labwork shows that miscarriage is inevitable, then I try to offer support and encouragement while the mom walks through the next several days. In most cases, mom is able to pass the baby on her own, and we stay in touch via phone or email. Spotting usually progresses into bleeding, and cramps accompany the bleeding as the cervix dilates enough to pass everything, which typically happens within a week of the initial spotting. In the event that it takes a longer amount of time, then we can use herbs to help encourage things to move along, we closely monitor for infection, and occasionally we need to transfer to an OBGYN for further care.

Once a miscarriage has taken place, I really encourage moms to take it easy, and make sure that they give their body time to heal both physically and emotionally. Oftentimes a mom can be left feeling very tired and anemic, as the body usually loses a significant amount of blood, and the intensity of labor can leave her worn out. There is also the emotional side of processing the loss, and this combined with the hormonal swings that go along with pregnancy followed by delivery can create quite a roller coaster of emotions to work with, and mom needs to know that this is normal and okay…and that her body is grieving and adjusting, which takes time!

The good news is that a previous miscarriage in and of itself does not negatively affect care for a future pregnancy. As I mentioned before, we usually don’t know what the root cause was, but there are many moms who go on to carry a healthy pregnancy following a miscarriage. Sometimes it can help a mom to relax more if she has more frequent monitoring during the early weeks of pregnancy after a miscarriage, and I am glad to do progesterone and Hcg testing to make sure that these levels are increasing like they should during the initial weeks. Oftentimes these moms also want to get an ultrasound performed earlier, in order to know that everything is looking good and that baby is growing like he should. Other than these factors, there isn’t much different for prenatal care, unless a mom has had several miscarriages in a row.

If a mom has had several repeat miscarriages, I highly recommend consulting with a NaPro Fertility Specialist (these providers concentrate on helping to achieve and maintain correct hormonal balance in order to prepare a mom’s body for and help in maintaining pregnancy). Many moms have inadequate progesterone levels, and having a specialist helping to monitor levels and provide prescription strength progesterone when needed can be a tremendous blessing, and prevent the trauma of further losses.

In closing, here are some suggestions if you are walking through a miscarriage:

  • Drink red raspberry leaf tea frequently in order to help balance your hormones and increase your iron as you recover (although stop drinking if you become pregnant again, until you reach the second trimester).
  • Take Evening Primrose Oil to help regulate hormones and support the body.
  • Consider taking an herbal-based iron supplement for several weeks to help restore your iron levels.
  • Take time to rest, don’t push yourself too hard, drink a lot of fluid, and take time to reflect on the short life you were given to carry, and allow yourself time to recuperate and heal before trying to resume your normal responsibilities.
  • Check out these sites that have further tips: Healing After Miscarriage and Healing Naturally.

And if you are preparing for pregnancy following a miscarriage, here are some ways to support your body:

  • Take folate (not synthetic folic acid!) and methylated B vitamins regularly.
  • Start taking a high-quality plant-based (not synthetic!) prenatal vitamin to build your body’s supply of needed vitamins and minerals.
  • Look into the benefits of using a quality, natural based over-the-counter progesterone cream to help promote healthy progesterone levels.
  • Consider having some herbal tincture on hand (such as C & B formula from Mountain Meadow Herbs) that you could take at the first sign of any cramping or spotting-this tincture helps to calm the uterus.
  • Check out this blog post for more practical tips: Preventing Miscarriage

In closing, would you have any suggestions you would add? If you have experienced a miscarriage, what was the best information and advice you were given? Any suggestions for moms hoping to get pregnant soon after going through a loss? I’d love to hear your answers if you would be willing to share!

 

Natural & Nutritious Formula Options: Resources & Info for Families Needing a Healthy Alternative to Breastmilk
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Natural & Nutritious Formula Options: Resources & Info for Families Needing a Healthy Alternative to Breastmilk

Before I had children, I would have said that breastmilk is the absolute best choice for feeding a baby, and that a mom should try everything possible to breastfeed…and that if you tried hard enough, you would be able to succeed. However, once I entered the realm of motherhood, and actually experienced the things I had only previously read/observed/seen, I have learned that ideals are not always reality. My youngest baby just turned 10 months old, and I have once again faced the challenges of tongue-ties, latch issues, lack of sufficient supply, colic, fussiness, food sensitives, and more. Some of those subjects will be material for future posts, but I mention them to give you the background as to what inspired this post. As we have worked through these challenges, my husband has encouraged me that perhaps the things we learned will benefit others, so this is an attempt to do just that!

If you’ve struggled with nursing challenges, you totally understand the emotional roller coaster that is included. For some reason, the inability to feed and nurture your baby via the way in which you were designed to nourish him cuts deeply into our mother-hearts. As we tried one thing after another, I also felt like I was mourning a loss…I WANTED to nurse my baby, and I wanted to feed him the best, and know that I was nurturing him both emotionally and physically. I mean, breast milk is the best, right?!? And on top of those emotions (and who is not hormonal and emotional when you have a baby, aren’t sleeping, and are worried about your baby’s health?!?), there are all the questions about what to do, and if you’re going to supplement, what are you going to use??

This is where I want to help! While I know it can take a while before you can look at your situation objectively, there ARE other options available by which you can feed your baby and know that you are giving him something that is actually going to help him thrive and will meet his nutritional needs. I think that moms in the midst of feeding challenges have enough on their plates that they don’t need to add sorting through all the supplement information on top of it. My hope is that I can give you some pointers, and put some information at your fingertips in order to simplify your quest to figure out what is best for you and your baby.

As I spent time researching different options available, here are the three categories that I would recommend checking out:

  1. Weston Price Foundation Home-Made Formula: (find info here) This is what I used with my second child, who had similar nursing challenges and needed to supplement. At the time of his baby-hood, we lived in a rural area and had access to organic, raw milk from a dairy I trusted. He did really, really well on this formula, and I liked the fact that I knew exactly what was in it, and that it was REAL food. It took a bit to get the rhythm down and purchase all the ingredients, but once the pantry was stocked it didn’t take long to whip it up, and was actually a low-cost option long term. When he reached 6 months he used this formula exclusively until he was eating table foods, and was healthy and happy.  Once I used this, I figured my quest for a good supplement was over, but I didn’t count on the individual baby involved! My current baby could not tolerate it made with the milk I had available, and was also unable to tolerate it when made with goats milk. So the research continued as I tried to figure out how to help THIS baby and his own personal needs…
  2. Mt. Capra Goat Formula: (Info here) As I was continuing to research my options, I came across a number of recommendations for this formula. While it is not made using raw milk, you still assemble it yourself according to a specific recipe, thus allowing you to know exactly what it is in it, and still sticking close to the “real food” ideal. There is a kit available to simplify the process of acquiring all the ingredients, and the Mt. Capra website supplies high quality resources. After my baby didn’t tolerate the goat’s milk, I decided against the investment needed to try this, but it still looks like a really good, healthful option, and I’ve heard that there are many happy, thriving babies using this formula!
  3. European Formulas: I eventually stumbled across the realm of imported baby formulas from Europe. I’ll warn you, they aren’t cheap. And they are powered (that part still bugs me if I think about it long-what about feeding your children REAL food?!?). But they have been a literal answer to prayer for me and this baby. One of my big objections to using traditional formula is the fact that most of them are sweetened using corn syrup solids. Corn syrup!?!? We don’t even eat that ourselves, so why would I feed it to my little baby? And then there are the issues of soy, additives, and the list goes on. So I was amazed when I realized that there are several options of formula available that are made from organic milk, sweetened with lactose, have pre/probiotics, and are soy free. Instead of repeating information about these formulas myself, I’m going to include some links where you can see the brands available, along with their features and ingredients:

I will admit, too, that while powdered formula might not fit my ideal, it has been a helpful simplification to our life! My baby actually really liked the taste, and I happily observed that his diapers were hardly different in texture/smell than the usual breastmilk diapers. At 10 months (he started using formula exclusively at 7 months) he is a solid little guy that is SO much happier than he was before. There are several different suppliers in the US, and I have been happy purchasing from www.buyorganicformula.com.  Their customer service has been excellent, and my order always arrives promptly, and I’d highly recommend checking out their site. If you sign up for their mailing list, they will frequently send you coupon codes that can be quite helpful!

My happy fellow at 9 months!

My hope is that my experience and time spent searching can help to lift the load for another mom wading through her options! May you be encouraged today, and remember that you can still have a special bond with your baby AND know that you are meeting his/her nutritional needs even if you need do it in a different way than nursing.

I’d love to hear your thoughts-and what worked for you. Please feel free to comment with your own resources, experiences, stories and information-it’s great when we can help each other this way. Thanks for your contribution!

Postpartum Home Visit in Pictures
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Postpartum Home Visit in Pictures

In January, I received a request from a photo-journalism student at Penn State, who wondered if she could photograph me and some “cute babies” for a project. The day after she emailed, little Brielle made her appearance, and Brielle’s family graciously gave permission for Baidi to join us at their home for the second half of their home postpartum visit. Baidi was absolutely tickled to get to see a brand new baby, and gave us all the gift of numerous photos of our time together. For those of you who have wondered what a typical postpartum visit looks like, here’s your peek!

Generally, this visit takes place sometime between 24-48 hours after delivery, as the required tests need to be performed during this window. First mom gets attention, and we talk about how things are going, any issues/concerns, and make sure her physical condition is within normal limits. Then mom or dad checks over the birth certificate info I bring (double checking spelling and any details) while baby gets checked over.

If baby is happy, we start with the pulse oximeter screening for congenital heart defects, a newer requirement in PA for all babies.

Then comes an exam, where baby’s heart rate & respirations are listened to, skin/cord/eye condition are noted, and overall condition is assessed.

Next, baby is weighed in preparation for the newborn metabolic screening (current weight must be listed along with birth weight). Here you can see daddy holding the baby while the blood samples are collected-our hope is to keep the baby feeling safe & secure throughout the experience!

Lastly, baby is snuggled and we go over any other questions or concerns. All the necessary paperwork is gone over and a copy of the newborn exam and newborn screen info is given to the parents for their pediatrician. And all of this without the family needing to leave their own home!

A big thank you to Kelly, Daniel & Brielle for their willingness to share this experience with  you!

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And thank you to Baidi for your great photos!

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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!

Is Homebirth the Right Option for Me?
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Is Homebirth the Right Option for Me?

As a midwife providing home birth services, I hear this question frequently. It is my goal to provide families with the information they need in order to make the right decision for them-home birth is not for everyone, just like hospital birth is not for everyone! Ultimately, the choice of where to give birth and which care provider to use is the responsibility of the parents seeking such services, and it’s my desire to assist you by providing accurate information that can assist you in making this decision.

Since this question is one of the foundations of whether or not to pursue working with a midwife and planning towards a home birth, I thought it might be helpful to provide links and resources that may help you in determining the answer to this question. As always, I am happy to sit down and talk with anyone who wants to ask specific questions and discuss their options in person, but I know that many of you would like to gather some more detailed information before a formal meeting. Thanks to the availability of information via the internet, great books, educational videos and more, there are many resources that you can access to learn about the potential risks and potential benefits of midwifery care, and specifically the home birth option.

FILMS & DOCUMENTARIES:

  • Why Not Home? The Surprising Birth Choices of Doctors and Nurses: This is THE current film on home birth and why some families make this choice…and this film in now available to watch online and/or be purchased for home viewing! From the description on the website: Why would doctors who attend birth in hospitals choose to have their own babies at home? What do they know about birth that others don’t? Join Jessicca Moore, filmmaker and nurse practitioner, on a compelling journey through maternity care in the United States. Told through the lens of doctors, nurses, and midwives, Why Not Home? examines the latest evidence on risks and rewards of different birth settings. The film presents a balanced and accessible view on the latest research, along with moving personal stories of medical practitioners faced with big decisions for their own growing families. Viewers are challenged to move beyond preconceived ideas, and to envision a fresh future for maternity care in America. Watch it here.
  • The Business of Being Born: This film has been out for a number of years now, but it still contains some great information on birth choices, interventions, birth locations and more. You can watch it free on youtube here.
  • Natural Born Babies: short video of several moms and dads describing what influenced them to make the choice to deliver at home. Watch here

ARTICLES:

BOOKS:

  • Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience by Rikki Lake & Abby Epstien.  An easy-to-read overview of options available to moms, this book covers all the possibilities (hospital, home, OB/GYN, midwifery care, etc.) and why different options may work best for different situations and individuals.
  • Ina May’s Guide to Childbirth by Ina May Gaskin. Ina May began her career as a midwife back in the hippie movement of the 1970’s. Since then she has delivered thousands of babies, and has done extensive research in the field of natural birth, and she shares her wisdom in this book. She highlights the need to make a choice of birth location in which the mom feels totally comfortable, be that home, birth center or hospital. Great information about routine procedures, tests, and how to have a healthy pregnancy and wonderful birth experience.
  • Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block. While not a very positive or light-reading style book, this one can really help you understand how medicalized maternity care has become in our country, and enables you to think through some of the routine policies and procedures that are in place in our countries hospitals. Very eye-opening and thought-provoking.

WHAT MIGHT IT LOOK LIKE?

And finally, some couples wonder about what a home birth might look like. What about “the mess”? How can it work at home, if we’ve only experienced the hospital setting? How do midwives adapt to different settings, positions and environments? How does the medical side of midwifery care happen in a home setting? These videos, pictures and personal stories can give you a glimpse of what home birth with a midwife looks like for some families:

I’d love to hear from you-what helped you to determine whether home, birth center or hospital was the right location for your birth? What resources would you recommend to help other families make their decisions? Feel free to comment below, or send me an email with your suggestions. I love hearing from my readers!