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

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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! 

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!

 

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

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Interview: 10 Year Anniversary of Gentle Delivery ~ Part 2

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

How do you manage being a midwife and a mom?

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

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

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

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

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

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

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

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

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

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

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

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

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

This really ties in with the whole mom/midwife balance topic, as this is another way we try to walk this line. As a general rule, I cap a month with two due clients. Occasionally I will take on a third, if my family is at a stage where this is more possible, and if I have a slower month before or after. As a mom approaches her due date, her prenatal visits need to take place more frequently, resulting in more mamas needing to be seen each week. Then you factor in a home visit (an additional afternoon besides my usual appointment day), the birth (for anywhere from 3-30 hours), birth paperwork, another visit to their home for a postpartum check, and the frequent contact via phone/text/email that takes place over this time, doing this more than twice a month in additional to caring for other moms is about what I can do and still enjoy my work. Here again, if I didn’t have young children, and all the unexpected things that factor into life as you care for little people, it would be much easier to add more clients due in a month. But I want to enjoy both my own children and the opportunity to do births, and this number seems to be working well for this stage in life!IMG_0031

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

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!

Preparing for birth-some excellent resources!
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Preparing for birth-some excellent resources!

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

    This winter I’ve found myself in the remote hills of Arkansas, with more time on my hands than usual, as my husband is teaching at a small winter Bible School for young people. Keeping the children occupied is my main job here, but with the absence of our usual activities and schedule AND having all our meals provided, I’ve enjoyed the chance to finally dig into some of the resources that have been sitting on my shelves at home waiting for me to get to them.
    So, with that introduction, I want to mention a few EXCELLENT resources that would be worth any of you expectant moms, or anyone wanting to learn more about birth, to take time to watch or read. I can’t believe I’ve had these around this long and didn’t realize what treasures they were!
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The first one I’ll mention is the Parent Class DVD by Spinning Babies teacher Gail Tulley. I’ll confess that this one I have recommended to clients as I’ve taken one of her classes in person myself, and know she has alot to offer. But I didn’t realize how many jewels were in this educational presentation! It was a great refresher to me as a midwife, as Gail does and excellent job of teaching you how to help “make room” for your baby in your pelvis, and help your entire body to function more efficiently with less discomfort. The only drawback with this DVD is that, while she is teaching this class to a participating group of expectant couples, she does get fairly technical with some of her explanations. But in the long run it is helpful, as I think it helps you to get a better idea of WHY some of her positional suggestions and exercises help to eliminate certain issues. Using a great variety of teaching aides, examples, charts and object lessons, Gail shows you how exactly the uterus, baby, brain and body all work together, and how you can help. This would be great DVD for an expectant couple to watch together, or for any midwife or doula to watch in order to give you some great ideas of how to help your clients through specific issues and achieve better positioning for babies. It is well worth the $ you would need to invest, in my opinion! You can find out more about Gail, and purchase this DVD here.
    Next in my pile of resources was a book by Ina May Gaskin. If you’ve been in the childbirth realm long, you’ll recognize this name as one of the most famous midwives in the USA. Ina May has been practicing since the 1970’s, and is probably most well known for her involvement with births on “The Farm” in rural TN. People have come from all over the world to have their babies in this community that has come to be known for it’s amazing work with natural childbirth. I’ll admit that while I’ve appreciated many of the things I’ve read or heard taught by Ina May, I was still a bit skeptical of her book “Guide to Childbirth”. I think I was expecting it to have a real “back to earth” or “hippie” type flare, which I know can turn off families who are looking for evidence-based and scientific information on preparing for birth. I was in for a big surprise! Ina May’s Guide to Childbirth has been amazing. Written in an easy-to-read manner, it is full of so much helpful information. Starting with birth stories to help women realize that birth is both natural and do-able, it then proceeds to teaching you about the things you really need to know about how your body works, how to care for yourself during pregnancy, how to understand tests and the “whys” behind them, helpful suggestions for choosing both caregivers and birth locations, ways to prepare for labor, and the list goes on. I love her honest, down-to-earth style of writing, yet all of her information is based on evidence, research, and studies, and she includes citations and information for further study. If you are wanting just one book to help you understand pregnancy and prepare for birth, this one is it. And it’s not just for moms planning to birth at home-there is information in this book that would help anyone to be better prepared and ready for the amazing experience of labor and delivery.
    The last resource I’ll mention here is a DVD that was given to me by one of my clients. She had purchased it during her last pregnancy, and wanted to pass it on to other moms when she was done with it. “Practicing for an Active Birth”  is basically a childbirth class presented by Instructor Neri Choma by Birth Coach Method. While Neri could probably be a bit more dynamic in her teaching style (I’d suggest watching 30 min. at a time-the DVD is about 2 hrs. and 15 min. long), she does a very good job of helping  you to understand the process of labor and the terms used to talk about each stage, and gives couples LOTS of great position and relaxation techniques. Using charts and models, she helps you to learn how to visualize what is happening during each stage of labor, and how you might be able to help facilitate comfort and relaxation during each stage, working together as couples. While I think that it is best for couples to take a live childbirth class whenever possible, this would be an excellent option for those who might not have that opportunity in their area.
    I personally feel like much of preparing for a great labor and birth involves understanding how your body works so you are not tensed with fear of the unknown. If you KNOW what is happening, understand WHY you are experiencing certain sensations, and have IDEAS for what to do and when, you and your partner will be able to relax and work together much better. Moms (and dads!) that are prepared tend to do much better emotionally and physically through the marathon of labor. I would strongly recommend you look into any or all of these resources as ways to prepare for a wonderful experience of bringing your baby into the world.
    I’d love to hear about what worked for you. Do you have any favorite resources you would care to share with others? Tell us about it in the comments! And consider sharing  this post with your pregnant friends to help them hear about ways they can prepare for labor and birth from the comfort of their own home.
2016 Highlights for Gentle Delivery
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2016 Highlights for Gentle Delivery

What a year 2016 turned out to be! I’m very thankful for the many clients I was privileged to work with, and for the many special memories that were made. When it comes to births, 2016 was extremely unpredictable, and I’ll be thankful if 2017 isn’t quite as adventurous. We had one very early baby, one very late baby, a set of twins, a baby that came so fast we didn’t make it in time (!), and about everything in between. 🙂

A few highlights and items of interest from the past year:

– Great birth team and back-up midwife:

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Rose Marie, Lynelle & Myself with twins!

I was grateful to have the ongoing help of my current student, Lynelle Martin, as well as the help, support and back-up services of Midwife Rose Marie Spicher. These ladies are great to work with! Since relocating to PA several years ago, I have really missed the network of midwives that I used to assist and work with, and Rose Marie has been such a blessing to fill this niche. I’m grateful to know that clients are in caring, capable hands during the times I need to be off-call or out of town.

 

– Opportunities to further my education: Attending one day of Midwifery Today’s International Conference in Harrisburg, PA was a great way to meet up with other

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Bridge Certificate 

midwives, listen to lectures on issues and complications during labor, and make new friends in the midwifery world. I also had the opportunity to attend the Midwives Alliance of PA Educational Retreat, where we spent two days learning about a variety of subjects such as congenital heart defect screening, perinatal mood disorders, atypical findings in newborn exams, and more. Updating my Neonatal Resuscitation Certification and CPR at the local Mt. Nittany hospital is always a great way to get better acquainted with the closest hospital in my area, and I enjoy the learning opportunities these occasions afford. Finally, towards the end of the year, I submitted the needed proof of 50 hours of continuing education credits in certain areas (pertaining specifically to emergency and complications during labor and immediate postpartum) and applied for and received my “Midwifery Bridge Certificate”. This ensures that my education and training as a Certified Professional Midwife are also up to the standards set forth by the International Confederation of Midwives to ensure competent and qualified care for women.

– Addition of CCHD screening at postpartum home visits: 

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Trying out the Pulse Oximeter

One new requirement for midwives providing out-of-hospital births in PA is that of submitting Critical Congenital Heart Disease screening result along with newborn blood screening test. This year Gentle Delivery added a Pulse Oximeter to our kit, and we’ve been successfully performing this test on all of our babies since this fall. We’re happy to be able to try to offer our moms and babies a full range of services-did you know that free hearing screenings are also now available for our clients?

 

– First Public Event: “Birth Expo 2016” & “Why Not Home?” Film Screening 

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Celebrating Birth Expo 2016

We are attempting to help educate the public on the full variety of choices they have locally when it comes to birth-this includes support (such as doulas), care providers (CNM’s, CPM’s and OBGYN’s), choice of birth location, and resources that help them to succeed in parenting (such as breastfeeding and babywearing). With these thoughts in mind, Gentle Delivery hosted the first “Birth Expo” for Centre County in July 2016. We were very excited about the support of over 30 businesses and birth professionals that came together for the day, and we’ve received alot of positive feedback from parents who found out about resources they didn’t know were available in this area. Viewing the new film “Why Not Home?” also provided a way for more families to hear about the option of home and midwife-attended birth. The big question now is whether to host something similar in 2017…if we did, would you be interested in helping to make it happen? Please contact me with your interest!

– New Resources in the Library

The library in the prenatal office continues to grow, with more books and resources added in 2016. Some of my personal favorites include “Redeeming Childbirth” by Angie Tolpin and “Your Best Birth” by Rikki Lake. Check out the list of Recommended Reading  to see all of the titles available for clients to check out.

– Gift bag for Newly Expectant Moms 

Helping moms to connect with local support services and resources is something we are passionate about! Due to being located in a university town, many of the families we interact with don’t have any family or previous connections in the area. One way we have attempted to help with this is by giving each family who comes in for an initial interview a free bag full of samples from natural-minded companies, coupons, and lots of cards, brochures and information from many area birth professionals and mommy/baby-centered support groups and businesses. If you or your business would like to be included in this welcome bag, send us an email or message and let us know!

– Our own special gift to new babies… instagramcapture_ee2d01d4-3eb4-45ec-8440-8612375dcf01

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And while not necessarily “important” news, we’ve had fun giving our babies in 2016 special onesies to commemorate their big event! I have fun taking the time to make each of these little shirts for our babies, and clients in 2017 can also look forward to this little “thank you” gift that we pass on to our families.  img_0348

Thank you for allowing us to serve you all in 2016, and blessings to each of you as you head into the new year! Remember, too, to follow this blog for future updates, “like” us on Facebook to receive current info and informative articles (Gentle Delivery), and watch for our photos of new arrivals on Instagram @gentlemidwife . We’d love to keep in touch!

 

 

 

News & Updates from Gentle Delivery!
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News & Updates from Gentle Delivery!

There have been lots of things happening around here this spring, and I thought it would be good to give you all some updates on exciting new developments at Gentle Delivery Childbirth Services. Here’s a brief summary of assorted news items…take a minute to check out what is going on!

  • Addition of Pulse Oximetry Screenings for Critical Congenital Heart Defects (CCHD):

My new Pulse Oximeter just arrived in the mail last week, and I’m excited to be offering at-home CCHD screenings in keeping with PA legislation. These screenings have been mandatory in hospitals since Act 94 was passed in 2014, and this year midwives are being asked to join in reporting these screening results. This is a simple, non-invasive test that I will perform at the home postpartum visit within 24-48 hrs of your baby’s birth. To find out more about the testing, click here.

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Matthias helping me try out the new pulse oximeter!

  • New Apprentice for 2016!

As some of you know, I’ve been working on confirming a regular assistant/student, and I’m glad to be able to introduce you to Lynelle Martin. You can find out more about her by clicking on the “Current Assistants/Students” page, and those of you with babies due this year will be meeting her as she helps out with prenatals once a month and attends home visits.  She recently finished her Neonatal Resuscitation Certification, giving clients the added benefit of two CPR and NRP certified attendants at births.

  • Midwifery Today Conference:

I’m looking forward to writing up a more detailed report about some of the things I learned as I attended a day of the Midwifery Today Conference in Harrisburg, Pa. I enjoyed lively conversation with Lynelle and Rose Marie (another midwife I want to introduce you all to at a later time!) on the drive down, and was encouraged as I visited with many other midwives from all over the country-including Kathy, the midwife who delivered several of my siblings and was instrumental in getting me started in this field. Midwifery conferences tend to attract an extremely diverse group of midwives (ranging from Amish to Hippie and everything in-between!), and there are so many things to learn from each one. The added benefit is more CEU’s that I am required to get each year in order to keep my certification.

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Lynelle, Myself and Rose Marie after a long day at the conference!

  • YourWaterBirth.com Account Set Up:

I now have an account with Your Water Birth, a business offering affordable waterbirth and homebirth supplies, and if you are a client you can contact me for a code that will give you a 10% discount on your order! While there is a very affordable option in State College for those wishing to rent a birth pool, this company offers a great deal for those wishing to purchase their own pool and supplies. Check them out!

  • Travel Dates for Winter 2017

Just giving you all a heads up that my family will be taking a 3 week trip to the Midwest from Jan-Feb 2017 in order for my husband to teach at a Bible School for young people. We’re excited about the opportunity, and I will be glad to give you referral information if you are looking for a midwife over that time. For those who like to plan ahead, here’s your chance! <smile>

  • Advertising Cards Available:

I recently printed up some post-card sized advertising cards that contain contact information, a testimonial and information about the CPM certification. These will be on display at the area kids’ consignment sale at the end of April, but if you would like some yourself to pass out to friends, family and/or local home-birth-supportive businesses, I’d be happy to provide you with a stack!

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  • New Babies:

And lastly, no update is complete without a few pictures of sweet spring babies! Blessings as you enjoy the lovely spring weather that is here at last!

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Nothing like a peaceful newborn!

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so sweet and tiny

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Ready to call it a night and tuck everyone into bed!