pregnancy preparation

Pre-conception Considerations: Things to Think About Before Getting Pregnant
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Pre-conception Considerations: Things to Think About Before Getting Pregnant

I’ve had several ladies reach out this year asking for information to consider as they hope to conceive sometime in the next few months. As I started replying to some of these inquiries, I realized that it might be helpful for others in similar positions to have some of this information at their fingertips. My hope is that some of these suggestions can help you to achieve the healthiest pregnancy possible as you actively prepare your body for the amazing stress and strength that growing a baby places on your entire system-this is certainly worth seriously considering and prepping for, and I can guarantee you won’t regret any time and effort you invest before pregnancy!

Let’s start at the beginning:

  • Educate Yourself on Your Hormones and Cycle:
    • Understanding how your body works, and how to read your fertility signs (temperature, cervical mucous, etc.) can make a huge difference in both your ability to conceive and in determining an accurate due date. There are some disorders or challenges that can be identified early on if you have been keeping track of your fertility signs, and this can save you time, money and heartache if you know what to look for and when to get medical intervention. Simple things such as knowing you ovulate “late” compared to traditional due date calculators can save you the challenge of being considered “overdue” when you actually didn’t have an accurate due date to start with!
    • For better understanding, I highly recommend the book Taking Charge of Your Fertility by Toni Weschler. This guide helps you to really get to know how the women’s body works, how to chart your cycle, and how to understand all the information you are pulling together. The TCOYF app is also a great way to track your cycle, and it’s free! Another helpful book on the subject is The Fifth Vital Sign by Lisa Hendrickson-Jack (as a disclaimer, I JUST ordered this book and have it sitting in my “to read” pile-it looks great, but I haven’t read through it yet!).
    • For those particularly wanting to use fertility tracking as a guide to Natural Family Planning, the Art of Natural Family Planning Student Guide is a good way to delve into some of the details, which can also be an aid in achieving pregnancy.
  • Birth Control/Hormonal Contraception:
    • If you’ve been on hormonal contraceptives, it’s important to remember that it can take up to three months for normal cycles and fertility to return. The sooner you can get off any hormonal BC the better for  your overall health! Aviva Romm has a great article on fertility issues after hormonal contraceptives and getting off the pill here: Post Pill Reset and I highly recommend the new documentary The Business of Birth Control for better understanding of how hormonal contraceptives can negatively affect your overall fertility and health while providing an introduction to other non-hormonal options.
  • Deal with Any Current Health Concerns Now
    • Do you have weight you need to gain or loose? Start understanding healthful eating, and work on that now BEFORE  you add pregnancy to the mix! I’ll add more on diet below, but healthful eating habits should begin now, and will provide a great foundation for the demands of pregnancy on your body.
    • Are you currently on any medication that could have a negative effect on a developing baby? Many health challenges (such as elevated BP) can be managed by diet, lifestyle and supplement changes, and these are best achieved before pregnancy. If you’re hoping to have a low-risk delivery at home, this is even more important to consider, as any compilation of medications can increase your risk and rule out homebirth. Also, remember that you should be under the care of a physician or medical provider before attempting to wean off any medications, especially for BP, anxiety, depression, etc. You need to do this safely, and sometimes these changes can take time!
    • Thyroid health: many women these days experience thyroid imbalances, and it can make a huge difference on your ability to carry a healthy pregnancy if you are on top of these imbalances before pregnancy, and have a provider who can work with any sort of needed thyroid medication especially during the early days of pregnancy. Learn more about thyroid and it’s effect on pregnancy by reading Aviva Romm: Thyroid in Pregnancy
  • Learn more about healthy food choices:
    • There are so many things to learn about how food and our daily choices affect the way in which our body works! From supporting the organs, optimizing brain function, regulating blood sugar…the food we eat has so much to do with how our entire body operates. Add to this the growth and development of an additional entire human body and placental organ, and you’ll start to get a glimpse of how important solid nutrition is to your body and that of your future baby! The best book on the subject that I have read is Lily Nichol’s Real Food For Pregnancy, and I would encourage any woman who is pregnant or considering pregnancy to read it and really digest her wisdom and suggestions. Lily covers more than just diet, and her overall suggestions when it comes to regulating blood sugar, exercise guideline, and prenatal vitamin recommendations are all amazing and educational.
  • Support your Liver!
    • This might seem like an odd topic, but did you know that your liver performs under extra stress during pregnancy? There are many pregnancy complications that can arise when the liver is not functioning well, and there are some studies that suggest that a healthy, supported liver can reduce the amount of morning sickness a mom might experience. With all of these factors on the table, I highly recommend either purchasing a liver cleanse and using it a few months before getting pregnant, or at least taking a high-quality Milk Thistle supplement for a month or two before conception, and continuing to take it during the first trimester. Here is an article that addresses this further: Milk Thistle for Morning Sickness
  • Prenatal Vitamins:
    • Start your research on prenatal vitamins now, and begin taking them daily. Remember, the critical time for baby’s development are in the early weeks, so your body needs to start getting a good foundation of nutrients so that your body is ready to nourish the developing brain, organ and other nutrient needs of a growing tiny baby. Many moms end up sick enough that they cannot continue taking prenatal vitamins during part of the first trimester, so having this foundation laid ahead of time is key!
  • Further Reading:
    • If you’re wanting to read more about how to optimize your fertility and prepare well, many providers recommend the book It Starts with The Egg. Rebecca Fett goes into detail about diet, supplements and other foundational principles of helping your body to achieve healthy conception!

In closing, I hope you’ve found these suggestions informative! I’d love to hear what else you would add to this list, and what has helped you as you’ve prepared for pregnancy. Maybe you’re not pregnant yet, but you’ve found a great resource…or maybe you followed some preconception guidelines and are currently in the middle of pregnancy…either way, I’d love to hear what you found most helpful!

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!