Suggestions for a Healthy Pregnancy

Suggestions for a Healthy Pregnancy

Recently I’ve been searching for a short, easy-to-read handout on nutrition and exercise. I was having trouble finding what I wanted…something that hit the high points, but wasn’t so detailed that no one would take the time to read it. Here’s what I came up with, though there is SO much more that could be said. I encourage each of you mama’s to research nutrition, supplements and exercise so that you know WHY you are doing what you’re doing for you and your baby!

2266-19942-1-SPDuring pregnancy, your body faces extra demands and nutritional needs. Making wise choices in caring for your physical needs can help to build a healthy baby, improve your energy levels, experience less complications during birth, and have a more rapid recovery. How is that for motivation?

Diet Recommendations:
There are many varied suggestions out there as far as pregnancy diet goes. While it is important for you to do your research and make the best choices for your particular situation, the following are a few principles to go by when it comes to what you eat:
– Major on high-quality protein. Protein helps to give you sustained energy, builds good skin integrity, and keeps your blood sugars in check. Some ideas include: Greek yogurt, cheese, nuts, nut butter, chia seeds, eggs, meat, and seeds.
– Consume a variety of vegetables, preferably organic whenever possible. This helps to provide you with more fiber, and the multitude of natural vitamins and minerals that vegetables contain.
– Add quality oils to your diet. Recent research has proven that quality fats are good for us, contrary to what we used to be told! Coconut oil, olive oil, and butter (esp. if it’s grass fed!) are examples of good fats to be consuming.
– Reduce your intake of carbs-especially simple carbs. While carbohydrates are good in moderation, they shouldn’t be considered the foundation of your diet. Carbohydrates tend to elevate blood sugar levels, as well as adding extra pounds to you and the baby during the last several months of pregnancy. When eating carbs, do your best to make sure they are made of whole grains whenever possible, which provide you with fiber and a slower sugar release. Using a variety of organic grains (such as oats, spelt, rye, etc.) are better choices than only consuming wheat products.
– Stay away from artificial sugars, and limit your intake of refined sugar. Try using maple syurp, honey, coconut sugar or other more natural-type sugars when you need something sweet!
– Try to limit fruit juices, and eat whole fruit instead.
– Keep healthy snacks on hand, so that it’s easiest to make good choices when you’re hungry!
Supplements:
Ideally, your nutritional needs should be met through a healthy, balanced diet. But most of us can still use a bit more help!  The basis of your supplements should include a high-quality prenatal vitamin, one made from natural food sources instead of being chemically engineered. Seeking Health, New Chapter Organic, and Thorne Research are good brands, but there are more out there. Most moms are also lacking in sufficient calcium and magnesium, and I recommended taking a minimum of 1000 mg. of calcium each day. This can also help you to sleep better at night, and experience less muscle cramping and discomfort. Other supplements are normally suggested and added as needed, and we can discuss your particular needs during our prenatal visits.newborn

Exercise:
In preparing for your labor and birth, it’s good to keep in mind that it is similar to preparing for a marathon. No one decides to run a marathon and then does it the next day-it takes lots of preparation and training for the big event. It’s much the same with giving birth. The more prepared and equipped your body is, the better able you’ll be able to handle the challenge and the easier your recovery will be. I highly recommend the following:
– Take a brisk walk at least 3 times each week, trying to go at least 1 mile in distance.
– Incorporate some type of exercise program (even just 10 min. long!) into your daily routine, and make it happen at least 3 times a week. There are many different 10 min. pregnancy workouts on youtube, and many other options you can take advantage of. A routine that incorporates lots of squats and leg-strengthening moves can be especially helpful in getting your body prepared for birth.
– Visit the “spinningbabies” website for information on daily exercises that encourage good alignment for mom and good positioning for baby. I have an excellent DVD on this subject that I encourage each of my clients to borrow and watch.
– Consider visiting a chiropractor during the last trimester to ensure your body is ready for birth!

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Frequently Asked Questions

Frequently Asked Questions

If you are considering a home birth, perhaps the following are questions you have wondered about. Don’t hesitate to contact me with any specific questions…I’d love to help you in any way I can! Please note, these questions and answers pertain specifically to my practice here at Gentle Delivery Childbirth Services, and may not apply to other midwives and practices.

Q. At what point in my pregnancy should I contact you?
A. You are welcome to contact me at any time-with preconception questions or as soon as you find out your pregnant. A free no-obligation consultation where you can ask questions and see my office can occur at any point, but I typically schedule your first actual appointment once you are between 10-12 weeks along, as that allows the baby to be mature enough to hear the heartbeat. The earlier you are in touch, the greater chance I will have an opening over the time you are due, though it’s never too late to talk with me about your options, either…we can begin care late in the pregnancy when necessary, too!

Q. What does a normal prenatal look like, and where does it take place?
A. Prenatal appointments normally take place in my home office, usually on Tuesday and Thursday afternoons, although other times are possible. I generally expect to take anywhere from 30 min. to an hour, with the goal being able to spend enough time to answer any questions or concerns a couple might have, as well as including education regarding exercise, nutrition, positioning, childbirth, etc. At each visit a urine sample is checked, weight is recorded, BP is taken, and baby is listened to, measured, and palpated to see his or her position. Other testing and/or procedures will be performed as needed. The normal schedule for visits is every month until 28 weeks, followed by bi-weekly appointments until 36 weeks, and weekly visits thereafter. A home visit is performed at 36 weeks, in order to give myself and any other birth attendants a chance to see your location in normal daylight hours! 

Q. Do I need to see a doctor besides seeing you for prenatal care?
A. That honestly depends upon your personal preferences. The prenatal care I give would be similar to what you would receive from a doctor, including labs and referrals for things like sonograms. Most of my clients do not see a doctor while receiving care from me, as it keeps costs down and keeps them from multiple prenatal care visits. If your OB office is open to co-care, it can provide you with a seamless transition in case of transport, especially if it is covered by your insurance provider. If care with an OB is covered in full by your insurance provider, you may benefit from continuing care with them in order to have the costs for your labwork and other testing covered completely.

Q. Will my insurance cover your services, or how can I afford it?
A. Sadly, many insurance companies do not cover home midwifery care, though it is always worth checking into thoroughly. I would be happy to provide you with some information on how to best discuss this with your insurance company, and I am also willing to give you a written statement complete with insurance codes to submit to your insurance company. In order to keep my own costs down, I do not file insurance, but I do try to make care accessible to all families by charging a sliding scale fee based upon your family’s income. Keep in mind, too, that when using insurance, you will have a co-pay, and for some people the cost of my services are either similar or lower than the co-pay amount you would be paying with a hospital delivery.

Q. I notice you have a student working with you. How does that influence my care?
A. When a student is interning for midwifery training, their level of involvement varies according to where they are at in their studies. A student midwife begins by observing all aspects of midwifery care, and applying the academic knowledge she has already received to practical, hands-on situations. As her experience expands, so do her opportunities-she assumes more responsibility depending upon her level of experience and skill. Students are always grateful for any opportunity afforded them to learn, and would love to be as involved with your care as you feel comfortable with. I always strive to make sure the client feels completely comfortable with any care provided by a student, whether that is allowing the student to feel for baby’s position and fundal measurement, or whether it is as extensive as allowing the student to participate in a high level of care during delivery. Whether you prefer lots of involvement or minimal involvement, a student generally acts as my birth assistant during the actual labor and delivery, helping to provide labor support, take notes, and in general act as my second set of hands. 

Q. Who will attend my birth? Is is okay to invite others to be present in addition to the birth team?
A. Normally I attend births with one or two qualified assistants. These ladies are usually either skilled students or birth attendants, and enable me to know you are getting the best care possible, allowing both baby and mom to be cared for in case of emergency. Besides this, whomever else you choose to have present at your birth is up to you. I’ve been at births where it was the bare minimum of people, and I’ve been to births where there was a crowd! The main issue is that you feel totally and completely at ease and comfortable with whomever is present, as that can majorly impact your experience.

Q. Are children welcome to attend the birth?
A. It’s your birth, so you get to decide if you want your children present or not! If you are planning on having your children attending, I strongly recommend you having an extra person handy whose sole responsibility is caring for your child(ren) so that you can focus on the delivery.

Q. Do you do waterbirths?
A. Yes! Laboring and delivering in the water are both options. For many people, their home tub is comfortable enough, but if you’re wanting to use an actual “birth pool”, I can put you in touch with rental possibilities.

Q. I had a cesarean with my previous delivery, does that rule out a home birth?
A. I am happy to help women VBAC whenever possible. For most women, a VBAC at home is statistically safer than a repeat c-section. Make sure you get a copy of your previous medical records, and we can discuss your particular situation in person in more detail.

Q. What birth positions are options at home?
A. There are about as many options as there are women!  One benefit to delivering at home is the flexibility to figure out what works the best for you…whether that is squatting, laying in bed, standing in the shower, or wherever you are the most comfortable. I have a traditional “birth stool” that I bring along to births which gives you the option of a low squat, but most women instinctively find a position that works the best for them.

Q. Are you prepared for possible emergencies?
A. Yes. I maintain current certification in both neonatal resuscitation and CPR, bringing along emergency equipment in case of a baby with breathing difficulties. I also carry equipment to assist with stabilizing a mom in the rare case of hemorrhage. It’s my goal to make your home birth experience as safe as possible, which includes careful monitoring of both baby and mom during and after labor, so as to catch any concern that is out of the scope of “normal”. Consistent prenatal care combined with healthy, low risk moms lowers the chance of emergency procedures drastically, but your birth team stays alert for any signs of possible surprises. We can discuss this question in more detail during your consultation if you wish.

Q. So, laboring at home sounds nice, but what about the mess that comes along with birth?
A. Most people are surprised at how little mess is involved. I have families purchase disposable underpads (available at most drugstores) and a cheap shower curtain, which we use to protect surfaces such as the bed and carpet for the actual birth. These things get thrown away afterwards, and myself or my assistant will start laundry before we leave your home. We also make sure to tidy things up so that you aren’t left with clean up!

Q. How do I go about getting documentation for my child?
A. I will file all needed paperwork with the state, which includes the official birth certificate and request for a social security number. I also perform the newborn screening test on your baby during the home visit which occurs 24-48 hours after birth.

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Sweet baby feet as baby is being weighed during the newborn exam!

 

Preparing for your birth…

Preparing for your birth…

Newborn-Baby-FeetThis information is written specifically to give first time mothers  and first time VBAC moms suggestions for how to improve their chances at achieving a natural, easier delivery. But that doesn’t mean this is just for them! All of these suggestions can help ANY mom as she prepares for an optimal birth!  Pregnancy and  childbirth is such a special and exciting time, and it is also something to be prepared for ahead of time. It is good to keep in mind that a woman’s body was designed to give birth, and that, normally speaking, your body does know what to do to get the baby out. On the flip side, though, is the fact that this is the first time your body has ever experienced this process. Because of this, labor can sometimes last longer, and be more physically demanding, as your body takes the time it needs for all of the muscles and bones to work together and stretch to allow your baby to enter this world. If you have invested time and effort into preparing ahead of time, your body will benefit, both in the labor and recovery processes. Just think, you wouldn’t run a marathon without giving adequate training and preparation-and so it is with childbirth. You must condition your mind and body to give you the best results.

Throughout the pregnancy:

–          Read and educate yourself! Take childbirth classes, together with your husband. This will help you both to be informed about the physical and emotional processes, and allow you to discuss ideals, hopes, and dreams before labor begins. I believe that education can also help to reduce the level of pain, as it helps you to understand what is going on in your body, instead of fearing the unknown. The more you can find out ahead of time, the more able you will be to relax, knowing your body is doing what it was intended to do. There are many books, DVD’s, and classes available-talk with me if you need suggestions!

–          Eat a healthy diet. A diet full of good, healthful foods (vegetables, protein, and complex carbohydrates), and low in sugars, fats and simple carbohydrates, can help you in several areas. One, it doesn’t build a huge baby. A smaller baby is easier to push out! Secondly, it allows your body to be able to function at it’s optimal ability, as your energy level is increased. Thirdly, good nutrition can build better skin integrity, which decreases your chances of tears.

–          Exercise regularly. Exercise is an extremely important factor, as labor and birth are very much physical events. Stretching, and building up your endurance level throughout the pregnancy will enable you to persevere if your labor gets long and tiresome. Throughout the last few weeks, walking briskly (until your pelvis hurts!) for at least 45 min. every day, can help to encourage the baby’s arrival to happen sooner rather than later.

–         See a Chiropractor-if your body is not in alignment before labor, this can really slow things down and keep the baby from descending. While having regular adjustments can be helpful, it’s an especially good idea during the last 3-4 weeks, as it can help your body to relax and get the baby into the best possible position before labor begins.

–          Visit http://www.spinningbabies.com and try some of Gail’s suggested techniques for helping baby to achieve the best position. Regularly implementing techniques such as inversions and belly sifting can help to reduce your overall labor time by helping your body to stay aligned and encouraging good position of the baby!

–          Practice relaxation. If you can learn to relax, go limp, and let your body work before labor begins, then the better able you will be to do this during labor. Remember, fighting pain and discomfort works against you during labor-you must open up, let go, and relax in order for your uterus to function the most efficiently. And the more efficiently it works, the easier it will be on you! In practicing, pick times of the day when you can work on letting each area of your body go limp. Find out what helps you to relax: water, music, massage, etc., and then have these available during labor.

During the last 5 weeks:

–          I encourage moms to take the following supplements:

  • Gentle Birth Formula ~ this is a specially formulated blend of herbs in a tincture form that work to help prepare the uterus for the upcoming birth. You begin at 35 weeks by taking 2 dropperfulls a day throughout the first week, and increasing the amount to 2 dropperfulls 3x/day for the remaining weeks. Mothers who take this herb usually have more “warm-up” contractions, which help the cervix to begin dilation and effacement before actual labor. This tincture can be purchased through In His Hands Birth supply at the same time that you order your birth kit.
  • Super Primrose Oil or Borage Oil ~ this supplement is in a soft-gel form, and you begin taking 1-2 capsules orally beginning at 35 weeks. Around 36-37 weeks, you may begin inserting one capsule vaginally at night when ready to go to bed. The high GLA content and natural prostaglandin that these oils contain helps the cervix to soften, making dilation easier. It’s a great way to give your body a head-start towards dilation!

In closing, remember to keep yourself hydrated, rest often, and take care of yourself. And when labor begins, try to get some rest before getting excited.   You need to conserve the energy for later. So think about some activities that provide fun distraction (games, movies, going out for supper, etc.), and try to focus on other things until the contractions become consistent and strong enough that you can’t be distracted through them….

Helping Baby Achieve the Best Position…a little report on my day at Spinning Babies!

Helping Baby Achieve the Best Position…a little report on my day at Spinning Babies!

At the end of April, I had the special opportunity to take the Spinning Babies workshop taught by Gail Tully at the Midwifery Today Conference in Harrisburg. While the day was packed with information, I enjoyed every minute of it…I honestly felt excited about the prospect of having another baby myself after learning so many practical tips on how to promote optimal fetal positioning for both the baby’s sake and the mother’s comfort. Gail has a wealth of information at her fingertips, and I think I’d have to take the class several more times before I could really retain it all (even though I took lots of notes!), but I wanted to at least give a few pointers from things that I learned. Visit her website at: http://spinningbabies.com/ to learn more yourself.

To begin with, Gail showed a diagram about the structure of the uterus, and how it is covered in fascia, just like all of our other muscles. When the fascia is pulled or stretched in an unnatural angle, it is going to affect the way that the baby is positioned in the uterus. This is one reason why it is important to watch your repetitive movements…do you carry a child on your hip? bat a baseball? If the muscles and ligaments are too tight, too loose, or twisted, the baby will NOT be able to settle into the correct position. The balance of your soft tissue can be more important than your pelvic size. Thus, doing specific exercise techniques throughout your pregnancy (and during labor when needed) in order to help align these muscles can make a big impact on what position the baby settles into. When the womb is symmetrical, the baby will naturally assume a more flexed position.

When it comes to the “perfect position”, the place to aim for is having baby settled on the left side. The tendency is for baby to settle on the right side, as our uteri have a natural propensity towards this direction. However, the shorter, curved left side encourages the baby to flex his head and assume a “C” type position-his physiology is actually enhanced by this flexed position, as well as this position providing more consistent, even pressure on the cervix, which in turn encourages dilation. When the baby is on the mom’s steeper right side, the baby naturally wants to assume a more “military presentation”, where the head is not flexed-this causes uneven pressure on the cervix, and can really reduce progress in preparing the cervix for labor, and stalling progress during labor itself.

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Demonstrating how the different muscle layers work to support or constrict the uterus

Another interesting aspect Gail brought out is how thyroid malfunction can cause the baby to assume a negative position. A root metabolism issue can affect the way in which the uterus operates, as well as causing it to be more susceptible to twisting. Making sure your entire body is working optimally can help prepare you for a better pregnancy and birth! The fact that we spend so much time sitting both in the car and in a reclined position also contribute to a asymmetrical uterus. Women used to be encouraged to sit “like a lady” with good upright posture, which can also help to promote good posture of the womb.

In presenting exercise techniques, Gail focused on three separate types of exercises that she calls the “3 Sisters” to provide balance and room for mom and baby. Each of these exercises helps the mom to relax, and thus in turn helps to relax the fascia of the uterus, which then helps to provide the balance to help the uterus to become more symmetrical. She would encourage pregnant mamas to do these exercises at the minimum of once a week, but once a day would be even more ideal! Besides encouraging baby to engage in a good position, these exercises can also help to improve mom’s comfort by relaxing the muscles that receive so much strain during pregnancy. In labor, these techniques help to promote descent of the baby, and can be done multiple times. Rather than try to explain these techniques myself, I’ll point you in the direction of where you can find instructions on her website:
– First, encourage deep squats and calf stretch. Then move on to the “3 Sisters of Balance” http://spinningbabies.com/techniques/activities-for-fetal-positioning/423-the-3-sisters-of-balance- :
1.  Rebozo sifting: helps relax the broad ligament and get the mother loose and relaxed herself. http://spinningbabies.com/techniques/activities-for-fetal-positioning/rebozo-sifting
2. Forward Leaning Inversion: This is best for resolving a transverse lie, and helps to encourage healthy circulation. http://spinningbabies.com/techniques/the-inversion
3. Side Lying Release: Helps relieve pressure on ligaments.

Once these techniques have been performed to help achieve balance, your next goals are Gravity and Movement-especially to help during a pause in labor.

During labor, you can use these techniques to help whenever you reach a point where progress is being stalled. Gail encouraged us to rethink the usual question of “what is dilation?” and instead think “where’s the baby?”. If the baby isn’t descending, then something needs to change, regardless of what dilation is. And depending on where baby is at, different techniques are needed to get the baby to descend. For any stall, she recommends trying the “3 Sisters of Balance” in order to relax mom and balance the uterus.

As you attempt the three above techniques, consider where baby is: If he is stuck at the brim of the pelvis (characterized by a long latent phase, or start-and-stop labors for days), then the baby needs to flex his head in order to enter the pelvis. Tight round ligaments can prevent baby from descending. At this point it is much more important to get the baby to enter the pelvis, rather than trying to get labor to become more regular. Dilation won’t do any good if the baby isn’t in the pelvis! Trying Gail’s Abdominal Lift and Tuck followed by Walchers, can help to flex that little guys head and get him to descend. http://spinningbabies.com/techniques/activities-for-fetal-positioning/abdominal-lift-and-tuck  http://spinningbabies.com/techniques/activities-for-fetal-positioning/walchers

If baby is stuck in the mid-pelvis (right at the ischial spines), labor tends to stall around 5-7cm. This can often be caused by a tight pelvic floor, and special attention to the side-lying release technique can help to relax those tight muscles. Trying a lunge, and the “Shaking the Apple Tree” techniques can also help to get the pelvic floor relaxed and help baby to descend.

When labor stalls around 9-10 cm (think anterior lip, etc), realize that you must address the root cause, not just push back the lip. Trying positions that open up that part of the pelvis can provide more room (deep squat, McRoberts, hip press, toilet, etc.). Sometimes putting pressure on the sacrotuberal ligaments can help them release and provide more room for birth. If there’s not an urge to push, try to rest, and wait until the body is ready-sometimes mama just needs a break!

There were many, many more things that Gail taught and shared…not to mention all the stories of different complicated, stalled labors where these techniques were used. If you ever have a chance to sit in on one of Gail’s classes, I would highly recommend it! Much of her information is located on her website, as well, which is an excellent resource for both midwives and mamas alike.

Spinning babies1

Where is baby’s position in relation to the mom’s pelvis? How can we use that information to help us decide which technique(s) to try?

Special Suggestions for first-time moms

This information is written specifically to give first time mothers suggestions for how to improve their chances at achieving a natural, easier delivery. Pregnancy and birth is such a special and exciting time, and it is also something to be prepared for ahead of time. It is good to keep in mind that a woman’s body was designed to give birth, and that, normally speaking, your body does know what to do to get the baby out. On the flip side, though, is the fact that this is the first time your body has ever experienced this process. Because of this, labor can sometimes last longer, and be more physically demanding, as your body takes the time it needs for all of the muscles and bones to work together and stretch to allow your baby to enter this world. If you have invested time and effort into preparing ahead of time, your body will benefit, both in the labor and recovery processes. Just think, you wouldn’t run a marathon without giving adequate training and preparation-and so it is with childbirth. You must condition your mind and body to give you the best results.

Throughout the pregnancy:

–          Read and educate yourself! Take childbirth classes, together with your husband. This will help you both to be informed about the physical and emotional processes, and allow you to discuss ideals, hopes, and dreams before labor begins. I believe that education can also help to reduce the level of pain, as it helps you to understand what is going on in your body, instead of fearing the unknown. The more you can find out ahead of time, the more able you will be to relax, knowing your body is doing what it was intended to do. There are many books, DVD’s, and classes available-talk with me if you need suggestions!

–          Eat a healthy diet. A diet full of good, healthful foods (vegetables, protein, and complex carbohydrates), and low in sugars, fats and simple carbohydrates, can help you in several areas. One, it doesn’t build a huge baby. A smaller baby is easier to push out! Secondly, it allows your body to be able to function at it’s optimal ability, as your energy level is increased. Thirdly, good nutrition can build better skin integrity, which decreases your chances of tears.

–          Exercise regularly. Exercise is an extremely important factor, as labor and birth are very much physical events. Stretching, and building up your endurance level throughout the pregnancy will enable you to persevere if your labor gets long and tiresome. Throughout the last few weeks, walking briskly (until your pelvis hurts!) for at least 45 min. every day, can help to encourage the baby’s arrival to happen sooner rather than later.

–          Practice relaxation. If you can learn to relax, go limp, and let your body work before labor begins, then the better able you will be to do this during labor. Remember, fighting pain and discomfort works against you during labor-you must open up, let go, and relax in order for your uterus to function the most efficiently. And the more efficiently it works, the easier it will be on you! In practicing, pick times of the day when you can work on letting each area of your body go limp. Find out what helps you to relax: water, music, massage, etc., and then have these available during labor.

During the last 5 weeks:

–          I encourage moms to take the following supplements:

  • Gentle Birth Formula ~ this is a specially formulated blend of herbs in a tincture form that work to help prepare the uterus for the upcoming birth. You begin at 35 weeks by taking 2 dropperfulls a day throughout the first week, and increasing the amount to 2 dropperfulls 3x/day for the remaining weeks. Mothers who take this herb usually have more “warm-up” contractions, which help the cervix to begin dilation and effacement before actual labor. This tincture can be purchased through In His Hands Birth supply at the same time that you order your birth kit.
  • Super Primrose Oil or Borage Oil ~ this supplement is in a soft-gel form, and you begin taking 1-2 capsules orally beginning at 35 weeks. Around 36-37 weeks, you may begin inserting one capsule vaginally at night when ready to go to bed. The high GLA content and natural prostaglandin that these oils contain helps the cervix to soften, making dilation easier. It’s a great way to give your body a head-start towards dilation!

In closing, remember to keep yourself hydrated, rest often, and take care of yourself. And when labor begins, try to get some rest before getting excited.   You need to conserve the energy for later. So think about some activities that provide fun distraction (games, movies, going out for supper, etc.), and try to focus on other things until the contractions become consistent and strong enough that you can’t be distracted through them….