Labor: How will I know?

Many women who have never experienced labor wonder how they will know labor has begun.  While labor is different for every woman, here are a few things to keep in mind if you think you may be in labor. Full term labor is different from preterm labor. For information on preterm labor, see the previous post. If you are 37 weeks or more along in your pregnancy, this may help you determine if you are in labor.

What are contractions?

Contractions are actually the contractions of the uterus, or a shortening and tightening of the uterus. The uterus is a muscle and contracts just like any other muscle will. In early labor, uterine contractions are usually short (less than 30 sec) and painless. In early labor, contractions may come every 2- 15 minutes. When the uterine contractions become strong enough, they will start to open and thin out the cervix (the opening to the uterus). As labor progresses, uterine contractions become longer (over 45 sec), stronger (increasingly uncomfortable), and increase in frequency (every 2-5 minutes)

                                                     Early Labor              Active Labor

Discomfort                                       Slight                       Stronger

Length of contractions                  10 - 45 sec               45-90 sec

Frequency of contractions          2 -15 minutes           2- 5 minutes

Early labor often mimics what you experience when you have your period, or will be like a very strong period.  If you had backache or menstrual cramps when you had your period, this is most likely what you will experience in early labor. Early labor can be off and on. It can start and stop or it can also be steady.  Early labor in a first time mom can last from 2 to 24 hours. Once early labor is over, the mother usually will experience an increase in the amount of discomfort caused by the contractions as well as an increase in the intensity and the frequency of the contractions.

Quick labors or precipitous labors in a first time mom are the exception and not the rule. Many women hear stories about a friend or sister's labor that was only 2 or 3 hours long. A precipitous can happen, but it is much more likely to happen for women who are having their 2nd or 3rd child. Precipitous deliveries are also more common in a woman who is not yet 37 weeks.  The next time you hear of a story when a woman gave birth very quickly, most likely she was not having her first child or she was not yet 37 weeks.

The water breaking: Always contact your health care provider if your water breaks. The water breaking may bring on the start of labor, or it may happen while you are already in labor. You also can have your water break and labor does not start.  The water breaking does not necessarily mean that labor has begun.

If you think you are in labor, it is good to consult with your health care provider for advice.

Preterm Labor

Signs and Symptoms of Preterm Labor 

These signs and symptoms are not to be ignored

Preterm Labor is labor that starts before 37 weeks or pregnancy

• Contractions - any tightening of the uterus or abdomen that is rhythmic or comes and goes.
• Increased vaginal discharge - vaginal discharge is normal in pregnancy, but if there is a change in the amount of discharge, color, or odor
• Watery discharge - any dischage that is like water which soaks through the underwear
• Backache - a dull lower back ache that is off and on
• Menstrual-like cramps (more than 5 in one hour)- this is the most common symptom of true preterm labor
• Abdominal cramping with or without diarrhea
• Pink discharge
• Vaginal bleeding: Any blood or bleeding from the vagina is abnormal before 37 weeks

If you experience any of these symptoms, notify your health provider right away.

GBS: Group Beta Strep (Streptococcus)

Group B Strep or Group Beta Streptococcus (GBS)  is a harmless bacteria that can colonize in the vagina as well as the gastrointenstinal and respiratory tracts. Approximately, 25% of pregnant women have GBS in the vagina or rectum.  GBS can become hazardous if it colonizes in the urinary tract and causes a urinary tract infection or if it colonizes on the skin of a newborn. This is why all women are screened at 35-37 weeks for the presence of GBS in their vagina and rectum. If a woman is positive for GBS, she will be given antibiotics through an IV during labor to prevent the bacteria from being able to colonize on the newborn's skin.
Screening
All pregnant women are screened at 35–37 weeks of gestation unless preterm labor is suspected. Women are screened by obtaining a single swab (cotton tip) specimen from the lower vagina and rectum. 
Treatment
If a woman's culture comes back positive for GBS, she will be treated propholactically in labor with IV antibootics to prevent the bacterial from colonizing on her newborn's skin. Common antibotics useed are penicillin and ampicillin. Clindamyicin may be used if a patient is allergic to penicillin. Be sure to notify your provider of all medicataion allergies. If  a cesearean is planned, she will not need antibotics for GBS.

Mental Health, Gun Control and Homeland Defense

Maybe I'm a dreamer, but I wish mental health care were as easy to get as, say, a gun. - Andy Borowitz

While I've used this blog mainly for the purpose of giving out information to my patients and to comment on the state of maternity care in the US or talk about child birthing and midwifery, I break now to talk about one thing political that I feel is utterly important. Yes, gun control is an issue here and is a serious issue in relation to what happened today, but so is the lack of mental health services in America.

Today, I need to say something about the state of mental health in our country. I've always told my husband that If we ever won the lottery, I'd like to devote most of these talents to fighting global warming, human trafficking or slavery, and improving mental health in America. For a country that is so "rich" we are so poor when it comes to mental health services.

In 2005, a NIH $20 million study found that one-quarter of all Americans met the criteria for having a mental illness, and fully a quarter of those had a serious disorder that significantly disrupted their ability to function day to day.  This puts American in the number 1 slot for mental health issues in the world.  We also are an "epic fail" when compared to other industrialized countries on mental health services.
Mental illness is really a disease of youth.  Half of those who will ever be diagnosed with a mental disorder show signs of the disease by age 14, and three-quarters by age 24.  However, less than half of youth that need treatment, get it. Those who seek treatment usually don't do so until a decade or more.  The reason for delays include insurance restrictions and lack of access. And the treatment they receive is usually inadequate. These are real brain disorders and they desperately need treatment.

And yes, I'm just going to come out and say it that it is a travesty when you think about how much we spend on defense in this country when we have sick people out there who are like ticking time bombs.

Obama was wrong when he said that the United States spends more on defense than the next 10 countries combined, we spend more the next 13 countries combined. When we allow mental health to rage out of control, we have a real threat to our neighborhoods and schools. We have what happened today in Newton, CT. Good God be with us now, when we are in trouble.

It brings me to a second issue and that is gun control. I'm going to also come out and say: I can accept the right to bear arms. But, my question is: what do you need to bear arms for?  I get that you want to protect yourself, but are you starting up your own military?  The weapons that were used today were a .223 caiber rifle and a Glock, which can carry up to 32 rounds of magazines.  Is that your plan when someone breaks into your home to attack you? To go through 32 rounds? Hardly, the most appropriate weapon for homeowner self protection.  Sure, a handgun or a pistol, but a rifle?  We have to think about when the second amendment was written, they didn't have these types of weapons. Come on, let's get serious about homeland defense and get a little bit more serious about gun control.

 .223 caliber rifle

Pump it up!

Ways to Increase Breast Milk Production

There are several theories about how to increase breast milk production.  What breastfeeding really comes down to is: supply and demand. Breastfeeding is generally a supply and demand situation.

The more demand there is on the breast for milk either from a little babe or a pump, there more milk will be made. Women's bodies are capable of adapting to a newborns desire for an adequate milk supply.  Only very few and rare circumstances with prevent a woman from being able to make enough breast milk for her babe. There are some women who are very gifted and are able to make enough milk without even batting an eyelash, and there are other women, myself included, that have to struggle to keep the milk supply flowing.

Here are tips for keeping increasing lactation

 

1) Drink 12 glasses of fluids a day:  This is so important to keep up an adequate milk supply.  In this case: water makes milk.  Don't go 1 hour without drinking at least 8 oz.

2) Pump in between feedings: Start pumping 1 hour after the morning feeding, when milk supply is at it's peak. Then gradually increase it to three times a day.  It's usually best to pump 45 min - 1 hour after emptying a breast at a feeding.


3) Keep stocked: Have plenty of breast pump supplies, bottles, or breastmilk bags clean and ready. The last thing you want to keep you from pumping is having to continually clean breast pumping supplies.  Having a good stock and washing them all at once, makes the pumping process easier

4) Get a good electric pump: Advent, Medela and Playtex all make great electric pumps. It is pointless to waste precious time pumping on a hand or manual pump.

5) Fenugreek - fenugreek is an herb that will increase milk supply. It comes in teas, pills and powder forms.

6) Mother's milk tea: Mother's milk tea is made by Traditional Medicinal and is sold at most Whole Foods or health food stores. It is also available online. It has herbs that promote lactation like fenugreek and anise.

7) Use heat: After a hot shower or after heat packs are applied to a breast, the will have more milk due to the increased circulation. Take advanteage of a hot shower or apply a heat pad before pumping or feeding.

Transition

Now that's powerful stuff

The term transition or in transition refers to the period of time just before the birth. Some like to quantify transition as having a beginning and an end. They say transition is from 6 or 8 to 10 cm or is the 25-30 minutes before the birth. I tend to disagree. As a mother of 3, I can say my transition was severely different for each, and I'm only one woman. The homebirth midwife who trained me always referred to labor and contractions as a period of changes.  She would often ask her clients to notify her when the next "change" in contractions was coming. She didn't explain how it would be, but somehow her clients knew when that "change" had taken place.  "Transition" she said "is the final change in contractions before the birth." "Some changes happen radically and quickly." She continued, "and some come slowly and steadily."  I like this word change.  It is a neutral word that has neither a positive or a negative spin on it.  It is what it is. Transition is what it is.  It is the actual moment when the body is getting ready to bring a new life into this world.
In my experience as a midwife, I also notice, feel, experience a change in my clients. It is the time when women say things like: "I can't do it." "I can't take it anymore."  "I don't have the strength" or even things like: "I'm dying."  As a provider, I know that the birth is soon imminent, but I see these women lost in the present moment and the beauty of a being completely devoted to it. Sometimes I will remind the woman that this too will pass, but other times I simply take in the beauty of complete serenity to the present.
 In my own personal experience with labor, this was the time when I felt that my entire existence had come down to this moment. It was awesome to be solely focused on what I was doing and unaware of any other time or place.  For me, it was the hardest part of each labor. It was the time when I so desperately relied on my team.  (which also was different in each labor).  The funny thing is, that for me the most helpful thing was being yanked out of the present and into the past and the future.  For my second and third labors, I knew I had done this before and I knew that I wouldn't be in this moment forever. I knew that somewhere in the future was my rapture, my relief. 
Transition is powerful. Transition is awe-ful and transition is the final moments before you hold your precious gift. Remember this when you go there, and if you can't rely on yourself to remember, get a teammate that will do it for you.  Happy, peaceful and blessed birth to you.

Occiput Posterior

The occiput posterior position, otherwise known as "OP" or "the baby is posterior" is when the baby head down but the face is looking up or facing the mother's pubis symphsis.  Another common term to describe the occiput posterior position is: the baby is "sunny-side up"
More commonly, when labor begins and the baby descends into the pelvis, the baby is facing the mother's spine and has his face looking at the mother's back.  This position is known as occiput anterior or OA.
These pictures to the right are examples of the baby descending in the occiput posterior position.
When a baby is posterior, this may envoke anxiety in a mother as she has heard stories about the difficulties this can bring on in labor.  However, often when the baby is posterior, there may be a reason: either the shape of the mother's pelvis, position of the placenta or umbilical cord, or size and gestation of the baby. This position may be the prefered position for some babies.

Turning a baby that is occiput posterior
Most babies that begin labor in the posterior postion will roate on their own to the favorable anterior position.  For some labors it can be advantageous to attempt to assist this rotation before labor begins or in early labor by:

• Remaining upright and walking/hiking
• Climbing stairs
• Doing squats and lunges
• Avoid recliner chairs or an excessively reclined position
• Do the cat/cow yoga pose 
• Acupuncture can assist in rotating the baby and getting the baby to engage into the pelvis
• Consult your OB provider about homeopathic remedies to ready the cervix & uterus
• Ask a provider to determine if the baby is right, left or center posterior and try different side-lying positions accordingly.

 
CAT COW POSITION
Always consult with your OB provider before attempting any exercise routine in pregnancy or labor. 

Going Natural

Preparing for Natural Childbirth

Almost every single woman in the world is equipped to have a natural childbirth.  However, in modern America, with easy access to pain relieving medication, sometimes it can be difficult to choose a different option during childbirth.  If natural childbirth is something you may consider, here are a few tips to prepare.

1. Preparation: While you can never actually prepare for what to expect in childbirth, just like a runner can't know what to expect running her first marathon, preparation is key to success. 
2. Read:  Read about labor and birth. Read about what happens to the body as a woman progresses  through pregnancy and into labor as well as what happens to the body during labor.  Read inspiring birth stories such as those found in Ina May's Guide to Childbirth, Embracing Birth, and Journey to Motherhood are great ways to emotionally and mentally prepare for childbirth.
3. Get your provider's support: Talk with your provider about your desires and ask how they will be able to support your decision to not use pharmacological pain medication.
4. Assemble a birth team:  While a labor coach or doula isn't for every woman, labor companions/coaches have been known to be very effective in reducing the use of pain medication during labor. Getting your partner involved is also helpful.  Dr. Bradley wrote the book a Husband-Coached Childbirth, which is applicable for any birth partner, relative, sister, friend to read to prepare for childbirth.
5. Exercise: Prep the body for the marathon of labor. Labor is physically demanding and being in good shape will help you feel prepared both mentally and physically. Exercise on a weekly basis
6. Learn how to relax: Choose a relaxation method and practice it before the delivery. Relaxation is key to handling the discomforts of labor. Many techniques are effective such as: meditation, guided imagery, hypnobirthing/hypnosis, deep breathing or focuses breathing, or listening to music or affirmations. Try some methods out before the labor and choose one that works for you.
7. Know your options and restrictions: Talk with your provider about changing positions, using a birthing ball, or hydrotherapy during labor.  Discuss with your provider the use of fetal monitoring during labor or IV therapy that may limit your mobility.
8. Consider hydrotherapy: Water can be extermely soothing for a laboring woman and some settings may require notification ahead of time or you may have to rent a tub.
9. Take a tour: Be familiar with the setting where you will give birth. This will help you to visualize your labor before it takes place. 
10. Plan ahead: Have a bag packed, any insurance paperwork, ID cards, and documents you may need for the labor in one place ready to go.  Have child care options ready for your other children.
11. Enjoy your labor experience and welcoming your new babe into the world.

Always consult with your health care provider before beginning any exercise, class, or meditation program.

Green Pregnancy Juice

Baby Juice

This is one of my favorite green juices to make in pregnancy.

I bunch of Kale
I bunch of Chard
I bunch of Collard
2 sticks of Celery
1/2 to 1 Cucumber
Green apples or pears to taste

Juice and enjoy. Freeze for later. Yum!

Breastfeeding- Planning to Breastfeed

Getting off to the Right Start

Breastfeeding is a wonderful way to bond with your baby.  It has great health benefits for the mother and the baby and is something that is as age old as delivery itself.  Many women are intimidated by breastfeeding. Some women have been given inacurate advice from previous providers that they cannot produce enough milk or are unable to breastfeed. Except for a very few rare cases, most women should be able to produce enough milk for their infants and breastfeed successfully.

Planning to breastfeed is a great way to ensure success. Some women are natural breastfeeders and other women can have difficulties in the beginning.  Even though, it's hard not to compare ourselves to others, (especially sisters and mothers) each woman is unique. The majority of women who stick with breastfeeding find they are very successful after just after two or three days with their babe.

Some great ways to ensure successful breastfeeding:

• Get the baby to the breast as soon as possible after delivery. Once a baby is born, he will be alert and responsive for the first 60-90 minutes.  This is a great time to get the baby to the breast in a very relaxed way. Because a full-term infant is born with brown fat that they metabolize in the first few hours of life, there is no rush to feed them immediately.  Also, their stomachs are small (like a marble) and they cannot take in a lot of milk in the first few days as it is. This time can be used to get to know your babe and get to know your babe at the breast.
• Skin to skin:  Keeping your baby's skin on your skin as much as possible is a great way to encourage breastfeeding. This helps to decrease stress in the newborn and has been shown to increase breastfeeding success.
• Try, try, again.  Don't be intimidated. Even when unsure, the best thing to do simply get the baby to the breast. Attempt breastfeeding.  It is a very natural thing for both the mother and the baby.  You might be surprised how easily a baby will naturally latch on the breast
• Utilize the resources at your birthing facility. Many hospitals and birthing centers will have lactation specialists that can come and evaluate breastfeeding. Having someone telling you, you are doing it right is one of the biggest confidence boosters. Have someone watch you breastfeed and evaluate your latch before you leave the birthing facility.
• Try to avoid a bottle or pacifier in the first 48 hours.  This will help to avoid nipple confusion and also signal to the body to produce milk.
• Learn how to use a breast pump early on.  A pump is a great ally when milk supply is down.  Production is a supply and demand operation. The more demand there is (stimulation on the nipple) for milk, the more milk the body will make.
• Eat. The first 6 weeks are not a great time for dieting in order to establish a great milk supply. Also excessive exercising during this time may decrease milk production.
• Drink. Water is an essential component to milk production and a decrease in water intake will decrease your milk supply.
• If difficulty still persists after 2-3 days, consider having a lactation consultation or your midwife come to your home to assist with latch.
• Have confidence in yourself and your ability to breastfeed. It's all natural.

VBAC After 3 Sections

A Vaginal Birth After Cesarean, actually . . . after 3 Cesareans

It's true. It happened, I was there and I witnessed it. This lovely, powerful woman had not one but three previous cesarean sections.  She found a competent and skilled provider and safely gave birth vaginally to her fourth child.  I write this to encourage anyone who may be contemplating a VBAC (vaginal birth after cesarean).  Align yourself with a provider you trust, putting yourself in very capable hands, trust your gut and your intuition and be open to the outcome.

Insomnia in Pregnancy

Unfortunately, insomnia is common in pregnancy and many teas and medications used to treat it can be contraindicated. Here are some tips to avoid insomnia in pregnancy.

• As much as possible, try to maintain a regular schedule of waking and going to bed
• Avoid caffeine after 3 pm
• Exercsie in the before the afternoon for at least 20 minutes
• Stop taking naps
• Try acupuncture
• Reduce stress by exercsing, massage, taking a warm bath, reading, going for a walk, etc
• Avoid night time stimulus: turn the TV off a least 1 hour before bed, keep lights low
• Use pillows or supports to sleep for comfort
• Don't eat too close to bedtime
• Meditate or pray
• Cherry juice concentrate has natural melatonin and may help induce sleep
• Drinking warm milk at bedtime

 

Preparing for Labor

Preparing for labor can begin as early as the 1st trimester or as late as the week of delivery. Before following any of the steps mentioned here, be sure to review these with your practioner, as they may not be appropriate for every woman.

First Trimester

Exercise: Moderate exercise (150 minutes a week) is very important in preparing for labor. It helps prevent carrying too far overdue and some studies say can even shorten labor. It also is good for keeping the weight of the baby within a normal range as it promotes blood flow and circulation.  It also is benefitical in keeping weight gain within the normal limits.  Exercising after meals is a good time

Prenatal Yoga and Stretching:  Keeping limber can also help in labor as it increases flexibility and can decrease discomfort from back pain, sciatica pain, and other musculoskeletal ailments.  This will help to reduce discomfort in labor.

Kegels: Kegels help to strengthen the pelvic floor and can actually reducing the amount of time a woman is in the second stage of labor (also known as pushing).

Eat right: Eating right is important eary in the pregancy and prevent excessive weight gain

Red Raspberry Leaf Tea:  This tea is a uterotonic, meaning it strengthens the uterus. It can be consumed at any stage of pregnancy.

Second Trimester

Take a birthing class:  This is a good time think about the type of labor you want and seek out and sign up for a birthing class.  There are many different options (click here for previous post about class options).

Take a tour of your hosptial setting or schedule a tour: If planning on birthing outside of the home, it can be helpful to familarize  yourself with the setting you have chosen.  It is helpful to get to know the policies and procedures at the hosptial, so you can plan on what to expect when you arrive.

Keep exercising, stetching, kegeling & eating right.

Third trimester

Reduce anxiety:  Great ways to reduce anxiety and tension related to labor include reading or listening to inspiring birth stories.  Practice relaxed breathing or meditation techniques.

Stretching: talor sitting, pelvic rocking and squatting are great stretches that prepare the pelvic area for labor. Sit talor style or squat while watching TV, talking on the phone or having a snack.

Talk to your Provider: At one of your prenatal visits, go over with your provider your expectantaions about the birth and your preferences.

Pre-register at the Birth Setting: Mail in any necessary paperwork and insurance information.

Read up on breastfeeding:  If you plan on breastfeeding, it may help to read a book, take a class or speak with a consultant or expert about breastfeeding basics.

Get plenty of rest: Getting more than 6 hours a night can actually reduce the length of a labor. Rest is very important for the body to rejuvenate and heal.

Preping the birth team:  It's a good time to think about who you would like to be at your birth, husband, friend, sister, or birth coach. Make sure everyone is on board and have all phone numbers handy.

Set up the nursery or baby area.

Keep exercising, stretching, kegeling & eating right.

After 36 weeks

Have a hospital bag packed and plans care for your other children.

Nest: Nesting (cleaning and organizing) helps prepare the woman for labor mentally.  It can reduce anxiety and tenstion and is something that makes many women feel more mentally prepared.

Take 500-1000 mg of Evening Primrose Oil orally to aid ripening the cervix.

Be intmate with your partner and go on dates: This is a good time to connect with your partner before the baby comes. Sexual intercourse can be helpful in ripening the cervix before labor.

Drink large quaniteis of red raspberry leaf tea (can be infused with nettle) 2-3 cups a day.

Continue to practice relaxed breathing and medication technqiues.

Keep exercising, stretching, kegeling and eating right - walking, hiking, yoga, and swimming a great exercise for this time.

Not all of these steps may be appropriate for every woman or pregnancy. Please consult with your obstetrical practitioner before implemeting any of these ideas.

Essential Lifestyle Changes to Enchance Fertility

There are a lot of simple lifestyle modifications women, AND men can do to enhance their natural fertility, whether they've been trying for 1 month or 1 year.  A few good ones a reviewed below.

SMOKING - stop smoking
Seems like common sense, but some may not have an exact understanding of how smoking effects fertilty. Smoking can causes changes in the health of a woman's fallopian tubes (which is the place where natural fertilization takes place).  It can also be harmful to cervical mucous, which is what enhances a sperm's ability to reach the egg during ovulation. In addition, smoking is associated with an increased risk of miscarriage.  Smoking is also thought to prematurely age the ovaries by up to 4 years and can decrease the quality of sperm.


WEIGHT - maintain a health weight
Another way to enchance fertility is by maintaining a healthy weight.  Women who fall into weight extremes underweight or overweight are less likely to conceive naturally. Fat stores estrogen and estrogen is what is in birth control pills, so too much estrogen (stored in fat) can be like taking a birth control pill.  Birth control pills are 99% effective in preventing pregnancy.  Another concern with weight is an increased insulin level in the blood. Insulin is the hormone that the pancreas produces to absorb glucose (or sugar) into the blood stream. A high level of insulin in the blood can effect other sex hormones decreasing overall fertility.

ALCOHOL

Women are attempting pregnancy should avoid drinking. Women who drink 4 or more drinks a week tend to take longer to achieve a pregnancy and are at higher risk of undergoing an infertility evaluation. Investigators have used the concept of a "standardized alcoholic drink" in most studies of ethanol and infertility. A standardized drink is typically defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits, which is the equivalent of 12 grams of ethanol.

CAFFEINE

It is unclear whether high caffeine consumption affects female fertility, but the thought is that it does. Especially caffeine from coffee.  I usually recommend to switch a morning cup of joe with green or white tea. Green tea has polyphenols and is very high in antioxidants and green tea has been thought to increase fertility by as much as 50%. Great.

 

Pregnancy Power Salad

Jicama Pomegranate Salad

When I'm pregnant I can't get enough salad, especially in the summer. So I've complied a few of my favorite pregnancy super foods to make a super yummy pregnancy power salad.

• 1 small head of romaine cut with a knife
• 2 cups of raw spinach
• 10-14 walnuts loosely crushed
• 1 jicama, peeled and julienne
• 1/2 cup of pomegranate seeds
• 2 hard boiled egg whites chopped

** You can also add avocado, chunks of corn or mandarin oranges


Lime vinaigrette

• 1/4 cup fresh lime juice
• 1/4 cup apple cider or red wine vinegar
• 1/2 teaspoon salt
• 1 tablespoon honey or agave
• 3 tablespoons olive oil, avocado oil, walnut oil, or brown rice oil

Place the chopped romaine and spinach in a bowl and drizzle the dressing to taste. Cover with jicama, walnuts, pomegranate seeds and egg whites and enjoy.

Fetal Kick Counts

After the 28th week or the third trimester, a woman may become increasing aware of the baby kicking in the womb.  Before this, some women don't even feel the baby moving until the 20th week and it can be different with each pregnancy.  In general, I usually counsel a woman that she should  be aware of the movements regularly throughout the day,  paying attention that she perceives a grouping of movements in the morning, afternoon and evening. Babies can be active at different times of the day and usually by the 28th week,  a woman will gain a sense of what a normal amount of movement is for her baby.  Counting can be very helpful if she perceives a change in the frequency or a decrease in fetal movements.  Fetal movements are a great predictor of fetal well being and fetal kick counts is a way to quantify fetal movements.  Other reasons to do fetal kick counts are if a woman's provider instructs her to do so, she has a medical indication in which they are recommended, it's something she enjoys, or she feels a sense of calm and reassurance by doing so.

How to do fetal kick counts:

• It is best to count while sitting or resting.
• The woman should place her hands on her belly and time how long it takes her to perceive 10 kicks.
• Without being distracted, a woman should perceive 10 kicks in 1-2 hours.
• If after 30 minutes of waiting, a woman does not perceive movement, she should walk, change positions, drink something cold or have something sweet to eat.
• If there is any concern regarding the amount, frequency or quality of fetal movements, a woman should contact her provider for counseling. 
• The proper way to do fetal kick counts should always be reviewed with an obstetrical health care provider.**

• There are apps for smartphones and mobile devices that can be helpful  
• Baby Kick Counter and Wiggle Wrecorde

• Or check out this link for a handy chart.

Internet Information Overload

Nowadays, we are on internet information overload. For almost anything and everything we think up, we can find some internet article, website, group or post to back our claim.  We then discuss, distribute, and disseminate.  This can sometimes lead to having medical information backed by views or popularity as opposed to clinical evidence.  It can lead to a bit of confusion.  Is Sushi bad? What about induction if I've had a VBAC?  Should I take progesterone? and on an on.  This is why I strongly advocate women talking with a provider they trust about their questions or concerns.  As a provider myself, I strive to be an expert provider that has a moderation between experience combined with evidence-based practice and offer this continually to my patients.  The benefit of an provider who is experienced but also up-to-date on the latest research is invaluable.

The field of Obstetrics changes every month as new research is tested and trialed. There are new treatments, new recommendations, and new safe practices.  Because a lot in the field of obstetrics stays the same over time (giving birth has been around for a while!), even some providers can get complacent when it comes to reading research and changing their practices and conceptions.  It's common for even some long practicing providers to practice out-of-date care, so its not surprising that internet information can also be a bit behind the times. 

While the internet can be a great source of information, it can also be a scary and frightening place for an already vulnerable pregnant couple. I strongly advocate talking with your provider about the latest research regarding a question or concern that you have.  Most providers who read research regularly are happy to "get geeky" and talk shop for a while in terms that are easily understandable, even if they are in a rush.  So go for it and don't be afraid to ask about what the research says.

Obama Care

The Affordable Healthcare Act
It's hard to completely understand how this change will impact us each specifically. The Obama campagin has a tool on their website where you can put in specific factors about the health care you have now and it will generate a read out of how your care will change.  Linked here

The Pros include: (taken from Slate, the Wall Street Journal and Barack Obama and Mitt Romney's campaign websites)

• An increase in benefits for the uninsured
• Senior citizes will gain acess to billions of dollars in prescription benefits
• Everyone withinsurance will get free preventive serices
• It will increase coverage for those with a pre-existing condition
• Working families are protected from losing their health care or being forced into bankruptcy when a family member gets sick or is in an accident
• adult children can stay on their parent's health plan until the age of 26
• Mammograms, pap smears and immunixations will be covered without a co-pay including breastfeeding support, contraception, HPV testing, and domestic volence screenings
• Insurance companies are now required to justify rate hikes, and consumers have the ability to appeal to an independent third party when insurance companies refuse to cover services or care
• Starting in 2014, all Americans will have access to affordable health insurance no matter their circumstances—whether they change jobs, lose their job, decide to start a business, or retire early
• For patients, there will be fewer cash payments and lower fees.
• States can opt out of the act
• The law is expected to reduce the deficit by $127 billion from 2012 to 2021.

The Cons

• The act forces an insurer to sell a policy to someone who is already sick, which severely limits the insurer's right to charge that person a higher premium
• The bill, itself more than 2,400 pages long, relies on a dense web of regulations, fees, subsidies, excise taxes, exchanges, and rule-setting boards to give the federal government extraordinary control over every corner of the health care system
• States can opt out of certain sections of the act
• It you don't purchase health insurance you are responsible for a tax
• Flexible Spending Accounts will shrink to a maximum of $2,500
• You will only be able to deduct a medical expense from your taxes if it exceeds 10% of your gross income
• The costs are unknown

The unknowns:

• It is not known exactly how much this act will cost.  Speculation on both sides report a drastic increase in governement spending while democrats boast a reduction in spending and the overal deficit.  It remains unknown.
• The effect of “comparative effectiveness” practice guidelines on individual practioners. This is a part of the act that is aimed at improving quality while reducing costs. Republicans argue that it will be a way to manipulate provider freedom. This is explained in more detail in this NYT article. Click here

The Birth Plan

It's true, there is a common belief among labor & delivery nurses and obstetricians that birth plans lead to the BIG ROOM, aka the operating room. While this stereotype is entirely unfair (as many stereotypes are), in their defense, I think it may be that a few women who "birth plan" sort of ruined it for the rest, by zealously typing up binders full of planning and structuring for their exact, idyllic birth.

The birth plan, theoretically makes sense. Planning in any situation usually makes that situation less stressful and more enjoyable. That's the funny thing about the birth plan - you can't! And birth often is more than idyllic without adhering to a plan.

The best way to "birth plan."

1) Prepare. Prepare for the unexpected. Labor will most likely begin at an unexpected moment. Pack ahead of time and have plans for different scenarios with work, transportation, and childcare (if needed). Tour the facility where you plan to give birth.
2) Communicate. Talk to your partner and your provider about what your preferences are for the birth. Ask your provider about what you expect and any protocols at the facility where you will give birth. A lot of your preferences may be what your provider already practices like skin to skin and not performing episotomies.
3) Trust. Trust your body and your ability to birth. Trust your provider to have your interests at heart. Trust your provider to take your preferences and make them happen whenever possible.
4) Be flexible. Plan to go with the flow
5) Relax and enjoy. As much as possible, try to relax and enjoy the birthing process.

Filling out a birth plan or a list of preferences can be a good way to go over your preferences with your provider.  In the birth setting, it can prevent you from having to constantly repeat yourself.   Keep it brief and relevant.

Childbirth Class Options

General Childbirth Classes
Many general classes are taught by a hospital, birthing facility or employee of a specific birthing facility.  These classes can be great general overviews on how to prepare for the birthing process without a specific concept in mind for the birth experience.  Many times the classes are basic and review specific facility policies and procedures.  Often, these classes don't have a set philosophy or model of instruction and are often advertised on the facilities website.  

International Childbirth Education Association

This is an organization that also offers general childbirth classes. It was founded in the early 60's and is not aligned with a particular philosophy or method.  Their main goal is to educate mothers and decrease the fear surrounding childbirth. This organization was one of the original supporters of father involvement and midwifery.  They not only certify childbirth educators but doulas, prenatal fitness educators, postnatal educators, and postnatal doulas.

Lamaze
Ferdinand Lamaze, a French obstetrician, developed the Lamaze Method of childbirth.  Traditionally known from their breathing method or techniques, their core values are about building confidence in the mother, providing support, and using evidence-based practices and techniques in their instruction. Each certified lamaze instructor works a bit differently; but, the classes are usually limited to 10-12 couples and are broken up into 4 or 6 sessions. 

The Bradley Method
Dr. Bradley & his Bradley method was one of the first obstetricians to bring father's into the delivery room and strongly believes in partner-coached childbirth.  He wrote the book Husband-Coached Childbirth.  Bradley classes are usually some of the most comprehensive classes and are taught in 12 installments over 12 weeks. Partners are strongly encouraged to attend. Some certified teachers break up the classes into 8 longer sessions.

Hypnobirthing
Hypnobirthing, also known as the Mongan Method is a childbirth educational series that utilizes relaxation techniques and self-hypnosis.  It was founded by Marie Mongan, a hypnotherapist, and has beliefs that pain does not have to accompany labor.  It is traditionally taught in 5 sessions lasting 2.5 hours each. Marie wrote the book Hypnobirthing: The Mongan Method.

Calm Birth
The method focuses on meditation and progressive relaxation techniques.  The method blends psychosomatic medicinal practices and mental awareness focusing exercises.  Influences into the method come from Buddishm, Tao, & Hinduism.  Special techniques include womb breathing and giving and receiving mediation. The founder wrote the book Calm Birth and published a CD with sounds for relaxation and meditation.

Birthing from Within
This is more of a philosophy of birth than a method of preparation yet their are certified birthing from within teachers.  The philosophy focuses on inspiring and teaching expectant parents that birth is a rite of passage.  The goals include co-creating holistic prenatal care and minimizing emotionally difficult birth through preparation.  Pam England, the founder, wrote Birthing from Within.

Other Childbirth Preparation Programs
Dancing for Birth Link
Purebirth Link

Preparing for the Postpartum Period

The postpartum period can sneak up on us and catch us off guard. We spend countless hours preparing for the labor and the delivery but not as much for the postpartum period.  Those inital days and weeks can be very challenging even for the experienced mom, so I recommend a little preparation and planning to ease the transition. Here are a few suggestions.

BREASTFEEDING SUPPORT
1) If you plan on breastfeeding, set up a postpartum doula or lactation consultation ahead of time to meet with you in your home after the delivery

• Ask your provider for a recommendation during a prenatal visit
• There are plenty of doula organizations D.O.N.A and ICEA (to name a few) that have lists on their website for postpartum doulas.
•  The international lactation consultant association also has a listing by area

HOUSEHOLD HELP
2) Get cleaning and laundry help set up ahead of time.

• Due to the needs of a newborn and sleep deprivation, it's very difficult to keep a home organized and clean.  
• Sometimes it can be very distracting to have the dishes and the laundry pile up. 
• The postpartum period isn't a time to be stubborn. Take as much help as you can get (even daily) from hired help or from family for the first 6-14 weeks to do household chores and cleaning. 

MEALS
3) Get meals set up ahead of time.

• Mealtrain.com is a website that will allow your friends and family to organize meals. Most people are happy to help out in this way and it let's them feel involved and part of the birthing experience.
• Make meals in your last few weeks of pregnancy that can be easily heated up and freeze them like lasagna, sauces, baked goods and soups
• Don't be afraid to buy frozen meals. Trader Joe's and Whole Foods sell great frozen (even organic) meals.

FINANCES
4) Put some money aside. Sometimes, it's not possible, but if you start putting even just a little away week by week of your pregnancy, it can help.

• Financial stress can contribute to postpartum depression. 
• Keeping a little money aside can be a stress relief even it it's not needed.

SOCIAL SUPPORT
5) Find a community

• Connecting with other new moms can lead to a better sense of self-efficacy as well as decrease the baby blues and postpartum depression.
• The National Mother's Center Association has a list by area of Mother's Centers, groups and actives by area.
• Holistic Mom's Network is another national group that has local chapters
• La Leche League also has local chapters, groups and actives to be a part of 
• Ask your birthing facility or provider about support groups

Headaches in Pregnancy

Headaches in pregnancy are common and can happen at any stage. They do tend to be more common in the first trimester, up to 20 weeks. Here is a great overview of headaches in pregnancy.

HEADACHES 

What causes them?

Hormonal changes

Nasal congestion

Allergies

Hunger (low blood sugar)

Fatigue

Lack of sleep

Food triggers

Eyestrain

Tension

Stress & anxiety

Caffeine withdrawal

TMJ or Jaw tension

What to do about them?

Avoid triggers such as MSG and artificial sweeteners

Teas, coffee, wine and nuts have tannic acid which trigger headaches

Aged cheeses and added nitrites to meats can be triggers

Stay hydrated with lemon water

Talk a warm shower

Place a hot compress on the temples or over the eyes

Take a warm bath

Exercise to increase circulation

Drink a caffeinated beverage 

For congestion try inhaling steam or a warm compress over the sinuses

For tension, anxiety or stress get a massage

Wear a mouth guard at night

Consider acupuncture or acupressure

  The vitamin supplement magnesium has been associated with lower headaches in pregnancy*

Tylenol, as recommended on the bottle, is safe for most pregnancies*

Links

American Pregnancy Association

Mayo Clinic

*You should always discuss your pregnancy symptoms with your provider at each visit, including headaches.  Any severe headache, blurry vision, or floaters should be reported to your provider right away. Always consult your provider before taking any medications, supplements, or herbs in pregnancy.

Midwives as a Status Symbol

New York Times Article Click Here

Midwives as a Status Symbol

Are we really the next pooch in a prada or a Buggaboo stroller?

The NewYork consumer has changed, but so have we; and, so has New York herself.  Nowadays, most of us have higher education degrees and are delivering in the hospital as well as the home. It wasn't until 1992 that we were legally prescribing medication in New York and 2010 that we were able to legally practice independently.  New York trusts us, while we have the outcomes and education to support why she should.  In addition, we happily provide care for the "hippy-dippy spiritual birth," but we also provide what many women want: simple and supported, natural hospital birth.

The Importance of Postpartum Support

Women are doing excellent jobs of preparing for childbirth. They begin labor with many weeks or months of studying, preparing, exercising, and practicing.  Even these women, though, can be side swiped when it comes to the postpartum period.  It's overwhelming, but something that women can also prepare for.
Postpartum support in American is dramatically undervalued.  Women are discharged from the hospital in 48 hours (sometimes less) and expected to go back to work in 6 weeks.  There are no routine/standard home visits or groups for women from their hospital or providers like in many other countries and women are expected to figure it out on their own and basically cope as opposed to thrive.
The rise of postpartum depression has escalated. Up to 80% of women experience postpartum blues or a milder, generally shorter lived and non-medicated form of postpartum depression. While it is often fleeting, it's disconcerting and emotionally taxing. While hormonal changes are often the culprit for postpartum blues, women report that feel they have ample postpartum support from family, friends or professional support (doulas, nurses, midwives, lactation specialists) seldom report postpartum blues and depression.
Postpartum depression occurs about 10% of the time while major depression occurs in 6% of women.  The difference between postpartum depression and postpartum blues is that in order to be diagnosed as depressed, the woman must have the symptoms of depression most of the day, every day for two weeks or longer.
Women who are at risk for postpartum depression include women who have: marital stress, childcare stress, a lack of perceived social support from family and friends, lack of emotional and financial support from the partner, living without a partner, and complications with their own relationship with their mother.  There are other factors that place a women as risk, but each of these aforementioned risk factors involve a perceived sense of lack of support.  It is proven that in cultures where support from extended family is available and where spousal support is encouraged the rates of postpartum depression are lower.  So, as part of a labor team, family, or circle of friends . . . support those mommas!

Natural Hospital Birth

At the risk of being a groupie, I just have to mention how excited I am by Cynthia Gabriel's book Natural Hospital Birth, The Best of Both Worlds.
In America, we are so unindated with compromise and moderation.  We have business class, crossover SUVs, and 2% milk, but when it comes to birth we have been black and white for a long time,  Cynthia's book, however,  is an anthem to the 50 Shades of Grey natural hospital birth allows us.

I'm elated that this middle of the road option is also being applied to the birthing room.  I mean, where would America be without the middle class? Women no longer have to choose between the two extremes of home birth or overly defensive hospital birth, armed only with a birth plan and a semi-supportive, annoyed practioner.  We are seeing all types of women, providers, and births in the hosptial setting. It's darn well about time!

Amazon link to the book

The Importance of Kegels

Kegels - Never to be Underestimated

I feel I can never stress enough the importance of doing Kegels.   After a recent gal pal date, over coffee, I realized "do your kegels" is the "monthly self-breast exam" and "practice safe sex" women's health motto for this new decade. 

We, as women, do Kegels to prevent complications that arise with the pelvic floor from age, regardless of whether or not we had children.  These complications can include urinary incontinence, urinary urgency, pain during intercourse, pelvic organ prolapse, and uterine or cervical prolapse.

Ok, but what are Kegels?  The Kegel muscles are the group of muscles that make up the pelvic floor. Kegel exercise are the subsequent exercise that strengthen these muscles.

How do I do Kegels? The best way for women to do Kegel exercises is to imagine they are trying to pick up a marble with their vagina.   Another way to know a woman is doing them correctly is to try to stop the flow of urine. They can be done in any position (sitting, standing, lying).  They should be done in 3-5 times a day for 10 reps each set.  Pilates exercises are known for consistently engaging the Kegel muscles.  Most women need 3-4 weeks before they will begin to see improvement.

Benefits in Pregnancy. Kegels can also be beneficial in pregnancy and labor and delivery, as a strong pelvic floor offers the pregnant woman more support during pregnancy and more strength in delivery. 

Some resources:

 The Mayo Clinic Guide to Kegels a step-by-step guide to exercising the pelvic floor.

Kegelmasters - Like lifting weights for the pelvic floor. Products that provide resistance and increased strength training.

Light Bladder Leakage - information about light bladder leakage and it's link to menopause.

New York Times Magazine: Ina May Gaskin

Thank you Ina May!

Mommy Wars: The Prequel
Ina May Gaskin and the Battle for at-Home Births

New York Times Article. Click here

8 Foods Pregnant Women Should Eat

Almonds: These nuts are less allergenic than their cousins the peanuts, cashews & macadamia nut.  They are  high in folic acid, fiber & B vitamins have a low glycemic index. They are high in vitamin E, which can help with vascular health. Their fat content make them a great snack, which helps you to feel satisfied. Try a 20-30 almonds as a snack.

Chia Seeds: A What? Exactly. This is becoming a more popular food in healthy eating circles.  Chia seeds are the ultimate vegetarian source of omega-3 fatty acids, important for brain and eye development. They have 5000mg per ounce.  They are high in fiber and contain a moderate amount of protein (4g in 1oz). In addition, they contain minerals like potassium, phosphorus, calcium and manganese.

Cherries:  These berries are often overlooked as a superfood. They are the right color to give that rich antioxidant boost and are high in fiber and vitamin C.  They also have natural melatonin which can  aid with insomnia in pregnancy.

Chickpeas: An overlooked legume.  These beans are a great source of protein and also are high in folate.  They can have 15g of protein per cup. They also are a great source of minerals like selenium and zinc.  So eat up that hummus.

Eggs: One egg has every single essential amnio acid we need.  It's one of the very few dietary sources of vitamin D and also contains vitamins A, B6, B12, E, chlorine, iron, calcium and folic acid.  One egg has approximately 12g of protein.  Need I say more?

Flaxseeds: Known primarily as a great vegetarian source of omega-3, flax actually have less omega-3 than the chia seed, but many other wonderful properties. Flax has ligands which help balance hormones and can help stabilize mood swings in pregnancy.

Mushrooms:  Especially types like Shiitake are a great low calorie highly satisfying food. They are  high in several minerals such as: selenium, copper and potassium. They can be helpful in reducing inflammation in pregnancy

Yogurt:  There is just no getting around how wonderful yogurt is.  All natural, no sugar added, live culture yogurt is high in lactobacillius which quells yeast (a common complaint in pregnancy). Many types of yogurt are high in protein as well as calcium. The list of medicinal benefits is vast: decreased muscle cramps, promotes skeletal growth, decreases inflammation, aids in digestion, improves skin, decreases nausea.

Pesky Yeast

Ugh, yeast infections in pregnancy. What to do? Especially if you are in the 1st trimester and the regular azoles (terconazole & monistat) are not generally recommended.  Here are some natural remedies for yeast.  They can be cumbersome.  But, when done correctly, are very effective.


Garlic - Garlic has a range of health benefits from anticarcinogenic to insect repellant. It is also a wonderful antimicrobial (bacterial, fungal, parasitic). Garlic can be ingested orally (one raw cloves, capsules 600-900 mg) or inserted vaginally (one raw clove) every night for 3-7 nights.

Acidophilus - Also known as lactobacillus acidophilus is a friendly bacterial that helps to maintain a normal gut and a normal vaginal pH by acting like a natural antibiotic. Acidophilus can be found in pill and powder form. Some suggest that the refrigerated form is more effective. It can also be found in yogurt and yogurt products.

Tea tree oil - This oil may be applied topically for symptomatic relief of itching or burning.  It also has antiseptic properties which is why it is better than vitamin E or vitamin A oils.


Gentian Violet - This is a dye that is a powerful yeast killer.  It should be applied liberally in the perineal area.  It will keep the skin purple for a few days and will also dye underwear.

Allspice - Allspice is actually a green fruit (berry) that grows on the Pimenta tree.  While traditionally used to cure indigestion or stomach aches, it also has been found to have antiseptic an anesthetic effects especially against candida albicans (yeast).

Boric acid - There is a lot of controversy over boric acid capsule use in pregnancy.   Some practitioners and pharmacists are adamant that it should only be used in non-pregnant women. I also don't typically recommend it, but included it here to be complete.  It is very effective, when used as boric acid capsules, 98% of women with chronic yeast report being cured from chronic yeast.  Insert into the vagina up to twice a day for 2-4 weeks. Boric acid should NEVER be ingested orally.

The Bradley Diet for Pregnancy

There are many different reasons to eat many different ways in pregnancy; but, the Bradley Diet is one of my all time favorite GENERAL diets for normal healthy pregnancies. See below.

A WELL BALANCED PREGNANCY DIET CONSISTS OF:

Every day of the week you and your baby should have:

1. 2-4 servings of dairy. Whole dairy is preferred: whole milk, buttermilk, or cheese, yogurt, even occasionally ice cream, etc.... 
2. Up to two eggs a day, (hard boiled, in french toast, or added to other foods).
3. 40-75 grams of protein a day (depending on weight): beans, edamame, greek yogurt, cottage cheese, eggs, whey, turkey, fish (low mercury), chicken, lean beef, lamb, pork, 
4. Two good servings of fresh green leafy vegetables: kale, chard, mustard greens, collard, turnip greens, spinach, or dark lettuce. Juicing is a great way to get leafy greens.
5. Minimum of two servings of 100% whole grain: 100% sprouted whole wheat, millet, amaranth, rye, farro, spelt, quinoa, wild rice, oats, or sprouted grains.
6. A piece of citrus fruit or glass of juice of lemon, lime, orange, tomato, or grapefruit.
7. Three tablespoons healthy oils; olive, avocado, grapeseed, nuts & seeds or organic butter.
8. Other fruits and vegetables.

Also include in your diet:

1. A yellow or orange-colored fruit once a week.
2. Whole sweet potato or yam once a week.
3. Plenty of fluids, water, juice etc.
4. Salt food to taste for a safe increase in blood volume.
5. Avoid processed foods and preservatives whenever possible
6. Limit saturated fats from animal meats
7. Use lots of different colors in your foods, blue, red, green, even black (peas, beans, etc)

Avoid if possible

1. Any processed carbohydrates: most breads, cereals, pastas, crackers, or cookies. Try to eat foods that have a short shelf life (less than a week)
2. Candy and sodas, try instead 70% dark chocolate, nuts, or 5 ingredient ice cream.
3. Eating too much fruit. It can be possible to have too much fruit, try to limit your fruit to 1-2 servings a day and fill up on vegetables. 
4. High sugar fruits like grapes, watermelon, figs, and mango.
5. Avoid the "bad" veggies: Corn, soy, white potatoes, and carrots.

You may substitute proteins if you wish, being sure your proteins are complete, and that you get approximately the appropriate amount of proteins for your weight and height. If you substitute, also be sure all the elements necessary for a well balanced diet are available every day.

Placenta Encapsulation

Placentophagy, the process of eating the placenta after childbirth, is not routinely practiced in humans except in China where the placenta may be dried for medicinal herbs.  Most commonly, in the Western world, the placenta is incinerated after childbirth by the health care facility where the mother gave birth.  More commonly as in Japan, Turkey, the Ukraine, & New Zealand, the placenta is buried and a given a ceremony or funeral.  Placentophagy is actually quite common in mammals.  Aside from the pinnipedia, the cetacea, and the camel, the human is the only other mammal that does not routinely eat it's placenta after childbirth.  Placenta encapsulation is becoming more popular in the west as women are using it to starve off the 'baby blues' and 'bounce back' after childbirth.




January Jones, the rockin' blonde from Mad Men, has returned to work 7 weeks after giving birth to 'Xander' at 34.  She also attributes her speedy recovery to her placenta.  The star admits to doing placental encapsulation.

Morning Sickness Makes Me Nauseous

It's enough to make you nauseous just thinking about all the remedies (pharmaceutical and complimentary) for nausea.  Most women ask their mom, sister or friend, or grandma, most of whom swear by one remedy or another.

If you are suffering from nausea and vomiting in pregnancy, you are not alone. It has been estimated the as many as 80% of women deal with nausea in their pregnancy.  So what really works?

From both my personal, professional and anecdotal experience with patients, I have found this graduated approach to work most effectively.

Prevention
(you may already be beyond this part, then move ahead)
The best way to prevent nausea and vomiting in pregnancy is to:
1) Avoid Triggers such as: processed & packaged foods, greasy or spicy foods, & personal triggers
2) Skip on the high saturated fat diet like excessive beef, chicken, pork, and excessive dairy
3) One serving a day of non-fat greek yogurt may be helpful and is great source of protein.
4) Change from eating three large meals a day to six small ones
5) Try to maintain a stable blood sugar throughout the day (avoid high sugar snacks)
6) Take your prenatal vitamin(s) in the evening with food
5) Nosh on fruit, vegetables, seeds, popcorn, brown rice, or almonds throughout the day
6) Walk at least 30 min everyday.

Mild Nausea
If you feel nausea only sometimes throughout the day and not everyday, I recommend:
1) See the suggestions from prevention above

2) In addition to your prenatal, take vitamin B6 (25 mg) three times a day an vitamin C (200-500mg) three times a day. Usually three days is enough to see a change. If there isn't a reduction in nausea these vitamins may not help, and can be discontinued. Both are water soluble and are harmless to a mom-to-be. There are several over the counter (OTC) prenatal lozenges and lollipops like B-natal that patients find work well.

3) Ginger - raw ginger root (a small slice the size of a pumpkin seed) may be eaten anytime you feel nauseous. Simply peel, cut and eat. Ginger ale, ginger candies, and commercial ginger teas do not have the same effect.
4) One tbs of apple cider vinegar, usually in the morning
5) Anise or Fennel seed tea.
6) At this stage fluids are usually best if drank cold and in small amounts.
7) It remains important to not let the stomach get empty and continue with small frequent meals.



Moderate Nausea
If you are experiencing mild nausea almost every day for a large part of the day, I recommend:
1) The over the counter (OTC) antihistamine Doxylamine combined with vitamin B6 can be effective.
2) Sea-bands are also found in most drugstores.
3) Acupuncture may also be equally effective.
4) Reglan or Zofran may be considered (see below).

Severe Nausea or Hyperemesis Gravidarium
If you are experiencing extreme nausea every day all the time you should consult with your provider.  Many providers will prescribe pharmaceuticals: usually reglan  or zofran.
Reglan (metoclopramide) is an antiemetic and a pregnancy category B (safe) medication. Reglan is commonly used in the pediatric population.  Zofran (ondansetron), another antiemetic is a category B medication.  While may women start and can have relief with reglan, zofran (antidotally) is must more effective and brings on much more relief. In cases of hyperemesis gravidarium hospitalization and IV treatments may be necessary. Talk to your provider about these symptoms immediately.

Let them eat fish! Just not BIG ones.

Mercury is found naturally in our environment. Most commonly as a liquid or a gas. We are exposed to it through the dental work in our mouths, the food we eat, mainly fish, and until recently, vaccines. While the body is capable of eliminating mercury from the body, it should only be consumed in tiny amounts.

But we love fish and maybe aren't so crazy about the saturated fats in pork, beef, and chicken.  Fish are a great source of omega 3s, the B vitamins and protein which are so essential to the developing brain of a fetus.  So to aid with the confusion, I've added a link below which clearly charts what is suitable for a mother-to-be.

Here is a great resource from the American Pregnancy Association about types and amounts of fish suitable for pregnancy. 

Click here.  

Seems fish isn't such a catch 22 after all.