Heartburn in Pregnancy

Thursday, June 25, 2020

Heartburn in Pregnancy

Why does it happen?

Heartburn is incredibly common and will plague between 17%-45% of pregnant people (Vazquez JC. Heartburn in pregnancy. BMJ Clin Evid. 2015;2015:1411. Published 2015 Sep 8.).

This happen because of two hormones: progesterone and relaxin. They are responsible for relaxing the muscles in your body during pregnancy to allow for growth and stretching in order to accommodate your baby. This causes your esophagus and the sphincter that keeps it closed to relax as well. Also, as your baby grows your “real estate” gets smaller and smaller.

With this change, your stomach gets squished which forces stomach acid back up into your esophagus. Not pleasant, but there are ways to combat this physical change and discomfort!

First, what not to do!

  • - Do not stop eating. Your baby needs to be nourished. Not eating will actually increase your stomach acid making your heartburn worse.

  • - Do not munch on antacids (TUMS, Rolaids) like candy as this has been linked to calcification of the placenta*. This means your placenta will begin to develop these very hard, rocklike spots and obviously this is not healthy for your baby. Also too much calcium can block iron absorption so be mindful of that. Many actiacids use aluminum as an active ingredient such as aluminum hydroxide or aluminum carbonate and should be avoided in pregnancy. Antiacids can cause constipation and due to the high sodium bicarbonate in some formulas, it can elevate your blood pressure which is not great for anyone at risk for preeclampsia.

What to do? (Please check with your provider before using/adopting these remedies): 

  • - Begin with eating smaller meals. I recommend also snacking every hour with just a handful of something light, but filling like almonds, popcorn, 3-5 crackers, a handful of grapes or blueberries, a bowl of strawberries or watermelon, a hard-boiled egg, etc. Eating smaller meals will benefit you in several ways: it will allow your belly to digest before adding more since the space is limited, it will provide you and your baby consistent fuel (and energy), and it will support stable blood sugar. Along with eating small meals is eating slow. Do not scarf down your dinner in 10 minutes flat and be shocked that your heartburn is out of control. Your tummy just can’t digest that amount of food consumed in a matter of minutes at once anymore.

  • - Drink a glass of milk. Milk can coat the inside of your stomach and help dilute the stomach aid. Yogurt can do the same thing for you! You can also try a shot of Apple Cider Vinegar, eating ginger or sipping ginger tea, a spoonful of honey or chamomile tea with honey.

  • - Papaya Enzymes. Caution here because papaya FRUIT (vs. the extracted enzyme) is contraindicated as a possible cause of pre-term labor. The caveat here is that it’s UNRIPE papaya fruit but since you don’t ever really know the ripeness of fruit you purchase in the store, it’s best to stay away altogether (unripe papaya has also been linked to miscarriage in a few studies when consumed in the first trimester).

  • - Orange Peel Extract: I have never heard of this and have never recommended this, but this is a very interesting article and the sources are provided at the bottom. 

  • - Stay hydrated. Rather than downing a glass of water once an hour, it’s better to consume liquids consistently throughout the day. The recommended amount of water for an average pregnancy and average sized female is 8-10 cups (equal to 65-80 ounces or 2-2.4 liters).

  • - Avoid laying down after eating. You should not lie down for at least 45-60 minuets after eating. This is most difficult after dinner so I say find an activity that requires you to be upright—either standing or sitting. If you lie down too soon, the stomach acid that is working to digest the food in your stomach will slip right up and you might even feel nauseas or find yourself throwing up.

  • - Avoid eating right before bed. I always say if you can eat 2 hours before bed, then that’s enough, but some doctors would say you shouldn’t eat anymore than 3 hours before bed. I believe this truly depends on your body and only you will know what that time is for you. However, try not to eat super hearty meals before bed because this will have your stomach working in overdrive. If you need to eat right before bed (trust me, I feel you), I recommend something water based like grapes, watermelon, or celery. These are easy things to digest, but be mindful that the sugar from the grapes and watermelon may spike your blood sugar or make your baby have a dance party.

  • - Sleep Elevated. You can achieve this several ways. You can purchase a wedge pillow or you can stuff rolled up towels (or a yoga mat) under the top of your mattress to create an angle at your head. This will prevent stomach acid from going back into your esophagus while you’re lying flat.

  • - Chew sugarless gum after eating dinner (or any large meal). This is a very interesting one, but it works similarly to giving a baby with acid reflux (or just really bad spit up) a pacifier after feeding them (before burping) to keep them sucking. This continuous sucking, despite not eating, keeps their gastrointestinal system activated which keeps them digesting longer and we generally see a decrease in spit up. Same with adults, but our gastrointestinal system is activated by chewing since we are not infants anymore. The chewing gum will keep your stomach activated. The increased saliva might also help to neutralize the stomach acid.

  • - Speak with your doctor. They may suggest a H2 blocker like Tagamet or Zantac. Be mindful that long term use of these have been linked to pH unbalance in your stomach and gut.


  • - This is a condition where the placenta begins to harden (calcify) in specific spots. These spots are indicators of the “age” or “ efficiency” fo the placenta meaning the more calcification the “older” and less efficient your placenta is considered to be.

  • - This is a great informational article but provides no evidence-based citations or any real sources. 

  • - It’s not regulated by the FDA nor has it been evaluated by any formal study that it is safe to consume daily TUMS during pregnancy.

  • - The Placenta is in charge of filtering all calcium that crosses the blood-brain barrier. If there is too much, your placenta will actually hold the extra calcium —causing calcification of the placenta. Calcification of the placenta has been associated with pre-term labor. TUMS should never be taken at the same time as prenatal vitamins due to a possible adverse interaction between the two.

  • - Calcium Carbonate is the active ingredient in antacids and too much calcium has been shown to block iron absorption. Iron is extremely important in pregnancy. Your body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to your tissues. During pregnancy, you need up to double the “normal” recommended dose to increase the red blood cells to in-turn increase the oxygen levels reaching your baby. 

  • - There are a few studies that show (one of these is as a journal of veterinarian medicine—not too far off as we generally test on rats, pigs, or rabbits for pregnancy related research) an almost toxic level of calcium in fetal blood compared to mothers. Read more about these studies  here or here.

  • - Another product similar to TUMS, called Tame the Flame, is provided by Healthy Mama. 

  • - It is possible that magnesium or Vitamin D can help offset the potential “overdose” of calcium.

Calcium During Pregnancy:

Remember: It is not our job to tell clients what they should and shouldn’t take during pregnancy. Our responsibility is to share with them the potential risks, the sources we have available, and alternatives choices they have as options to consider.

If you are looking for more resources and support surrounding diet and nutrition in pregnancy - join us in The Birth Lounge to have an informed pregnancy and confident birth experience!

5 Resources to have an Informed Pregnancy & Birth

Wednesday, June 17, 2020

5 Resources to Have an Informed Pregnancy & Birth 

“Being informed”...what does that even mean in a day and age where influencers have more power than traditional marketing and every stay-at-home mom can start a vlog to grow a following of thousands without ever taking off her yoga pants or washing her hair. It’s hard to know who is actually qualified to talk about whatever they’re sharing and who is just being paid to share their latest gluten-free pasta and organic face mask. 

When it comes to pregnancy and birth, it can be a million times more challenging to navigate all the information coming from every direction. Everyone will have an opinion about all the things all the time, so go ahead and brace yourself. The best thing you can do as an expectant parent is to educate yourself on your options and what the data says is safe and appropriate care. We’ve gathered the 5 best resources to help you navigate pregnancy, birth, and postpartum with evidence-based information and empowering education. 

  1. - Evidence-Based Information: Evidence Based Births This should be your first step when you are faced with a decision about your pregnancy or your birth. Rebecca Dekker received her Master of Science in Nursing and her Doctor of Philosophy in Nursing from the University of Kentucky. She publishes articles that compile research and stats for all things pregnancy and birth. If you are pregnant, this could very well be your most used resource. 

  2. - Book: Expecting Better This is a must-read for all expecting parents. Dr. Emily Oster is an economist that has compares “standard practice” and what the data actually shows to disprove typical recommendations in today’s labor and delivery units (and even before!). Emily lays out the numbers so simply that you walk away understanding questions you didn’t even know you had to begin with. Professor Oster breaks down the most controversial topics like eating sushi and deli meat while pregnant. She even tackles drinking coffee and newborn vaccinations! You won’t find a clearer picture of what the science says than Expecting Better

  3. - Book: Crib Sheet Dr. Emily Oster wrote a second book that is a “data-driven guide to the early years” and you know we had to give it a review. She, again, delivers the most interesting statistics that leave you feeling dumbfounded as to why we have some of the current recommendations we have today. She is tackling topics like birth weight, circumcision, and sleep training. Professor Oster delivers this evidence-based material in digestible forms that leaving your feeling empowered to make the best decision for you. 

  4. - Community: The Birth Lounge One of the biggest (and best!) pieces of advice someone can share with an expectant parent is to find a village BEFORE their baby arrives. Connecting with other expecting or new parents will be a game changer for pregnancy, birth, and postpartum. Ask any human that has ever had a baby and they will tell you that the support system around you (in-person and online) is everything and that’s exactly what The Birth Lounge provides! This is an online space that connects you to other expectant parents so you can begin to prepare for your birth together. The Birth Lounge steps you through preparing for your birth and planning for your tiny human’s arrival. 

  5. - Podcast: The Informed Pregnancy Podcast Doctor Elliot Berlin is an award winning prenatal chiropractor, childbirth educator and birth doula. Dr. Berlin hosts a podcast that serves as a platform for birth professionals (medical doctors, doulas midwives, alternative medicine doctors) to share casually and openly about their experiences in the field and their opinions on various topics.  This podcast is fascinating and is binge-worthy on all accounts. 

You have ¾ of a year, 40 weeks, 9 months, 280 days (roughly) to prepare for your baby. In this time, you can explore all of your options, create the perfect plan and find the confidence you need to achieve your ideal birth. There’s no rush if you start making small decisions now and gradually approach the “scarier” topics. Start small by watching gentle birth videos or reading birth stories. The only way to turn scary topics tiny topics that you’re confident about is educating yourself on how you can stay in control of these scary situations. Knowing what choices you have will help remind you that you are in control. Take the time to connect with a community before your baby arrives. These people will help support and encourage you when you need it most plus give you advice when you have no clue where else to turn. Seek out support in understanding what the science says and what standard practice looks like at your birth place. Sit down and think about the choices you need to make and explore the options you have for each one. Be intentional with putting together a birth team that understands your preferences and will support you in those. 

Nature has given you the time to learn. We’ve given you the resources to explore. Now, jump in and get ready for the journey of a lifetime! Becoming a parent will change you at your core and you will experience a love like no other. Knowing how to best support your baby (and yourself) in this time doesn’t have to be stressful, we’ve made it easy. 

If you are concerned about having an informed birth or being feared into decisions that are not based in evidence and science, let us help! Join The Birth Lounge to have an informed and confident birth experience, push for less than one hour, and avoid a c-section!

The Link Between Inductions & C-Sections: What American Women NEED to Know

Wednesday, June 10, 2020

The Link Between Inductions & C-Sections: What American Women NEED to Know

The Backstory
Every now and then there’s a partner (of a client) that really imprints on me. To be honest, it’s usually the ones that challenge me. They question everything. Sometimes they even go out and seek their own research to share at our next prenatal. These are my faves. I can see how much they love their spouse. How much they care. How much they want to protect and understand. Sometimes it’s anxiety and sometimes its fear. But, sometimes, and these are the ones that get me, it’s from a place of truly understanding the injustices in our medical system and they are equipping themselves to be an anchored place of support during a very natural event that our society has somehow medicalized. They recognize the essential need to educate and prepare themselves in order to protect their partner.

So there I was, sitting in a prenatal with a wonderful couple I had grown to love over the last few months of working together planning for their birth. This dad knew his wife’s worst fear was a c-section. We had openly talked about her fear and how she didn't have too many preferences, but avoiding a c-section was definitely #1. I had shared with them how much induction increases your risk of having a cesarean birth and then he asked a question I didn’t know the answer to.

“Do other countries see this same trend with inductions causing c-sections?”

I had never looked beyond the US to see what other countries reported their induction rates to be and if they are correlated with their c-section rates... So there I went, into the abyss of research, numbers, stats, and tons of randomized-controlled trials.  Here’s what you need to know about inductions, c-sections, and how they impact one another from a worldly view. 

**Trigger warning** Infant mortality is highly intertwined with c-sections and inductions. It is mentioned below. 

What You Need to Know

First, one of the biggest reasons we see women manipulated into c-section in The United States of America is “being past due”. I’ve even had providers tell clients that their baby is more likely to be stillborn if they go “any bit” past their due date. This simply is not true and is fear mongering. This article also shares two trials and "neither trial found an increase in the risk of Cesarean or forceps/vacuum during birth with 41-week induction compared to continuing to wait for labor until 42 weeks. Both of these trials took place in countries that follow the Midwifery Model of Care, and the overall Cesarean rates were low (only 10-11%)." So this alone shares that if we wait you decrease your risk from 33% of the average American women (increase that up to 70% for an induction) down to 10-11% for the midwifery model of care and 3-4% using our approach and the birth lounge videos. It's very important to understand that Obstetrical care and midwifery care yield very different results as far as birth outcomes are concerned.

Sweden has been a country that has stood out to me from the beginning of my practice. This is a country that truly cares about it’s people. This study from Sweden shares finding that suggest, "Induced labor was associated with 2-3 times greater risk of unplanned cesarean delivery among all women, except multiparas in gestational week 37-38, and with a 20-50 percent higher risk of vacuum extraction after the adjustment for confounding factors." It is a little bit older, published in 2016.

They (Sweden) also found that inducing between 41 and 42 weeks reduces the rates of complications of large babies so waiting until that "prime time" window is up is also right on track with thinking about induction which is your plan so that's perfect. We know (very hard science here, not anything anyone can negate or argue) that first born babies are expected to arrive between the gestational window of 40+5 to 41+2. This means that right off the bat, from the very beginning, your due date is wrong. 

A first time mom should not expect her baby any sooner than 5 days after her original due date. 

This Austrian study, published in 2017, shares how the hands off approach (rather than active management/trying to control) to labor has better outcomes for women. Very simply put, "The routine use of various interventions such as episiotomy, electronic fetal monitoring and pain control has strongly increased during recent years [35], although such interventions are not recommended in the the guidelines of the World Health Organization (WHO) on the care of women giving birth, nor have they been demonstrated to improve maternal or neonatal outcomes." Surprisingly enough (or is it?) , American women are subjected to such things on a daily basis in conjunction with being forced to push in positions we know are not conducive to the way the human body works to eject a baby, being yelled at for advocating for themselves, or brutal obstetrical violence at the hands of providers who want things done their way and their way only. 

You have so much control as a birthing person, but you have to know what the actual science says...rather than what medical school and a medical system founded on racist and sexist beliefs has fed to your doctor for them to recite to you. Remember, despite popular misconceptions, your doctor doesn’t have the final word. Their malpractice insurance is. Their facility policies are. Their governing body (The American College of Obstetrics and Gynecology) is. BUT, none of that negates the fact that hospital policy is not the law. It is merely a suggestion, a preference. It’s what your hospital wants you to do in order to be a “good patient” and make their job as easy as can be while getting you in and out as fast as possible to continue depositing into their bottom line. 

In the end, the only person that can save you from a birth you don’t want is you

A Global Perspective

The world c-section rates are gathered here and corroborated by this article that shares the undeniable correlation between infant mortality and c-sections. Now the interesting thing that I found when I dove into all of this was that there's not great research out there on induction rates, but there is a clear influence of cesarean births and infant mortality in these countries. From top to bottom, it's a predictable pattern. As the c-section rate grows, the infant mortality does as well. Take a look!

Sweden takes the cake with the #2 spot in the world! They almost never do c-sections with a 16.4% rate country wide. Their infant mortality rate is just over 2%. This can be explained by natural causes.

The UK comes in #4 on the world chart with a c-section rate of 23-27% and an infant death rate of 3.6%

The USA has a c-section rate of 32-33% (these articles says 32%, but the stats that are commonly used in the birth world by providers is 33%), putting us at #10 on the world list. Our national infant death rate of 5.6%.

Turkey just blows the whole world away with a whopping 50% c-section rate. I mean, can you even imagine? Can you even wrap your head around the fact that half of all women have a major abdominal surgery when they have a baby? Similarly, we can see this dangerous trend ripples into impacting infants, too, as their infant mortality rate is 9.1%. Nothing about nearly 10% of babies not surviving is explainable by nature. Nothing. 

Disclaimer: Netherlands took the board with the #1 spot of lowest cesareans, but their infant mortality rate was above 3%. I didn't find any reason this might be true, but they are the wildcard as it doesn't fit the pattern.

If you are worried about a c-section and fear being tricked into an unnecessary major abdominal surgery, check out this masterclass to learn how to have an informed and confident birth without being rushed or feared into decisions. 

If you look at the trends, you will also notice that as Sweden drops, so does the UK, followed by the US. I believe this is evidence of how countries seem to adopt new birth cultures. First Sweden masters it, then the UK adopts it, and then the US will eventually shift, too! We see this currently with things like eating in labor, the rise in popularity of midwifery care, and the dwindling demand of hospital staff about erythromycin cream on baby's eyes. These are all things that other countries have changed to match current research, but US hospital policy hasn't quite made it there yet. I can’t say I’m surprised, but I am hopeful. I’m hopeful that if we all raise our voices together, we can demand that our maternity care is evidence-based and individualized (meaning your care is tailored to you & not based on outdated science and racist/sexist measurables) --that is the bare minimum that our medical system can provide to its patrons. 

One Last Thing Before You Go

Finally, I wanted to share two pieces of information that I think will be key for you in your journey of achieving your dream birth. The idea that one thing leads to another and quickly spirals out of control is not new to the birth space. We know good and well that the concept of “cascade of interventions” rings true way too often and leaves so many women feeling broken, confused, and second-guessing their own abilities. In order to feel powerful and confident in making decisions for yourself during labor, you need to have the whole story--not just what your hospital wants you to know (see the problem with hospital based childbirth education?).

These little tidbits may be a gamechanger. 

Here is a bit of evidence that shares it has been determined that it is not beneficial to have cervical exams and in fact, it TRIPLES your risk of your waters breaks prematurely (before contractions) so that alone is a reason to not have any cervical exams until we are out of that 40+5 to 41+2 window. You can see here that our idea of "normal" labor is distorted because it is based in the 1950's (literally) and this ideation can be super harmful to women when we are setting realistic expectations for labor. Stay in control of knowing what we expect from a first time mama and concrete into your brain that your baby knows their perfect timing. 

In this new training, I share The BRACE Technique that teaches women how to evaluate what is evidence based during labor and how to navigate the decision making process. This new training is based on this research and I think it'd be worth the watch for you! It's less than an hour of your time!

Finally, one of the worst things women share with me is being told they have a
“Big baby,” but when the baby is born they are much smaller than expected. These women often have feelings of being lied to, manipulated, or taken advantage of by their provider. Here is some evidence for Inducing for Suspected "Big Baby" and here's a helpful webinar. This evidence is why I feel so strongly that we don't induce for a baby baby. Even the methods we use to “diagnose” a big baby are incredbily inaccurate. 

Here's one last thing: this one isn’t common, but it comes up every now and again and is yet another reminder that our current medical care system does not make all decisions based on evidence and science. Check out the evidence on Low Amniotic Fluid and why inducing for this reason may not be the best answer when it’s used as a “blanket statement” solution... Also a bit of information showing that inducing for due dates actually usually causes more harm than good if there is not a solid, medically founded reason for it. 

The Final Word

You are responsible for you birth. You are responsible for planning and educating yourself. You are responsible for speaking up and using your voice. You are responsible for saying “no” when it counts. 

You can do this. 

If you are concerned about having an unwanted c-section or being feared into decisions that are not based in evidence and science, let us help! Join The Birth Lounge to have an informed and confident birth experience, push for less than one hour, and avoid a c-section!

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